Sleep quality in women with diabetes in pregnancy: a single-center retrospective study.

PURPOSE: Sleep quality is an important indicator of individual quality of life, which not only affects people's mental health but is also closely related to the occurrence of many diseases. Sleep disorders associated with diabetes in pregnancy can greatly endanger the health of both mothers and babies, and their hazards are strongly associated with blood glucose levels. This study explored the quality of sleep and sleep disorders in pregnant women with diabetes. METHODS: From June 2020 to July 2021, a total of 693 patients diagnosed with diabetes during pregnancy in Gansu Provincial Maternal and Child Health Hospital were used as the experiment group, including 626 patients with gestational diabetes mellitus (GDM) and 67 patients with pregestational diabetes mellitus (PGDM). At the same time, 709 women not having diabetes were randomly selected as the control group. To obtain the general situation of the participants, the participants were surveyed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG (S, Snoring; T, Tiredness; O, Observed apnea; P, high blood Pressure; B, Body mass index > 35 kg/ m2; A, Age > 50 years; N, Neck circumference > 40 cm; G, male Gender) questionnaire. The differences in sleep quality and obstructive sleep apnea-hypopnea syndrome (OSAHS) were analyzed between the experiment group and the control group by using chi-square and t-test, and the clinical features and related factors of sleep disorder were analyzed. RESULTS: Compared with the control group, the age, pre-pregnancy weight, body mass index (BMI), and neck circumference were larger in the experimental group (P < 0.05). The experimental group had higher PSQI scores for sleep quality, time to fall asleep score, sleep duration, sleep efficiency, sleep disorder, and daytime dysfunction than the control group (all P < 0.001). Specific analysis of the clinical features of sleep disorders indicated that the experimental group scored higher than the control group (P < 0.05). The analysis of the types of daytime dysfunction showed that the experiment group scored higher in terms of frequently feeling sleepy and lack of energy to do things than the control group (P < 0.05). Analysis of STOP-BANG scores indicated that the proportion of patients with GDM or PGDM having fatigue, hypertension, BMI > 35 kg/m2, and neck circumference > 40 cm was higher than that in the control group (P < 0.05). According to regression analysis, sleep quality of patients with GDM was significantly impacted by the increases in age (OR: 1.243, CI:1.197-1.290), neck circumference (OR: 1.350, CI: 1.234-1.476), PSQI score (OR: 2.124, CI:1.656-2.724), and sleep efficiency score (OR: 3.083, CI:1.534-6.195), whereas that of patients with PGDM was impacted by age (OR: 1.191, CI:1.086-1.305), neck circumference (OR: 1.981, CI: 1.469-2.673), and PSQI score (OR: 7.835, CI: 2.383-25.761). CONCLUSIONS: Pregnant women with diabetes had poorer sleep quality and a higher risk of developing OSAHS than those without diabetes. There may be some link between sleep quality and the onset of diabetic.

Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study.

INTRODUCTION: Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. METHODS: In a cross-sectional study, adult patients (≥ 18 years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. RESULTS: A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when the PSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). CONCLUSION: PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.

Short-Term Continuous Positive Air Pressure Treatment: Effects on Quality of Life and Sleep in Patients with Obstructive Sleep Apnea.

Background and Objectives: The aim of this study was to evaluate short-term continuous positive air pressure (CPAP) treatment for health-related quality of life (HRQL) in patients with obstructive sleep apnea. Materials and Methods: Our subjects were 18−65 years old, diagnosed with moderate-to-severe obstructive sleep apnea and treated with CPAP between January 2020 and June 2021 in Hospital of Lithuanian University of Health Sciences Kaunas clinics. All the patients completed the Epworth Sleepiness Scale (ESS), the 36-Item Short Form Health Survey (SF-36), the and Pittsburgh Sleep Quality Index (PSQI) before and after 3 months of treatment. Polysomnography was also repeated. Statistical analyses were performed using SPSS 27.0 software. The value of p < 0.05 was considered as statistically significant. Results: The active-treatment group comprised 17 subjects with a mean age of 51.9 ± 8.9 years. The total SF-36 questionnaire score improved from 499.8 ± 122.3 to 589.6 ± 124.7 (p = 0.012). The SF-36 role limitations due to emotional problems (p = 0.021), energy (fatigue) (p = 0.035), and general health (p = 0.042) domains score significantly improved after CPAP treatment for 3 months. The PSQI mean score at baseline was 12.6 ± 2.9 and in the post-treatment group, it was −5.5 ± 2.3 (p = 0.001). The ESS also changed significantly from a pretreatment mean score of 10.9 ± 5.7 to −5.3 ± 3.2 (p = 0.002) after 3 months. Conclusions: Improvement in HRQL is seen even after a short treatment period with CPAP. Questionnaires are a good tool to evaluate CPAP treatment efficacy.

