Sleep Disorders in Patients with Severe COVID-19 Treated in the Intensive Care Unit: A Real-Life Descriptive Study in Vietnam.

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients with sleep disorders may be at greater risk for respiratory exacerbation or death compared to those without. After being infected with COVID-19, patients have many symptoms related to sleep disorders, especially those with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. This study aimed to evaluate sleep disturbances in patients with severe SARS-CoV-2 infection who were treated in the Intensive Care Unit (ICU). METHODS: This cross-sectional study used the questionnaire provided by the Vietnam Sleep Disorder Study (ViSDiS) research, elaborated by the Vietnam Society of Sleep Medicine (VSSM). Seventy-seven COVID-19 patients were included. RESULTS: There was a significant difference in sleep status before and after SARS-CoV-2 infection among participants. Up to 83% of them reported experiencing insomnia after illness, 60% reported having frequent nightmares, and more than half of participants reported nocturia (p < 0.0001). More than 81.8% of patients with severe SARS-CoV-2 infection were unsatisfied with their sleep quality during hospitalization After SARS-CoV-2 infection, only 2.6% of participants felt they had good quality sleep (p < 0.0001). The majority of patients suffered from fatigue after SARS-CoV-2 infection, including a lack of energy, feeling heaviness in their limbs, aggravation of pre-existing sleep disorders, idleness, constant fatigue throughout the day, and difficulty concentrating. CONCLUSION: Sleep problems are highly prevalence among hospitalized patients with severe COVID-19 in the ICU. Healthcare providers should pay attention to sleep problems and their associated symptoms to initiate appropriate treatment to improve severe COVID-19 patients' health status and minimize the risk of death.

Stress and sleep quality in medical students: a cross-sectional study from Vietnam.

Background: The COVID-19 pandemic has resulted in significant global social and economic disruptions, as well as changes in personal attitude and behavior. The purpose of this research is to assess the sleep quality and stress levels of medical students. Method: Data was collected from medical students over the course of a month in 2021. A total of 4,677 students at the University of Medicine Pham Ngoc Thach were invited to complete an anonymous web-based survey, which included the Pittsburgh Sleep Quality Questionnaire Index (PSQI) for measuring sleep quality and the COVID-19 Student Stress Questionnaire (CSSQ) for evaluating stress. Results: A total of 1,502 students participated in our survey. More than half of the participants exhibited poor quality of sleep as indicated by their PSQI score. Many students reported going to bed after midnight and spending time on their smartphones. Among the students surveyed, 21.84% experienced low levels of stress (CSSQ ≤6), 63.38% had mild stress (7 ≤ CSSQ score ≤ 14), 14.78% reported high levels of stress (CSSQ >14). Conclusion: This study showed a high prevalence of poor sleep quality in the surveyed students, which could be attributed to changes in their behavior following the COVID-19 outbreak. Mild stress was also frequently observed, and it may be related to sleep disorders in this population. These important findings provide valuable insights for making recommendations, including lifestyle modifications to improve sleep quality.

Personalized Medicine and Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common disease that is often under-diagnosed and under-treated in all ages. This is due to differences in morphology, diversity in clinical phenotypes, and differences in diagnosis and treatment of OSA in children and adults, even among individuals of the same age. Therefore, a personalized medicine approach to diagnosis and treatment of OSA is necessary for physicians in clinical practice. In children and adults without serious underlying medical conditions, polysomnography at sleep labs may be an inappropriate and inconvenient testing modality compared to home sleep apnea testing. In addition, the apnea-hypopnea index should not be considered as a single parameter for making treatment decisions. Thus, the treatment of OSA should be personalized and based on individual tolerance to sleep-quality-related parameters measured by the microarousal index, harmful effects of OSA on the cardiovascular system related to severe hypoxia, and patients' comorbidities. The current treatment options for OSA include lifestyle modification, continuous positive airway pressure (CPAP) therapy, oral appliance, surgery, and other alternative treatments. CPAP therapy has been recommended as a cornerstone treatment for moderate-to-severe OSA in adults. However, not all patients can afford or tolerate CPAP therapy. This narrative review seeks to describe the current concepts and relevant approaches towards personalized management of patients with OSA, according to pathophysiology, cluster analysis of clinical characteristics, adequate combined therapy, and the consideration of patients' expectations.

