Sleep and memory complaints in long COVID: an insight into clustered psychological phenotypes.

This study evaluated clinical features of individuals with long COVID (5-8 months after diagnosis) who reported sleep and memory problems (62 cases) compared to those without (52 controls). Both groups had a similar mean age (41 vs. 39 years). Around 86% of the participants were non-hospitalized at the time of infection, and none of them were vaccinated at that point. Subsequently, both cases and controls received the vaccine; however, the vaccination rates differed significantly between the groups (30.7% vs. 51.0%). Cases and controls had similar rates of symptoms at acute COVID phase. However, cases were more likely to experience coryza, dyspnea, headache, and nausea/vomiting during long COVID. Regarding new-onset symptoms in long COVID, 12.9% of cases had dyspnea, and 14.5% experienced nausea/vomiting, whereas in the control group there were only 1.9% and 0.0%, respectively. Cases also had a significantly higher prevalence of persistent headache (22.6% vs. 7.7%), and dyspnea (12.9% vs. 0.0). In addition, cases also showed an increased rate of mental health complaints: disability in daily activities (45.2% vs. 9.6%; P < 0.001); concentration/sustained attention difficulties (74.2% vs. 9.6%; P < 0.001); anxiety-Generalized Anxiety Disorder 2-item scale (GAD-2) ≥ 3 (66.1% vs. 34.6%; P = 0.0013); and "post-COVID sadness" (82.3% vs. 40.4%; P < 0.001). We observed a significant correlation between sadness and anxiety in cases, which was not observed in controls (P=0.0212; Spearman correlation test). Furthermore, the frequency of concomitant sadness and anxiety was markedly higher in cases compared to controls (59.7% vs. 19.2%) (P < 0.0001; Mann-Whitney test). These findings highlight a noteworthy association between sadness and anxiety specifically in cases. In conclusion, our data identified concurrent psychological phenotypes in individuals experiencing sleep and memory disturbances during long COVID. This strengthens the existing evidence that SARS-CoV-2 causes widespread brain pathology with interconnected phenotypic clusters. This finding highlights the need for comprehensive medical attention to address these complex issues, as well as major investments in testing strategies capable of preventing the development of long COVID sequelae, such as vaccination.

Persistent, new-onset symptoms and mental health complaints in Long COVID in a Brazilian cohort of non-hospitalized patients.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections lead to acute- and chronic Long COVID (LC) symptoms. However, few studies have addressed LC sequelae on brain functions. This study was aimed to examine if acute symptoms of coronavirus disease 2019 (COVID-19) would persist during LC, and if memory problems would be correlated with sleep, depressive mood, or anxious complaints. METHODS: Our work followed a cohort of 236 patients from two public hospitals of the Federal District in mid-western Brazil. Patients' interviews checked for clinical symptoms during acute and LC (5-8 months after real-time reverse transcription polymerase chain reaction, RT-qPCR). RESULTS: Most cases were non-hospitalized individuals (86.3%) with a median age of 41.2 years. While myalgia (50%), hyposmia (48.3%), and dysgeusia (45.8%) were prevalent symptoms in acute phase, fatigue (21.6%) followed by headache (19.1%) and myalgia (16.1%) commonly occurred during LC. In LC, 39.8% of individuals reported memory complaints, 36.9% felt anxious, 44.9% felt depressed, and 45.8% had sleep problems. Furthermore, memory complaints were associated with sleep problems (adjusted OR 3.206; 95% CI 1.723-6.030) and depressive feelings (adjusted OR 3.981; 95% CI 2.068-7.815). CONCLUSIONS: The SARS-CoV-2 infection leads to persistent symptoms during LC, in which memory problems may be associated with sleep and depressive complaints.

microRNA signatures in prodromal REM sleep behavior disorder and early Parkinson's disease as noninvasive biomarkers.