Adverse effects of circadian desynchrony on the male reproductive system: an epidemiological and experimental study.

STUDY QUESTION: Is circadian desynchrony a risk factor of male reproductive damage in semen parameters and/or reproductive hormones? SUMMARY ANSWER: Circadian desynchrony correlates with decrease of sperm count, which was improved when circadian desynchrony was attenuated. WHAT IS KNOWN ALREADY: Circadian desynchrony caused by work (shift work) and non-work-related reasons is prevalent worldwide and has been found to be associated with decreased female fertility, but whether it harms male reproductive health is unclear. STUDY DESIGN, SIZE, DURATION: A hybrid research was conducted. (i) A cross-sectional study of 1346 Chinese men in 2007 was used to analyze the association between semen/hormone biomarkers and work-related circadian desynchrony, which was divided into rotating shift work and permanent shift work against non-shift work. (ii) A cohort of 796 Chinese undergraduates from 2013 to 2014 was used to analyzed the association between semen/hormone biomarkers and non-work-related circadian desynchrony (between school days and days off). (iii) The biomarker identified simultaneously in both populations was further validated in male C57BL/6J mice housed under conditions simulating circadian desynchrony. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 17 semen/hormone biomarkers were compared among rotating shift workers and permanent shift workers against non-shift workers in the 1346 reproductive-age Chinese men. A total of 14 semen/hormone biomarker was analyzed in the undergraduate cohort for correlation with non-work-related circadian desynchrony (measured by Munich Chronotype Questionnaire) in 2013 and 2014 and compared between the 2 years. Photoperiod-shifting method was used to establish the mouse model, in which the biomarker was examined and molecular mechanism was explored by apoptosis analysis, DNA content analysis, transcriptome sequencing, real-time PCR and western blotting. MAIN RESULTS AND THE ROLE OF CHANCE: Among the semen/hormone biomarkers, sperm count was found to be lower in rotating shift workers, who had a higher risk of low sperm count defined by Chinese Ministry of Health (total sperm/ejaculate < 120 × 106) than non-shift workers (odds ratio = 1.26, 95% CI 1.05-1.52). This biomarker was replicated in the undergraduate cohort, where each hour of circadian desynchrony was associated with 1.16 (95% CI 1.02-1.31) fold odds of low sperm count, and sperm count increased during 2014 in men who reduced circadian desynchrony after 2013. A decrease of sperm count with circadian desynchrony and its recovery after removal of circadian desynchrony was also observed in the mouse model. During asynchrony, increased apoptosis was found in seminiferous tubules and the marker genes of post-spermatocyte stage cells were down-regulated. The most enriched functional pathway was homologous recombination, which happened during meiosis. LIMITATIONS, REASONS FOR CAUTION: The study of human beings was observational while the animal study has potential difference in circadian desynchrony exposure and species susceptibility. Further researches are needed to clarify the causal relationship in men. WIDER IMPLICATIONS OF THE FINDINGS: These findings provide novel insight to the effect of circadian desynchrony on male reproductive health and a potential strategy for prevention of reproductive damage. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the National Key R&D Program of China [2017YFC1002001] and National Natural Science Foundation of China [81871208]. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: NA.

Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

OBJECTIVE: To assess the effects of tinnitus treatments on sleep disorders in patients with tinnitus. DESIGN: Subjects completed the Pittsburg Sleep Quality Index (PSQI), Tinnitus Handicap Inventory (THI), Self-rating Depression Scale (SDS), and State Trait Anxiety Inventory (STAI). The questionnaire results and the patients' sex, age, time since the onset of tinnitus, and mean hearing level were examined, and differences between a sleep disorder group and a normal sleep group were examined. Patients completed the questionnaires again after initiating tinnitus treatments (counselling and use of sound generators), and the change in questionnaire scores at follow-up was evaluated. STUDY SAMPLE: Patients (N = 100) with tinnitus who visited Keio University Hospital and started treatment without medication between 2005 and 2008. RESULTS: Sixty-six percent of the patients had sleep disorders. Compared with patients without sleep disorders, patients with sleep disorders had significantly higher SDS and STAI scores at the first visit. The mean PSQI scores showed significant improvement at follow-up. CONCLUSIONS: Sleep disorders in patients with tinnitus improved after tinnitus treatments. Complex interactions between depressive symptoms and anxiety may occur in these patients. The improvement in sleep disorders at follow-up was correlated with improvements in tinnitus severity and state anxiety.

Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index.

Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients. More studies are needed about sleep disorders in cancer patients. In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients. Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients. The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (40.4%) patients had global PSQI scores >5, indicating poor sleep quality. There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 0.05); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0.006). Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 0.02). In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients. Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia.

Poor Sleep Quality and Its Influencing Factors Among Iranian Patients with Esophageal and Gastric Cancer.

Background: Sleep quality is a notable factor of well-being. It also may play a role in the development and progression of chronic diseases and cancers. Therefore, this study was performed to investigate poor sleep quality and its influencing factors among Iranian patients with esophageal and gastric cancer. Methods: In this cross-sectional study, a total of 312 Iranian adult patients who suffered from esophageal and gastric cancers were employed from a gastrointestinal cancer-based cohort study conducted in a referral hospital in Tehran between 2015 and 2018. Persian version of the Pittsburg Sleep Quality Index (PSQI) was used to measure poor sleep quality. Univariate and multiple logistic regression models were applied to determine the related factors to poor sleep quality. Results: Of the participants, 203 (65.06%) were men, and 75.96% had gastric cancer. The mean age was 63.13±12.10 years. The results demonstrated that more than 62% of the patients had poor sleep quality. 148 (62.44%) patients out of 237 patients with gastric cancer had poor-quality sleep. Also, 46 (64.38%) patients out of 237 patients with esophageal cancer had poor-quality sleep. Based on the results of multiple logistic regression models, marital status has a negative association with poor sleep quality (odds ratio [OR]=0.32, P=0.015). In addition, having chronic disease (OR=2.16; P=0.028) and wealth index (OR=3.11, P=0.013; OR=3.81, P=0.003; OR=3.29, P=0.009; OR=3.85, P=0.003 for rich, moderate, poor, and poorest subgroups, respectively) had a positive association with poor sleep quality. Conclusion: The findings showed that about two-thirds of the patients studied were poor sleepers. Also, it was observed that marital status, chronic disease, and wealth index were important factors associated with poor sleep quality.

Circadian rhythm sleep disorders in patients with multiple sclerosis and its association with fatigue: A case-control study.

