Chronic insomnia in older adults produced by the COVID-19 pandemic

Introduction: The COVID-19 pandemic has rocked our society to its core. Insomnia is the most common sleep disorder in later life and impacts approximately 20%-50% of older adults >65 years, therefore, especially vulnerable to mental health problems, including fear, anxiety and depression. Objective(s): To analyse the changes in older patients with chronic insomnia produced by the covid-19 pandemic. Method(s): Consecutives individuals aged >=65 years of the sleep unit were included, 50 patients before a COVID-19 pandemic (BeCOVID) and 50 patients posterior a COVID-19 pandemic (POSTCOVID). Clinical history specific for sleep disorders;scores on sleep-questionnaires: Epworth Sleepiness Scale (ESS) >=8 sleepiness mild, moderate or severe;Insomnia Severity Index (ISI)>=15 clinical insomnia moderate or severe;psychological tests Beck depression inventory (BDI-II), no-mild <=19, moderate-severe (20-63);the state-trait anxiety inventory (STAI) considered positive above 50th percentile. Result(s): A total of 8 patients BeCOVID and 25 POSTCOVID with chronic insomnia, the most prevalent sleep disorders in older adults produced by COVID-19 (p = < 0,001), age (72.5 +/- 0.8 and 71 +/- 0.9) years old. Intake of benzodiazepine hypnotic drugs in (63/40%), nonbenzodiazepine hypnotic drugs (13/12%) and antidepressants (25/32%) of the patients. Chronic diseases (hypertension 75/76%;mellitus diabetes 38/18%, dyslipidaemia 56/25%;glaucoma 38/8%), psychiatric disease previous 0/8%. Other sleep disorders, obstructive sleep apnoea 63/72%, rest leg syndrome 32/25%, periodic leg movement (PLM) disorders 63/16%, REM sleep behaviours disorders 0/4% and circadian rhythms disorders 2/2%. When comparing polysomnography no significant difference were observed in sleep architecture parameters such as sleep latency, REM sleep latency, efficiency, total sleep time, proportion of sleep stages (N1, N2, N3 y REM), wake after sleep onset, arousals index, PLM index or apnoea-hypopnea index (AHI) or changes of phases number were observed. Sleeps questionnaires show moderate or severe clinical insomnia in 50/76%, depression mild 20/32%, moderate 20/16% severe 0/8%, anxiety state 60/40% and trait 60/64%. Conclusion(s): Immediate interventions are essential in order to enhance psychological resilience.COVID-19 pandemic was associated an increase of chronic insomnia and generalized anxiety disorder in older patients.

HP38: Neurophysiological assessment of peripheral neuropathies associated with COVID-19

Neurological complications associated with COVID-19 are a significant cause of morbidity, affecting both central and peripheral nervous systems. We aim to assess the electrophysiological features of peripheral nerve injuries (PNI) in patients with COVID-19. Methods: We included 31 patients between March 2020 and April 2021 with a suspected diagnosis of PNI with COVID-19. We performed motor and sensory nerve conduction studies and electromyography (EMG) in the upper and lower extremities. Results: The mean age was 66.8±3.1 years (21 males, 10 females). A 96.7% (30 patients) were admitted to ICU, with a mean stay of 32.9±5.1 days. The neurophysiological examination showed, in descending order: mixed polyneuropathies 22.6% (7 patients), motor axonal polyneuropathies 19.4% (6 patients), sensorimotor axonal polyneuropathies 19.4% (6 patients), peroneal mononeuropathies 12.9% (4 patients), brachial plexopathies 12.9% (4 patients), Guillain-Barré syndrome (GBS) 6.4% (2 patients), Miller Fisher syndrome (MFS) 3.2% (1 patient) and femoral mononeuropathy 3.2% (1 patient). The low amplitude in both motor and sensory conduction studies was the most common neurophysiological finding except in GBS and MFS that showed prolonged distal latency and slow conduction velocity. EMG showed spontaneous activity in all patients. Conclusion: Our study shows the main neuropathy damage related to COVID-19 was critical illness polyneuropathy;however, we must consider mononeuropathies in these patients. There is broad evidence concerning the peripheral nervous system injury as a complication in patients hospitalized by COVID-19, being the neurophysiological tests a valuable tool to assess the peripheral nerve function. [ FROM AUTHOR] Copyright of Clinical Neurophysiology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

