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Trials Jun 2024Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line... (Comparative Study)
Comparative Study
BACKGROUND
Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined.
METHODS
This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment).
DISCUSSION
The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I.
TRIAL REGISTRATION
Trial registration number in the German Clinical Trials Register: DRKS00028153 ( https://drks.de/search/de/trial/DRKS00028153 ). Registered on 16th May 2023.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy; Treatment Outcome; Internet-Based Intervention; Equivalence Trials as Topic; Quality of Life; Germany; Multicenter Studies as Topic; Internet; Cost-Benefit Analysis; Time Factors; Severity of Illness Index
PubMed: 38858707
DOI: 10.1186/s13063-024-08214-6 -
Scientific Reports Jun 2024Although previous studies point to a high mental health burden in veterinarians, little is known about mental health in Austrian veterinarians as well as potential...
Although previous studies point to a high mental health burden in veterinarians, little is known about mental health in Austrian veterinarians as well as potential underlying factors of poor mental health. We assessed mental health in Austrian veterinarians, compared it to the mental health of the general population, and explored potential risk factors for poor mental health in veterinarians. A total of n = 440 veterinarians (72.0% women; mean age: 44.53 ± 11.25 years) took part in an online survey in 2022 in which validated screening tools for symptoms of depression (PHQ-9), anxiety (GAD-7), sleep disorders (ISI-2), perceived stress (PSS-4), and alcohol abuse (CAGE) were applied. Multivariable logistic regression revealed higher adjusted odds for exceeding cut-offs for clinically relevant depressive, anxiety, and insomnia symptoms in veterinarians (1.35-2.70) compared to the general population. Mental health symptoms in veterinarians were associated with female gender, physical inactivity, higher smartphone usage, higher working hours, less professional experience, and working with pets. In conclusion, it appears that veterinarians encounter mental health challenges that are more pronounced than those experienced in the general population. The teaching of strategies to improve mental hygiene as part of the curricula of veterinary education and targeted training and mentoring of employers and their team should be implemented to improve mental health in the veterinary profession.
Topics: Humans; Female; Male; Austria; Adult; Veterinarians; Middle Aged; Mental Health; Prevalence; Depression; Risk Factors; Surveys and Questionnaires; Anxiety; Sleep Initiation and Maintenance Disorders
PubMed: 38858563
DOI: 10.1038/s41598-024-64359-z -
CMAJ : Canadian Medical Association... Jun 2024
Topics: Humans; Sleep Apnea, Obstructive; Child; Continuous Positive Airway Pressure; Polysomnography; Child, Preschool
PubMed: 38857936
DOI: 10.1503/cmaj.230897-f -
Pharmacology, Biochemistry, and Behavior Aug 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.
Topics: Narcolepsy; Humans; History, 20th Century; History, 21st Century; Orexins; Animals; Central Nervous System Stimulants
PubMed: 38852786
DOI: 10.1016/j.pbb.2024.173804 -
European Journal of Medical Research Jun 2024Previous observational studies have indicated a potential link between insomnia and bladder cancer, yet the underlying causal relationship remains uncertain. The current...
BACKGROUND
Previous observational studies have indicated a potential link between insomnia and bladder cancer, yet the underlying causal relationship remains uncertain. The current study employed a bidirectional two-sample Mendelian randomization (MR) analysis to investigate this association.
METHODS
A two-sample MR analysis was conducted utilizing publicly available summary data from genome-wide association studies (GWAS) on insomnia and bladder cancer. Various regression methods including the inverse variance weighted (IVW), weighted median, MR-Egger, weighted mode, and simple mode methods were employed for the MR analysis. The presence of pleiotropy and heterogeneity in the MR results was also assessed. Furthermore, additional sensitivity tests were performed to mitigate potential biases.
