Psychological symptoms and quality of life in patients with inflammatory bowel disease in China: A multicenter study.

AIMS: To investigate the current situation of mental psychology and quality of life (QoL) in patients with inflammatory bowel disease (IBD) in China, and analyze the influencing factors. METHODS: A unified questionnaire was developed to collect clinical data on IBD patients from 42 hospitals in 22 provinces from September 2021 to May 2022. Multivariate Logistic regression analysis was conducted, and independent influencing factors were screened out to construct nomogram. The consistency index (C-index), receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, accuracy, and clinical utility of the nomogram model. RESULTS: A total of 2478 IBD patients were surveyed, including 1371 patients with ulcerative colitis (UC) and 1107 patients with Crohn's disease (CD). Among them, 25.5%, 29.7%, 60.2%, and 37.7% of IBD patients had anxiety, depression, sleep disturbance and poor QoL, respectively. The proportion of anxiety, depression, and poor QoL in UC patients was significantly higher than that in CD patients (all p < 0.05), but there was no difference in sleep disturbance between them (p = 0.737). Female, higher disease activity and the first visit were independent risk factors for anxiety, depression and sleep disturbance in IBD patients (all p < 0.05). The first visit, higher disease activity, abdominal pain and diarrhea symptoms, anxiety, depression and sleep disturbance were independent risk factors for the poor QoL of patients (all p < 0.05). The AUC value of the nomogram prediction model for predicting poor QoL was 0.773 (95% CI: 0.754-0.792). The calibration diagram of the model showed that the calibration curve fit well with the ideal curve, and DCA showed that the nomogram model could bring clinical benefits. CONCLUSION: IBD patients have higher anxiety, depression, and sleep disturbance, which affect their QoL. The nomogram prediction model we constructed has high accuracy and performance when predicting QoL.

Sleep quality and psychological disorders in breast cancer female patients receiving radiotherapy at a tertiary oncology center in West Saudi Arabia.

PURPOSE: Breast cancer is the most prevalent type of cancer among women worldwide. Many recently diagnosed and treated breast cancer patients complain about sleep disorders, depression, anxiety, stress, and fatigue. This study aimed to evaluate sleep quality among breast cancer patients and to assess its association with psychological disorders, and socio-demographic and clinical characteristics of patients. METHODS: This cross-sectional study was conducted among women who received radiotherapy for breast cancer (stage 1-3) at King Abdul-Aziz Medical City-Jeddah from January to August 2021. Each participant completed a personal information form, the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the International Physical Activity Questionnaire (IPAQ). Clinical data were collected from the medical records to evaluate certain risk factors. Descriptive statistics were used for participant characteristics, and analyses of variance were used to assess associations between the qualitative variables. RESULTS: Fifty-six women with a mean age of 50.1 years and an average of 10 months after cancer diagnosis were included. Poor sleep quality was present in 58% of respondents. Symptomatic depression, anxiety, and stress were found in 34%, 32%, and 30% of women, respectively. Poor sleep quality was associated with depression (p = 0.031), anxiety (p = 0.03), and stress (p = 0.024) and was independently associated with hot flashes. In multivariate analysis, patients with depression or with cancer for more than 6 months were less likely to have good sleep after controlling other variables (21.74 and 14.71 times, respectively). CONCLUSION: Poor sleep quality was present in 58% of women with breast cancer receiving radiotherapy and was significantly associated with depression, anxiety, stress, and hot flashes. Depression level and cancer duration were significant predictors of sleep quality. Early identification and proper management of psychological and sleep disorders are necessary to improve the quality of life and survival of breast cancer patients.

Sleep Disorders in Kidney Transplant Recipients.

