Stress indices in methadone maintenance treatment - Cross sectional and follow up study.

To study the prevalence of perceived high stress among methadone maintenance treatment (MMT) patients, and whether stress can predict outcome, and whether stress may improve during treatment, we studied a sample of 107 MMT patients using Perceived Stress Scale (PSS) questionnaires. We studied if PSS scores on admission predict long-term retention, and we monitored stress indices (PSS, heart rate variability, saliva cortisol) on admission, 6 and 12 months later, to measure changes. Variables included demographic data, history of adverse events, and urine test. A sample of 79 (73.8%) males and 28 (26.2%) females whose age at opioid use onset was 22.1±7.2 years and age at study onset 50.5±10.8 years was studied for PSS. Both high and very-high PSS patients characterized (logistic regression) as abusing benzodiazepine, and with history of depressive symptoms. The very-high PSS group on admission (n=29) had shorter cumulative retention (1.8 years, 95%%CI 1.2-2.4) compared with 50 others (2.8 years, 95%%CI 2.3-3.3, p=0.03). Monitoring stress indices among 25 patients found that no-benzodiazepine and cocaine use on admission, opioid discontinuation after 6 months, and any substance discontinuation after a year were associated with stress reduction. Conclusion: stress level appears to normalize among MMT patients if no other substance is abused.

[SLEEP OF ELITE YOUNG ATHLETE AT THE ACADEMY FOR SPORT EXCELLENCE AT THE WINGATE INSTITUTE].

INTRODUCTION: Sleep duration and quality have a critical role in cognitive and athletic performances. A relationship was demonstrated between sleep deprivation, reduced performance and elevated injury risk. The recommended sleep duration for teenagers is at least 9 hours a day but most sleep less. AIM: To estimate sleep duration among elite adolescent athletes at the Academy for Sport Excellence at the Wingate Institute, by quantifying the changes after joining the academy and the relation to school performances and the usage of medical services. METHODS: Data from medical records, including sleep screening questionnaires and a number of the athletes' medical appointments were analyzed. RESULTS: Athletes reported that sleep duration was less than recommended before joining the academy. After joining the academy the average sleep duration decreased (7.37 vs 7.7 hours, P = 0.05) and daytime sleepiness was elevated (13/24 v 11/24 Epworth-Sleepiness-Scale (ESS), P = 0.002). Correlations between changes in sleep duration and changes in school achievements before and after joining the academy were demonstrated (P = 0.027). No correlation was found between sleep duration at the academy and usage of medical services. CONCLUSIONS: Elite adolescent athletes do not sleep enough and are tired during the day. Reduction in sleep duration and elevation in sleepiness were observed with the transition to practice, study and life at the Academy for Sport Excellence. DISCUSSION: In accordance with previous studies, our findings showed elite young athletes are in a state of continuous sleep deprivation that interferes with their school achievements. Further research is needed to evaluate the importance of sleep duration and quality in performance for the health of young athletes.

Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome.

PURPOSE: Newly developed algorithms putatively derive measures of sleep, wakefulness, and respiratory disturbance index (RDI) through detailed analysis of heart rate variability (HRV). Here, we establish levels of agreement for one such algorithm through comparative analysis of HRV-derived values of sleep-wake architecture and RDI with those calculated from manually scored polysomnographic (PSG) recordings. METHODS: Archived PSG data collected from 234 subjects who participated in a 3-day, 2-night study characterizing polysomnographic traits of chronic fatigue syndrome were scored manually. The electrocardiogram and pulse oximetry channels were scored separately with a novel scoring algorithm to derive values for wakefulness, sleep architecture, and RDI. RESULTS: Four hundred fifty-four whole-night PSG recordings were acquired, of which, 410 were technically acceptable. Comparative analyses demonstrated no difference for total minutes of sleep, wake, NREM, REM, nor sleep efficiency generated through manual scoring with those derived through HRV analyses. When NREM sleep was further partitioned into slow-wave sleep (stages 3-4) and light sleep (stages 1-2), values calculated through manual scoring differed significantly from those derived through HRV analyses. Levels of agreement between RDIs derived through the two methods revealed an R = 0.89. The Bland-Altman approach for determining levels of agreement between RDIs generated through manual scoring with those derived through HRV analysis revealed a mean difference of -0.7 +/- 8.8 (mean +/- two standard deviations). CONCLUSION: We found no difference between values of wakefulness, sleep, NREM, REM sleep, and RDI calculated from manually scored PSG recordings with those derived through analyses of HRV.