RESULTS
No significant causal relationship was detected between insomnia and bladder cancer using IVW method (OR = 0.761, 95% CI 0.996-1.005; P = 0.76). Similarly, the IVW model did not reveal any causal effect of bladder cancer on the risk of insomnia (OR = 1.47, 95% CI 0.772-2.799; P = 0.24). Consistent results were obtained from the other four methods employed. There was no evidence of horizontal pleiotropy or heterogeneity in our MR analysis (P > 0.05). The sensitivity analyses further supported the reliability of the estimated causal effects.
CONCLUSIONS
This study presents no evidence for a causal relationship between insomnia and bladder cancer.
Topics: Humans; Urinary Bladder Neoplasms; Mendelian Randomization Analysis; Sleep Initiation and Maintenance Disorders; Genome-Wide Association Study; Polymorphism, Single Nucleotide; Risk Factors
PubMed: 38849949
DOI: 10.1186/s40001-024-01920-6 -
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 -
BMC Women's Health Jun 2024Pregnant women faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize...
BACKGROUND
Pregnant women faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize the potential impact of these challenges on the mental health of pregnant women and to provide appropriate resources and support to mitigate their effects.
METHOD
By using the convenience sampling approach, a total of 401 pregnant women from two hospitals of different grades in two cities were included in the survey. The cross-sectional survey was conducted by basic characteristics, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Insomnia Severity Index (ISI) and self-made questionnaire.
RESULTS
Insomnia affected 207 participants (51.6%), depression affected 160 participants (39.9%) and anxiety affected 151 participants (37.7%). Moreover, pregnant women in provincial capital city were more likely to experience anxiety, depression and insomnia than those in county-level city (P < 0.01). Pregnant women's anxiety, depression and insomnia were positively correlated with the severity of COVID-19 infection (P < 0.05). However, COVID-19 infection had no appreciable impact on maternal demand for termination of pregnancy and cesarean section (P > 0.05).
CONCLUSION
Pregnant women frequently suffer from anxiety disorder, depression and insomnia as a result of the omicron pandemic in China. During this period, the community and medical professionals should provide more psychological counseling, conduct health education and offer virtual prenatal care to pregnant women (particularly in the provincial capital city).
Topics: Humans; Female; COVID-19; China; Pregnancy; Adult; Cross-Sectional Studies; Depression; Anxiety; Pregnant Women; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Young Adult; SARS-CoV-2; Pregnancy Complications; Mental Health
PubMed: 38849811
DOI: 10.1186/s12905-024-03087-y -
Medicine Jun 2024Crouzon syndrome is an extremely rare craniofacial dysplasia, which is mainly caused by the early ossification and closure of the coronal suture of the skull.... (Review)
Review
RATIONALE
Crouzon syndrome is an extremely rare craniofacial dysplasia, which is mainly caused by the early ossification and closure of the coronal suture of the skull. Craniofacial deformities can cause stenosis of the nasal cavity and posterior nasal meatus, resulting in sleep apnea.
PATIENT CONCERNS
A 9-year-old boy with sleep snoring for 6 years, progressive aggravation in the past 1 month and accompanied by apnea during sleep.
DIAGNOSES
This case was diagnosed with Crouzon syndrome complicated with severe obstructive sleep apnea and severe hypoxemia.
INTERVENTIONS
After adenoidectomy, he was admitted to the pediatric intensive care unit with ventilator-assisted respiration. During this period, the blood oxygen saturation fluctuated greatly. After trying to extubate, the blood oxygen was difficult to maintain and had to be intubated again. After active treatment, extubation was successful.
OUTCOMES
The wound of nasopharynx recovered well and the sleep state was significantly improved 3 months postoperation.
LESSONS
It is suggested that the time of ventilator-assisted breathing should be prolonged and the perioperative airway management should be strengthened in order to reduce the risk of postoperative complications.
Topics: Child; Humans; Male; Adenoidectomy; Craniofacial Dysostosis; Respiration, Artificial; Sleep Apnea, Obstructive
PubMed: 38847734
DOI: 10.1097/MD.0000000000038534 -
Danish Medical Journal May 2024Healthcare databases are a valuable source for epidemiological research in obstructive sleep apnoea, but accurately registered diagnoses are pivotal in contributing...