Tiredness, depression, and sleep disorders in frontline healthcare workers during COVID-19 pandemic in Vietnam: A field hospital study.

Background: The COVID-19 outbreak witnessed in the autumn of 2021 led to unprecedented changes in healthcare systems in some emerging countries. Many field-hospitals, temporary sites of care for COVID-19 patients, were built around the country and followed by the healthcare workers who were mobilized. This study aimed to measure sleep disorders, depression, and fatigue in volunteers working at field hospitals during the COVID-19 outbreak. Methods: This was a cross-sectional study. The self-report questionnaire was used for each study subject. Sleep characters, including STOP's elements were questioned. Healthcare workers' burnout was detected by using Pichot's questionnaire. Results: One hundred front-line healthcare workers (FHWs), predominantly last year and graduated medical students, were included in the study (86% female subjects). The mean sleep-time of FHWs before, while working, and during the isolation period after working at COVID-19 field hospitals were: 7.78 ± 1.48, 5.71 ± 1.40, and 8.78 ± 2.31 h per day, respectively. Burnout was not a crucial issue for these volunteer subjects. The mean scores of Pichot's Fatigue Scale and Pichot's Depression Scale, measured after 4 weeks working at field hospitals, were 4.18 ± 5.42 and 2.54 ± 3.36, respectively. Thirteen participants were suspected of depression. The fatigue scores decreased significantly in the group who claimed short sleep latency. The factor that increased the depression score was "anxious feeling" (p = 0.001). Other significant factors were "short sleep latency," "observed sleep apnea," "tiredness, daily sleepiness" and "snoring." Conclusion: Appropriate work schedule, better sleep conditions, and mental health support could be helpful for FHWs. The mandatory 2 weeks of isolation after working in field hospitals provided opportunity for FHWs' recovery.

Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin.

PURPOSE: Stigma is a major burden of epilepsy. In sub-Saharan Africa the few studies that addressed epilepsy stigma emphasize enacted, rather than perceived, stigma. This inattention may compromise clinical management and delay help seeking, thereby contributing to the treatment gap. We assessed perceived stigma and identified sociocultural and psychological factors explaining greater stigma among people with epilepsy (PWE) in Benin. METHODS: PWE included in this study were ascertained using a door-to-door survey in the general population in a Beninese rural area. We applied both qualitative and quantitative research methods to assess stigma and patient's experience and beliefs. An Explanatory Model Interview Catalogue (EMIC) and verbally administered questionnaires provided data for demographic, clinical, and sociocultural features. Sociocultural features were evaluated in terms of illness-related experience and sociocultural representations of epilepsy. Depression and anxiety were also screened. RESULTS: Eighty PWE were included. About 68.7% reported feeling stigmatized. Multivariate regression revealed that factors independently associated with perceived stigma were experience of social isolation (p < 0.001), experience of marital problems (p < 0.01), and presence of anxiety disorder (p < 0.01). DISCUSSION: Perceived stigma is an important issue in epilepsy in Benin. Social factors seem to be more influential than sociocultural representation of epilepsy. Insofar as research is needed in other African countries to determine the nature and relevant features of stigma to improve treatment and control.

Knowledge of epilepsy in the general population based on two French cities: implications for stigma.

The objective of this study was to assess the knowledge and attitudes of people living in two French counties. The data were collected from 1777 adults in the general population who were interviewed. Knowledge of and attitudes toward epilepsy in these French samples proved largely favorable: 90.6% identified epilepsy as different from a mental disorder or lunacy, and 79.2% correctly identified epilepsy as a brain disorder. The majority agreed with the statements that people with epilepsy should have the opportunity to get married and that children with epilepsy should be allowed to go to school with others. However, gaps in knowledge and erroneous beliefs prevailed, notably among men, old people, and individuals with low levels of education. This study yielded encouraging results. However, further studies are needed to confirm these findings and gain a better understanding of the contribution of French public knowledge to the causative factors generating stigma in France.

