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Purpose of Review: Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates. Recent Findings: The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night. Summary: Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups. Supplementary Information: The online version contains supplementary material available at 10.1007/s40675-023-00258-5.
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Objective: To assess the sleep quality among medical students, comparing their sleep cycles during physical and online studies along with other factors associated with sleep patterns. Study Design: Cross-sectional Questionnaire based survey Place and Duration of Study: Department of Community Medicine, HITEC Institute of Medical Sciences Taxila from 1st January 2020 to 31st March 2020 Methodology: One hundred and forty seven students were surveyed in a time period of 1 month. The questionnaire included PSQI Pittsburgh Sleep Quality Index and other clinically validated questions. Students with known sleeping disorders were excluded from this survey. Result(s): There were 81 (55.1%) females and 65 (44.2%) males with mean age 20+/-1.4 years. Out of these 94(63.9%) were classified as "Poor Sleepers" and only 53 (36.1%) were "Good Sleepers". Poor sleep quality was associated with female gender (p<0.05), day-scholar residence status (p<0.054), excessive time required to sleep (p<0.00), excessive screen time usage (p<0.007), increased hours of study (p<0.089), experiencing trouble while driving, eating and socializing (p<0.002), lack of enthusiasm (p<0.000), unsatisfactory daily activities (p<0.000) and poor daytime alertness levels (p<0.360). 104 (70.7%) were aware of the effects of melatonin on sleep, only 51 (34.7%) admitted to have used coffee to stay awake at night. 98 (66.7%) subjects were pre-exam workers, 95 (64.6%) admitted not being able to wake up easily in the morning. Conclusion(s): The students and hostelites that used less screen time slept better. Excessive daytime tiredness was also a result of poor sleeping habits. Students who studied for longer periods of time and had difficulty waking up in the morning slept poorly. Poor sleepers also find it difficult to interact and are often unambitious about performing their daily menial tasks, as well as displeased with their daily activities. As a matter of fact, we deduce that sleep quality has unanticipated consequences for medical students' social and mental health.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Introduction: During the COVID-19 pandemic, the lifestyle and sleep habits of children with chronic lung disease have changed. Aims and objectives: To evaluate the differences in sleep habits in the first year of the pandemic in children with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). Method(s): Primary caregivers of children with CF and PCD aged 3-16 years who were evaluated for sleep habits at the beginning of the pandemic were re-evaluated at the end of the first year of the pandemic. The Sleep Disturbance Scale for Children (SDSC) was used and questions were asked about sleep habits and weight changes during the first year of the pandemic. Result(s): Primary caregivers of 31 children with CF and 14 children with PCD were included in the study. The median age of the children were 10.0 (7.5-12.0) years, 42.2% of the children were female. The mean BMI of children with CF was 15.8+/-1.8, and 20.0+/-3.5 in children with PCD (p:0.001). The mean daily screen time was 2h (1-3) at the beginning and 5h (4-6) in the first year of the pandemic among children with CF, 2h (1-2.2) at the beginning and 5h (4.7-6) in the first year of the pandemic among children with PCD (p<0.001, p:0.001, respectively). There were no differences in terms of disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, sleep hyperhidrosis scores between two groups during first year of pandemic. Conclusion(s): While daily screen time increased in children with CF and PCD, sleep disturbances and changes in daily habits continued in the first year of the pandemic.
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Many people report suffering from post-acute sequelae of COVID-19 or "long-COVID", but there are still open questions on what actually constitutes long-COVID and how prevalent it is. The current definition of post-acute sequelae of COVID-19 is based on voting using the Delphi-method by the WHO post-COVID-19 working group. It emphasizes long-lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post-acute sequelae of COVID-19. In this international survey study consisting of 13,628 subjects aged 18-99 years from 16 countries of Asia, Europe, North America and South America (May-Dec 2021), we show that post-acute sequelae of COVID-19 symptoms were more prevalent amongst the more severe COVID-19 cases, i.e. those requiring hospitalisation for COVID-19. We also found that long-lasting sleep symptoms are at the core of post-acute sequelae of COVID-19 and associate with the COVID-19 severity when COVID-19 cases are compared with COVID-negative cases. Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long-lasting symptoms after hospitalisation for COVID-19. Understanding the importance of sleep-related symptoms in post-acute sequelae of COVID-19 has a clinical relevance when diagnosing and treating long-COVID.
