Impact of biological rhythms on perception of illness and cognitive flexibility in bipolar patients in remission.

Our study aims to examine the possible mediating effects of biological rhythms on the relationship between illness perception, cognitive flexibility, and functionality in bipolar patients in remission. A total of 150 patients with bipolar disorder (BD) were enrolled. The sociodemographic data form, Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), Brief Illness Perception Questionnaire (BIPQ), Cognitive Flexibility Scale (CFS), Young Mania Rating Scale, Montgomery and Asberg Depression Scale, Beck Anxiety Inventory, and Short Functionality Assessment Scale were applied to the patients in the study. The mean age of the patients was 42.10 ± 12.92 (SD). The participants were 48.7% (n = 73) female and 66.6% (n = 100) BD-I. There was a negative correlation between the total BRIAN score and favorable BIPQ scores and a positive correlation between the total BRIAN score and unfavorable BIPQ scores (except timeline). Additionally, multiple regression analyses revealed that the total BRIAN score could predict favorable BIPQ (except treatment control) and unfavorable BIPQ (except timeline) scores (p < 0.05). The total CFS score also could predict favorable BIPQ (treatment control) and unfavorable BIPQ scores (except timeline). The second step mediation analysis showed that biological rhythm mediated the relationship between illness perception and cognitive flexibility. Our study found that biological rhythms played a full mediating role in the relationship between the perception of illness and cognitive flexibility. In addition, worsening in biological rhythms in bipolar patients could cause negative beliefs and attitudes towards their diseases with an unfavorable clinical course. Therefore, regularity in biological rhythms should be highly recommended for bipolar patients.

The REM-sleep-related characteristics of narcolepsy: a nation-wide multicenter study in Turkey, the REMCON study.

INTRODUCTION: Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of narcolepsy type 2 (NT2) has not been delineated. Except for the hypocretin deficiency and cataplexy, all clinical and laboratory features used in the diagnosis of NT2 are identical to those used for NT1. The aim of this study was to assess the rapid eye movement (REM) sleep-related characteristics in the patients with narcolepsy; the characteristics of REM sleep in polysomnography (PSG) and multiple sleep latency test (MSLT) recordings, the quantification of REM sleep without atonia (RSWA) and atonia index, and the analysis of rapid eye movements (REMs) during REM sleep. MATERIALS AND METHODS: This study was planned by the Sleep Medicine Study Group of the Turkish Neurology Society, and conducted in 11 centers in eight cities in Turkey. The analysis of RSWA was analyzed by reviewing all REM sleep periods on nocturnal PSG and MSLT recordings per standard criteria. The total duration of the increased muscle tone during REM sleep in the chin and bilateral leg electromyography (EMG) recordings was calculated as RSWA index. The REMs index was also investigated the relation to the RSWA. RESULTS: A total of 274 patients were involved; 147 patients (53.6%) were males and 127 patients (46.4%) were females; the mean age was 29.1 ± 12.0 years. The diagnosis of NT1 was made in 166 patients (60.6%), and 108 patients (39.4%) were diagnosed as having NT2. The mean Epworth sleepiness scale score was significantly higher in patients with NT1 than the patients with NT2 (P = 0.001). The diagnosis of REM sleep behavior disorder (RBD) was made in 19.3% of the patients with NT1 versus in 2.8% of the patients with NT2 (P < 0.001). The percentage of SOREMP in PSG recordings was significantly higher in patients with NT1 (37.1%) than those with NT2 (18.9%, P = 0.001). MSLT showed that the mean sleep latency was shorter in patients with NT1 compared to those with NT2 (P < 0.001). The total duration of REMs on electrooculography recordings was also significantly higher in patients with RSWA in comparison with the patients without RSWA (P = 0.002). Total duration of REMs was significantly and positively correlated with the duration of RSWA on chin-EMG and leg-EMG recordings (P = 0.001). ROC analyses showed an RSWA index of ≥2% for the RSWA on chin-EMG with a sensitivity of 86.7% and a specificity of 71.3% (P < 0.001). The REMs index ≥20% was associated with the presence of RSWA with a sensitivity of 70.0% and a specificity of 57.1% (P = 0.008). CONCLUSIONS: In this nation-wide study, we identified for the first time that the increase in REMs density during REM sleep may be a major correlate of the RSWA. Significant positive correlations were demonstrated between the total duration of REMs on electrooculography recordings and the mean durations of RSWA in both chin and leg EMG recordings. A REMs index of >20% was demonstrated to have a moderate sensitivity and specificity in the diagnosis of RSWA. As observed in chin RSWA index, REMs index also showed a significantly high association with RBD, in comparison to RSWA per standard criteria.