OBJECTIVES: Kidney transplant is the primary treatment option for end-stage renal disease, owing to its favorable outcomes in terms of survival, healthcare expenses, and overall quality of life. However, sleep disturbances are common among patients with chronic kidney disease and may not always improve after kidney transplant. This review aims to summarize the available literature pertaining to sleep issues in kidney transplant recipients. MATERIALS AND METHODS: We conducted a comprehensive search by using PubMed and Ulakbim databases, without imposing any restrictions on publication dates. The primary objective of the search was to identify relevant studies involving the keywords "kidney transplantation," "sleep disorders," and "nursing care." RESULTS: Restful sleep is a key component in the recovery process after kidney transplant. Posttransplant physical conditions should be evaluated in terms of the side effects of surgery and drugs, as well as other factors that may have serious effects on the sleep cycle. The frequency of insufficient sleep before and after kidney transplant was shown to be 37.5% before transplant, 37.5% after 3 months, and 20.0% after 6 months. In addition, both kidney transplant recipients and hemodialysis patients had lower sleep quality than people with normal kidney function. CONCLUSIONS: Sleep disorders can have detrimental effects on kidney allograft function, emphasizing the crucial need for systematic screening and management to ensure the survival of both the graft and the recipient. In light of this, it is imperative for nurses to regularly assess the sleep health of transplant recipients and, when deemed necessary, employ specific nursing interventions to address sleep problems and enhance overall sleep quality during the provision of care.

Indoor air pollution and cognitive function among older adults in India: a multiple mediation approach through depression and sleep disorders.

BACKGROUND: Studies across multiple countries reveal that depression and sleep disorders can lead to cognitive decline. This study aims to speculate on the effect of different sources of indoor air pollution on cognition and to explore the mediation effect of depression and sleep disorders on cognition when exposed to indoor air pollution. We hypothesize that an older adult experiences higher cognitive decline from indoor pollution when mediated by depression and sleep disorders. METHODS: We use data from Longitudinal Aging Study in India (LASI), 2017-2018, and employ a multiple mediation model to understand the relationship between indoor air pollution and cognition through sleep disorders and depression while adjusting for possible confounders. Sensitivity analysis was applied to see the effect of different sources of indoor pollution (cooking fuel, indoor smoke products, and secondhand smoke) on cognitive performance. RESULTS: The effect of three sources of indoor pollutants on cognition increased when combined, indicating stronger cognitive decline. Unclean cooking practices, indoor smoke (from incense sticks and mosquito coils), and secondhand smoke were strongly associated with sleep disorders and depression among older adults. Indoor air pollution was negatively associated with cognitive health (ß= -0.38) while positively associated with depression (ß= 0.18) and sleep disorders (ß= 0.038) acting as mediators. Sensitivity analysis explained 45% variability while adjusting for confounders. CONCLUSION: The study lays a foundation for future investigations into the nexus of indoor pollution and mental health. It is essential to formulate policies to reduce exposure to varying sources of indoor air pollutants and improve screening for mental health services as a public health priority.

Longitudinal patterns of patient-reported sleep disturbances after surgery for lung cancer.

PURPOSE: The purpose of this study was to identify longitudinal heterogeneous trajectories of sleep status, adjusted for the effect of pain over time, among patients who had surgery for lung cancer and to quantify how disturbed sleep in the hospital affects functional recovery after discharge. METHODS: We included patients from a surgical cohort (CN-PRO-Lung 1). All patients reported symptoms using the MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) daily during postoperative hospitalization. Group-based dual trajectory modeling was used to investigate trajectories of disturbed sleep and pain during the first 7 days of postoperative hospitalization. Cox regression was used to compare the recovery of walking ability between the different sleep trajectories. RESULTS: Among 421 patients, disturbed sleep trajectories comprised low (31%), moderate (52%), and high (17%) groups. The surgical approach and number of chest tubes were associated with pain, and the number of chest tubes was also associated with sleep disturbances (OR = 1.99; 95% CI: 1.08-3.67). Recovery of walking ability after discharge was significantly slower in the high (median days = 16; 95% CI: 5-NA) and moderate disturbed sleep trajectory groups (median days = 5; 95%CI: 4-6) than in the low group (median days = 3; 95% CI: 3-4). CONCLUSION: Changes in disturbed sleep among patients with lung cancer followed three distinct trajectories over the first 7 days of hospitalization after surgery. Dual trajectory analyses highlighted the high concordance between specific trajectories of disturbed sleep and pain. Patients at high sleep disturbance and high levels of pain may benefit from appropriate interventions for both symptoms in combination with the patient's surgical approach and the number of chest tubes.