Natural history and mortality of chronic epilepsy in an untreated population of rural Bolivia: a follow-up after 10 years.

PURPOSE: To evaluate the natural history and mortality of chronic epilepsy in an untreated prevalence cohort of people with epilepsy (PWE) in a rural area of Bolivia. METHODS: During 1994-1996 we carried out an epidemiologic survey in a sample of 9,995 subjects in the Cordillera province. At the end of the survey we identified 130 PWE, of whom 118 were classified as having "active epilepsy." We revisited this cohort 10 years after the prevalence survey. RESULTS: We were able to trace 103 (87.3%) of the 118 PWE previously identified. Ten of the 103 subjects died during the follow-up period. Of the 93 PWE still alive, adequate information on the occurrence of seizures was available for 71 subjects, of whom 31 (43.7%) were seizure-free for more than 5 years; only 3 of these 31 subjects have taken an antiepileptic drug (AED) for more than 1 year. Generalized seizures were associated with a better prognosis. Mortality rate in our prevalent cohort was 10.0/1,000 person-year at risk [95% confidence interval (CI) 5.5-18.3], without a significant increased risk respect to the general population [standardized mortality rate (SMR) 1.34; 95% CI 0.68-2.39]; a significant increased risk of death was found for patients with remote symptomatic epilepsy (SMR 3.0; 95% CI 1.2-6.3) but not with idiopathic epilepsy. Three of the 10 subjects died of causes possibly related to epilepsy. DISCUSSION: Our data suggest that spontaneous remission of epilepsy occurs in a substantial proportion of untreated patients affected by chronic epilepsy; concerning mortality, we found a 3-fold increased mortality in patients with remote symptomatic epilepsy.

Improving tuberculosis case detection rate with a lay informant questionnaire: an experience from the Lao People's Democratic Republic.

PROBLEM: In many countries, the tuberculosis (TB) annual case detection rate is below the target of 70%. In the Lao People's Democratic Republic in 2005, it did not exceed 55% APPROACH: The DOTS strategy promotes passive case detection of TB. In order to increase the detection rate, we validated a questionnaire targeting lay informants at village level to notify patients with chronic cough and assessed the relevance for TB case-finding. A three-item questionnaire was sent through the district health departments to all villages in six districts in six provinces. The village headmen were asked to notify chronic cough patients. Answers were validated in a door-to-door survey (20 villages/district). In a sub-sample (four villages/district) all confirmed patients were screened for TB and paragonimiasis. LOCAL SETTING: Attapeu, Luang Namtha, Luang Prabang, Saravane, Savanakhet and Vientiane provinces in the Lao People's Democratic Republic. RELEVANT CHANGES: Lay informant questionnaires sent from district health offices to villages are cost-effective and foster interaction between the health services and remote and underserved communities. Although the correct detection of patients is highly dependent on direct respondents, a substantial number of new TB and paragonimiasis cases were consistently diagnosed in chronic cough patients. LESSONS LEARNED: Out of 456 questionnaires, 295 were returned (65%). Return rates were highly variable between districts (48-87%), questionnaires' sensitivity (56-98%), positive predictive value (34-88%) and correlation between number of notified and confirmed patients (r: 0.26-0.78). In sub-sampled villages (13,541 population) 19 (5.1%) TB and 26 (7.0%) paragonimiasis cases were detected in 374 chronic cough patients. This quick questionnaire approach proved motivating for district authorities and village key informants, although no incentives were provided. The highly operator-dependent approach yielded a consistent detection rate of TB and paragonimiasis cases. This approach brings health services and populations in need in close contact, which is particularly crucial in remote and underserved areas.

Risk factors for epilepsy in rural Lao PDR: a case-control study.

The objective of this study was to assess the major etiologic categories of epilepsy in a rural district of the Lao PDR. Thirty-one newly identified patients with confirmed active epilepsy were compared with 124 controls, matched for gender, age and village residence. Risk factors for epilepsy were investigated with particular focus on cysticercosis serology. A history of head trauma (OR=4.7, p=0.05), family history of epilepsy (OR=12.8, p=0.03), and the use of human feces to fertilize domestic vegetable gardens (OR=4.9, p=0.04) were significantly associated with epilepsy. The study did not confirm any direct relation between epilepsy and cysticercosis serology. The cysticercosis seroprevalence was nil in the epilepsy group. This is the first study in the Lao PDR on epilepsy risk factors representing important data for the subregion. Parasitic, environmental, and behavioral factors of this traditional population deserve further studies to explain the missing link between epilepsy and cysticercosis.

