Effect of PM2.5 exposure on Vitamin D status among pregnant women: A distributed lag analysis.

BACKGROUND: Serum vitamin D levels are associated with exposure to air pollution, however, the lagged effect of exposure to air pollution remains unknown in pregnant women. METHODS: Pregnant women who delivered at a maternity center in Shanghai, China, from 2015 to 2019 were included in the present study. The concentration of particulate matter 2.5 (PM2.5) before 25-Hydroxyvitamin D [25(OH)D] detection was estimated using the satellite-based grid models. The distributed lag non-linear models were performed to examine the lagged association between weekly-specific PM2.5 exposure and vitamin D deficiency (VDD) or serum 25(OH)D levels. RESULTS: Among the 58,025 pregnant women included in the study (mean age at conception, 30.77 ± 3.75 years; mean prepregnancy BMI, 21.09 ± 2.55 kg/m2), 61.32% were diagnosed with VDD. Weekly-specific PM2.5 exposure at weeks 1-10 before the detection of 25(OH)D was significantly associated with an increased incidence of VDD (p < 0.05). For every 10 µg/m3 increase in PM2.5 exposure, the serum 25(OH)D level decreased by 1.346 nmol/L (95%CI: 1.183-1.508 nmol/L). The association between average PM2.5 exposure and VDD at 1-10 weeks was more significant in weather conditions with low mean sunshine hours (OR: 1.246, 95%CI: 1.221-1.271). CONCLUSION: Our study provided suggestive evidence that PM2.5 exposure at 1-10 weeks before the 25(OH)D detection may decrease the circulating 25(OH)D levels in pregnant women and increase VDD risk in pregnant women. More attention should be paid to the long-term impact of PM2.5, in particular, during weather conditions with a relatively short duration of sunshine.

An observational clinical and video-polysomnographic study of the effects of rotigotine in sleep disorder in Parkinson's disease.

PURPOSE: Sleep disturbance is common in Parkinson's disease (PD) and negatively impacts quality of life. There is little data on how dopamine agonists influence nocturnal sleep in PD, particularly in sleep laboratory data to measure sleep parameters and their changes objectively. The goal of this open-label study was to objectively evaluate the effect of rotigotine on sleep in PD patients by video-polysomnographic methods. METHODS: A total of 25 PD patients with complaints of nocturnal sleep impairment were enrolled. The sleep quality before and after stable rotigotine therapy was evaluated subjectively through questionnaire assessments and objectively measured by video-polysomnographic methods. The Parkinsonism, depression, anxiety, and quality of life of PD patients were also evaluated through questionnaire assessments. RESULTS: At the end of rotigotine treatment, the PD daytime functioning, motor performance, depression, subjective quality of sleep, and the quality of life improved. Video-polysomnographic analysis showed that the sleep efficiency and stage N1% were increased, while the sleep latency, wake after sleep onset, and the periodic leg movements in sleep index were decreased after rotigotine treatment. CONCLUSIONS: Video-polysomnographic analysis confirmed the subjective improvement of sleep after rotigotine treatment. This observation suggests that in PD rotigotine is a treatment option for patients complaining from sleep disturbances.

Low-Dose Atypical Antipsychotic Risperidone Improves the 5-Year Outcome in Alzheimer's Disease Patients with Sleep Disturbances.

Sleep disturbances (SD) accelerate the progression of Alzheimer's disease (AD) and increase the stress of caregivers. However, the long-term outcome of disturbed nocturnal sleep/wake patterns in AD and on increased stress of spousal caregivers is unclear. This study assessed the 5-year effect of nocturnal SD on the long-term outcome in AD patients. A total of 156 donepezil-treated mild-moderate AD patients (93 AD + SD and 63 AD - SD as a control group) were recruited. The AD + SD patients were formed into 4 subgroups according to the preferences of spousal caregivers for treatment with atypical antipsychotics (0.5-1 mg risperidone, n = 22), non-benzodiazepine hypnotic (5-10 mg zolpidem tartrate, n = 33), melatonin (2.55 mg, n = 9), or no-drug treatment (n = 29). SD were evaluated by polysomnography, sleep scale, and cognitive scale examinations. Moreover, all spousal caregivers of AD patients were assessed using a series of scales, including sleep, anxiety, mood, and treatment attitude scales. Our data showed that nocturnal sleep/wake disturbances were significantly associated with lower 5-year outcomes for AD patients, earlier nursing home placement, and more negative emotions of spousal caregivers. Treatment with low-dose atypical antipsychotic risperidone improved the 5-year outcome in AD + SD patients. In conclusion, low-dose atypical antipsychotic risperidone improves the 5-year outcome in AD patients with SD. Moreover, improvement of nocturnal sleep problems in AD patients will also bring better emotional stability for AD caregivers.

[Comparison of caloric responses between vestibular migraine and Ménière disease patients].