The Effects of Mobile Electronic Devices Use on the Sleep States of University Students.

Objective: In this study, the purpose was to evaluate the effect of mobile electronic devices (MEDs) use on the sleep states of university students. Methods: The study was conducted in a cross-sectional fashion between April 21, 2019 and May 31, 2019 with the participation of the students registered in a public university at medical faculties and faculty of health sciences. Television viewing, MED and desktop computer use form, Morningness-Eveningness Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Sleepiness Severity Index (SSI) were used as data collection tools. The data of 752 students (56.5% girls, mean age: 20.57 [SD = 1.54] years) were analyzed. Results: In this study, overall MED use times and PSQI, ESS, and SSI total scores were higher in students who had an evening-oriented chronotype. There was a negative relationship between overall and evening MED use times and the chronotype scores of the students. As a result of the regression analyses applied to the PSQI, ESS, and SSI dependent variables, a positive and significant relationship was detected with smartphone use times (P < 0.05, P = 0.05, and P < 0.001, respectively). In addition, there was a positive relationship between PSQI and ESS variables and iPod touch use times (P < 0.001 and P < 0.05, respectively). Conclusion: Overall MED use times were determined to be higher in students who had Type E chronotype. It was also determined that their sleep quality was poorer and their insomnia severity was higher, and there was more sleepiness in the students with chronotype E. Comprehensive interventions must be planned by professional healthcare staff for students on the topics of sleep hygiene and conscious media use.

Turkish reliability and validity study of the medical outcomes study (MOS) sleep scale in patients with obstructive sleep apnea

Background/aim: The purpose of the present study was to evaluate the Turkish reliability and validity of the medical outcomes study (MOS) sleep scale in patients who have obstructive sleep apnea. Materials and methods: The data of the study were collected from 120 adult patients with obstructive sleep apnea and from 90 healthy individuals between March 04 and May 31, 2019. Results: The Cronbach's α internal consistency reliability coefficient of the MOS sleep scale was found as 0.82. The test-retest reliability was acceptable (r = 0.76-0.94). Six factors were identified by the factor analysis. These were the same as those in the original MOS-Sleep. The correlations between the MOS-Sleep and other instruments administered in this study provided evidence for structural validity. A significant relation was determined between MOS sleep scale and obstructive sleep apnea syndrome (OSAS) severity and the healthy group ( P < 0.05). In addition, the Cronbach α internal consistency reliability coefficient of the healthy group in MOS sleep scale was found as 0.78. The items of the six factors that were obtained with the confirmatory factor analysis for the MOS sleep scale of the healthy group were found to be the same as in the original MOS-Sleep. Conclusion: Turkish MOS sleep scale is a measurement tool that consists of 12 items and 6 subdimensions with adequate validity and reliability indicators.

Relationship between Apnea-Hypopnea Index and Oxygen Desaturation in REM-Sleep Period and Morning Headache in Patients with Obstructive Sleep Apnea Syndrome.

INTRODUCTION: In patients with morning headache, REM sleep period decreases though little is known about its physiopathology. We evaluate the polysomnographic records of obstructive sleep apnea syndrome (OSAS) patients with the hypothesis that oxygen desaturations may be a better determinant in patients with morning headache, especially those in REM sleep periods. METHODS: Patient group (group 1) with a total of 361 patients with OSAS and the controls (group 2) with 107 healthy individuals were evaluated. The presence of morning headache was compared between the groups, and sleep parameters were correlated with morning headache. RESULTS: In group 1, patients with OSAS and morning headache, apnea-hypopnea index in the REM sleep period (26.7/hour, min-max: 0-108.4/hour) was higher than those in patients without morning headache (17.8/hour, min-max: 0-107.8/hour). The minimum oxygen saturation in REM sleep period and total sleep time (TST) was lower in patients with morning headache (REM sleep period: 82%, min-max: 50-94% ; TST: 79%, min-max: 50-97%) in compared to patients without morning headache (REM sleep period: 84%, min-max: 50-93% ; TST: 81%, min-max: 50-90%). CONCLUSION: Here we demonstrated that higher apnea-hypopnea index and lower oxygen saturation in REM sleep period were associated with morning headache in patients with obstructive sleep apnea syndrome.

