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Dementia and Geriatric Cognitive... 2024The rise in the elderly population has brought attention to mild cognitive impairment (MCI). Sleep disorders also affect many older adults, indicating an important area...
INTRODUCTION
The rise in the elderly population has brought attention to mild cognitive impairment (MCI). Sleep disorders also affect many older adults, indicating an important area of research for disturbed sleep and faster brain aging. This population-based study aimed to investigate the association of several sleep indicators with cognitive performance.
METHODS
This cross-sectional study focused on adults over 50 in the Ardakan Cohort Study on Aging (ACSA). MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test score (AMTS) in literate and illiterate individuals. Sleep characteristics were collected using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and Berlin questionnaire. The logistic regression models were used to analyze the data.
RESULTS
Overall, 3,380 literate and 1,558 illiterate individuals were included. In both groups, participants with MCI had a significantly higher PSQI global score ( < 0.05). Also, among the literate individuals, a significantly higher risk of having sleep-disordered breathing and poor sleep quality was observed in participants with MCI ( < 0.05). In illiterate individuals, higher sleep latency than 15 min increased odds of MCI ( < 0.05). However, after adjusting for all variables, only literate individuals with a sleep duration of more than 8 h had 66 percent increased odds of having MCI ( = 0.033).
CONCLUSION
Sleep duration might be associated with cognitive function in the older Iranian population. Our findings underscore the importance of considering sleep patterns in relation to cognitive health.
PubMed: 38939100
DOI: 10.1159/000539060 -
JACC. Advances Jun 2024Abdominal aortic aneurysm (AAA) is an important cause of cardiovascular mortality.
BACKGROUND
Abdominal aortic aneurysm (AAA) is an important cause of cardiovascular mortality.
OBJECTIVES
The authors aimed to explore the associations between sleep patterns and genetic susceptibility to AAA.
METHODS
We included 344,855 UK Biobank study participants free of AAA at baseline. A sleep pattern was defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness, and an overall sleep score was constructed with a range from 0 to 5, where a high score denotes a healthy sleep pattern. Polygenic risk score based on 22 single nucleotide polymorphisms was categorized into tertiles and used to evaluate the genetic risk for AAA. Cox proportional hazards regression models were used to assess the association between sleep, genetic factors, and the incidence of AAA.
RESULTS
During a median of 12.59 years of follow-up, 1,622 incident AAA cases were identified. The HR per 1-point increase in the sleep score was 0.91 (95% CI: 0.86-0.96) for AAA. Unhealthy sleep patterns, defined as a sleep score ranging from 0 to 3, were found to be associated with a higher risk of AAA for the intermediate (HR: 1.18, 95% CI: 1.06-1.31) and poor sleep patterns (HR: 1.40, 95% CI: 1.13-1.73), respectively, compared to the healthy pattern. Participants with poor sleep patterns and high genetic risks had a 2.5-fold higher risk of AAA than those with healthy sleep patterns and low genetic risk.
CONCLUSIONS
In this large prospective study, healthy sleep patterns were associated with a lower risk of AAA among participants with low, intermediate, or high genetic risk.
PubMed: 38938869
DOI: 10.1016/j.jacadv.2024.100967 -
Frontiers in Sleep 2024Identifying intervention methods that target sleep characteristics involved in memory processing is a priority for the field of cognitive aging. Older adults with...
INTRODUCTION
Identifying intervention methods that target sleep characteristics involved in memory processing is a priority for the field of cognitive aging. Older adults with greater sleep efficiency and non-rapid eye movement slow-wave activity (SWA) (0.5-4 Hz electroencephalographic activity) tend to exhibit better memory and cognitive abilities. Paradoxically, long total sleep times are consistently associated with poorer cognition in older adults. Thus, maximizing sleep efficiency and SWA may be a priority relative to increasing mere total sleep time. As clinical behavioral sleep treatments do not consistently enhance SWA, and propensity for SWA increases with time spent awake, we examined with a proof-of concept pilot intervention whether a greater dose of time-in-bed (TiB) restriction (75% of habitual TiB) would increase both sleep efficiency and SWA in older adults with difficulties staying asleep without impairing memory performance.