BACKGROUND: Circadian rhythm sleep disorders are a presentation of sleep disorders in patients with multiple sclerosis (MS). This study aims to compare this problem in MS patients with healthy people and to determine its association with chronic fatigue in MS patients. MATERIALS AND METHODS: A case-control study was performed on 120 MS patients and 60 healthy subjects matched for age and sex, in 2009 in MS Clinic Alzahra Hospital. Sleep quality, rhythm and fatigue severity were assessed using PSQI (Pittsburgh sleep quality index) and FSS (Fatigue severity Scale) questionnaires, respectively. Its reliability and validity has been confirmed in several studies (Cronbach's alpha = 0.83). This index has seven sections including patient's assessment of his/her sleep, sleep duration, efficacy of routine sleep, sleep disorders, use of hypnotic medication, and dysfunction in daily activities. RESULTS: Circadian rhythm sleep disorder was more frequent in MS patients relative to healthy subjects (P: 0.002). It was higher in MS patients with severe fatigue relative to MS patients with mild fatigue (P: 0.05). Fatigue severity was 49.9 ± 8.2 and 22.5 ± 7.4 in the first and second group, respectively. PSQI index was 7.9 ± 4.5 in patients with severe fatigue and 5.9 ± 4.5 in patients with mild fatigue and 4.5 ± 2.4 in the control group (P: 0.0001). CONCLUSION: Circadian rhythm sleep disorders are more frequent in MS patients and those with fatigue. Recognition and management of circadian rhythm sleep disorders in MS patients, especially those with fatigue may be helpful in improving care of these patients.

Association of changes in sleep duration and quality with incidence of depression: A cohort study.

BACKGROUND: The longitudinal relationship between sleep duration, sleep quality, and their changes with the risk of depressive symptoms is unclear. We examined the association between sleep duration, sleep quality, and their changes with incident depressive symptoms. METHODS: A total of 225,915 Korean adults without depression at baseline with a mean age of 38.5 years were followed for an average of 4.0 years. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index. The presence of depressive symptoms was assessed using the Center for Epidemiologic Studies Depression scale. Flexible parametric proportional hazard models were used to determine hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS: In total, 30,104 participants with incident depressive symptoms were identified. Multivariable-adjusted HRs (95 % CIs) for incident depression comparing sleep durations of ≤5, 6, 8, and ≥9 h with 7 h were 1.15 (1.11-1.20), 1.06 (1.03-1.09), 0.99 (0.95-1.03), and 1.06 (0.98-1.14), respectively. A similar trend was observed in patients with poor sleep quality. Compared with participants with persistently good sleep quality, participants with persistently poor sleep quality or who developed poor sleep quality were associated with the risk of incident depressive symptoms [HRs (95 % CIs) of 2.13 (2.01-2.25) and 1.67 (1.58-1.77), respectively]. LIMITATIONS: Sleep duration was assessed using self-reported questionnaire and the study population may not reflect general population. CONCLUSIONS: Sleep duration, sleep quality and their changes were independently associated with incident depressive symptoms in young adults, suggesting that inadequate sleep quantity and quality play a role in depression risk.

Sleep Quality and Poor Sleep-related Factors Among Healthcare Workers During the COVID-19 Pandemic in Vietnam.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has increased the workload of healthcare workers (HCWs), impacting their health. This study aimed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and identify factors associated with poor sleep among HCWs in Vietnam during the COVID-19 pandemic. METHODS: In this cross-sectional study, 1000 frontline HCWs were recruited from various healthcare facilities in Vietnam between October 2021 and November 2021. Data were collected using a 3-part self-administered questionnaire, which covered demographics, sleep quality, and factors related to poor sleep. Poor sleep quality was defined as a total PSQI score of 5 or higher. RESULTS: Participants' mean age was 33.20±6.81 years (range, 20.0-61.0), and 63.0% were women. The median work experience was 8.54±6.30 years. Approximately 6.3% had chronic comorbidities, such as hypertension and diabetes mellitus. About 59.5% were directly responsible for patient care and treatment, while 7.1% worked in tracing and sampling. A total of 73.8% reported poor sleep quality. Multivariate logistic regression revealed significant associations between poor sleep quality and the presence of chronic comorbidities (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.17 to 5.24), being a frontline HCW directly involved in patient care and treatment (OR, 1.59; 95% CI, 1.16 to 2.16), increased working hours (OR, 1.84; 95% CI,1.37 to 2.48), and a higher frequency of encountering critically ill and dying patients (OR, 1.42; 95% CI, 1.03 to 1.95). CONCLUSIONS: The high prevalence of poor sleep among HCWs in Vietnam during the COVID-19 pandemic was similar to that in other countries. Working conditions should be adjusted to improve sleep quality among this population.

