An in-depth analysis of postoperative insomnia in elderly patients and its implications on rehabilitation.

OBJECTIVES: (1) Assess the prevalence of postoperative insomnia; (2) identify the risk factors for postoperative insomnia before exposure to surgery; (3) explore the impact of postoperative insomnia on rehabilitation. METHODS: A study was conducted with 132 participants aged ≥ 65 undergoing spine interbody fusion. We collected the basic demographic data, Numeric Rating Scales (NRS), Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale (GDS), and Beck Anxiety Inventory (BAI). We measured Quality of Recovery 40 (QoR-40), GDS, BAI, NRS, and PSQI on the first and third nights post-surgery, followed by QoR-40 and NRS assessments two weeks after surgery. RESULTS: The cases of postoperative insomnia on the first and third nights and after two weeks were 81 (61.36%), 72 (54.55%), and 64 (48.48%), respectively, and the type of insomnia was not significantly different (P = 0.138). Sleep efficiency on the first night was 49.96% ± 23.51. On the first night of postoperative insomnia, 54 (66.67%) cases were depression or anxiety, and the PSQI was higher in this group than in the group without anxiety or depression (P < 0.001). PSQI, GDS, and the time of surgery were related factors for postoperative insomnia (PPSQI < 0.001, PGDS = 0.008, and PTime = 0.040). Postoperative rehabilitation showed differences between the insomnia and non-insomnia groups (P < 0.001). CONCLUSIONS: The prevalence of postoperative insomnia in the elderly was high, and postoperative insomnia had a significant correlation with postoperative rehabilitation. Interventions that target risk factors may reduce the prevalence of postoperative insomnia and warrant further research. CLINICAL TRIAL REGISTRATION: Multivariate analysis of postoperative insomnia in elderly patients with spinal surgery and its correlation with postoperative rehabilitation ( https://www.chictr.org.cn/bin/project/edit?pid=170201 ; #ChiCTR2200059827).

Comparative Efficacy and Safety of Multiple Wake-Promoting Agents for the Treatment of Excessive Daytime Sleepiness in Narcolepsy: A Network Meta-Analysis.

Purpose: Narcolepsy is a rare debilitating disorder for which multiple novel pharmacological options have been approved as treatment for the past few years. The current study systematically updates the comparative efficacy and detailed safety analysis of approved wake-promoting agents in narcolepsy. Methods: Randomized controlled trials (RCTs) were searched for diagnosed narcolepsy with approved interventions. Efficacy outcomes included the Maintenance of Wakefulness Test (MWT), Epworth Sleepiness Scale (ESS), Clinical Global Impression of Change (CGI-C), and Patient Global Impression of Change (PGI-C). Safety outcomes including overall adverse event (AE) risk were measured. The study was registered at PROSPERO (CRD 42022334915). Results: The final analysis included 17 RCTs with five drug treatments: modafinil/armodafinil, sodium oxybate, pitolisant, solriamfetol, and lower-sodium oxybate (LXB). For efficacy measures, interventions included in each outcome were effective compared with placebo. Furthermore, the magnitude of solriamfetol effect on MWT (9.11 minutes; 95% CI=7.05-11.16), ESS (-4.79; 95% CI=-6.56 to -3.01), and PGI-C (9.39; 95% CI= 2.37-37.19), and LXB effect on CGI-C (9.67; 95% CI=2.73-34.26) was greater than that of other treatments included in each outcome compared with placebo. For safety measures, all interventions had an acceptable safety profile with LXB having least risk for overall AEs (0.56; 95% CI=0.20-1.53), serious AEs (0.33; 95% CI=0.09-1.20), AEs leading to treatment discontinuation (0.11; 95% CI=0.01-2.04), and all-cause discontinuation (0.04; 95% CI=0.00-0.67) compared to placebo. Placebo had the lowest risk for exploratory AEs. Conclusion: All approved interventions were effective in controlling the symptoms of narcolepsy at varying degrees with an acceptable safety profile.

