Construction and verification of the prediction model for risk of sleep disturbance in elderly patients with hypertension: a cross-sectional survey based on NHANES database from 2005 to 2018.

OBJECTIVE: To construct and verify a risk prediction model for sleep disturbance in elderly patients with hypertension, aiming to offer guidance for sleep management in this demographic. METHODS: A cohort of 6,708 elderly hypertensive patients from the NHANES database, spanning 2005 to 2018, met the inclusion criteria and were selected for this study. Participants were randomly assigned to a development group (n = 4,696) and a verification group (n = 2,012) in a 7:3 ratio. The occurrence of sleep disturbance was assessed across the subjects. Independent risk factors for sleep disturbance were analyzed using weighted multivariate logistic regression within the development group. A predictive model for sleep disturbance risk in elderly hypertensive patients was developed and verified using Stata 17.0. The model's predictive accuracy and stability were evaluated using the verification group's data. RESULTS: Of the 6,708 subjects, 2,014 (30.02%) were identified with sleep disturbance, and the weighted prevalence of sleep disturbance among elderly hypertensive patients was 33.283%. Weighted multivariate logistic regression analysis in the development group revealed that six factors were independently associated with sleep disturbance: higher total depression scores, higher education level, asthma, overweight, arthritis, and work restriction (OR > 1 and P < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the nomogram prediction model was 0.709 in the development group and 0.707 in the verification group, indicating good discrimination ability. Brier scores for the nomogram model were 0.185 in the development group and 0.189 in the verification group, both below 0.25, suggesting good calibration. Decision Curve Analysis (DCA) determined that the nomogram's clinical net benefit was maximized when the threshold probability for sleep disturbance in elderly hypertensive patients was 0.13-0.67 in the development group and 0.14-0.61 in the verification group, highlighting the model's clinical utility. LIMITATIONS: This study is not without its limitations, including issues with data collection, the absence of external validation, and the non-extrapolation of results. CONCLUSION: The prevalence of sleep disturbance among elderly hypertensive patients stands at 33.283%. The nomogram model, based on identified risk factors for sleep disturbance in this population, has demonstrated good predictive efficiency and clinical relevance. It serves as a valuable tool to assist healthcare providers in identifying elderly hypertensive patients at high risk for sleep disturbance.

Psychological factors and biochemical indicators influencing sleep disturbance of patients with primary biliary cholangitis in China: a cross-sectional survey analysis.

Objective: The impact of primary biliary cholangitis (PBC) on sleep disturbance is relevant to treatment decision-making processes. Studies on sleep disturbance in Chinese patients with PBC are still lacking. Methods: We analyzed and compared the health-related quality of life (HRQoL) of 107 PBC patients by using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire 9 (PHQ-9), Short Form (36) Health Survey Questionnaire (SF-36), Fatigue Visual Analog Scale (F-VAS). Patients' biochemical markers were also collected for correlation analysis with HRQoL. Receiver operating characteristic (ROC) curves and area under the curve (AUCs) were used to determine the diagnostic performance of PSQI, GAD-7, and biochemical markers for assessing the impaired liver function (Child-Pugh B-C) of PBC diagnosis. Results: Sixty-two (57.9%) PBC patients suffered from poor sleep quality (PSQI >5). The global PSQI score was positively correlated with GAD-7 (r = 0.561, p < 0.001), and PHQ-9 scores (r = 0.652, p < 0.001). There was a negative correlation (r = -0.216, p = 0.025) between sleep quality and red blood cell (RBC) count. PBC patients with poor sleep quality had significantly higher GAD-7 scores (5 vs. 0, p < 0.001), PHQ-9 scores (5.5 vs. 0, p < 0.001), and lower albumin levels (39.6 vs. 37.6 g/L, p = 0.040) than those with good sleep quality. Based on the SF-36 scores, PBC patients with poor sleep quality had lower physical functioning scores (85 vs. 80, p = 0.022), role physical scores (100 vs. 75, p = 0.007), and worse mental health (60 vs. 56, p = 0.002) than those with good sleep quality. ROC analyses showed that the AUC and optimal cut-off values of the combination of PSQI, GAD-7, and RBC for assessing the impaired liver function in PBC diagnosis were 0.771 and 0.193, respectively. Conclusion: The sleep disturbance was strongly correlated with the severity of anxiety, depression, and RBC count in PBC patients. Meanwhile, PBC patients with poor sleep had poor HRQoL and lower albumin levels. It is feasible to use the combination of PSQI, GAD-7, and RBC for initial screening of the impaired liver function in PBC. Besides routine blood biochemical and imaging indicators, evaluating mental health-related indicators in PBC patients is imperative.