The importance of sleep in memory, learning, and other cognitive functions.

Sleep is important for brain health, having both a restorative function and playing an important role in cognitive functions, e.g., attention, memory, learning, and planning. This review finds that sleep disturbances are prevalent and associated with poorer cognitive functioning in neurodegenerative disorders such as Parkinson's disease and in people with non-neurodegenerative diseases such as cancer and mood disorders. Screening for and treating sleep disturbances are potential supplementary approaches to preventing and treating cognitive impairment.

New-Onset Sleep Disorders before Cardiac Surgery May Indicate an Increased Risk of Postoperative Atrial Fibrillation.

PURPOSE: We aimed to determine if sleep disorders before cardiac surgery indicate an increased risk of postoperative atrial fibrillation (POAF). METHODS: In this study, 238 patients undergoing coronary artery bypass grafting in our center were included. Patients were separated into the preoperative sleep disorder group and the control group. The primary endpoint was the incidence of POAF, and the secondary endpoints were the incidence of postoperative stroke, duration of invasive ventilation, length of intensive care unit, and hospitalization stay. Propensity score matching and multivariable logistic regression were used for adjusting potential confounders. RESULTS: A total of 165 (69.3%) patients had sleep disorders before surgery, and 73 well-matched pairs were generated. A higher incidence of POAF was found in the preoperative sleep disorder group (16.4% versus 5.5%, p = 0.034). In multivariable logistic regression, preoperative sleep disorders were correlated to a higher risk of POAF (odds ratio = 4.627, 95% confidence interval: 1.181-18.123, p = 0.028). In the subgroup of patients without long-term sleep disorders, those who experienced preoperative sleep disorders had a higher incidence of POAF (16.1% versus 4.3%, p = 0.024), meanwhile, no difference was found in the subgroup of long-term sleep disorders. CONCLUSION: New-onset sleep disorders before cardiac surgery may indicate a higher incidence of POAF.

Sleep disturbance and decrements in morning energy contribute to a higher symptom burden in oncology patients.

OBJECTIVE/BACKGROUND: An emerging area of research is the relationship between sleep disturbance and decrements in energy. Given the paucity of research on the co-occurrence of these two symptoms, study purposes were to identify subgroups of oncology patients with distinct joint sleep disturbance AND morning energy profiles and evaluate for differences among the subgroups in demographic, clinical, and sleep disturbance characteristics, as well as the severity of other common symptoms and QOL outcomes. PATIENTS/METHODS: Patients (n = 1336) completed measures of sleep disturbance and energy 6 times over two cycles of chemotherapy. All of the other measures were completed at enrollment. Latent profile analysis was used to identify the distinct joint sleep disturbance and morning energy profiles. RESULTS: Three distinct profiles were identified (i.e., Low Sleep Disturbance and High Morning Energy (Normal, 20.6%), Moderate Sleep Disturbance and Low Morning Energy (Moderately Severe, 52.1%), Very High Sleep Disturbance and Very Low Morning Energy (Very Severe, 27.3%). Compared to Normal class, other two classes were more likely to be female, less likely to be employed, and had higher comorbidity burden and poorer functional status. Symptom scores and QOL outcomes exhibited a dose response effect (i.e., as the profile worsened, symptom scores increased and QOL scores decreased). CONCLUSIONS: Given the associations between sleep disturbance and decrements in energy and a higher symptom burden, poorer QOL outcomes, and increased mortality, assessment of these two symptoms needs to be a high priority for clinicians and appropriate interventions initiated.

Fibromyalgia in China: sleep quality is related to symptoms, quality of life and especially mental health.