Central sleep apnea and daytime sleepiness in Niemann-Pick type C disease: a report of 2 cases.

Niemann-Pick disease type C (NPC) is an autosomal recessive hereditary disease in which sphingomyelin and cholesterol are deposited in various organs of the body. The clinical manifestations of NPC include neurologic symptoms and cataplexy; other symptoms related to sleep have seldom been reported. One previous study described various sleep disorders including chronic insomnia, obstructive sleep apnea, restless legs syndrome, and rapid eye movement sleep behavior disorder, thus suggesting that sleep disorders in patients with NPC are more prevalent than previously thought and warrant close attention. Here, we describe sleep disorders in 2 patients with NPC and discuss the clinical characteristics and, for the first time, discuss potential pathogenic mechanisms underlying sleep disorders in such patients. CITATION: Zhang Y, Cheng Y, Li N, et al. Central sleep apnea and daytime sleepiness in Niemann-Pick type C disease: a report of 2 cases. J Clin Sleep Med. 2023;19(2):409-414.

Cerebrospinal Fluid TNF-α and Orexin in Patients With Parkinson's Disease and Rapid Eye Movement Sleep Behavior Disorder.

BACKGROUND: Parkinson's disease (PD) pathological changes begin before motor symptoms appear. Rapid eye movement sleep behavior disorder (RBD) has the highest specificity and predictive value of any marker of prodromal PD. Tumor necrosis factor α (TNF-α) plays a part in the pathology of PD and disease conversion in isolated RBD (iRBD). TNF can also directly impair the hypocretin system in mice in vivo. As a result, we intend to investigate the effect of TNF-α on orexin levels in PD patients with RBD. METHOD: Participants were recruited from the Department of Neurology of Xuanwu Hospital, Capital Medical University to engage in assessments on motor symptoms, sleep, cognition, etc. Then we collected blood and cerebrospinal fluid of all patients and 10 controls' cerebrospinal fluid. The levels of TNF-α in the serum and cerebrospinal fluid, as well as the level of orexin in the cerebrospinal fluid, were measured in the patients. RESULTS: The difference in TNF- levels in cerebrospinal fluid and serum between the three groups were not statistically significant. The levels of orexin in the three groups were not significantly lower than in the control group. UPDRS-III scores were significantly higher in the PD+RBD and PD-RBD groups than in the iRBD group. There was no statistically significant difference in H-Y stages, PSQI, or ESS scores between the PD+RBD and PD-RBD groups. CONCLUSION: Our findings suggest that TNF-α may not have a significant effect on the orexinergic system in patients with Parkinson's disease and iRBD. As a result, it is necessary to investigate the changes in TNF-α and orexin levels in different disease stages and to enlarge the sample size to determine whether TNF-α affects the function of the orexin system, which may be related to the occurrence of RBD and disease progression in Parkinson's disease.

[Effect of Land-use on Soil Fungal Community Structure and Associated Functional Group in Huixian Karst Wetland].