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SESSION TITLE: Global Case Reports in Critical Care SESSION TYPE: Global Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Thrombotic complications in patients diagnosed with COVID-19 pneumonia are emerging as an important and significant morbidity and mortality burden, with overwhelming inflammation, hypoxia, immobilization, and diffuse intravascular coagulation among possible causes of a procoagulant state (1). Obstructive sleep apnea (OSA), with intermittent arterial oxygen desaturation, may in its turn contribute to a procoagulant state, causing hemodynamic alterations as polycythemia and sluggish blood flow (2). Here we report on a case of sudden and massive non-lethal pulmonary thromboembolism (PTE) in a patient with COVID-19 severe pneumonia, for whom OSA was suspected and documented as a possible concurrent mechanism of thromboembolic complication during follow-up. CASE PRESENTATION: A 55-year-old male non-smoker obese (BMI 33 Kg/m2) was admitted to our hospital after 9 days of fever. In the Emergency Room, a chest HRCT scan showed bilateral diffuse ground glass opacities. He was treated with subcutaneous Tocilizumab (324 mg) single shot, Remdesivir (200 mg/day for first day and 100/daily for further 4 days), methyl-prednisolone 40 mg/daily, Enoxaparin 6000 UI/twice daily, azithromycin 500 mg/daily, high flow nasal cannula oxygen (50 L/min, TC 34°C, FiO2 35%) for moderate acute respiratory failure due to COVID-19 pneumonia (pO2: 58 mmHg, PCO2 34 mmHg pH 7.50, P/F 275). After 10 days, patient's clinical conditions worsened, needing non-invasive respiratory support;D-dimer increased abruptly, rising to 10 ng/mL, with findings consistent with PTE at a computed tomographic angiography (CTA, Fig 1). The patient was successfully treated with 10 mg/daily subcutaneous fondaparinux for 12 days, while assisted in the Intensive Care Unit, being discharged home in room air shortly later with oral anticoagulants. At the 3-month follow-up visit, OSA was suspected due to reported excessive daytime sleepiness and weakness, snoring, disturbed night sleep, morning headache in the last 4 years. The patient underwent a home sleep apnea test (HSAT) overnight. Test results revealed an AHI of 50 events/h, with several prolonged episodes of obstructive sleep apnea (307 apnea and hypopnea (A+H) events, 70 obstructive apnea and 233 hypopnea events, with a mean duration of 10% and an average arterial saturation of 93% (Fig. 2). He was adapted to CPAP therapy, with benefit and good correction of polygraphic indexes. DISCUSSION: The pathogenetic mechanisms of COVID 19 and OSA could have played a synergistic effect on endothelial damage, thus increasing the risk of thromboembolism. CONCLUSIONS: The presence of underdiagnosed comorbidities may well worsen the clinical course and complication of COVID-19;an earlier diagnosis of OSA is a prerequisite for timely treatment and, potentially, improved long-term clinical outcomes. Reference #1: Suh YJ, et al. Pulmonary embolism and deep vein thrombosis in COVID 19: a systematic review and meta-analysis. Radiology 2021;298 (2): E70-E80. Reference #2: Alfonso-Fernandez A., Garcia Surquia A., de la Pena M. OSA is a risk factor for recurrent VTE Chest. 2016;150 (6): 1291-1301. DISCLOSURES: no disclosure on file for Antonietta Esposito;no disclosure on file for Antonella Frattari;no disclosure on file for Giustino Parruti;no disclosure on file for Giorgia Patrizio;no disclosure on file for Pierpaolo Prosperi;no disclosure on file for Giorgia Rapacchiale;No relevant relationships by ANTONELLA SPACONE no disclosure on file for Giacomo Zuccarini;
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The FDA has approved tirzepatide (Mounjaro - Lilly), a peptide hormone with activity at both glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, to improve glycemic control in adults with type 2 diabetes. Tirzepatide, which is injected subcutaneously once weekly, is the fi rst dual GIP/GLP-1 receptor agonist to become available in the US. Selective GIP receptor agonists are not available in the US;GLP-1 receptor agonists have been available for years. Copyright © 2022, Medical Letter Inc.. All rights reserved.
