An Exploratory Study on the Effects of Forest Therapy on Sleep Quality in Patients with Gastrointestinal Tract Cancers.

The improvement of sleep quality in patients with cancer has a positive therapeutic effect on them. However, there are no specific treatment guidelines for treating sleep disturbance in cancer patients. We investigated the effect of forest therapy on the quality of sleep in patients with cancer. This study was conducted on nine patients (one male, eight female; mean age, 53.6 ± 5.8 years) with gastrointestinal tract cancer. All patients participated in forest therapy for six days. They underwent polysomnography (PSG) and answered questionnaires on sleep apnea (STOP BANG), subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Stanford and Epworth Sleepiness Scales), and anxiety and depression (Hospital Anxiety and Depression Scale) to evaluate the quality of sleep before and after forest therapy. Sleep efficiency from the PSG results was shown to have increased from 79.6 ± 6.8% before forest therapy to 88.8 ± 4.9% after forest therapy (p = 0.027) in those patients, and total sleep time was also increased, from 367.2 ± 33.4 min to 398 ± 33.8 min (p = 0.020). There was no significant difference in the STOP BANG score, PSQI scores, daytime sleepiness based on the results of the Stanford and Epworth Sleepiness Scales, and depression and anxiety scores. Based on the results of this study, we suggest that forest therapy may be helpful in improving sleep quality in patients with gastrointestinal cancers.

Discriminating neurological from psychiatric hypersomnia using the forced awakening test.

INTRODUCTION: Sleep inertia refers to the inability to attain full alertness following awakening from sleep and is a major component of hypersomnia. As event-related potentials (ERPs) are correlated to the degree of consciousness, they allow exploring information processing in transitional states of vigilance. Their modifications during forced awakening (FA) context have been shown to reflect sleep inertia. OBJECTIVES: To assess the diagnostic value of a FA test using an oddball stimulation protocol during a nap in a representative sample of patients with excessive daytime sleepiness (EDS). METHODS: One hundred and seventy three patients [30 narcolepsy, 62 idiopathic hypersomnia, 33 sleep apnoea syndrome, and 48 other (mainly psychiatric) hypersomnia] performed an auditory target detection stimulation task during pre-, post-nap wakefulness, and during two successive intra-nap FA while the EEG was simultaneously recorded. Both the accuracy of target detection and the ERPs were evaluated. ERPs during forced awakening test were considered to reflect sleep inertia if they presented with a P300 delay and/or sleep negativities (N350/N550). RESULTS: Pre-nap behavior and ERPs were normal in all patients. Behavioral results were significantly worse during FA than during wakefulness for all groups of patients. P300 latencies were significantly delayed on FA conditions in each group of patients except the psychiatric group. Sensitivity and specificity for detection of sleep inertia were 64% and 94%, respectively, with predictive values of 96% (positive) and 50% (negative). CONCLUSIONS: Our results suggest that the FA test could be helpful as a diagnostic procedure for discriminating neurological from psychiatric hypersomnia.

Sleep-disordered breathing affects auditory processing in 5-7-year-old children: evidence from brain recordings.

Poor sleep in children is associated with lower neurocognitive functioning and increased maladaptive behaviors. The current study examined the impact of snoring (the most common manifestation of sleep-disordered breathing) on cognitive and brain functioning in a sample of 35 asymptomatic children ages 5-7 years identified in the community as having habitual snoring (SDB). All participants completed polysomnographic, neurocognitive (NEPSY), and psychophysiological (event-related potentials [ERPs] to speech sounds) assessments. The results indicated that sub-clinical levels of SDB may not necessarily lead to reduced performance on standardized behavioral measures of attention and memory. However, brain indices of speech perception and discrimination (N1/P2) are sensitive to individual differences in the quality of sleep. We postulate that addition of ERPs to the standard clinical measures of sleep problems could lead to early identification of children who may be more cognitively vulnerable because of chronic sleep disturbances.

Patient education combined in a music and habit-forming intervention for adherence to continuous positive airway (CPAP) prescribed for sleep apnea.