Sleep quality and its associations with disease activity and quality of life in older patients with rheumatoid arthritis.

PURPOSE: Sleep disturbance is among the most important geriatric syndromes, and its evaluation is part of the routine comprehensive geriatric assessment (CGA). Previous studies have demonstrated that older patients with rheumatoid arthritis (RA) have poorer sleep quality than younger control patients. However, there needs to be more data on the sleep quality of older patients with RA with age-matched controls. METHODS: Totally 100 participants, 50 older RA patients classified according to the ACR criteria, and 50 age- and gender-matched control patients without RA were included in the study. All patients underwent CGA, including assessing their functionality, depressive, cognitive, and nutritional status. In addition, sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI), and RA disease activity by a rheumatologist using the Disease Activity Score 28 (DAS28-CRP), and quality of life with the RA QoL questionnaire (RAQoL). RESULTS: The median age was 70 years (min-max: 65-86), and 62.5% were female. Co-morbidities and comprehensive geriatric assessment parameters were similar between the two groups. Median PSQI global score was higher in patients with RA than controls [9 (min-max: 1-20) vs. 5 (min-max: 1-13), p = 0.029). When the patients were categorized with respect to being 'poor sleepers' (PSQI score > 5), 62% of patients with RA and 38% of controls were poor sleepers (p = 0.016). The patients classified as poor sleepers were more likely to have a diagnosis of RA, higher DAS28-CRP and RAQoL scores, lower grip strength, and be a woman. PSQI global scores were significantly positively correlated with DAS28-CRP scores (r = 0.514, p < 0.001), RAQoL scores (r = 0.689, p < 0.001), number of medications used (r = 0.292, p = 0.003), and YDS scores (r = 0.407, p < 0.001), and significantly negatively correlated with handgrip strength (r = - 0.351, p = 0.001). CONCLUSION: The results suggest that older patients with RA might have poorer sleep quality compared to age- and gender-matched controls. Moreover, sleep quality correlated with RA disease activity and QoL in old age.

Sleep Quality and Nicotine Dependence Among Lebanese University Residents and Fellows: A Cross-Sectional Study.

Background and objectives Sleep quality and nicotine addiction are important public health issues with significant negative impacts on individual well-being and the performance of healthcare professionals. This study aims to determine the prevalence and association of nicotine dependence and poor sleep quality among residents and fellows enrolled in the Lebanese University. Methods A cross-sectional study using the snowball-sampling technique was conducted in Lebanon between January and March 2023. Data were collected through an online survey that included information on socio-demographic characteristics, nicotine dependence, and sleep quality. A total of 350 residents and fellows were included in the study. Bivariate analysis and multivariable logistic regression were carried out to identify the factors associated with sleep quality. Adjusted odds ratio and 95% confidence intervals were reported. Results One quarter (25.1%) of the residents and fellows were smokers; among them, 44.3% smoked I Quit Ordinary Smoking (IQOS), 14.8% smoked cigarettes, 10.2% smoked waterpipe (WP), 12.5% smoked cigarettes and WP, and 18.2% smoked IQOS and WP. According to the Pittsburgh Sleep Quality Index (PSQI), 34.3% of participants had poor sleep quality. Smokers had 12.5 times higher odds of experiencing poor sleep quality compared to non-smokers (adjusted odds ratio ORadj = 12.58 with 95% confidence interval [CI] of 7.07-22.36; p-value <0.001). In addition, smoking a combination of two types of tobacco products (cigarettes with WP or IQOS with WP) posed the highest risk of poor sleep quality, with an adjusted odds ratio of 31.54 (95% CI of 9.15-45.74, p-value <0.001). Elevated Fagerström Test for Nicotine Dependence (FTND) and Lebanon Waterpipe Dependence Scale (LWDS-11) scores indicated an increased risk of poor sleep quality (adjusted odds ratio ORadj = 4.69 with 95% CI of 2.179-10.10; p-value <0.001; and adjusted odds ratio ORadj =1.27 with 95% CI of 1.04-1.55; p-value 0.019, respectively). Conclusion Our study found a significant association between nicotine dependence and poor sleep quality among medical residents and fellows, with smokers being more susceptible to sleep disturbances. The high prevalence of IQOS smoking among medical residents and fellows in Lebanon highlights the urgent need for comprehensive research investigating the effects of heated tobacco products. Furthermore, our study reveals a critical insight into the potential additive effects of nicotine, suggesting that the concurrent use of multiple tobacco products may further elevate the risk of poor sleep quality. Recognizing the implications of our findings, it is imperative to develop targeted interventions and educational programs that promote healthier sleep habits and facilitate smoking cessation among medical residents and fellows.