INTRODUCTION
Healthcare databases are a valuable source for epidemiological research in obstructive sleep apnoea, but accurately registered diagnoses are pivotal in contributing quality evidence. We examined positive predictive values (PPV) of the International Classification of Diseases, tenth version (ICD-10) diagnosis for "obstructive sleep apnoea" and "sleep apnoea" in the Danish National Patient Register.
METHODS
Using the Danish National Patient Registry, we randomly sampled 100 patients from the North Denmark Region diagnosed with "obstructive sleep apnoea" (ICD-10 code DG4732) and 100 patients diagnosed with "sleep apnoea" (DG473*) during the year 2020. We calculated the PPV using a documented Apnea-Hypopnea Index (AHI) ≥ 5 to confirm the recorded diagnosis. A total of 70 patients were referred to the private sector for assessment of the AHI and excluded due to limited access to their data.
RESULTS
The study population included 130 patients, among whom 64 were diagnosed with "obstructive sleep apnoea", and 66 patients were registered with "sleep apnoea". The PPV for "obstructive sleep apnoea" was 93.8% (95% confidence interval (CI): 85.0-97.5%), and the PPV for "sleep apnoea" was 80.3% (95% CI: 69.2-88.1%).
CONCLUSIONS
Our findings indicated a high validity of the ICD-10 code DG4732 with a PPV of 93.8% and a lower PPV (80.3%) for the ICD-10 code DG473* for identifying patients with obstructive sleep. The "obstructive sleep apnoea" diagnosis is a suitable source of data for epidemiological research to identify patients with the disease.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Sleep Apnea, Obstructive; Denmark; Male; Female; Middle Aged; International Classification of Diseases; Registries; Aged; Adult; Reproducibility of Results; Predictive Value of Tests
PubMed: 38847413
DOI: 10.61409/A11230701 -
Scientific Reports Jun 2024Sleep onset insomnia is a pervasive problem that contributes significantly to the poor health outcomes associated with insufficient sleep. Auditory stimuli phase-locked... (Randomized Controlled Trial)
Randomized Controlled Trial
Sleep onset insomnia is a pervasive problem that contributes significantly to the poor health outcomes associated with insufficient sleep. Auditory stimuli phase-locked to slow-wave sleep oscillations have been shown to augment deep sleep, but it is unknown whether a similar approach can be used to accelerate sleep onset. The present randomized controlled crossover trial enrolled adults with objectively verified sleep onset latencies (SOLs) greater than 30 min to test the effect of auditory stimuli delivered at specific phases of participants' alpha oscillations prior to sleep onset. During the intervention week, participants wore an electroencephalogram (EEG)-enabled headband that delivered acoustic pulses timed to arrive anti-phase with alpha for 30 min (Stimulation). During the Sham week, the headband silently recorded EEG. The primary outcome was SOL determined by blinded scoring of EEG records. For the 21 subjects included in the analyses, stimulation had a significant effect on SOL according to a linear mixed effects model (p = 0.0019), and weekly average SOL decreased by 10.5 ± 15.9 min (29.3 ± 44.4%). These data suggest that phase-locked acoustic stimulation can be a viable alternative to pharmaceuticals to accelerate sleep onset in individuals with prolonged sleep onset latencies. Trial Registration: This trial was first registered on clinicaltrials.gov on 24/02/2023 under the name Sounds Locked to ElectroEncephalogram Phase For the Acceleration of Sleep Onset Time (SLEEPFAST), and assigned registry number NCT05743114.
Topics: Humans; Male; Female; Adult; Sleep Initiation and Maintenance Disorders; Acoustic Stimulation; Middle Aged; Electroencephalography; Cross-Over Studies; Treatment Outcome; Alpha Rhythm
PubMed: 38844793
DOI: 10.1038/s41598-024-63385-1