HP36: Diaphragm impairment in patients with COVID-19: A case-control study

Objective: Physicians have observed ventilation disorders in patients with COVID-19. The possible impairment of the diaphragm could be related to the systemic inflammatory response that typifies this infection. We aimed to assess the diaphragmatic function in patients with severe COVID-19. Methods: We recruited patients admitted with pneumonia and positive PCR for SARS-CoV-2, differentiating two groups according to their respiratory symptoms. The cases group consisted of 9 inpatients with moderate-severe dyspnea, pain with diaphragmatic origin or hiccup. The control group consisted of 10 inpatients who suffered from mild dyspnea. We performed phrenic nerve electroneurogram and diaphragmatic ultrasound to assess the diaphragmatic function. Results: We observed differences in the amplitude of evoked potentials, being 25.92% (SEM:7.22) in the cases group vs 19.81% (SEM:5.27) in the control group (p = 0.711). The right diaphragm thickness mean was 46.67% (SEM:8.86) in the cases group vs 62.15% (SEM:5.58) in the control group (p = 0.432), the left diaphragm thickness mean was 57.89% (SEM:15.36) in the cases group vs 73.34% (SEM:6.74) in the control group (p = 0.730), the right expiratory fraction mean was 0.53 (SEM:0.11) in the cases group vs 0.59 (SEM:0.05) in the control group (p = 0.674), and the left expiratory fraction mean was 0.58 (SEM:0.15) in the cases group vs 0.73 (SEM:0.07) in the control group (p = 0.195). Conclusion: Although diaphragmatic dysfunction is difficult to detect, our combined functional and morphological approach with electroneurograms and ultrasounds could improve diagnostic sensitivity. We suggest that diaphragmatic dysfunction could play a relevant role in respiratory failure in patients with COVID-19. [ FROM AUTHOR] Copyright of Clinical Neurophysiology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

HP05: Diagnostic and prognostic assessment in respiratory and hemodynamic changes related to prone position in COVID-19 patients

Objective: One of the most relevant findings of COVID-19 is the respiratory damage that leads to an impairment in tissue oxygenation during the course of the disease. To study this disease's physiopathology, we have analyzed the respiratory patterns and the hemodynamic variations related to postural changes in inpatients with COVID-19. Methods: We performed a prospective study including 11 polygraph and hemodynamic studies from inpatients admitted for COVID-19 who benefited from positional changes. To assess the respiratory parameters, we conducted polygraph studies. To evaluate the hemodynamic variables, we used a thoracic electrical bioimpedance. Results: We observed a minimum oxygen saturation median of 85.00% (IQR: 7.00) in the supine position vs 91.00% (IQR: 8.00) in the prone position (p=0.173). The airflow restriction in the supine position was 2.70% (IQR: 6.55) vs 1.55% (IQR: 2.80) in the prone position (p=0.383). We observed a slight tendency to decrease in all parameters in the prone position concerning the hemodynamic variables, although they were no statistically significant. We show a decrease in vascular resistance mean in the prone position, being 18.2% vs 36.4% in the supine position (p=0.871). Conclusion: Our report shows an improvement in oxygen saturation and airflow restriction related to the placement of the patient in the prone position. Also, we observed a mild enhancement in hemodynamic variables. The data shown is relevant because early identification of the more severe cases could help anticipate the clinical progression using the therapeutic oxygen measures necessary to avoid the disease's fatal progression. [ FROM AUTHOR] Copyright of Clinical Neurophysiology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)