Relationship between Polygenic Risk Score and the Hypnotics in Bipolar I Disorder.

Objective: Bipolar disorder (BD) is marked by significant change in mood and energy levels with sleep disturbance a common feature, resulting in diminished quality of life and impaired daily functioning. This study assessed the association between BD-polygenic risk scores (PRS) and hypnotics in bipolar I disorder (BD-I) patients. Methods: Large-sample data were collected from the genome-wide association study of a multicenter Bipolar Genomic Study, and 1,394 BD-I patients with available medication information were divided into two groups depending on whether they used hypnotics or not. The Diagnostic Interview for Genetic Studies (DIGS) score was used to assess the clinical manifestations and function of the participants and the association between the use of hypnotics and genetic risk was analyzed. Results: Of the 1,394 total participants, 556 (40%) patients received hypnotics, mostly benzodiazepines, administered singly or in combination with other sleeping agents such as, Z-drugs, melatonin-related drugs, and trazodone. The DIGS score was significantly higher for negative categories in the group prescribed hypnotics as was the BD-PRS score, according to the four p value thresholds (p = 0.3, 0.2, 0.1, and 0.05). Logistic regression analysis confirmed a statistically significant association between the BD-PRS and hypnotic use. Conclusion: Our results suggest an association between hypnotic use and genetic susceptibility to BD. Sleep disturbances in participants were based on the prescription status of hypnotics supporting the hypothesis that sleep disturbances may be associated with genetic aspects of BD-I. Further genetic studies on genetic overlaps between BD and specific phenotypes or medication responses are required.

Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms.

ABSTRACTBackground: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD.Objective: We tested trauma type (interpersonal violence [e.g. assault] vs non-interpersonal trauma [e.g. motor vehicle collision]) as a risk factor for TRNs in a predominantly low-income, Black, urban sample in Detroit, MI, USA.Method: We recruited patients from the intensive care unit following traumatic injury (N = 88; Mage = 39.53 ± SD 14.31 years, 67.0% male, 67.0% Black, 47.7% annual income ≤ $20,000) and administered surveys at three post trauma timepoints: one week (T1), one month (T2; n = 61), and two months (T3; n = 59). Trauma type was assessed at T1 via electronic medical records. Participants reported the extent to which their dreams' content was similar to the trauma for which they were hospitalized across T1-T3. Participants then completed the PTSD Checklist for DSM-5 at T3.Results: TRNs were more prevalent over time among patients exposed to interpersonal violence (80%) vs non-interpersonal trauma (48.7%, p = .005). Patients hospitalized for interpersonal violence faced greater odds for TRNs across timepoints relative to non-interpersonal trauma patients (Odds Ratio = 4.95, p = .021). TRNs, in turn, prospectively predicted PTSD symptoms such that TRNs at T2 presaged more severe PTSD at T3 (p = .040, ηp2 = .31), above and beyond T1 PTSD status.Conclusions: This prospective study provides first evidence that interpersonal violence exposure is a robust risk factor for TRNs, which prospectively contribute to PTSD symptom development. Early intervention on TRNs after interpersonal violence exposure may decrease PTSD risk. Future studies are encouraged to use ambulatory methods to capture nightmares sooner after they occur.