Sleep Quality of Covid-19 Recovered Patients in India.

Objective: The second wave of the Covid-19 pandemic in India was widespread and caused psychological distress among the citizens. Hospitals were running at a premium, increasing deaths and trepidation stories were on air by media, this generated sleep disturbances for many. This study aimed to examine the sleep quality of Covid-19 recovered patients in India during the second wave of the pandemic. Methods: Patients who had recently recovered from Covid-19 were invited to participate in this cross-sectional study using various social media platforms. An online survey questionnaire, including socio-demographics, health-related information, Covid-19 related information, and the Pittsburgh Sleep Quality Index (PSQI), was administered in June 2021. Descriptive statistics were used to compare the scores among the mild, moderate, and severe groups. ANOVA was used to find the difference between the groups for global PSQI scores. Results: A total of 311 participants (261 mild, 45 moderate, and 5 severe) provided usable responses. The Global PSQI score for the overall study sample was 8.22 ± 3.79. In the severe group, scores were higher 16.8 ± 2.59, and statistically significant from mild or moderate groups. Sleep quality of Covid-19 recovered patients was found to be statistically significantly different based on their gender (P < .001), annual income (P < .001), employment status (P < .001), and marital status (P < .001). Conclusion: Females, employment in the private sector, annual income below rupees 11 lakh, and unmarried Covid-19 recovered patients reported poor sleep quality. As our findings indicate poor sleep quality among the Covid-19 recovered patients during the second wave in India, designing psychological interventions is recommended to support their wellbeing post-recovery.

Sleep quality of Singapore residents: findings from the 2016 Singapore mental health study.

Given the importance of sleep for physical and mental wellbeing, it is crucial to understand the extent of insomnia among community dwellers. However, there is a paucity of population wide epidemiological studies to estimate the prevalence of poor sleep quality. This present study aimed to 1) characterize the sleep quality of a nationally representative sample (n = 6126) of Singapore residents using Pittsburg Sleep Quality Index (PSQI) and 2) identify the sociodemographic correlates of poor sleep in this population. A total of 27.6% of respondents reported poor sleep quality (PSQI score ≥5). Sociodemographic correlates of poor sleep quality in the Singapore population included, but were not limited to, females (AOR = 1.44, 95% CI = 1.17 to 1.77, p-value = 0.001), Malays (vs Chinese) (AOR = 1.53, 95% CI = 1.23 to 1.9, p-value < 0.001), Indians (vs Chinese) (AOR = 1.22, 95% CI = 1.02 to 1.47, p-value = 0.03), ex-smokers (vs non-smokers) (AOR = 1.43, 95% CI = 1.07 to 1.92, p-value = 0.02), persons with comorbid mental health conditions (vs no mental health conditions) (AOR = 14.11, 95% CI = 6.52 to 30.54, p-value < 0.01), and persons with physical multimorbidity (vs no physical conditions) (AOR = 1.63, 95% CI = 1.24 to 2.15, p-value < 0.001). The prevalence of poor sleep in Singapore is comparable to that of other countries in the Asian region. Targeted public health campaigns to psycho-educate vulnerable groups on the importance of good sleep hygiene may improve the overall wellbeing of residents in Singapore.

Anxiety, depression, and sleep disorders among healthcare workers during the COVID-19 pandemic.