Studying the impact of land-use on fungal communities and their functional groups in wetland soil can provide a theoretical basis for the protection of wetlands. The top soil (0-20 cm) samples were collected from the wetlands with Phragmites communis (PCW), wetlands with Cladium chinense (CCW), abandoned paddy fields (APF), paddy fields (PF), and corn fields (CF) in the Huixian Karst Wetland. The fungal community structure and its functional groups were analyzed using high-throughput sequencing methods and the FUNGuild database, respectively. The results showed that the Simpson and Shannon index in PF and CF were significantly higher than those in PCW and CCW. Ascomyceta was the most dominant phylum in five land-use types with the abundance of 70.60%-87.02%, followed by Rozellomycota in PCW with the abundance of 7.14% and Basidiomycota in CCW, APF, PF, and CF with the abundance of 9.70%, 5.19%, 8.13%, and 7.50%, respectively. Pleosporales was the most dominant order in PCW with the abundance of 16.47%, while Hypocreales was the dominant one in CCW, APF, PF, and CF with the abundance of 22.52%, 23.50%, 17.60, and 23.80%, respectively. Ascobolus and Archaeorhizomyces were the most dominant genera in PCW and CCW with the abundance of 6.65% and 13.44%, respectively, and Fusarium was the most dominant genus in APF, PF, and CF with the abundance of 10.22%, 10.51%, and 11.12%, respectively. Saprotroph was the main trophic mode in the Huixian wetland with the abundance of 48.67%-80.13%. The abundance of pathotroph in CF (5.39%) was higher than that in PCW (2.34%) and CCW (1.53%). Dung saprotroph-wood saprotroph and soil saprotroph were the most dominant functional groups in PCW and CCW, respectively, while animal pathogen-endophyte-lichen parasite-plant pathogen-soil saprotroph-wood saprotroph was the most dominant functional group in APF, PF, and CF. Redundancy analysis showed that both soil water content and the ratio of carbon-to-nitrogen were the main factors affecting fungal communities, and available nitrogen was the main factor affecting the functional groups. Overall, the results indicated that land-use has changed the soil fungal diversity and community structure, complicated the functional groups, and increased the risk of corn disease in the Huixian Karst wetland.

[Comparison of Soil Bacterial Community Structure Between Paddy Fields and Dry Land in the Huixian Karst Wetland, China].

In order to explore the effect of land-use change on soil bacteria in wetland systems, the topsoil (0-20 cm) of a natural wetland (NW), paddy field (PF), and dry land (DL) were collected in the Huixian karst wetland. The α-diversity, species composition, and abundance of soil bacterial communities were analyzed using high-throughput sequencing. The effect of environmental factors on bacterial community structure was also examined. The results showed that the soil bacteria in the Huixian karst wetland can be divided into 49 phyla and 145 classes. The Shannon index of bacteria in the PF was significantly higher, and the Simpson index of bacteria in the NW is significantly lower, than in the other two land-use types. The dominant phyla (operational taxonomic units, OTUs>1%) in the NW were Proteobacteria (52.15%), Actinobacteria (15.16%), and Acidobacteria (8.80%); the dominant phyla in the PF were Proteobacteria (45.79%), Acidobacteria (17.20%), and Chloroflexi (11.75%); the dominant phyla in the DL were Proteus (51.42%), Acidobacteria (15.51%), and Chloroflexi (7.43%). The dominant classes (OTUs>1%) in the NW were α-Proteobacteria (17.98%), ß-Proteobacteria (13.72%), and Actinobacteria (13.13%); the dominant classes in the PF were Acidobacteria (14.35%), ß-Proteobacteria (13.37%), and δ-Proteobacteria (12.02%); the dominant classes in the DL were α-Proteobacteria (19.44%), Formobacteria (13.30%), and Acidobacteria (13.03%). Among the dominant OTUs (>0.3%), the dominant genera of in the NW were Sphingomonas (OTU2, 59), Micromonospora (OTU5, 24 and 50487), Gemmatimonas (OTU1), and Tenotrophomonas (OTU8); the dominant genera in the PF were Lysobacter (OTU4 and 115) and Aquabacterium (OTU33); the dominant genera in the DL were Sphingomonas (OTU85, 157 and 2916), Rhodanobacter (OTU19 and 52), and Penlobacterium (OTU60). A heatmap showed that there were significant differences in soil bacterial community structure among the three land-use types. Redundancy analysis showed that pH, soil organic carbon (SOC), total nitrogen (TN), alkali-hydrolyzable nitrogen (AN), exchangeable Mg2+, exchangeable Ca2+, soluble organic carbon (DOC), and available phosphorus (AP) were the main factors that affected the bacterial community structure in the Huixian karst wetland. These results indicate that changes in land-use types have significantly shaped the structure of soil bacterial communities in this area.