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Introduction: The therapeutic benefits of sleep in the critically ill has been extensively studied in the medical literature.1 Chronic insomnia increases a patient's risk of delirium, cortical atrophy, diabetes, cancer, cardiovascular death from arterial hypertension, myocardial infarction and heart failure.2 Insomnia reduces interaction during videocalls with family and limits co-operation with physiotherapy, medical and nursing interventions, potentially delaying rehabilitation and recovery. Objectives: To improve sleep by introducing an individualised melatonin regimen and a multidisciplinary targeted approach to managing insomnia in an adult intensive care unit. Methods: A retrospective analysis was conducted in a single centre UK adult ICU. Data was retrieved from pharmacy dispensing records, electronic medical notes and prescriptions from September 2020 to March 2021. The primary outcome was resolution of insomnia. Other information collected included causes of insomnia, referral to psychology for cognitive behavioural therapy (CBT), prevalence and resolution of delirium, adverse effects, and death. Each patient received a tailor made regimen based on Bellapart et al's original concept of mimicking the natural endogenous secretion of melatonin.3 However, unlike previous studies3,4,5 dosing was modified and adjusted according to patient response. A loading dose of 0.75 to 3mg was administered at 21:00 followed by a smaller hourly dose of 0.25 to 0.5mg between 22:00 and 03:00. Additionally, the duration of treatment continued for as long as therapeutic benefit was realised, which included post discharge from ICU. Prior experience of conventional melatonin dosing did not demonstrate therapeutic benefit from the original pilot study and when nursing staff inadvertently omitted the hourly dose between 10pm and 3am. Adverse effects were documented. Sleep hygiene measures were introduced and standardised where possible e.g. ear plugs, eye mask, dim lights, environmental noise reduction and minimal night time physical interventions from nursing and medical staff. The principal investigator referred to psychology patients who expressed fear and anxiety as a cause of insomnia. Results: 132 patients were admitted during September 2020 to March 2021. 30 patients received tailor made melatonin regimens (22.7%). The medical notes of four (13.3%) patients could not be accessed for data collection and were, therefore, excluded from the study. The primary outcome of resolution of insomnia occurred in 23 out of 26 (88.4%) patients. At the time of ICU discharge, delirium had occurred in 15 patients (57.7%), resolved in 10 patients (66.7%), three (20%) patients remained intermittently delirious, one remained continuously delirious, and one died. Mechanical ventilation, environmental noise, necessary medical and nursing interventions throughout the night and infection accounted for 23 (88.4%) of patients' insomnia. Fear or anxiety were expressed by eight (30.8%) patients as a cause of insomnia whilst medicines e.g. steroids, beta blockers accounted for six patients (26.1%). Seven patients (26.9%) expressing fear or anxiety were referred to psychology for adjunctive CBT. One patient experienced excessive daytime drowsiness, which resolved with dose regimen adjustment. One patient died of a cause unrelated to melatonin. Conclusion: An individualised melatonin regimen combined with a multidisciplinary targeted approach can result in resolution of insomnia in ICU patients, with minimal risk of adverse effects.