Interpersonal violence exposure is a risk factor for trauma-related nightmaresTrauma-related nightmares predict PTSD symptoms, above and beyond baseline PTSDTreating nightmares early after interpersonal violence may decrease PTSD risk.

Prevalence and assessment of sleep-disordered breathing in head and neck cancer patients: a systematic review.

STUDY OBJECTIVES: Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population. METHODS: A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects. RESULTS: The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent. CONCLUSIONS: There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required.

Potential Role of Sleep Disturbance in the Development of Early Puberty: Past Clinical Evidence for Future Management.

The incidence of early puberty in children has been increasing. It has been suspected that both genetic and various environmental factors such as nutrition and hormonal exposure could influence the mechanisms underlying the earlier onset of puberty. Interestingly, several previous studies have reported a strong connection between sleep and puberty. Specifically, it was discovered that luteinizing hormone (LH), a potential marker for the onset of puberty, was increased during the deep sleep period. Furthermore, a high prevalence of early puberty was observed in patients with sleep disorders, especially in those experiencing narcolepsy. In this review article, findings related to the association between sleep disturbance and early puberty have been comprehensively summarized. Any contrary findings are also included and discussed. Advances in the knowledge surrounding sleep disturbance have led to a greater understanding of a correlation between early puberty and sleep disorder and provide alternative therapeutic options for the treatment of central precocious puberty in the future.

Positive impact of sunlight exposure on mental health in a naval population.

Naval shipboard operations impose numerous environmental and occupational stressors, which can adversely affect mental and physical health outcomes. Moreover, this operational setting also complicates the implementation of countermeasures to protect personnel from these stressors. Thus, any easily accessible or modifiable protective factors should be explored further for their potential to support the health of military personnel. Daily sunlight exposure is one such factor that has demonstrated positive effects on health outcomes. For the current study, sunlight exposure and self-reported health outcomes were explored in a large population of U.S. Navy personnel (N > 11,000). Mediator analyses examined the relationship between mental and physical health while controlling for key confounding variables such as morale and exercise. Although the overall regression models indicated only a slight impact on physical health, sunlight exposure had a significant direct effect on mental health even while controlling for the mediating influence of morale. Sunlight exposure also had an impact on morale and an indirect influence on mental health through morale. Additional analyses further supported the possible mental health benefits of sunlight exposure even while accounting for occupational differences. The results suggest that prescribed sunlight exposure aboard ships could be used to promote positive mental health during naval operations.

Health impact of environmental and industrial noise - a narrative review.

Industrial noise sources are among the environmental noise sources that are ranked second among the causes of ill health in Europe by the World Health Organization. The aim of this paper is to summarize and review of published information focusing on noise annoyance from industrial activities and mining. A search for articles was performed using the bibliographic databases platforms. The epidemiological evidence shows that environmental noise may be associated with cardiovascular and metabolic diseases, impaired cognitive development in children, mental health, post-irritability, and sleep disturbances. As a result of efforts to minimize the effects of industrial noise on human health, the New South Wales Environment Protection Authority published A Guide to the Noise Policy for Industry in 2017, which sets out recommended noise levels, methods, and procedures for noise management based on the latest scientific evidence. Social networks can be used to assess the population's noise annoyance and to verify the effectiveness of the measures. The industrial noise sources are typically defined by low-frequency noise. Low-frequency noise has very low attenuation and is only slightly affected by obstacles, therefore it can be a major cause of night noise annoyance. An association was confirmed between exposure to low-frequency noise and sleep disturbance, psychological problems, cognitive impairment, increased social conflicts, anxiety, emotional instability, nervousness, and reduced mental performance - concentration, and visual perception. In view of the long tradition of mining and industry, the assessment of noise from these activities from the perspective of its impacts on human health is an inherent part of legislative processes. Med Pr Work Health Saf. 2024;75(5).

Prenatal exposure to hypoxic risk conditions in autistic and neurotypical youth: Associated ventricular differences, sleep disturbance, and sensory processing.