OBJECTIVE: In this study, we examined the level of anxiety and depression, daytime sleepiness, and sleep quality in healthcare workers working during the COVID-19 pandemic. METHODS: This study was conducted in a tertiary care university hospital. Socio-demographic information form, Beck Anxiety Scale, Beck Depression Scale, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale were used as data collection tools. RESULTS: A total of 273 healthcare workers were recruited into the study. It was determined that there is an enormous mental health burden on healthcare workers. About 100% and 45.4% of the participants got above-threshold scores from Beck Anxiety Scale, and Beck Depression Scale, and the prevalence of daytime sleepiness and impaired sleep quality was 11.4% and 38.8%, respectively. The female gender was found to have more severe anxiety levels and lower sleep quality (p<0.001). In logistic regression analysis, the female gender was a risk factor for having a level of severe anxiety, and the nursing profession was a risk factor for having severe anxiety and low sleep quality (p<0.05). CONCLUSION: Global serious outbreaks cause increased depression and anxiety levels and sleep disorders in healthcare workers. Therefore, we believe that trainings and support which aims to strengthen the psychological well-being of healthcare workers should be implemented.

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure.

INTRODUCTION: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients' compliance with treatment and, thus, clinical outcomes. OBJECTIVE: We aimed to evaluate the clinical outcomes of patients with a remote access program. METHODS: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and health-related quality of life during the 6 months of follow-up. RESULTS: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500-1,000] and 752 mL [490-986] vs. 824 mL [537-1,183]). The daily antihypertensive pill need (4 [0-7] vs. 2 [0-6]) and alarms received from the device decreased (from 4 [3-8] to 2 [0-3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months. CONCLUSION: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs.

Sleep Disturbances Rate among Medical and Allied Health Professions Students in Iran: Implications from a Systematic Review and Meta-Analysis of the Literature.

Medicine and healthcare professions are prestigious and valued careers and, at the same time, demanding, challenging, and arduous jobs. Medical and allied health professions students, experiencing a stressful academic and clinical workload, may suffer from sleep disturbances. In Iran, several studies have been conducted to explore the prevalence rate among medical and healthcare professions students. The aim of this systematic review and meta-analysis was to quantitatively and rigorously summarize the existing scholarly literature, providing the decision- and policy-makers and educators with an updated, evidence-based synthesis. Only studies utilizing a reliable psychometric instrument, such as the Pittsburgh sleep quality index (PSQI), were included, in order to have comparable measurements and estimates. Seventeen investigations were retained in the present systematic review and meta-analysis, totaling a sample of 3586 students. Studies were conducted between 2008 and 2018 and reported an overall rate of sleep disturbances of 58% (95% confidence interval or CI 45-70). No evidence of publication bias could be found, but formal analyses on determinants of sleep disturbances could not be run due to the dearth of information that could be extracted from studies. Poor sleep is highly prevalent among Iranian medical and healthcare professions students. Based on the limitations of the present study, high-quality investigations are urgently needed to better capture the determinants of poor sleep quality among medical and healthcare professions students, given the importance and the implications of such a topic.

Information on Bedtimes and Wake Times Improves the Relation Between Self-Reported and Objective Assessments of Sleep in Adults.