OBJECTIVES: To investigate sleep quality in patients with fibromyalgia (FM) and to analyse the effect of sleep on FM symptoms and quality of life. METHODS: Patients with FM and healthy subjects were recruited to assess their sleep quality, and patients were further assessed for pain, fatigue, depression, psychological stress and quality of life. The patients were divided into a sleep disorder group as measured by the Pittsburgh Sleep Quality Index (PSQI score >7 points) and a group without sleep disorders (PSQI score ≤7 points). Linear regression analysis was used to explore the effect of sleep quality on FM pain controlling for sex and age, and the effect of sleep quality on FM fatigue, depression, psychological stress and quality of life controlling for sex, age and pain. RESULTS: A total of 450 patients and 50 healthy subjects participated in the study. The number of FM patients with sleep disorders was significantly higher than that of healthy subjects (90% vs. 14%, p≤0.001). In addition to the number of pain sites, the levels of pain, fatigue, depression, stress symptoms and quality of life were significantly impaired in FM patients with sleep disorders (p<0.05). In terms of the effects on quality of life assessed with the 36-item short-form health survey, the decrease in mental health was more substantial than the decrease in physical health (B=-12.10 vs. B=-5.40). CONCLUSIONS: Similar to FM patients in other countries and regions, a decrease in sleep quality is also the core symptom of FM patients in China and is significantly correlated with the severity of pain, fatigue, depression and stress symptoms and reduced quality of life, especially with regard to mental health, suggesting that the treatment of this disease should include sleep disorder interventions.

Factors associated with the sleep disturbances of people with breast cancer during chemotherapy in China: A cross-sectional study.

AIM: The aim of the study was to investigate the incidence of sleep disturbance and its relationship with anxiety and depression symptoms, social support and hope in breast cancer patients in China during chemotherapy. DESIGN: A single-centre cross-sectional study. METHODS: A total of 329 breast cancer patients were selected via convenience sampling method before they began chemotherapy (n = 115), before the 5th week of chemotherapy (n = 117) or 1 month after chemotherapy ended (n = 97) and administered paper-and-pencil questionnaires to evaluate sleep quality, depression and anxiety symptoms, social support and hope. Risk factors significantly associated with sleep disturbance during bivariate were incorporated in the multivariate analysis. Bivariate analyses showed that age, menopausal status, depression and anxiety symptoms, emotional/informational support, tangible support, affectionate support, positive social interaction and total support were predictors of sleep disturbance. RESULTS: Sleep disturbance was prevalent in breast cancer patients before (27.0%), during (32.5%) and after (39.2%) chemotherapy, with 37.4%, 41.9% and 52.6% of participants, respectively, reporting sleeping below the recommended 7 h. Only 8.6%-15.5% of patients reported taking sedative-hypnotic drugs during the chemotherapy. Multivariate analyses found that participants reporting clinically significant anxiety (HADS > 8) were 3.5 times more likely to report sleep disturbance (PSQI > 8) than participants without clinically significant anxiety, and each increment in emotional/informational support was associated with a 9.04% reduced risk of sleep disturbance. Moreover, age was an independent predictor of sleep disturbance during multivariate modelling.

Interaction effects between sleep disorders and depression on heart failure.

BACKGROUND: Sleep disorders and depression were recognized as independent risk factors for heart failure, whether their interaction effects also correlated with the risk of heart failure remains elusive. This study was to explore the interaction effects between sleep disorders and depression on the risk of heart failure. METHODS: This was a cross-sectional study that included data from 39,636 participants in the National Health and Nutritional Examination Survey (NHANES) database. Poisson regression model was applied to evaluate the associations of depression or sleep disorders with heart failure. The relative excess risk of interaction (RERI), attributable proportion of interaction (API) and synergy index (SI) were used to measure whether the interaction effects between depression and sleep disorders on heart failure was statistically significant. RESULTS: The risk of heart failure was increased in people with sleep disorders [risk ratio (RR) = 1.92, 95% confidence interval (CI): 1.68-2.19) after adjusting for confounders including age, gender, body mass index (BMI), race, marital status, education level, annual family income, drinking history, smoking history, diabetes, hypertension and stroke. The risk of heart failure was elevated in patients with depression after adjusting for confounders (RR = 1.96, 95%CI: 1.65-2.33). Patients with depression and sleep disorders were associated with increased risk of heart failure after adjusting for confounders (RR = 2.76, 95%CI: 2.23-3.42). The CIs of interactive indexes RERI was -0.42 (95%CI: -1.23-0.39), and API was -0.15 (95%CI: -0.46-0.16), which included 0. The CI of interactive indexes SI was 0.81 (95%CI: 0.54-1.21), which contained 1. CONCLUSION: Depression and sleep disorders were independent risk factors for heart failure but the interaction effects between depression and sleep disorders on the occurrence of heart failure were not statistically different.