OBJECTIVE: As many as 50% of patients diagnosed with obstructive sleep apnea stop adhering to the prescribed medical treatment of continuous positive airway pressure (CPAP) within 1-3 weeks of onset. Thus, a theory-based intervention using music to support habit formation was designed to improve CPAP adherence at onset. The intervention materials included directions for CPAP nightly use, a diary for recording nightly use and writing about CPAP benefits or problems. In addition, an audiotape with softly spoken instructions for placing the CPAP mask comfortably, using deep breathing and muscle relaxation along with the slowly decreasing music tempo was provided to listen to at bedtime each night. METHODS: Effects of this music intervention were tested in a randomized, placebo-controlled trial of 97 patients with 53 males (55%) and 44 females (45%). Moderate to severe apnea/hyponea scores (per sleep laboratory data) and medical diagnosis of OSA were required for study inclusion. RESULTS: Compared to placebo controls, a greater proportion of experimental patients were adhering (chi(2)=14.67, p<0.01; a large difference, Phi=0.39) at the end of the first month of CPAP onset. There were no differences in CPAP adherence at 3 (X(2)=0.065, p=0.79) and 6 (X(2)=.118, p=0.73) months. Patients' diary data and satisfaction survey results indicated the intervention was rated as helpful and guided formation of a relaxing, habitual routine of CPAP nightly use. CONCLUSION: The intervention had a strong effect for improving adherence to CPAP at 1 month. PRACTICE IMPLICATIONS: Adherence at the onset of treatment is critical and the audio music intervention was easily administered. Other interventions that target problems interfering with longer-term CPAP adherence are needed.

Green tea catechin polyphenols attenuate behavioral and oxidative responses to intermittent hypoxia.

RATIONALE: The intermittent hypoxia (IH) that characterizes sleep-disordered breathing impairs spatial learning and increases NADPH oxidase activity and oxidative stress in rodents. We hypothesized that green tea catechin polyphenols (GTPs) may attenuate IH-induced neurobehavioral deficits by reducing IH-induced NADPH oxidase expression, lipid peroxidation, and inflammation. OBJECTIVES: To assess the effects of GTP administered in drinking water on the cognitive, inflammatory, and oxidative responses to long-term (>14 d) IH during sleep in male Sprague-Dawley rats. METHODS: Cognitive assessments were conducted in the Morris water maze. We measured levels and expression of malondialdehyde (MDA), prostaglandin E(2), p47(phox) subunit of NADPH oxidase, receptor for advanced glycation end products (RAGE), and glial fibrillary acidic protein expression in rodent brain tissue. MEASUREMENTS AND MAIN RESULTS: GTP treatment prevented IH-induced decreases in spatial bias for the hidden platform during the Morris water maze probe trails as well as IH-induced increases in p47phox expression within the hippocampal CA1 region. In untreated animals, IH exposure was associated with doubling of cortical MDA levels in comparison to room air control animals, and GTP-treated animals exposed to IH showed a 40% reduction in MDA levels. Increases in brain RAGE and glial fibrillary acidic protein expression were observed in IH-exposed animals, and these increases were attenuated in animals treated with GTP. CONCLUSIONS: Oral GTP attenuates IH-induced spatial learning deficits and mitigates IH-induced oxidative stress through multiple beneficial effects on oxidant pathways. Because oxidative processes underlie neurocognitive deficits associated with IH, the potential therapeutic role of GTP in sleep-disordered breathing deserves further exploration.

The role of behavioral sleep medicine in the assessment and treatment of sleep disordered breathing.

With the dramatic rise in obesity in the United States, comorbid medical issues, such as sleep apnea and other forms of sleep disordered breathing (SDB), are becoming increasingly prevalent. Individuals with SDB have impairments in social, cognitive, and emotional functioning and an overall reduction in quality of life. Continuous positive airway pressure (CPAP) is the first-line treatment for SDB. CPAP use is associated with improvements in psychosocial functioning when individuals use the machine regularly. Unfortunately, CPAP adherence rates are often low. Patients sometimes discontinue CPAP therapy due to undesirable side effects, such as anxiety, insomnia, and nasal discomfort, or inconvenience. The goal of this review is to highlight the growing role of behavioral sleep medicine in the assessment and treatment of SDB and psychosocial impairments comorbid with SDB. More than any other health specialty, psychologists with behavioral sleep medicine experience are in the best position to treat psychiatric symptoms exacerbated by SDB-related sleep disturbances. Behavioral sleep medicine specialists also possess the expertise to address psychological obstacles to CPAP use. The assimilation of behavioral sleep medicine specialists into sleep clinics is likely to improve the overall quality of care for patients with SDB.

A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia.

OBJECTIVE: To prospectively evaluate the relationship between obstructive sleep apnea syndrome (OSAS), nocturia and quality of life in elderly patients free of the urologic and medical conditions that lead to increased nocturia. METHODS: Prospective study of nocturia in men 65 years and older with isolated OSAS or sleep onset insomnia. After a 7-day nocturia evaluation and nocturnal polysomnography, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Quality of Life (SF-36) were administered. RESULTS: OSAS patients with frequent nocturia had significantly greater body mass index (BMI), greater apnea-hypopnea index (AHI), lower lowest oxygen saturation and lower SF-36 subscale scores. Treatment with nasal continuous positive airway pressure (CPAP) for OSAS and behavioral techniques for insomnia improved ESS and BDI scores for all three groups. SF-36 subscale scores improved more in subjects with multiple nocturia. AHI and BMI explain 38% of the variance for nocturia. CONCLUSION: Nasal CPAP reduces OSA and nocturia and improves quality of life of elderly patients.