STUDY OBJECTIVES: To investigate the correlation between self-reported and objective measures of total sleep time (TST) in adults and examine whether sex, race/ethnicity, and weight status influence this association. METHODS: Participants were individuals who screened for sleep intervention studies, providing > 7 days of wrist actigraphy sleep data (TSTobj) and reporting sleep duration (TSTPSQI) using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (n = 53 men, 60 women; 59% minority/Hispanics; age 30.9 ± 9.7 years; body mass index 26.2 ± 3.2 kg/m2). In addition, TSTbed/wake was calculated as the difference between bedtime and waketime, minus the time to fall asleep, from the PSQI. Univariate regression analyses were performed to assess the relation between TSTobj and TSTPSQI and TSTbed/wake and compare the relation by sex, race, and ethnicity. Bland-Altman tests were done to assess bias by sex, race/ethnicity, weight status, and sleep quality. RESULTS: TSTbed/wake correlated with TSTobj (r = .57, P < .0001). TSTPSQI and TSTbed/wake were greater than TSTobj (0.63 ± 0.99 hours and 0.79 ± 0.76 hours, respectively, both P < .0001). The difference between TSTPSQI and TSTobj did not vary by sex (ß = .12, P = .52), race/ethnicity (ß = .15, P = .48), age (ß = -.01, P = .27), or body mass index (ß = .04, P = .13) whereas that between TSTbed/wake and TSTobj varied by age (ß = -.020, P = .0051), BMI (ß = .054, P = .0021), race/ethnicity (ß = .36, P = .021), and sleep efficiency (ß = -.089, P < .0001). CONCLUSIONS: Calculating TST using self-reported bedtimes and wake times provided TST estimate that correlated with TSTobj but greater over-reporting occurred in younger and heavier individuals, non-whites or Hispanics, and those with low sleep efficiency. In clinical and research settings, asking individuals to report bedtimes, wake times, and length of time to fall asleep may more accurately estimate TST than asking about sleep duration alone.

Serum Levels of Melatonin and Sleep Evaluation Scales in the Diagnosis of Sleep Disorders in Patients with Idiopathic Parkinson's Disease.

INTRODUCTION: Sleep disturbances, such as difficulty in initiation of sleep, decrease in total sleep duration and efficacy, frequent awakenings, and increased daytime sleepiness are among the most common non-motor symptoms in patients with idiopathic Parkinson's disease (PD). However, patients usually do not consider these symptoms as important as their motor symptoms, and do not complain. We aimed to investigate PD patients for subtle sleep disturbances using sleep evaluation scales, and to evaluate the relationship between these tests and the serum levels of melatonin during night-sleep. METHODS: A total of 40 PD patients (19, female), older than 50 years, registered in our "Movement Disorders Out-patient Clinic", and 40 healthy, age and sex-matched control subjects (20, female) were included in the study. All subjects were assessed using Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Serum melatonin levels during night-sleep were measured in blood samples taken at 00:00 and 05:00 hours in every subject. Both groups were compared for demographical data, sleep evaluation scales and serum levels of melatonin. RESULTS: Patients with PD had significantly higher scores in PSQI and ESS than the healthy controls (p<0.001). Although the serum melatonin levels at two different time points during night sleep were lower in PD patients than the controls, these differences did not reach statistical significance (p=0.104 at 00:00 am, p=0.528 at 05:00 am). There was no significant correlation between the PSQI scores and serum melatonin levels in patient group (p>0.05). However, there was a significant but weak correlation (r=-0.353, p=0.025) between ESS scores and the serum melatonin levels measured at 05:00 hours in patients, but not between the melatonin levels measured at 00:00 hours. CONCLUSION: Sleep evaluation questionnaires such as, PSQI and ESS, can provide useful information in PD patients with mild sleep disturbances. However, serum melatonin levels alone were not helpful in diagnosing the sleep disorders.

Sleep disorders in primary antiphospholipid syndrome.

The objective of this study was to evaluate the sleep quality, the presence of sleep disorders in patients with primary antiphospholipid syndrome (pAPS), and their possible clinical and laboratory associations. This was a cross-sectional study of 40 consecutive pAPS patients and 211 healthy age- and sex-matched controls. Demographic and clinical data, drug use, and antiphospholipid antibodies were evaluated. Sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI). pAPS patients had significantly worse sleep quality than healthy controls. Analyzing the individual components, pAPS had worse scores in five of seven components: sleep duration (p = 0.002), habitual sleep efficiency (p = 0.003), sleep disturbance (p < 0.001), use of sleep medication (p < 0.001), and daytime somnolence (p = 0.03). No association of sleep disturbance and demographic, clinical, and laboratory features of the disease was observed. This is the first study to analyze sleep quality in pAPS. We observed that pAPS had significant worse sleep quality; however, no demographic, clinical, or laboratory feature was associated with sleep disturbance.