Sleep, sleep spindles, and cognitive functions in drug-naive patients with first-episode psychosis.

STUDY OBJECTIVES: Various lines of clinical findings have suggested abnormalities in macro- or microstructural parameters of sleep in patients with schizophrenia. Meanwhile findings are inconclusive due to some confounding factors, such as the heterogeneity of the disorder, drug regimen, and duration of the illness. There are a few studies in the literature that have been conducted on drug-free patients with first-episode psychosis (FEP). Based on this knowledge, we aimed to explore sleep characteristics, sleep spindles, and neuropsychological profiles of the drug-naive patients with FEP. METHODS: The study sample consisted of 21 drug-naive patients with FEP and 21 healthy participants. Polysomnography recordings were conducted for 2 subsequent nights. A neuropsychological test battery was administered for assessing cognitive functions. The Positive and Negative Syndrome Scale was applied to measure symptom severity of the patients. Spindle detection was performed visually. RESULTS: According to the results of the study, the patient group's percentage of stage N2 sleep and sleep efficiency index was lower than in the control group. Among sleep spindle parameters, spindle density was found to be reduced in the patient group. The results of neuropsychological tests measuring executive functions, learning, and memory support the idea that there is a global cognitive deterioration from the early course of the disorder. In the psychotic group, negative symptoms were negatively correlated with verbal memory, learning, verbal fluency, and semantic organization. We found that the percentage of stage N3 sleep decreased while negative symptom severity increased. In addition, the percentage of stage N1 sleep increased as negative symptom severity increased. Reduction in stage N3 sleep was associated with an impairment in learning, verbal fluency, and response inhibition. The sleep spindle density and cognitive functions did not show any associations. CONCLUSIONS: Taken together, these findings suggest that patients with FEP show global cognitive impairment (except for attention and processing speed), which is associated with changes in sleep architecture and higher score in a scale assessing negative symptoms. We conclude that cognitive function and spindle parameters differ nonlinearly among patients with FEP.

Is there a relationship between oxygen saturation and MRI-induced anxiety? A prospective study.

PURPOSE: To prospectively examine the possible relationship between oxygen saturation changes and anxiety during MRI examinations. MATERIAL AND METHODS: One hundred and fifty randomly-selected patients referred to our department for MRI examination were included. Participants were asked to complete the Spielberger State and Trait Anxiety Inventory (STAI) to monitor subjective evaluation of anxiety. Both state (STAIs) and trait (STAIt) anxiety levels were recorded as pre-MRI scores. Following the inventory, oxygen saturation levels were measured before, during and immediately after an MRI scan. The patients completed the STAI again immediately following the procedure, and the post-MRI scores were recorded. The scan duration and examined body part were also noted. RESULTS: Ninty-one patients (60.7%) were female and 59 (39.3%) were male. Mean age was 43.68 ± 15.59 years. One hundred and thirty-one of them were head-first examinations, while 19 of them were foot-first, in reference to position on the table. Statistically significant relationships were found between pre- and mid-MRI oxygen saturation levels and mid- and post-MRI oxygen saturation levels. Additionally, mid-MRI saturation levels were significantly lower compared to pre- and post-MRI saturation levels (p = .001 for both measurements). The mean pre-MRI STAIs score was 35.6 ± 10.14, while the mean post-MRI score was 36.45 ± 9.92. The mean pre-MRI STAIt score was 44.01 ± 7.76, and post-MRI score was 44.39 ± 7.75 in the study group. There was no statistically significant relationship between pre- and post-MRI STAI scores. No significant correlation was found between oxygen saturation levels and STAI scores. CONCLUSION: To investigate a possible relationship between oxygen saturation changes during MRI examinations and MRI-induced anxiety, we designed a prospective study. We detected statistically significant lower oxygen saturation levels during the examination compared to pre- and post-MRI levels. However, no statistically significant relationship was found between the oxygen saturation decrease and pre- and post-MRI STAI scores.