METHODS
Participants were adults ages 55-80 with diary-reported sleep efficiency <90% and wake after sleep onset (WASO) >20 min. Sleep diary, actigraphy, polysomnography (PSG), and paired associate memory acquisition and retention were assessed before and after a week-long TiB restriction intervention ( = 30). TiB was restricted to 75% of diary-reported habitual TiB. A comparison group of = 5 participants repeated assessments while following their usual sleep schedule to obtain preliminary estimates of effect sizes associated with repeated testing.
RESULTS
Subjective and objective sleep measures robustly improved in the TiB restriction group for sleep quality, sleep depth, sleep efficiency and WASO, at the expense of TiB and time spent in N1 and N2 sleep. As hypothesized, SWA increased robustly with TiB restriction across the 0.5-4 Hz range, as well as subjective sleep depth, subjective and objective WASO. Despite increases in sleepiness ratings, no impairments were found in memory acquisition or retention.
CONCLUSION
A TiB restriction dose equivalent to 75% of habitual TiB robustly increased sleep continuity and SWA in older adults with sleep maintenance difficulties, without impairing memory performance. These findings may inform long-term behavioral SWA enhancement interventions aimed at improving memory performance and risk for cognitive impairments.
PubMed: 38938690
DOI: 10.3389/frsle.2023.1265006 -
International Journal of Surgery... Jun 2024Postoperative depression has a profound impact on patients' postoperative rehabilitation and overall quality of life. Preventing postoperative depression is of...
BACKGROUND
Postoperative depression has a profound impact on patients' postoperative rehabilitation and overall quality of life. Preventing postoperative depression is of significant value because conventional antidepressants have a slow onset of action. Esketamine showed prompt and sustained antidepressant efficacy. Nevertheless, the safety and effectiveness of perioperative esketamine in preventing postoperative depression are still unknown. The purpose of this meta-analysis was to assess the safety and effectiveness of perioperative intravenous esketamine in relation to its ability to prevent postoperative depression.
MATERIALS AND METHODS
Randomized controlled trials were searched in the following databases: Web of Science, Cochrane Central Registry of Controlled Trials, PubMed, and Embase. The primary outcome assessed is the postoperative depression scores. Postoperative pain ratings and adverse effects constituted secondary outcomes. Subgroup analyses were carried out on the basis of multiple variables, including the absence or presence of preoperative depression, the mode of esketamine administration, the dosage of esketamine, and the type of anesthesia.
RESULTS
A total of 16 studies encompassed 1161 patients who received esketamine intervention, whereas 1106 patients served as controls. Esketamine was efficacious in reducing postoperative depression scores when administered perioperatively, and the esketamine group maintained a lower postoperative depression score than the control group more than four weeks after surgery. Esketamine effectively alleviated postoperative pain scores without increasing the occurrence of postoperative nausea and vomiting, dizziness, drowsiness, nightmares, and dissociation.
CONCLUSION
The administration of esketamine during the perioperative has the potential to decrease postoperative depression and pain scores without increasing the incidence of adverse effects.
PubMed: 38935104
DOI: 10.1097/JS9.0000000000001870 -
Journal of Clinical Sleep Medicine :... Jun 2024Excessive daytime sleepiness (EDS) is prevalent and overwhelmingly stems from disturbed sleep. We hypothesized that age modulates the association between EDS and...
STUDY OBJECTIVES
Excessive daytime sleepiness (EDS) is prevalent and overwhelmingly stems from disturbed sleep. We hypothesized that age modulates the association between EDS and increased all-cause mortality.
METHODS
We utilized the Veterans' Health Administration data from 1999-2022. We enrolled participants with sleep related ICD9/10 codes or sleep services. A natural language processing (NLP) pipeline was developed and validated to extract the Epworth Sleepiness Scale (ESS) as a self-reported tool to measure EDS from physician progress notes. The NLP's accuracy was assessed through manual annotation of 470 notes. Participants were categorized into Normal-ESS, n-ESS, (ESS 0-10) and high-ESS, h-ESS, (ESS 11-24). We created three age groups: < 50 years; 50 to < 65 years; and ≥ 65 years. The adjusted odds ratio (aOR) of mortality was calculated for age, BMI, sex, race, ethnicity, and the Charlson Comorbidity Index (CCI), using n-ESS as the reference. Subsequently, we conducted age stratified analysis.