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Introduction: The hypothalamus plays a crucial role in regulating vital functions and circadian rhythms. Both the tumor involving the hypothalamic area and its treatment can lead to hypothalamic dysfunction, resulting in disturbances in sleep-wake patterns, sleep fragmentation, and increased daytime sleepiness. We describe two patients with craniopharyngioma who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes diagnosed as severe sleep disturbances. Case reports: Patient 1 is a 19-year-old male diagnosed with surgically treated craniopharyngioma. Subsequently, episodes of psychomotor slowing, afinalistic movements of the upper limbs diagnosed as seizures in another neurological center appeared;antiepileptic treatment was started without improvement. At the first examination in our center, excessive daytime sleepiness (EDS), fragmented nighttime sleep, episodes characterized by bimanual automatic gestures occurring during drowsy state, hypnagogic hallucinations, and sudden loss of muscle tone while awake were recognized. Actigraphy demonstrated irregular bedtimes, frequent nocturnal activity, and inappropriate daytime rest episodes. The Epworth Sleepiness Scale (ESS) showed subjective EDS (ESS=19). At PSG, hypersomnolence, severe sleep-related breathing disorder (SRBD), and no interictal and ictal seizure abnormalities were found. A BiPAP NIV was started, and antiepileptic therapy was discontinued. In the following months, PSG revealed marked improvement in SRBD and 1 SOREMP, and the MSLT a mean SOL of 6 min and 10 sec and 3 SOREMPs. These data allowed the diagnosis of secondary narcolepsy, and treatment with pitolisant was initiated with clinical improvement and reduced daytime sleepiness (ESS=9). Patient 2 is a 12-year-old male, surgically treated for craniopharyngioma at the age of 4 years, who developed episodes of myoclonic jerks, temporal and spatial disorientation, and psychomotor agitation during the lockdown period for COVID-19 emergency. Surmising paroxysmal epileptic episodes, the patient was hospitalized. The anamnestic data collection revealed a sleep-wake rhythm dysregulation, fragmented nighttime sleep, EDS, oneiric stupor-like episodes during which the patient performed simple automatic gestures mimicking daily-life activity, and severe impairment of alertness. The Long-term video-EEG, including polygraphic measurements, showed destruction of the wake-NREM sleep-REM sleep boundaries, episodes of undetermined state of vigilance, and concurrence of elements typical of different sleep stages. Moreover, a severe SRBD (AHI 19/h) has been observed. The MRI showed a volumetric increase in the post-surgical interpeduncular fossa and right paramedian cysts. Therefore, a multifactorial therapeutic plan including sleep hygiene and slow-release melatonin was started with improvement in nighttime sleep, but EDS persisted. Surgical treatment of cyst fenestration improved sleep-wake rhythm and behavior;BiPAP NIV was initiated with very poor adherence. Discussion: We aim to focus on sleep disorders as a possible complication of tumors involving the hypothalamic region. Our cases highlight that the clinical manifestation of these dysfunctions can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment that can harm patients' health and the quality of life of patients and their families. Conclusion: These findings support the need to incorporate comprehensive sleep assessment in survivors from childhood brain tumors involving the suprasellar/hypothalamic region.
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Introduction: "Wake Up and Learn" (WUAL) is a population based preventative sleep screening and education program for 7th to 12th graders through an asynchronously delivered virtual platform. The program was intentionally developed to be completely virtually delivered for scalability, which was of advantage during COVID allowing for the program to continue to be implemented with modest delays related to school schedule changes. This is a descriptive summary of excessive daytime sleepiness over two time points during the academic school year. Materials and Methods: The 7th to 12th grade students of Montgomery school district (Pennsylvania) were given an opt-out option for participation in the WUAL program. The surveys were generated using REDcap and included the Epworth sleepiness scale-CHAD (ESS-CHAD) and the childhood sleep habits questionnaire (CHSQ). The surveys became available online via the WUAL website (wakeupandlearn.org) and the students were instructed to access the website and complete the surveys as part of class time. Surveys were completed in December 2020 for the first time and then again in April 2021 as part of the planned three times per year surveillance. Due to school schedule changes experienced related to COVID the first survey planned for beginning of the academic year was skipped. Results: A total of 344 students completed ESS-CHAD in December 2020. There were 57 students with ESS scores greater than 10 (16.5%). In April, a total of 321 students completed ESS-CHAD with 49 students (15%) having ESS scores greater than 10. Of those with abnormal scores in December 15 (26%) had persistent sleepiness, 28 (49%) improved, and 14 (25%) did not provide a completed survey in April 2021. With this said, 34 (69%) of the respondents in April 2021 were newly identified to have pathologic sleepiness. 31% with persistent EDS from December 2020. Conclusions: Excessive daytime sleepiness is common in this adolescent high school cohort, but may not remain persistent over time. The majority of students who provided follow up responses had resolution of complaints of excessive daytime sleepiness between the two time points. Alarmingly, however, 34 additional students endorsed new complaints of EDS. Further examination of trends of EDS over time in this age group is required to better determine if this pattern is replicated in different school districts. If this is replicated it will be important to further explore factors that contribute to development, persistence and recovery from EDS. It is important to note that COVID and varying school structures (i.e in-person, virtual, hybrid) may have played a role in these findings. Wake Up and Learn is an on going program with plans for further expansion into additional school districts that may provide further insights into these trends. Acknowledgements: Thank you to Jazz pharmaceuticals and Janet Weis Children's Hospital for their support of the development and growth of this program.