Polysomnographic Assessment of Sleep Disturbances in Cancer Development: A Historical Multicenter Clinical Cohort Study.

BACKGROUND: Many cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk. RESEARCH QUESTION: What is the association between polysomnographic measures of sleep disturbances and incident cancer, and what is the validity of cluster analysis in identifying polysomnography phenotypes? STUDY DESIGN AND METHODS: We conducted a retrospective multicenter cohort study using linked clinical and provincial health administrative data on consecutive adults free of cancer at baseline with polysomnography data collected between 1994 and 2017 in four academic hospitals in Ontario, Canada. Cancer status was derived from registry records. Polysomnography phenotypes were identified by k-means cluster analysis. A combination of validation statistics and distinguishing polysomnographic features was used to select clusters. Cox cause-specific regressions were used to assess the relationship between identified clusters and incident cancer. RESULTS: Among 29,907 individuals, 2,514 (8.4%) received a diagnosis of cancer over a median of 8.0 years (interquartile range, 4.2-13.5 years). Five clusters were identified: mild (mildly abnormal polysomnography findings), poor sleep, severe OSA or sleep fragmentation, severe desaturations, and periodic limb movements of sleep (PLMS). The associations between cancer and all clusters compared with the mild cluster were significant while controlling for clinic and year of polysomnography. When additionally controlling for age and sex, the effect remained significant only for PLMS (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.06-1.50) and severe desaturations (aHR, 1.32; 95% CI, 1.04-1.66). Further controlling for confounders, the effect remained significant for PLMS, but was attenuated for severe desaturations. INTERPRETATION: In a large cohort, we confirmed the importance of polysomnographic phenotypes and highlighted the role that PLMS and oxygenation desaturation may play in cancer. Using this study's findings, we also developed an Excel (Microsoft) spreadsheet (polysomnography cluster classifier) that can be used to validate the identified clusters on new data or to identify which cluster a patient belongs to. TRIAL REGISTRY: ClinicalTrials.gov; Nos.: NCT03383354 and NCT03834792; URL: www. CLINICALTRIALS: gov.

An exploratory study of sleep habits in school-aged survivors of retinoblastoma.

OBJECTIVE/BACKGROUND: Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits. PATIENTS/METHODS: Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data. RESULTS: Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent. CONCLUSIONS: Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.

Sleep and Sleep Complaints in Juvenile Fibromyalgia Syndrome.

OBJECTIVE: To investigate sleep quality in juvenile fibromyalgia syndrome (JFS) and its effect on the global burden of the disease. METHODS: Consecutive patients with JFS who performed full-night polysomnography (PSG) were included in this cross-sectional study. JFS-related symptoms, neuropsychiatric features, and sleep quality were assessed using self-report measures. PSG sleep parameters, including N3 distribution index, were obtained from patients and age-matched healthy controls. RESULTS: We included 25 patients (20 females, median age 15.7 yrs). Nonrestorative sleep was reported by 22 of 25 (88%) patients. Patients with JFS showed significantly longer sleep period time (P = 0.004) and increased wake after sleep onset (P = 0.03) compared to healthy peers. The N3 distribution index was significantly lower in patients than in the control group (P = 0.02). Subjective poor sleep quality was related to Widespread Pain Index (WPI; r s -0.65), Symptom Severity Scale (r s -0.64), depressive symptoms (r s -0.58), fatigue (r s -0.44), and symptom severity upon awakening (r s -0.65). The N3 distribution index was correlated to depressive symptoms (r s 0.41) and irritability (rs 0.40). On multiple regression analysis, WPI was predicted by subjective sleep quality (ß -0.32, P = 0.04), whereas depressive symptoms were predicted by subjective sleep measures (ß -0.32, P = 0.04) and PSG parameters (N3 min: ß -0.07, P = 0.03). CONCLUSION: Sleep complaints are a key hallmark of JFS and have significant effect on relevant clinical domains of the disease, such as pain and depression.