Epidemiology, aetiology, and clinical management of epilepsy in Asia: a systematic review.

Epilepsy is a significant, but often underappreciated, health problem in Asia. Here, we systematically review the literature on epidemiology, aetiology, and management of epilepsy in 23 Asian countries. Prevalence estimates are available for only 11 countries from door-to-door surveys and are generally low. Figures for annual incidence in China and India are similar to those in the USA and Europe but lower than those reported from Africa and Latin America. There is a peak in incidence and prevalence in childhood, but a second peak in elderly people, as seen in developed countries, has not been documented. The main causes are head injuries, cerebrovascular disease, CNS infections, and birth trauma. Availability of epilepsy care depends largely on economic factors. Imaging and neurophysiological facilities are available in most countries, but often only in urban centres. Costly drugs, a large treatment gap, limited epilepsy surgery, and negative public attitude to epilepsy are other notable features of management in Asia. An understanding of the psychosocial, cultural, economic, organisational, and political factors influencing epilepsy causation, management, and outcome should be of high priority for future investigations.

Epilepsy in Laos: knowledge, attitudes, and practices in the community.

OBJECTIVE: We evaluated beliefs about, attitudes toward, and stigma associated with epilepsy in four districts of central Laos. METHOD: For this study, 83 people with epilepsy, 83 family members, and 166 matched villagers in Vientiane Province were interviewed. RESULTS: From patients to families to villagers, there existed a significantly increasing gradient of misbeliefs. Dubbed locally as "mad pig disease," epilepsy was viewed as having a supernatural origin by 25-42% of respondents, a life-threatening disease by 60%, a disease transmissible by consumption of pork meat by 10-21%, and a disease transmissible by contact with patients' saliva by 14.5% of patients and 44% of villagers (P<0.01). Stigma was high. People thought that they should avoid contact or sharing meals with patients (15% of patients, 62% of family members, P<0.001), and that persons with epilepsy should not get a job, get married (29 and 42%, P<0.016), or raise children (33-42%). CONCLUSION: Wrong beliefs may lead to stigma and hamper access to or compliance with modern epilepsy treatment. In traditional countries, education is the cornerstone of epilepsy management.

Prevalence of epilepsy in a rural district of central Lao PDR.

PURPOSE: To assess the prevalence of epilepsy in a rural district of Lao PDR and to describe the clinical and epidemiological profile of the disease. METHODS: Door-to-door screening was performed on the entire population of 8 randomly selected villages in the Hinheub district, using an internationally validated and standardized questionnaire. Additional passive case detection was performed through village key informants. Suspected epilepsy patients identified by the questionnaire were revisited and examined by an experienced neurologist on two follow-up visits. The confirmation of epilepsy was based only on an in-depth clinical examination. Electroencephalograms were performed at the district health care center. RESULTS: In the 8 villages, 277 suspected cases of epilepsy were identified among 4,310 interviewed subjects; 194 of whom (70%) underwent a clinical examination by a neurologist during the first visit while 65 of 83 remaining suspected cases were seen on the second confirmation visit. Twenty-seven persons with epilepsy were identified. Six additional patients were diagnosed in 219 self-referred subjects. An overall prevalence of 7.7 cases of epilepsy per thousand inhabitants was calculated (95% CI 5.3-10.7). Generalized epilepsy (21 cases, 63.6%) was commoner than partial epilepsy (9 cases, 27.3%). The remaining 3 cases (9.1%) were not-classifiable as either generalized or partial. EEG abnormal findings were found in 12 of the 24 patients (50.0%) who had an EEG registration. CONCLUSIONS: This is the first study in Lao PDR to estimate the prevalence of epilepsy. Compared to Western countries it shows a pattern towards a higher prevalence.