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Introduction: In November 2019, in China, an outbreak of a disease caused by the new coronavirus (SARS-CoV-2) has begun. The spread of Coronavirus Disease 2019 (COVID-19) to hundreds of countries, causing respiratory illness and death, especially in risk groups, led the World Health Organization to declare a pandemic in March 2020. For patient's management, an extensive network of multidisciplinary care is necessary, exposing them to a greater contamination risk. Objective: This study aims to describe the prevalence of sleep disorders on health professionals who care for patients with suspicion/ confirmation of COVID-19. Methods: This is a crosssectional study, carried out using an online form sent to health professionals, with higher education, of both genders, aged 18 years or more, from any city in Brazil. Data collection took place from August to December 2020 (epidemiological weeks 32 to 53). The participants were asked about the frequency of several sleep disorders, sociodemographic, health and lifestyle characteristics. Subsequently, descriptive statistics were performed. The study protocol was approved by the National Research Ethics Committee (CONEP) under opinion 4.073.427. Results: The sample consisted of 184 health professionals with an average age of 37 (±9,3) years, predominantly female (69,9%), physicians (48,4%), living in Rio Grande do Sul (77,7%), graduated in the last 10 years (53,3%), working in the morning (83,1%), afternoon (82,6%) and night (32,1%), who have non-transferable chronic diseases (25,5%), consume alcoholic beverages (54,9%) and practice physical activities (57,6%). Regarding sleep disorders, participants presented tiredness on waking up (88,6%), waking up at night (82,1%), excessive daytime sleepiness (73,4%), nightmares (69,6%), difficulty in starting sleep (69%), waking up too early and not being able to go back to sleep (63,6%), grinding or clenching teeth during sleep (59,2%), snoring (58,7%), sleep apnea (13%) and sleepwalking (8,7%). 74,5% of participants had 5 or more symptoms simultaneously. Conclusion: The results demonstrate a high number of symptoms of sleep disorders in the sample, especially tiredness on waking up and night awaking, as well as a high number of health professionals with 5 or more associated symptoms. The data are of concern, as they affect the performance of these professionals, which may expose them and the patients to greater risks.
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Introduction: The inflammatory process and multisystemic manifestation caused by Covid-19 infection can involve multiple sequelae with damage on physical, cognitive, psychological, and biological aspects. This condition results on poor quality of life, fatigue, dyspnea and sleep difficulties. The focus on sleep difficulties, the most common symptoms are related to night drowsiness and insomnia, but little is known about the clinical characteristics of these patients who develop this complication. Objective: Evaluate the main complaints and clinical signs in patients after COVID-19. - Rate the quality of sleep in post-COVID-19 Syndrome patients who have had mild, moderate and/or severe symptoms of the disease. Methods: Observational study and descriptive, with a quantitative approach to data. A general and a specific sleep quality questionnaire were applied to patients undergoing rehabilitation after the diagnosis of COVID-19, who did or did not need to be hospitalized, with symptoms that had started at least 5 weeks before the questionnaire response date. Participants who were unable to answer the questionnaires due to a deficit in understanding the questions asked, or who gave up on completing the questionnaires without finishing, were excluded. Results: 177 participants participated in the research, 124 men (70%) and 53 women (30%). 62.7% of participants reported at least one comorbidity and only 23 people (12.9%) were not vaccinated with any dose until participation in this study. With regard to hospital admission, 109 participants (61.6%) required admission to the ICU and of these, 57.8% (63) required orotracheal intubation, with prolonged hospital stay for more than 12 days. The most common symptoms after covid-19 were muscle fatigue (78.3%), excessive daytime sleepiness (51.4%), persistent cough (47.4%) and headache (47.1%). 81.4% of participants reported that they felt their sleep quality had worsened after the diagnosis of COVID-19. And after applying a specific questionnaire (PSQI), 93.7% of participants were classified as poor sleepers. There was a very strong correlation (r>0.9) with participants who assessed hospitalized and in invasive mechanical ventilation, with bad sleep quality. Conclusion: The post-COVID-19 Syndrome, associated with age, comorbidities, length of stay and use of invasive mechanical ventilation, were factors that are associated with a higher prevalence of sleep disorders.