Assessment of the role of serum ischemia-modified albumin in obstructive sleep apnea in comparison with interleukin-6.

OBJECTIVES: There is limited and contradictory information regarding the role of serum ischemia-modified albumin (IMA) in obstructive sleep apnea (OSA). In this study we examine the effects of OSA and obesity on IMA and interleukin-6 (IL-6), and detect whether IMA and IL-6 may be potential biomarkers in OSA. METHODS: Fifty-one males who underwent all night polysomnography test were included into the study. Body-mass index (BMI) and apnea-hypopnea index (AHI) of all patients were determined. Serum IMA and IL-6 levels, erythrocyte sedimentation rate (ESR), complete blood count, routine blood biochemistry and thyroid function tests were performed. RESULTS: Mean IMA [0.36 (± 0.04) U/ml, 0.89 (± 0.15) U/ml], mean IL-6 [1.01 (± 0.19) pg/ml, 2.02 (± 1.19) pg/ml] and mean ESR [4.14 (± 2.5) mm/h, 14.35 (± 13.7) mm/h] levels showed significant difference between non-OSA and OSA groups (P = 0.005, P < 0.001, P < 0.001, respectively). Sensitivity of IMA in distinction of non-OSA/OSA was equal to IL-6 and higher than ESR. IMA was also a stronger predictive factor than IL-6 and ESR in the evaluation of OSA groups (severe/mild/moderate OSA and non-OSA). IMA was the sole distinctive biomarker in assessment of obese and non-obese cases. IMA correlated with IL-6, AHI and ESR. CONCLUSION: Serum IMA may be a valuable oxidative stress indicator for OSA and could act as a better biomarker than IL-6 for reflecting the presence and the severity of OSA.

Mutual information analysis of sleep EEG in detecting psycho-physiological insomnia.

The primary goal of this study is to state the clear changes in functional brain connectivity during all night sleep in psycho-physiological insomnia (PPI). The secondary goal is to investigate the usefulness of Mutual Information (MI) analysis in estimating cortical sleep EEG arousals for detection of PPI. For these purposes, healthy controls and patients were compared to each other with respect to both linear (Pearson correlation coefficient and coherence) and nonlinear quantifiers (MI) in addition to phase locking quantification for six sleep stages (stage.1-4, rem, wake) by means of interhemispheric dependency between two central sleep EEG derivations. In test, each connectivity estimation calculated for each couple of epoches (C3-A2 and C4-A1) was identified by the vector norm of estimation. Then, patients and controls were classified by using 10 different types of data mining classifiers for five error criteria such as accuracy, root mean squared error, sensitivity, specificity and precision. High performance in a classification through a measure will validate high contribution of that measure to detecting PPI. The MI was found to be the best method in detecting PPI. In particular, the patients had lower MI, higher PCC for all sleep stages. In other words, the lower sleep EEG synchronization suffering from PPI was observed. These results probably stand for the loss of neurons that then contribute to less complex dynamical processing within the neural networks in sleep disorders an the functional central brain connectivity is nonlinear during night sleep. In conclusion, the level of cortical hemispheric connectivity is strongly associated with sleep disorder. Thus, cortical communication quantified in all existence sleep stages might be a potential marker for sleep disorder induced by PPI.

Comparison of Polysomnography and Multiple Sleep Latency Test Findings in Subjects with Narcolepsy and Idiopathic Hypersomnia.

INTRODUCTION: Both narcolepsy and idiopathic hypersomnia are the main causes of excessive daytime sleepiness. In this study, we aimed to compare polysomnography (PSG) and multiple sleep latency test (MSLT) findings in narcolepsy and idiopathic hypersomnia patients. METHODS: The files of patients with narcolepsy and hypersomnia who were admitted between 1995 and 2009 were reviewed. We evaluated data from 94 patients with narcolepsy with cataplexy, 49 with narcolepsy without cataplexy and 140 patients with idiopathic hypersomnia. RESULT: Sleep latency and REM latency were longer in idiopathic hypersomnia group than in narcolepsy with and without cataplexy group. Mean sleep latency in MSLT was the shortest in narcolepsy with cataplexy group. There was no difference in sleep efficiency, percentage of sleep stage and number of awakenings in PSG between three groups. CONCLUSION: The findings of the study indicated that narcolepsy patients differ from idiopathic hypersomnia patients in terms of sleep latency and REM latency in PSG.