RESULTS
The first ESS records were extracted from 423,087 veterans with a mean age of 54.8 (±14.6), mean BMI of 32.6 (±6.2), and 90.5% male. The aOR across all ages was 17% higher (1.15,1.19) in the h-ESS category. The aORs only became statistically significant for individuals aged ≥ 50 years in the h-ESS compared to the n-ESS category (< 50 years: 1.02 [0.96,1.08], 50 to < 65 years 1.13[1.10,1.16]; ≥ 65 years: 1.25 [1.21-1.28]).
CONCLUSIONS
High ESS, predicted increased mortality only in participants aged 50 and older. Further research is required to identify this differential behavior in relation to age.
PubMed: 38935061
DOI: 10.5664/jcsm.11254 -
Journal of Clinical Sleep Medicine :... Jun 2024To examine the effects of nurse-led brief behavioral treatment for insomnia (BBTI) on insomnia severity, sleep status, daytime function, quality of life (QoL),...
STUDY OBJECTIVES
To examine the effects of nurse-led brief behavioral treatment for insomnia (BBTI) on insomnia severity, sleep status, daytime function, quality of life (QoL), psychological distress levels, treatment response, and insomnia remission in young and middle-aged Asian adults with insomnia symptoms.
METHODS
This two-parallel, randomized controlled trial recruited 42 participants with insomnia symptoms randomly allocated to the nurse-led BBTI group or sleep hygiene (SH) group. The outcome measurements included the Insomnia Severity Index, sleep diary, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Brief Fatigue Inventory, RAND-36 Health Status Inventory, and the Depression, Anxiety and Stress Scale-21. The measurement time points included baseline, the end of each week of the intervention period, and one-month follow-up.
RESULTS
Compared with the SH group, participants in the BBTI group significantly improved insomnia severity, sleep onset latency, sleep efficiency, sleep quality, daytime sleepiness, and the mental components of QoL after completing nurse-led BBTI immediately and one month later ( < 0.05). In addition, 52.4% and 71.4% of the participants achieved remission after completing nurse-led BBTI immediately and one month later, which were significantly higher than the SH group (14.3%, = 0.02; 14.3%, < 0.001, respectively).
CONCLUSIONS
We suggested the relative effects of BBTI on declined insomnia severity and improved sleep status among young and middle-aged Asian adults with insomnia symptoms and confirmed the benefits of nurse-led BBTI in alleviating insomnia. Nurses should incorporate BBTI into insomnia care further to enhance the daytime function and quality of life of the population with insomnia symptoms.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Effects of Nurse-led Brief Behavioral Treatment for Insomnia: A Feasibility Randomized Controlled Trial; URL: https://clinicaltrials.gov/study/NCT05310136; Identifier: NCT05310136.
PubMed: 38935053
DOI: 10.5664/jcsm.11256 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache...
OBJECTIVE
To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache (MOH) in comparison with patients without MOH.
MATERIAL AND METHODS
The prospective case-control study included 171 patients, aged 18 years and older, with MOH (main group), and173 patients with primary headaches without MOH (control group). A neurologist conducted an initial examination and professional interview before the start of treatment. To diagnose sleep disorders, the International Classification of Sleep Disorders (3rd edition, 2014) was used. Additionally, an assessment was made using the Insomnia Severity Index Scale, the Epworth Sleepiness Scale (ESS) and the Lausanne Obstructive Sleep Apnea Syndrome Scale (NoSAS).
RESULTS
Statistically significant differences were revealed in the prevalence of the following complaints about sleep disorders in patients with MOH: lack of sleep (51.5%), frequent awakenings during sleep (43.3%), discomfort in legs before falling asleep or at rest in the evening (37.4%). Difficulties falling asleep occurred equally often in both patients with MOH (43.9%) and without MOH (37.0%), as well as daytime sleepiness (40.4% vs 36.4%) and the presence of snoring (13% of patients in each group). Patients with MOH were significantly more likely to suffer from chronic insomnia (60.2% and 47.4%, respectively, =0.02; OR 1.7; 95% CI 1.1-2.6) and restless legs syndrome (37.4% and 22.0%, respectively, =0.002; OR 2.1; 95% CI 1.3-3.4). The incidence of hypersomnia and obstructive sleep apnea syndrome did not have statistically significant differences.