There is a growing body of research that suggests conditions during the period of pregnancy and birth can affect how autism spectrum disorder (ASD) presents itself. This study aimed to investigate the incidence of oxygen deprivation during this period known as prenatal and perinatal hypoxic risk (HR) conditions in ASD compared with neurotypical control (NTC) youth. We also examined ventricular morphology variations associated with HR exposure, and to evaluate associations with clinical symptoms. Results from a cohort of 104 youth revealed a higher incidence of exposure to prenatal hypoxic conditions in the ASD group. Additionally, ASD individuals with prenatal hypoxic exposure (ASD + HR) demonstrated larger third ventricle volumes compared with both ASD and NTC individuals without such exposure (ASD-HR and NTC-HR, respectively). Furthermore, associations were identified between prenatal hypoxic exposure, third ventricle volume, sensory dysfunction, and severity of sleep disturbances. These findings suggest exposure to prenatal hypoxic risk conditions may exacerbate or modify the neurodevelopmental trajectory and symptom severity in ASD, emphasizing the need for better prenatal care and specific interventions to reduce these risks.

Effects of Sleep Deficiency on Risk, Course, and Treatment of Psychopathology.

This article reviews the literature on the relationship between sleep deficiency and unipolar and bipolar depression, anxiety disorders, and posttraumatic stress disorder. We consider the evidence for sleep as a contributory causal factor in the development of psychiatric disorders, as well as sleep as an influential factor related to the outcome and recurrence of psychopathology. A case for sleep deficiency being an important treatment target when sleep and psychiatric disorders are comorbid is also made. Our recommendation is that sleep deficiency is recognized as a means to positively impact the development and course of psychopathology and, as such, is routinely assessed and treated in clinical practice.

The Relationship Between Poor Sleep and Memory Impairment Among Shift Nurses in China: A Cross-Sectional Study.

Purpose: Many shift nurses experience poor sleep quality, and the effect on nurses' cognitive function remains unclear. The study aims to investigate sleep status and explore its association with cognitive function. Methods: This descriptive cross-sectional study was conducted in a tertiary care hospital in Fujian, China between March and September 2022. By convenience sampling method, 588 shift nurses participated in this study. The Pittsburgh Sleep Quality Index (PSQI) and Bergen Shift Work Sleep Questionnaire (BSWSQ) were used to assess sleep quality, while the Chinese version of Ascertain Dementia-8 (AD-8) was used to evaluate cognitive function. A PSQI score ≤7 is classified as good sleep quality, and a score >7 indicates poor sleep quality. An AD-8 score≥ 2 is considered indicative of memory impairment. Multivariate logistic regression analysis was conducted to explore the association between sleep status and memory impairment. Results: A total of 310 (52.6%) participants presented poor sleep quality. Among them, 52.2% of participants had day shift-related sleep problems, 45.9% had evening shift-related sleep problems, 61.9% had night shift-related sleep problems, and 15.0% reported rest-day/vacation-related sleep problems. The prevalence of poor sleep quality and each shift-related sleep problem in the memory impairment group were higher than in the normal memory group (P<0.05). Multivariate logistic regression analysis indicated that poor sleep quality (OR=2.073, 95% CI: 1.398~3.072), evening shift-related sleep problems (OR=1.707, 95% CI: 1.028~2.835), night shift-related sleep problems (OR=1.859, 95% CI:1.104~3.129), and rest-day/vacation-related sleep problems (OR=2.069, 95% CI:1.170~3.659) was significantly associated with memory impairment. Conclusion: This study highlights the prevalence of poor sleep quality among clinical nurses and identifies poor sleep quality and shift-related sleep problems (excluding day shift) as risk factors for memory impairment. Nurse managers should prioritize sleep quality and focus on cognitive function to enhance nurses' occupational health.

Biologics and oral systemic treatment preferences in patients and physicians for moderate-to-severe atopic dermatitis: a discrete choice experiment in the United Kingdom and Germany.