Clinical and Polysomnographic Features of Kleine-Levin Syndrome: Case Series.

Kleine-Levin Syndrome (KLS) is a rare disorder characterized intermittent hypersomnia, hyperphagia, hypersexuality, abnormal behaviors, and confusion. Patients are asymptomatic between episodes. The aim of this case series study was to determine the clinical features of patients with KLS and to compare the polysomnography (PSG) findings between symptomatic and asymptomatic periods. We compared the results of PSG investigations performed in symptomatic and asymptomatic periods in six patients diagnosed with KLS at Gulhane Military Medical Faculty Sleep Research Center between 1998 and 2005. The age at onset of KLS was approximately 18 years, the diagnosis delayed 2.67 years, hypersomnia episodes lasted approximately 11.5 days, until the correct diagnosis, the patients had experienced on average 5 episodes. Total sleep time in KLS patients during symptomatic period and stage 2 sleep percent was higher than in asymptomatic period. REM latency was shorter and stage 3 and REM percent was lower in asymptomatic period. The clinical features including the age of onset and episode duration are compatible with those from the previous studies. It was observed that the sleep architecture during symptomatic period was different from that in asymptomatic period.

[Sleep architecture in schizophrenia patients]. / Sizofreni Hastalarinda Uyku Yapisi

OBJECTIVE: Sleep disorders are a common and important part of schizophrenia's clinical Picture; however, the number of polysomnography-based studies of schizophrenia is limited and there is a lack of consensus regarding a specific sleep pattern in schizophrenia patients. As such, the aim of the present study was to investigate the sleep architecture in non-medicated schizophrenia patients. METHOD: The study included 13 adult male inpatients with schizophrenia, undifferentiated type, (based on DSM-IV-TR criteria) and an age- and sex-matched group of normal controls. The participants were studied during 2 consecutive nights in the sleep laboratory. The Brief Psychiatric Rating Scale (BPRS), Scale for Negative Symptoms (SANS), and Scale for Positive Symptoms (SAPS) were used for clinical assessment. Polysomnographic recordings obtained on the second night were used for analysis. RESULTS: Compared to the controls, the schizophrenic patients had less total sleep time, lower sleep efficiency, longer sleep latency, more awakenings, and increased duration of awakenings after falling asleep. In terms of sleep architecture, the schizophrenia patients showed no evidence of abnormal-slow wave sleep, but the percentage of REM sleep was reduced. REM sleep measures, including REM latency and density, did not significantly differ between the 2 groups. Based on correlation analysis between the sleep parameters and clinical symptoms, slow-wave sleep was inversely correlated with formal thought disorder. CONCLUSION: The findings indicate that in addition to decreased REM sleep time, disturbances in sleep initiation and maintenance were prominent in the non-medicated schizophrenia patients. The correlation between decreased decreased REM sleep and, slow-wave sleep, and formal thought disorder we observed in the patients might have been related to the underlying pathophysiology of schizophrenia.

Sleep stage and obstructive apneaic epoch classification using single-lead ECG.

BACKGROUND: Polysomnography (PSG) is used to define physiological sleep and different physiological sleep stages, to assess sleep quality and diagnose many types of sleep disorders such as obstructive sleep apnea. However, PSG requires not only the connection of various sensors and electrodes to the subject but also spending the night in a bed that is different from the subject's own bed. This study is designed to investigate the feasibility of automatic classification of sleep stages and obstructive apneaic epochs using only the features derived from a single-lead electrocardiography (ECG) signal. METHODS: For this purpose, PSG recordings (ECG included) were obtained during the night's sleep (mean duration 7 hours) of 17 subjects (5 men) with ages between 26 and 67. Based on these recordings, sleep experts performed sleep scoring for each subject. This study consisted of the following steps: (1) Visual inspection of ECG data corresponding to each 30-second epoch, and selection of epochs with relatively clean signals, (2) beat-to-beat interval (RR interval) computation using an R-peak detection algorithm, (3) feature extraction from RR interval values, and (4) classification of sleep stages (or obstructive apneaic periods) using one-versus-rest approach. The features used in the study were the median value, the difference between the 75 and 25 percentile values, and mean absolute deviations of the RR intervals computed for each epoch. The k-nearest-neighbor (kNN), quadratic discriminant analysis (QDA), and support vector machines (SVM) methods were used as the classification tools. In the testing procedure 10-fold cross-validation was employed. RESULTS: QDA and SVM performed similarly well and significantly better than kNN for both sleep stage and apneaic epoch classification studies. The classification accuracy rates were between 80 and 90% for the stages other than non-rapid-eye-movement stage 2. The accuracies were 60 or 70% for that specific stage. In five obstructive sleep apnea (OSA) patients, the accurate apneaic epoch detection rates were over 89% for QDA and SVM. CONCLUSION: This study, in general, showed that RR-interval based classification, which requires only single-lead ECG, is feasible for sleep stage and apneaic epoch determination and can pave the road for a simple automatic classification system suitable for home-use.