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study.

BACKGROUND: Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations. METHODS: Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. RESULTS: Less regular sleep routines (OR = 0.51, 95% CI = 0.28-0.93, p = .029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56-0.89, p = .004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06-1.52, p = .009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, -0.002; p = .005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p = .003). CONCLUSIONS: Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.

Predictors of Pain Reduction Among Fibromyalgia Patients Using Medical Cannabis: A Long-Term Prospective Cohort Study.

OBJECTIVE: Many patients with fibromyalgia (FM) report using cannabis as a strategy to improve pain. Given that pain often co-occurs with symptoms of anxiety and depression (i.e., negative affect) and sleep problems among patients with FM, improvements in these symptoms might indirectly contribute to reductions in pain intensity following cannabis use. The main objective of the study was to examine whether changes in pain intensity following initiation of medical cannabis among patients with FM could be attributed to concurrent changes (i.e., reductions) in negative affect and sleep problems. METHODS: This was a 12-month prospective cohort study among patients with FM (n = 323) initiating medical cannabis under the care of physicians. Patients were assessed at baseline, and follow-up assessment visits occurred every 3 months after initiation of medical cannabis. Patients' levels of pain intensity, negative affect, and sleep problems were assessed across all visits. RESULTS: Multilevel mediation analyses indicated that reductions in patients' levels of pain intensity were partly explained by concurrent reductions in sleep problems and negative affect (both P < 0.001). This remained significant even when accounting for patients' baseline characteristics or changes in medical cannabis directives over time (all P > 0.05). CONCLUSION: Our findings provide preliminary insight into the potential mechanisms of action underlying pain reductions among patients with FM who are using medical cannabis. Given the high attrition rate (i.e., 75%) observed in the present study at 12 months, our findings cannot be generalized to all patients with FM who are using medical cannabis.

Evaluation of the Effect of Self-Efficacy on Symptoms in Gastrointestinal Cancer Patients.

Objective: The incidence of gastrointestinal cancer is increasing day by day and is among the highest 10 cancer types in the world. This study was conducted to evaluate the effects of self-efficacy of patients with gastrointestinal system cancer on symptom clusters. Methods: This cross-sectional study was conducted with 105 patients treated for gastrointestinal system cancer in a hospital located in the south of Turkey. In the study, patients over 18 years of age without hearing or speech impairment were included. To determine symptom clusters, Latent Profile Analysis and comparison of self-efficacy scale items by symptom clusters were performed with Chi-square, ANOVA, and Kruskal Wallis test. Results: The mean age of the patients was 58.83 ± 13.1 years; of the patients, 37.1% had colon ca, 21.9% had rectum ca. The patients had higher mean scores of fatigue, pain, feeling distressed, feeling sad, dry mouth, sleep disturbance, loss of appetite and nausea in the last week. The patients had higher mean scores of fatigue, pain, feeling distressed, feeling sad, dry mouth, sleep disturbance, loss of appetite and nausea in the last week. Three symptom clusters were determined by latent profile analysis; high, moderate, mild. It was determined that the level of self-efficacy was high in the symptom cluster which is low symptom severity and number of symptoms (p < .05). Conclusion: The number and the severity of symptoms are lower in patients with high self-efficacy perceptions.

Identifying Sleep Disorders From Search Engine Activity: Combining User-Generated Data With a Clinically Validated Questionnaire.