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Introduction: Inadequate sleep habits can compromise the quality of sleep and performance in activities of daily living of the individual, even more, considering the COVID-19 pandemic, which significantly interfered in the sleep and mental health of the population. Objective: To encourage the perception of habits that negatively influence the sleep quality of young people during social isolation in times of COVID-19. Methods: A workshop was proposed through the Youtube platform, during a scientific event on “Mental Health”. Two speech therapists organized a workshop with the theme “Sleep care practices”. The theme was divided into three parts. First, the basic concepts in sleep, the notion of sleep phase distribution, and consequences of sleep deprivation were addressed. The second part included the explanation and stimulation for self-application of the Mini Sleep Questionnaire (MSQ) from the Epworth Sleepiness Scale (ESS). This MSQ questionnaire was selected because, in addition to being self-administered, it assesses the frequency of sleep-related complaints and the ESS Scale subjectively assesses excessive daytime sleepiness. Finally, the third and last part consisted of reflections on sleep hygiene, with tips on how to improve these behaviors and habits. Results: The interactive proposal based on practice in brainstorming, aimed to generate reflections to participants, seeking to highlight inappropriate points in their routines, in order to enable a new planning of behaviors related to habits that influence the various aspects of sleep hygiene. In eight days of making the video available on the aforementioned platform, 3,624 views and 388 likes were achieved. The total video time was 22 minutes and 20 seconds, with the first part having 5 minutes and 21 seconds, the second part with 6 minutes and 6 seconds and the third with 11 minutes. Conclusion: Through information and communication technologies it was possible to encourage and raise awareness of a considerable population with regard to practices favorable to quality sleep, in a short period of time.
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The proceedings contain 178 papers. The topics discussed include: polysomnography analysis in Moebius sequence syndrome: new insights on REM Sleep;the association of social jet lag and overweight/obesity considering the presence of binge eating: a cross-sectional study with Brazilian young adults;sleep irregularity and the association with hypertension and blood pressure levels: the ELSA-Brazil study;sleep quality and daytime sleepiness of high schoolers;results of digital treatment of cognitive behavioral therapy in patients with chronic insomnia at a referral hospital in Curitiba;sleep quality and excessive daytime sleepiness in patients treated in the intensive care unit for acute myocardial infarction;negative changes in sleep patterns are observed in patients admitted by COVID 19;sleep quality of cancer patients in a hospital in Northeastern Brazil;sleep quality and sleep duration in university students: a transcultural study;and sleep quality among Brazilian elderly practitioners and non-practitioners of physical exercise: a cross-sectional study.