Polysomnography in patients with post-traumatic stress disorder.

AIMS: The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. METHODS: Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. RESULTS: Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. CONCLUSIONS: PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD.

Quality of sleep in Turkish family caregivers of cancer patients.

The aim of this research was to determine the quality of sleep, reasons for sleep disturbances, and nonpharmacological strategies versus sleep disturbances of cancer patients' family caregivers. A descriptive, cross-sectional study design was used. Ninety family caregivers were included. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), demographic data form, and open-ended questions about reasons for sleep disturbances and nonpharmacological strategies used by family caregivers. Descriptive statistics, Kruskal-Wallis variance analysis, and Bonferoni-corrected Mann-Whitney U test were performed using SPSS program. The PSQI score of 72.22% of the caregivers was above 5, which indicated poor sleep quality. The most commonly determined reasons for sleep disturbances were "emotional distress because of the patient's illness" (83.33%), "financial problems" (36.66%), and "inadequate support system" (34.44%); 76.92% of caregivers used at least 1 nonpharmacological strategy, which included mostly "lifestyle practices" (54.28%) and "behavioral practices" (25.71%). The total PSQI scores of caregivers having an illness were significantly higher than those of caregivers having no illness (Z = 3.230; P = .001). Total PSQI scores did not differ by sex, age, education, marital status, or duration of caregiving (P > .05). This study implies that caregivers are in need of support by healthcare professionals to provide a positive environment during the care process.

Impact of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction due to nasal polyposis.

OBJECTIVE: The aim of this study was to investigate the effect of endoscopic sinus surgery on sleep quality in a patient group who has chronic nasal obstruction resulting from nasal polyposis. METHODS: Twenty-seven patients with nasal polyposis, filling at least 50% of each nasal passage, were enrolled in the study. Assessment of nasal patency was determined by nasal endoscopy and acoustic rhinometry. All patients underwent endoscopic sinus surgery with polypectomy. Sleep quality was evaluated, using visual analog scale, Epworth sleepiness scale, and polysomnography before and 3 months after the surgery. RESULTS: Nasal resistance decreased significantly after the surgery (P < 0.01). Snoring scores were significantly improved postoperatively (P < 0.01) and completely disappeared in 9 of 27 patients. A significant improvement occurred in mean daytime sleepiness scores in the postoperative period (4.14) as compared with the preoperative values (9.44; P < 0.01). There was no significant difference between preoperative (6.85) and postoperative (5.53) mean values of apnea-hypopnea index (P = 0.55). CONCLUSIONS: Endoscopic sinus surgery with polypectomy significantly improves sleep quality, including snoring and daytime sleepiness in patients with chronic nasal obstruction due to nasal polyposis. However, it has a limited benefit on apnea-hypopnea index scores.

The influence of emotional distress on the outcome of in-vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatment among infertile Turkish women.

BACKGROUND: To determine whether the emotional distress of infertile Turkish women is related to social support and influences the outcome of their IVF and/or ICSI treatment. METHODS: The Beck Depression Inventory, State- Trait Anxiety Inventory, and Social Support scales were administered to 104 primary infertile Turkish women before the date of their embryo transfer. Comparisons were made between the women who became pregnant and those who did not following the embryo transfer. RESULTS: Compared to the pregnant women, the non-pregnant women had a greater number of emotional symptoms despite similar levels of social support. Also, the increased severity of depressive symptoms and higher levels of anxiety were predictive of low pregnancy rates. CONCLUSION: The pregnancy rate of infertile Turkish women was associated with emotional distress and low levels of social support were associated with increased emotional distress. Further research is needed to determine the factors and mechanisms that contribute to emotional distress in the treatment of infertility.

Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors.

OBJECTIVE: To evaluate the effect of mirtazapine augmentation in patients with sexual dysfunction induced by current selective serotonin reuptake inhibitor (SSRI) treatment. METHODS: Forty-nine outpatients in remission from major depressive disorder with SSRI treatment and experiencing treatment-emergent sexual dysfunction were invited to participate and 33 (25 women and 8 men) were included in this 8-week open-label study. All patients continued her/his current SSRI treatment (dosages unchanged) and started on mirtazapine augmentation of 15 mg/day during the first week and 30 mg/day throughout the rest of the study. The Hamilton rating scale for depression (HAM-D), the psychotropic-related sexual dysfunction questionnaire (PRSexDQ), and the Golombok and Rust Inventory of Sexual Satisfaction (GRISS) were given to all patients at baseline and at each follow-up (end of the first, second, fourth, sixth, and eight weeks). RESULTS: Mirtazapine augmentation led to significant reductions in HAM-D, PRSexDQ, and GRISS scores throughout the study especially after week 4 and 48.5% of patients (n = 16) reported that they had no overall sexual dysfunction at the end of the study. CONCLUSIONS: Mirtazapine augmentation is a good choice for the treatment of SSRI-induced sexual dysfunction, and the results are typically seen later after 4-8 weeks.

[Is there gender difference in infertile couples with no axis one psychiatric disorder in context of emotional symptoms, social support and sexual function?]. / Psikiyatrik Birinci Eksen Tanisi Almayan Infertil Ciftlerde Emosyonel Semptomlar, Sosyal Destek ve Cinsel Islev Baglaminda Cinsiyet Farki Var Mi?

OBJECTIVE: It was aimed to evaluate the levels of emotional distress, social support and sexual function of infertile couples with no psychiatric Axis-I disorder according to gender differences. METHOD: The study sample of 103 primary infertile couples with no psychiatric Axis-I disorder according to DSM-IV were given Beck Depression Inventory, State and Trait Anxiety Inventory, Inventory of Perceived Social Support and Golombok Rust Inventory of Sexual Satisfaction (GRISS). RESULTS: The sample's depressive symptom severity did not indicate clinical depression, state anxiety was within normal range, and trait anxiety was high according to the scales. Compared to men, women had more severe depressive symptoms when they were the cause of couple's infertility whether alone or with their husbands, and higher trait anxiety in all infertility groups, and more perceived social support of family whether they or their husbands are the cause of infertility. According to sexual functioning profile obtained by the subscale scores of GRISS, more frequently defined problems of sexual relationship were non-communication and non-sensuality for men and avoidance for women in all infertility groups. The emotional distress of woman and man were correlated negatively with their perceived social support and positively with their sexual functioning. CONCLUSION: It was concluded that women had more social support and emotional distress and men had more problems of sexual function, however, satisfactory social support might decrease the emotional symptoms of both genders.

Evaluation of periodic leg movements and associated transcranial magnetic stimulation parameters in restless legs syndrome.

Restless legs syndrome (RLS), a sensorimotor disorder characterized by unpleasant sensations commonly localized in the legs, is frequently associated with periodic limb movements (PLMs) during sleep. We investigated the role of transcranial magnetic stimulation (TMS) and cortical silent period (CSP) duration as diagnostic and monitoring tools in 20 patients with primary RLS before and after 1 month of treatment and also studied 15 normal age- and gender-matched subjects. Polysomnographic assessment was undertaken and the PLM index determined in 17 of the 20 patients. We also studied the correlation between sleep efficiency index and CSP duration because of the increasing severity of the sleep disturbance and PLMs in patients with RLS. Our results demonstrate that the duration of the CSP was reduced in patients with RLS, and that dopaminergic treatment normalized this duration. There was no correlation between the PLM index and CSP duration. It may be speculated that PLMs and the CSP are due to different inhibitory mechanisms and they may be used separately as diagnostic and monitoring tools in patients with primary RLS.