Identification of quality of life concerns of patients with obstructive sleep apnoea at the time of initiation of continuous positive airway pressure: a discourse analysis.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is a common condition with multiple symptoms dominated by daytime somnolence. Thus many worries and concerns of patients remain hidden. Treatment by nasal continuous positive airway pressure (CPAP) can be imposing for the individual. An analysis of the freely expressed concerns of such patients is required. OBJECTIVE: To seek an in-depth analysis of how patients live with sleep apnoea by allowing them an open discourse and analysing the text of their statements. DESIGN: A trained psychologist conducted semi-directive interviews with patients attending a pulmonary rehabilitation and convalescent unit around the themes of sleep, health and treatment. An analysis of content and of discourse was carried out by textual analysis and by propositional analysis of discourse (PAD) with the aid of dedicated computer programs (Tropes, Sphinx Lexica). RESULTS: Thirty patients with severe sleep apnoea were interviewed of whom 15 were initiating treatment with CPAP. Patients spoke of abnormal fatigue (22 mentions) and somnolence (21 times). Many have problems with obesity (25 instances), snoring related problems (12). There were 30 mentions of depression with a relationship to alcohol and anti-depressives. Twenty six times the theme of nocturnal waking was raised. There were many instances of problems with CPAP (nasal mask and noise problems raised 21 times). Patients have problems with relationships and sex because of OSAS. Other concerns were loss of memory and fear of dying. CONCLUSION: In a non-directed conversation OSAS patients express concerns not revealed in the standard medical paradigm and such concerns should be addressed in assessing treatment or evaluating quality of life (QOL).

The breathing bear: effects on respiration in premature infants.

The sleep states and the regularity of quiet sleep (QS) respiration were investigated in premature infants who were provided a "breathing" teddy bear. The bear (BrBr) is a source of optional rhythmic stimulation that reflects the breathing rate of the individual infant it is with. At 33 weeks CA, 19 premature infants were given a BrBr and 17 were given a nonbreathing bear (N-BrBr). At 35 weeks CA, and again at 45 weeks CA, a 1-2-h interfeed motility recording was obtained. These analog signals were scored for active sleep, QS, and wakefulness; and each 10-s epoch of QS was judged for regularity of respiration using a four-point rating scale. At 35 weeks, the BrBr babies showed slower and more regular respiration during QS. At 45 weeks, the BrBr babies showed more QS and less active sleep. At both ages, only the BrBr babies showed a correlation between respiratory regulatory and the amount of QS. The findings suggest facilitation of neurobehavioral development as well as entrainment from optional stimulation, which reflects one of the infant's own biological rhythms.

Effects of submental stimulation for several consecutive nights in patients with obstructive sleep apnoea.

BACKGROUND: It has previously been reported that short term submental stimulation can reduce the frequency of apnoea and improve sleep architecture in patients with obstructive sleep apnoea. The effects of submental stimulation during consecutive nights on apnoea or on daytime sleepiness have not, however, been studied. METHODS: Patients with obstructive sleep apnoea were studied by polysomnography on a control night, for five consecutive nights of submental stimulation, and on three following nights (n = 8). A multiple sleep latency test (MSLT) (n = 8) and measurement of the upper airway resistance (n = 5) were performed during the day after the polysomnographic study, on the control night, and on the fifth stimulation night. In an additional five patients with obstructive sleep apnoea, matched for age, sex, and weight, the effects of two nights of stimulation were examined for comparison. Submental stimulation began when an apnoea lasted for five seconds and stopped with the resumption of breathing as detected by oronasal flow. RESULTS: The apnoea index, the number of times per hour that SaO2 dropped below 85% (SaO2 < 85%/hour), and the total apnoea duration expressed as a percentage of total sleep time during stimulation nights decreased to approximately 50% of the corresponding values on the control night. This improvement persisted for at least two nights after the five consecutive stimulation nights, but not after the two consecutive stimulation nights. Sleep architecture and MSLT following the stimulation nights improved but upper airway resistance did not change. CONCLUSIONS: Submental stimulation for five consecutive nights in patients with obstructive sleep apnoea improved the breathing disturbance, sleep quality, and daytime sleepiness. The effect lasted for the following two nights, but did not completely abolish the sleep disordered breathing.