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Introduction: Central sleep apnea (CSA) is a rare disorder caused by a reduction of airflow and ventilatory effort during sleep. CSA is rarely idiopathic and associated with medical conditions including heart failure, opioid medications, treatment emergent and high-altitude periodic breathing. At higher altitudes, hypoxemia induces periodic breathing with periods of deep and rapid breathing alternating with central apnea. Patients with high-altitude periodic breathing experience fragmented sleep, poor sleep quality, excessive daytime sleepiness, morning headaches and witnessed apnea. We discuss a patient with obstructive sleep apnea (OSA) who developed new-onset central sleep apnea after relocating to a higher altitude location. Report of Cases: A 75-year-old male with a history of moderate obstructive sleep apnea well controlled on CPAP for eight years, with no known cardiovascular or pulmonary disease, presented with new-onset excessive daytime sleepiness. He had recently relocated to an area in the Colorado mountains (7000 ft elevation) from his previous home in Los Angeles (sea level). His residual apneahypopnea index (r-AHI) displayed on his CPAP machine increased to 7-14/ hr from his normal of 1-2/hr after his relocation. Review of his compliance data revealed his central apnea index was elevated, contributing to his high r-AHI. A one-night nocturnal oximeter was mailed to the patient to use while on CPAP. Data revealed oxygen desaturation to less than 88% for about 2 hours of the night, worse during the early morning hours. The patient was advised to undergo a polysomnography and adaptive servo-ventilation titration if significant central sleep apnea was present. The patient declined due to concern about the COVID-19 pandemic. Supplemental nocturnal oxygen was initiated at 2L/min with normalization of the r-AHI. Conclusion: Patients with OSA who experience worsening symptoms or increased r-AHI despite excellent compliance with PAP therapy should be considered for repeat polysomnography or titration study. While it is expected that high-altitude central sleep apnea will improve with acclimatization, nocturnal supplemental oxygen in addition to PAP therapy is indicated for patients with high-altitude central sleep apnea to diminish hypoxemia and improve residual AHI and sleep quality.
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Three new drugs, all based on messenger RNA or small interfering RNA technology, represented a major therapeutic advance in 2021. But the bigger picture is that most of the new authorisations that advanced patient care were adaptations of existing drugs. And that more than half of this year's new authorisations were not advances, and in fact about one-tenth represented a step backwards compared to existing options.
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Introduction: PCD is a rare, progressive disease resulting in upper and lower respiratory tract manifestations that increase the risk of sleep disordered breathing. This study is the first to characterize sleep quality in Australian children with PCD and examine it is relationship to mood and health-related quality of life (HrQOL). Methods: Clinically stable children with PCD (1-18 years of age) were recruited. Subjective sleep quality was assessed with the SDSC, PDSS and OSA-18 questionnaires. HrQOL and depressive symptoms were assessed via age-appropriate QOL-PCD and CDI questionnaires. Demographic data including passive smoke exposure was recorded. Pulmonary function testing and ENT assessments were performed. Children underwent overnight polysomnography including transcutaneous CO2 and video monitoring (50% studies complete due to Covid restrictions). Results: Twenty-two participants (10 female) aged 8.1 ± 5.1 (mean ± SD) years were recruited. Mean(±SD) FEV1 was 78.2 ± 21.2%. Ninety-two percent of children assessed were diagnosed with chronic rhinosinusitis and 35% exposed to regular passive cigarette smoke. Polysomnography identified sleep fragmentation in 90% of studies and one case of mild obstructive sleep apnoea. Subjective sleep questionnaires revealed 76% of parents and 50% of children reported clinically significant scores indicating sleep disturbance and excessive daytime somnolence respectively. Twenty-seven percent of parents reported a moderate-severe impact of sleep disturbance on QOL. Forty-six percent of children had elevated depression scores. HrQOL and mood scores were correlated with poor subjective sleep quality. Children exposed to passive cigarette smoke had poorer subjective sleep quality and lower HrQOL and mood. Conclusion: Even in periods of clinical stability, children with PCD exhibit poor sleep quality and excessive daytime sleepiness and this is associated with lower mood and HrQOL. Based on these findings, we recommend routine screening for mental health and symptoms of sleep disturbance in children and adolescents with PCD. The continued education of children and families regarding the effects of cigarette smoke is advised.