Background: As the available treatments for moderate-to-severe atopic dermatitis (AD) expand, understanding patient and physician preferences becomes crucial for informed decision-making.Objective: To quantify patient and physician preferences for biologics and oral systemic AD treatment attributes.Materials and methods: We conducted a cross-sectional, online discrete choice experiment (DCE) involving 306 AD patients and 206 physicians throughout the United Kingdom and Germany. Qualitative interviews identified the key attributes for inclusion in the DCE. Each choice task comprised two hypothetical patient profiles. Data were analyzed using a random-parameters logit model.Results: Results indicated a significant emphasis on efficacy, with reducing sleep disturbance and itch ranking first and second among patients, and the reverse for physicians. Time to itch relief was the third most important efficacy attribute for both groups, but relatively more important for patients than for physicians. For both groups, the risk of eye problems was the most important safety concern of those included. Mode of administration was not of great importance compared to efficacy and safety attributes.Conclusions: Our findings suggest patients prioritize sleep disturbance, an attribute not captured in prior preference studies in AD, time to itch relief and itch. These findings emphasize the importance of addressing sleep-related issues, whilst also targeting fast itch control, to enhance patients' well-being.

Efficacy And Safety of Dual Orexin Receptor Antagonist (DORA) For Sleep Disturbance in Patients With Alzheimer's Disease Dementia. A Review Article.

INTRODUCTION: The rising prevalence of Alzheimer's disease (AD) and related dementia worldwide underscores the urgent need for effective interventions, particularly for managing neuropsychiatric symptoms (NPS) such as sleep disturbance. This review explores the emerging role of Dual Orexin Receptor Antagonists (DORA) in addressing sleep disturbance in patients with Alzheimer's disease dementia. METHODS: A comprehensive literature search identified four relevant publications between 2014 and 2024, detailing the use of DORA medications, including suvorexant and lemborexant, in patients with Alzheimer's disease. RESULTS: Findings suggest that suvorexant may improve total sleep time (TST), wakefulness after sleep onset (WASO), and sleep efficiency (SE) in Alzheimer's patients with insomnia. Lemborexant demonstrated potential in improving circadian rhythm parameters, particularly in patients with irregular sleep-wake rhythm disorder (ISWRD). Safety profiles of DORA medications appeared favorable, with mild to moderate adverse events reported. However, concerns over potential adverse events, such as falls, underscore the need for careful monitoring. CONCLUSION: While the evidence suggests promise for DORA medications in addressing sleep disturbance in Alzheimer's disease, limitations in study populations and duration highlight the need for further investigation. Future clinical trials should aim for broader inclusion criteria, encompassing diverse dementia subtypes and severity levels, to enhance generalizability. Additionally, longer-term trials are essential to assess the sustained efficacy and safety of DORA interventions in this vulnerable population.

Cardiometabolic Morbidity (Obesity and Hypertension) in PTSD: A Preliminary Investigation of the Validity of Two Structures of the Impact of Event Scale-Revised.