OBJECTIVE: To compare the features of caloric tests in vestibular migraine (VM) and Menière's disease (MD) patients, and provide objective evidence for differentiating the 2 groups of patients. METHOD: This case-control study included 11 MD patients with left ear involved and mild to moderate impaired hearing, and 18 matched cases with VM. All participants received caloric tests. Maximum slow phase velocities (SPVmax) were used to describe horizontal and vertical nystagmus respectively and were compared between the 2 groups. Horizontal and vertical canal parasis(CP) were calculated according to respective SPVmax. Unilateral (UW-VR) or bilateral (BW-VR) weakness of vestibular response, and positive unilateral (UVR) or bilateral (BVR) vertical response or negative bilateral vertical response (NBVR) were judged by the boundary point of SPVmax of 5°/s respectively. Total left (LV) or right (RV) Vertical reactions were calculated accoeding to vertical SPVmax,and inter ears difference of vertical responses (IED-VR) calculated from LV minus RV. RESULT: There were no significant differences in age and gender between the 2 groups. Horizontal SPVmax of all of caloric tests of VM group,except the left cold (LC), were statistically larger than that of MD group (P < 0.05) and the maximum responses of right warm (RW) caloric test in VM group (34.50 ± 17.77) were significantly greater than that in MD group (12.82 ± 6.69) (P < 0.01). Only the vertical SPVmax of RW of all caloric tests has statistically difference between the 2 groups (P < 0.01), and the maximum responses of RW caloric test in VM group (6.00 ± 4.45) were significantly stronger than that of LC in MD group (1.27 ± 2.00) (P < 0.01). Horizontal CP ≥ 25% of the 2 groups(VM: 72.22%, MD: 54.55%) were not statistically different, while the proportions of UW-VR and BW-VR in VM group (5.56%, 0) were significantly lower than that in MD group (27.27%, 18.18%) (P < 0.05). Vertical CP ≥ 25% of the 2 groups (VM: 94.44%, MD: 27.27%) were significantly different (P < 0.01), and the proportions of positive UVR (left: 5.56%, right: 77.78%) and BVR (0) and NBVR (16.67%) in VM group were significantly different from that in MD group (UVR (left: 9.09%, right: 0), BVR (0), NBVR (90.91%)) (P < 0.01). There was statistically difference between LV and RV in VM group (P < 0.01, LV < RV), while no difference were showed in MD group. IED-VR in VM group (left intenser: 16.67%, right intenser: 83.33%) was statistically different from that in MD group (left intenser: 36.36%, right intenser: 9.09%, both no difference: 54.55%) (P < 0.01). CONCLUSION: Vestibular responses of caloric test are more sensitive, and vertical reactions are more easily induced in VM patients than in MD. Caloric test can be used to differentiate the 2 groups of diseases.

Effects of Rotigotine on REM Sleep Behavior Disorder in Parkinson Disease.

STUDY OBJECTIVES: REM sleep behavior disorder (RBD) is a common manifestation of Parkinson disease (PD). In this study, we assessed the effects of rotigotine transdermal patch on RBD features in patients with PD. METHODS: In this prospective open-label study, eleven PD patients with untreated RBD were administered rotigotine patches for up to seven months to ameliorate their parkinsonism. The severities of their RBD symptoms before and after rotigotine therapy were evaluated through patient and bed partner interviews, a validated evaluation scale (REM sleep behavior disorder questionnaire-Hong Kong, RBDQ-HK), and blinded assessments based on video-polysomnographic (VPSG) measure. RESULTS: Rotigotine improved parkinsonism and subjective sleep quality in PD patients with RBD. The RBDQ-HK total score, especially the Factor 2 score, was decreased, which demonstrated that the subjective severity of RBD symptoms was improved after rotigotine treatment, especially the frequency and severity of abnormal RBD-related motor behaviors. The VPSG analyses showed that the total sleep time (TST) and stage 1% were increased and that the PLMS index was decreased. However, no differences in the RBD-related sleep measures were observed. CONCLUSIONS: The improved RBD symptoms and VPSG measures of PD patients in this study (TST, stage 1%, and PLMS index) suggest that, in PD, rotigotine may partially improve RBD-related symptoms. Rotigotine should be considered to be an optional drug for the treatment of RBD symptoms in PD.

Validation of the rapid eye movement sleep behavior disorder screening questionnaire in China.

We validated the Chinese version of the rapid eye movement sleep behavior disorder (RBD) screening questionnaire (RBDSQ) and calculated its cut-off value for idiopathic or symptomatic sleep behavior disorders (iRBD or sRBD) in Chinese people. Patients with RBD (n=63) and controls (n=165) were enrolled. After all subjects had completed a structured interview, the Chinese version of the RBDSQ and the video polysomnography test, we evaluated the reliability, areas under the curves and the best cut-off values of the RBDSQ and investigated the utility of RBDSQ for iRBD and sRBD in China. We found that Cronbach's alpha was 0.769 and the test-retest reliability was 0.916. RBDSQ scores in iRBD and sRBD patients were similar and higher than those in controls. A total of five points represented the best cut-off value for detecting all RBD patients. In Parkinson's disease, a total score of six points represented the best cut-off value for detecting sRBD. There was no statistically significant difference in total RBDSQ score between iRBD and sRBD, or male and female patients. There was no significant correlation between the RBDSQ score and duration or severity of RBD symptoms. The Chinese version of the RBDSQ had high sensitivity, specificity and reliability and could be used as a tool for screening RBD patients in China.