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Purpose: Night shift work is common in the current working environment and is a risk factor for many diseases. The study aimed to explore the relationship between night shift work with chronic spontaneous urticaria (CSU), and the modification effect of circadian dysfunction on it. Methods: A cross-sectional survey was conducted among Chinese workers. Exposure was measured by night work history and duration. Circadian dysfunction was characterized by excessive daytime sleepiness (EDS). The diagnosis of CSU was made by dermatologists who were investigating on the spot. The effect size was expressed as odds ratios (ORs). Results: A total of 8,057 participants were recruited, and 7,411 (92%) with complete information were included in the final analyses. The prevalence rates of CSU for workers without night shift and those with night shift history were 0.73 and 1.28%, respectively. Compared with workers who never worked night shifts, the risk of CSU increased with the length of night shift work: OR = 1.55 (95% confidence interval [CI]: 0.78-3.06) for duration <5 years and OR = 1.91 (95% CI: 1.12-3.26) for duration ≥5 years. EDS s EDS has been shown to modify this combination. Among workers without EDS, there was no association between night shift and CSU (OR = 0.94; 95% CI: 0.49-1.79). Whereas, in participants with EDS, the correlation was significant (OR = 3.58; 95% CI: 1.14-11.20). However, the effect modification by sleep disturbance was not observed. Conclusions: Night shift work is a risk factor for CSU, and there is a dose-response relationship between night shift work hours and the risk of CSU. This connection may be modified by circadian dysfunction.
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COVID-19 , Chronic Urticaria , Shift Work Schedule , Sleep Disorders, Circadian Rhythm , Cross-Sectional Studies , Humans , Shift Work Schedule/adverse effects , Sleep Disorders, Circadian Rhythm/epidemiology , Work Schedule ToleranceABSTRACT
Coronavirus infectious disease 2019 (COVID-19) is confirmed to develop neurocognitive complications. In the present paper, we describe two patients with laboratory-confirmed COVID-19 and excessive daytime sleepiness. In the present study, we reported two laboratory-confirmed cases of COVID-19 with excessive daytime sleepiness. Patients had drowsiness and mild confusion on presentation. In both cases, CNS infections, including meningitis and encephalitis, were ruled out. Both patients’ symptoms remarkably improved following the therapeutic course indicating the direct effect of SARS-CoV2 in sleep modulating centers on the brain. COVID-19 should be considered in patients with excessive daytime sleepiness and drowsiness in the current outbreak.
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The coronavirus disease (COVID-19) has brought significant social and economic disruptions and devastating impacts on public health, and vaccines are being developed to combat the disease. Timely vaccination may prevent complications and morbidity but may also potentially result in unforeseen outcomes in some special clinical populations. We report on a case of hypersomnia relapse after the COVID-19 vaccination, with the aim of informing the development of the guideline on vaccination in specific groups. A 19-year old female presented with persistent daytime sleepiness after receiving the COVID-19 vaccine. She had a known history of hypersomnia secondary to infectious mononucleosis but has fully recovered for 8 months. A series of examinations were performed on this patient. Neurologic and psychiatric examinations were unremarkable. Despite normal nocturnal subjective sleep quality (Pittsburgh Sleep Quality Index score = 5, Insomnia Severity Index score = 7), her Epworth sleepiness scale score (15) suggested an abnormal level of subjective sleepiness. Consistent with the subjective report, the objective assessment by Multiple Sleep Latency Test found mean sleep latency was 1.3 min with no sleep onset rapid-eye-movement (REM) period. We speculate that COVID-19 vaccine may potentially trigger the relapse of hypersomnia. The immune memory could be an explanation for the increased response to vaccine in patients with secondary hypersomnia. Caution should be warranted when administering COVID-19 vaccine in patients with hypersomnia secondary to infections.
ABSTRACT
Sleep disturbances are among the common nonmotor symptoms in patients with Parkinson's disease (PD). Sleep can be disrupted by nocturnal motor and nonmotor symptoms and other comorbid sleep disorders. Rapid eye movement sleep behavior disorder (RBD) causes sleep-related injury, has important clinical implications as a harbinger of PD and predicts a progressive clinical phenotype. Restless legs syndrome (RLS) and its related symptoms can impair sleep initiation. Excessive daytime sleepiness (EDS) is a refractory problem affecting patients' daytime activities. In particular, during the COVID-19 era, special attention should be paid to monitoring sleep problems, as infection-prevention procedures for COVID-19 can affect patients' motor symptoms, psychiatric symptoms and sleep. Therefore, screening for and managing sleep problems is important in clinical practice, and the maintenance of good sleep conditions may improve the quality of life of PD patients. This narrative review focused on the literature published in the past 10 years, providing a current update of various sleep disturbances in PD patients and their management, including RBD, RLS, EDS, sleep apnea and circadian abnormalities.