Background: Posttraumatic stress disorder (PTSD) and/or specific PTSD symptoms may evoke maladaptive behaviors (e.g., compulsive buying, disordered eating, and an unhealthy lifestyle), resulting in adverse cardiometabolic events (e.g., hypertension and obesity), which may implicate the treatment of this complex condition. The diagnostic criteria for PTSD have lately expanded beyond the three common symptoms (intrusion, avoidance, and hyperarousal). Including additional symptoms such as emotional numbing, sleep disturbance, and irritability strengthens the representation of the Impact of Event Scale-Revised (IES-R), suggesting that models with four, five, or six dimensions better capture its structure compared to the original three-dimensional model. Methods: Using a convenience sample of 58 Russian dental healthcare workers (HCWs: mean age = 44.1 ± 12.2 years, 82.8% females), this instrumental study examined the convergent, concurrent, and criterion validity of two IES-R structures: IES-R3 and IES-R6. Results: Exploratory factor analysis uncovered five factors, which explained 76.0% of the variance in the IES-R. Subscales of the IES-R3 and the IES-R6 expressed good internal consistency (coefficient alpha range = 0.69-0.88), high convergent validity (item total correlations r range = 0.39-0.81, and correlations with the IES-R's total score r range = 0.62-0.92), excellent concurrent validity through strong correlations with the PTSD Symptom Scale-Self Report (PSS-SR: r range = 0.42-0.69), while their criterion validity was indicated by moderate-to-low correlations with high body mass index (BMI: r range = 0.12-0.39) and the diagnosis of hypertension (r range = 0.12-0.30). In the receiver-operating characteristic (ROC) curve analysis, all IES-R models were perfectly associated with the PSS-SR (all areas under the curve (AUCs) > 0.9, p values < 0.001). The IES-R, both hyperarousal subscales, and the IES-R3 intrusion subscale were significantly associated with high BMI. Both avoidance subscales and the IES-R3 intrusion subscale, not the IES-R, were significantly associated with hypertension. In the two-step cluster analysis, five sets of all trauma variables (IES-R3/IES-R6, PSS-SR) classified the participants into two clusters according to their BMI (normal weight/low BMI vs. overweight/obese). Meanwhile, only the IES-R, PSS-SR, and IES-R3 dimensions successfully classified participants as having either normal blood pressure or hypertension. Participants in the overweight/obese and hypertensive clusters displayed considerably higher levels of most trauma symptoms. Input variables with the highest predictor importance in the cluster analysis were those variables expressing significant associations in correlations and ROC analyses. However, neither IES-R3 nor IES-R6 contributed to BMI or hypertension either directly or indirectly in the path analysis. Meanwhile, age significantly predicted both health conditions and current smoking. Irritability and numbing were the only IES-R dimensions that significantly contributed to current smoking. Conclusions: The findings emphasize the need for assessing the way through which various PTSD symptoms may implicate cardiometabolic dysfunctions and their risk factors (e.g., smoking and the intake of unhealthy foods) as well as the application of targeted dietary and exercise interventions to lower physical morbidity in PTSD patients. However, the internal and external validity of our tests may be questionable due to the low power of our sample size. Replicating the study in larger samples, which comprise different physical and mental conditions from heterogenous cultural contexts, is pivotal to validate the results (e.g., in specific groups, such as those with confirmed traumatic exposure and comorbid mood dysfunction).

Sleep disturbance in patients with cirrhosis and transjugular intrahepatic portosystemic shunt.

BACKGROUND: Sleep disturbance (SD) is a common occurrence in individuals with cirrhosis and significantly impacts their quality of life. Datas regarding post transjugular intrahepatic portosystemic shunt (TIPS) SD are scarce. This study aimed to explore the incidence and outcomes of post-TIPS SD. METHODS: From August 2018 to November 2019, 73 patients who underwent TIPS were prospectively recruited for the study. Sleep quality was evaluated via the Pittsburgh Sleep Quality Index (PSQI), and the presence of hepatic encephalopathy was evaluated according to the West Haven criteria before and after the TIPS procedure. RESULTS: Nineteen patients (26%) experienced new-onset SD after TIPS, with a median latency of 67 (40-98) days from the procedure. The median time from TIPS creation to occurrence was 67 (40-98) days. Minimal hepatic encephalopathy (MHE) post-TIPS emerged as an independent predictor of SD, with an odds ratio of 3 (95% CI: 1.04-8.78, P = 0.046). Notably, five of the six (83%) patients with SD experienced improvement after being administered eszopiclone. Ten of the thirteen (77%) patients with SD improved spontaneously without treatment. Furthermore, the prevalence of MHE was significantly greater among patients with SD than among those without SD (58% vs. 31%, P = 0.04). CONCLUSIONS: SD is prevalent in patients who undergo TIPS. MHE is an independent risk factor for the development of SD post-TIPS. Eszopiclone may be a safe and effective treatment option for patients with SD after TIPS. The study was registered with ClinicalTrials.gov under the identifier NCT03685994, with a registration date of September 23, 2018.