BACKGROUND: Sleep disorders are experienced by up to 40% of the population but their diagnosis is often delayed by the availability of specialists. OBJECTIVE: We propose the use of search engine activity in conjunction with a validated web-based sleep questionnaire to facilitate wide-scale screening of prevalent sleep disorders. METHODS: Search advertisements offering a web-based sleep disorder screening questionnaire were shown on the Bing search engine to individuals who indicated an interest in sleep disorders. People who clicked on the advertisements and completed the sleep questionnaire were identified as being at risk for 1 of 4 common sleep disorders. A machine learning algorithm was applied to previous search engine queries to predict their suspected sleep disorder, as identified by the questionnaire. RESULTS: A total of 397 users consented to participate in the study and completed the questionnaire. Of them, 132 had sufficient past query data for analysis. Our findings show that diurnal patterns of people with sleep disorders were shifted by 2-3 hours compared to those of the controls. Past query activity was predictive of sleep disorders, approaching an area under the receiver operating characteristic curve of 0.62-0.69, depending on the sleep disorder. CONCLUSIONS: Targeted advertisements can be used as an initial screening tool for people with sleep disorders. However, search engine data are seemingly insufficient as a sole method for screening. Nevertheless, we believe that evaluable web-based information, easily collected and processed with little effort on part of the physician and with low burden on the individual, can assist in the diagnostic process and possibly drive people to seek sleep assessment and diagnosis earlier than they currently do.

Sleep quality of patients with papillary thyroid carcinoma: a prospective longitudinal study with 5-year follow-up.

We evaluated the pre- and postoperative sleep quality of patients with newly diagnosed papillary thyroid carcinoma (PTC) who underwent thyroid surgery, and investigated the factors associated with persistent poor sleep quality. The Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and Stanford sleepiness scale were used to estimate sleep quality and daytime sleepiness. Face-to-face surveys were conducted preoperatively, and 1, 4, and 10 months after thyroid surgery. The PSQI was administered during a telephone interview about after 5 years after surgery. Forty-six patients (mean age 47.3 ± 10.1 years) with PTC (11 males, 35 females) were included in this study. Twenty-one participants underwent lobectomy and 25 underwent total thyroidectomy. Preoperatively, 35 (76.1%) patients showed poor sleep quality. PSQI scores at postoperative 1, 4, and 10 months were significantly lower than preoperative scores (p < 0.001). Postoperative 5-year PSQI scores decreased significantly compared to the preoperative scores (p < 0.001). Patients newly diagnosed with PTC suffered from sleep disturbance before and after surgery for at least 10 months, recovering to a comparable rate of sleep disturbance with the general population by 5 years after surgery. Higher preoperative PSQI score was at risk for prolonged poor sleep quality in patients with PTC.

Screening and management of sleep disorders in patients with fibromyalgia syndrome: a French multicentred, prospective, observational study protocol (FIBOBS).

INTRODUCTION: Sleep disorders are still often underestimated in patient care management even though they are present in the criteria of the American College of Rheumatology for the diagnosis of fibromyalgia syndrome (FMS). The objective of this study will be to assess the current situation of sleep disorders in patients with FMS in France and to estimate its prevalence. METHODS AND ANALYSIS: The FIBOBS study is a multicentred, prospective, observational trial performed by 46 specialised chronic pain structures in France. Patients with FMS visiting for a first consultation or follow-up (if they have already been followed up for less than a year with a pain management service) will be included after giving their informed consent. Data will be collected through the physician questionnaire filled during the inclusion visit. Patient self-questionnaires will be completed from home. The primary outcome of the study will be to estimate the prevalence of sleep disorders classified into three categories: (a) poor sleep quality in general, (b) sleep apnoea syndrome and (c) restless legs syndrome, using self-administered questionnaires. ETHICS AND DISSEMINATION: This protocol is approved by the ethics committee Comité de Protection des Personnes 'Ile de France II' in accordance with French regulations. The results will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT04775368.