CONCLUSION
Patients with MOH compared to patients without MOH have a significantly higher incidence of main complaints of sleep disorders, chronic insomnia and restless legs syndrome, which indicates the importance of sleep disorders in the pathogenesis of medication-overuse headaches and requires timely diagnosis and treatment to prevent the progression of both headaches and sleep disorders.
Topics: Humans; Male; Female; Middle Aged; Adult; Headache Disorders, Secondary; Prospective Studies; Case-Control Studies; Sleep Wake Disorders; Sleep Initiation and Maintenance Disorders; Incidence; Sleep Apnea, Obstructive; Prevalence; Aged
PubMed: 38934672
DOI: 10.17116/jnevro202412405293 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA). (Review)
Review
OBJECTIVE
Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA).
MATERIAL AND METHODS
The literature search was carried out using the databases PubMED, Google Scholar, E-library, Cyberleninka for the period 2013-2023 and included reviews and original articles.
RESULTS
The main groups of factors affecting adherence to CPAP therapy in patients with OSA have been established. These include sociodemographic and socioeconomic factors, the severity of OSA and the severity of clinical symptoms, and psychosocial factors. Strategies that can improve adherence were identified (educational technologies for patients, telemedicine technologies, behavioral therapy, modern technical interventions).
CONCLUSION
Factors that improve adherence to CPAP therapy are high levels of education and income, more severe OSA forms accompanied by daytime sleepiness, support from the patient's spouse and social support. Factors such as low levels of education and income, smoking, symptoms of depression and hypochondria, as well as side-effects worsen adherence to CPAP therapy, including refusal to continue treatment. It should be noted that all the identified factors are very closely associated with each other, so it is necessary to evaluate them comprehensively in each patient with OSA.
Topics: Humans; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Patient Compliance; Social Support; Socioeconomic Factors
PubMed: 38934667
DOI: 10.17116/jnevro202412405258 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep... (Review)
Review
Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.
Topics: Humans; Sleep Apnea, Obstructive; Tonsillectomy; Pharynx; Treatment Outcome; Otorhinolaryngologic Surgical Procedures; Bariatric Surgery
PubMed: 38934666
DOI: 10.17116/jnevro202412405253 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To examine the influence of sleep quality on psychophysiological testing results and autonomic state in university students of both sexes with different habitual...
OBJECTIVE
To examine the influence of sleep quality on psychophysiological testing results and autonomic state in university students of both sexes with different habitual physical activity level.
MATERIAL AND METHODS
One hundred and twenty-four 6 year medical students (88 women and 36 men) and 80 sport science students (42 women and 38 men) underwent a comprehensive psychophysiological study, including 7 tests: simple motor reaction, choice reaction, reaction under conditions of interference, reaction to a moving object, critical fusion frequency, as well as static and dynamic (by profile) dexterity tests. Autonomic status was assessed using heart rate variability, sleep quality and alertness were assessed based on self-report, and in athletes, using the Pittsburgh Sleep Quality Questionnaire (PSQI).
RESULTS
In the male athletes' group with morning chronotype the sleep quality was better than in medical students. Only female medical students demonstrated a deterioration in praxis with an increase in the severity of evening features in the chronotype and a decrease in self-assessment of sleep quality. Increased sleepiness in the first half hour after awakening significantly reduced the quality of performance of psychometric tests in all subjects. The most informative was critical fusion frequency, which was lower in girls with «poor» sleep, as well as the reaction to a moving object. In addition, sympathetic drive was increased in female medical students with poor self-rated sleep quality.
CONCLUSION
A decrease in the quality of sleep in students causes fine motor impairment, mediated by sex, the level of habitual physical activity and circadian chronotype.
Topics: Humans; Female; Male; Young Adult; Motor Skills; Exercise; Students, Medical; Adult; Sleep; Sex Factors; Sleep Quality; Surveys and Questionnaires; Students
PubMed: 38934664
DOI: 10.17116/jnevro202412405233