Prevalence of sleep disturbances in endometriosis patients: a systematic review and meta-analysis.

Objective: This study systematically analyzes the prevalence of sleep disturbance in patients with endometriosis. Methods: The PubMed, Web of Science, Embase, Wanfang, China National Knowledge Internet Database (CNKI), China Science and Technology Journal Database were searched from their establishment to January 2024, using the search terms endometriosis and sleep disturbance to collect relevant literature on the prevalence of sleep disturbance in patients with endometriosis. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias. The prevalence of sleep disorders in patients with endometriosis was systematically analyzed using Stata17.0 software. Results: Sixteen studies with 2573 participants were included. The prevalence of sleep disturbance in patients with endometriosis was 70.8% (95% confidence interval: 60.7%~80.9%). The said prevalence was higher in China than in Iran and the European countries (78.2 vs. 57.6 vs. 64.4, Q=9.27, P=0.010) and increased significantly since 2018 (79.0 vs. 61.3, Q=3.97, P=0.046). This prevalence was significantly higher in the cohort study than that in cross-sectional and case-control studies (84.0 vs. 74.0 vs. 59.5, Q=7.16, P=0.028). Conclusion: The prevalence of sleep disturbance is high in patients with endometriosis, particularly in China and its prevalence has increased significantly in recent years. Appropriate interventions are recommended to effectively prevent or minimize sleep disturbances in patients with endometriosis.

Effect of General Anesthesia vs Regional Anesthesia on Sleep Disturbance in Elderly Patients After Discharge from the Hospital for 3 Months.

Purpose: This study aims to investigate the impact of anesthetic methods on the occurrence of postoperative sleep disorders in elderly patients following their discharge from the hospital for 3 months. Patients and Methods: This retrospective observational cohort study included elderly patients aged >60 years who had undergone general and regional anesthesia from 1 June 2023 to 31 December 2023. These patients were then assessed for sleep by telephone callback using the Athens Insomnia Scale after discharge from the hospital three months later. The duration of pain and sleep disturbance experienced by patients following discharge was also recorded. Results: Following propensity score matching, 308 individuals were included in the study (154 in the GA group and 154 in the RA group). Compared with general anesthesia (11.7%), regional anesthesia (5.2%) reduced the prevalence of sleep disorders in elderly patients after discharge from the hospital. However, the duration of sleep disturbance and pain exhibited no statistically significant difference between the two groups (p=0.818; p=0.211). Conclusion: Regional anesthesia was associated with a reduction in the incidence of sleep disorders in elderly patients after discharge from the hospital for 3 months.

Clinical characterization of children and adolescents with ADHD and sleep disturbances.

Sleep disturbances (SD) are commonly reported concerns among parents and caregivers of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). While it is widely acknowledged that SD can worsen various aspects of children and adolescents' well-being (e.g., academic performance and emotional/behavioral state), a comprehensive clinical characterization of ADHD and SD is currently lacking. To address this gap, 136 children and adolescents diagnosed with ADHD (aged 6 to 14 years) were retrospectively selected by reviewing electronic health records of hundreds of patients with neuropsychiatric disorders referred to the children's hospital. Participants were divided into two groups based on the presence of SD, assessed via a parent-report questionnaire (94 ADHD without SD and 42 ADHD with SD). Standardized measures of adaptive behavior, academic performance, ADHD-related and emotional/behavioral symptoms were collected. Results documented that the group of ADHD with SD obtained worse scores in specific aspects of adaptive behavior (conceptual and practical domains), academic performance (text comprehension, writing), ADHD symptoms (inattention) and emotional/behavioral difficulties (especially, mood/emotional regulation and stress) compared to those with ADHD without SD. In addition, our results established a relationship between sleep problems and diverse clinical aspects of children and adolescents with ADHD, while controlling for age, cognitive level, gender, ADHD symptoms severity, and Body Mass Index. From a clinical perspective, our study suggests that the presence of SD in patients with ADHD may serve as an indicator for strengths and weaknesses in this population, even demonstrating an independent relationship with specific clinical dimensions. Implications to improve clinical diagnostic and therapeutic interventions are discussed.