The flow of gene expression or "The central dogma of molecular biology": DNA - RNA - protein, proposed by Watson & Crick sixty years ago, is a tightly controlled cell process. In the middle of this journey, the mRNA molecule is regulated by "RNA interference" (RNAi), a posttranscriptional gene silencing mechanism. A microRNA is an endogenous short double-stranded RNA that down-regulates hundreds of mRNAs by RNAi, maintaining healthy cell physiology. In contrast, aberrant expressions of microRNAs play a role in Parkinson's disease (PD) pathogenesis. The damage may start at an early period of brain degeneration, in the non-motor or "prodromal" stage, where autonomic, mood and sleep changes are often manifested. REM-sleep behavior disorder (RBD) is the prodromal manifestation with the highest odds for conversion into PD, thereby a valuable phenotype for disease prediction. The present review focuses on microRNAs' role in the pathogenesis of PD and RBD, summarizing the state-of-the-art of these RNA molecules as noninvasive biomarkers for non-motor prodromal (RBD) and early PD.

Restless legs syndrome and pain disorders: what's in common?

Between 10 % and 30 % of the population report chronic pain. More than half of these also have sleep complaints. From considering these data, it can be inferred there is a significant overlapping between these conditions. Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is characterized by complaints of an "urge to move" frequently associated with dysesthesias. From that perspective, these sensations can also have painful characteristics. By the same token, the presence of comorbid diseases as predicted by a higher prevalence RLS/WED, have many of them with pain as an important complaint. Pain is a multidimensional response involving several levels of expression ranging from somatosensory to emotional. The potential shared mechanisms between RLS/WED and pain may involve sleep deprivation/fragmentation effect, inducing an increase in markers of inflammation and reduction in pain thresholds. These are modulated by several different settings of neurotransmitters with a huge participation of monoaminergic dysfunctional circuits. A thorough comprehension of these mechanisms is of utmost importance for the correct approach and treatment choices.

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation.

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation / Medicina do sono Forense: uma revisao critica da literatura e breves comentarios sobre a situacao brasileira

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.

A medicina do sono é um campo relativamente novo dentro das Ciências Médicas. Seus aspectos legais encontram-se ainda na obscuridade, seja por falta de conhecimento dos mecanismos biológicos do desenvolvimento dos transtornos de comportamento e da violência praticada em estados alterados de sono, seja por virtual ausência de previsão legal do binômio tratamento/punição. Realizamos revisão atualizada da literatura para determinar as condições patológicas mais prevalentes envolvendo violência e sono, identificar seus fatores precipitantes mais comuns e os critérios médico-legais que podem auxiliar eventuais médicos-peritos ou assistentes na elaboração de pareceres abalizados em âmbito legal.

Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas.

BACKGROUND AND PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS) has been reported in the literature for many years. Nevertheless, this pathological association has not yet been extensively studied and many questions remain unanswered. The primary concern of this study is to evaluate the influence of nasal continuous positive airway pressure (n-CPAP) therapy on daytime sleepiness and fatigue as well as the presence of a possible long-term beneficial effect on RLS severity and, secondarily, to ascertain the clinical, neurophysiological and polysomnographic characteristics of a group of patients with both OSAS and RLS. PATIENTS AND METHODS: All patients had a diagnostic polysomnography (PSG) and a second polysomnography for titration of n-CPAP. Laboratory tests (blood glucose, serum ferritin), body mass index (BMI) calculation and a neurophysiological evaluation (auditory P300 and electroneuromyography) were done. The Epworth Sleepiness Scale (ESS) and the Pichot's questionnaire of fatigue/depression (PIC) were applied to all patients before and after three months of n-CPAP treatment. The International Restless Legs Syndrome Study Group rating scale (IRLS) was applied before and after n-CPAP. Results were compared. RESULTS: The ESS scores decreased from 10.64+/-4.83 at baseline to 7.41+/-3.5 (P<0.05). PIC scores decreased from 16.65+/-7.27 to 10.12+/-6.40 (P<0.01). IRLS scores decreased from 17.60+/-7.11 before to 12.52+/-9.25 after n-CPAP (P<0.05). CONCLUSIONS: Our findings suggest that not only fatigue and sleepiness but also the severity of RLS show a favorable response to n-CPAP in the group of patients with OSAS and RLS.