The Attitudes, Beliefs and Perspectives of Registered Nurses on Sleep Health Management in Residential Aged Care Facilities: A Qualitative Study.

AIM: To explore the attitudes, beliefs and perspectives of registered nurses (RNs) regarding sleep health and sleep health management of residents living in aged care settings in Australia. DESIGN: Qualitative inductive thematic analysis of semi-structured interviews. METHODS: Semi-structured interviews were conducted with RNs working in residential aged care facilities using a topic guide between August 2021 and April 2022. Participants were recruited using a convenience-based and snowball sampling approach. Interviews were audio-recorded, transcribed verbatim and inductively analysed for emergent themes. RESULTS: Eighteen interviews were conducted with RNs working in aged care. Thematic analysis of the data derived three main themes: (i) Awareness and observations of sleep health, (ii) assessment and management of sleep disturbances and (iii) barriers to implementing evidence-based sleep health management. It was found that the most common barrier to providing evidence-based sleep health practices was related to workplace constraints. Participants detailed the limitations of the RN's professional role and ability to work autonomously in sleep health practices. CONCLUSION: Despite the intentions of RNs to implement evidence-based non-pharmacological strategies for sleep health management, pharmacological interventions prevail. Systemic efforts to address organisational constraints in aged care may improve sleep disturbance management and assist with shifting the current attitudes around sleep health in aged care facilities. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study highlights that current sleep health management of residents in residential aged care is inadequate. Upskilling nurses in sleep health care techniques and improving organisational commitment to such care provision are issues urgently required to enhance the sleep health of residents. IMPACT: Current sleep health practices are not evidence-based in residential aged care. Optimising sleep practices in residential aged care that are person-centred is likely to improve quality of life and healthy ageing. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Insomnia as a predictor of treatment outcomes in adolescents receiving concentrated exposure treatment for OCD.

BACKGROUND: Research suggests that individuals with obsessive-compulsive disorder (OCD) frequently experience insomnia. Some previous studies have suggested that insomnia may predict treatment outcomes, but the evidence is limited, especially for adolescents. This study examined the prevalence of insomnia in an adolescent OCD patient sample, explored the correlation between OCD and insomnia, and tested whether levels of insomnia at baseline predict outcomes for adolescent patients receiving the Bergen 4-Day Treatment (B4DT) for OCD. METHODS: Forty-three adolescent OCD patients who received B4DT were selected for this study. Treatment outcome was quantified as change in Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores across time from pre- to posttreatment and 3-month follow-up. Insomnia symptoms were measured by the Bergen Insomnia Scale (BIS). Linear mixed models were used to examine the relationship between the BIS and changes in CY-BOCS scores. We controlled for symptoms of general anxiety disorder measured by the GAD-7 and depression symptoms measured by the PHQ-9. RESULTS: In this sample, 68.4% of the patients scored above the cutoff for insomnia on the BIS. There was a moderate correlation between baseline CY-BOCS and BIS that did not reach statistical significance (r = .32, p = .051). High BIS scores before treatment were significantly associated with poorer treatment outcomes, as measured by changes in CY-BOCS over time (p = .002). The association between baseline insomnia and change in OCD symptoms remained significant (p = .033) while controlling for GAD-7 and PHQ-9. CONCLUSION: Insomnia is common among adolescents with OCD, and these data suggest that these patients may be at increased risk for poor treatment outcomes. Future research to explore mechanisms and adjunctive treatments is warranted. TRIAL REGISTRATION: The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord: 2023/606482).