Effect of Mirror Therapy on Upper Limb Function in Children and Adolescents with Hemiplegic Cerebral Palsy: A Systematic Review and Meta-Analysis.

BACKGROUND: This review aimed to explore the effect of mirror therapy (MT) on upper limb function in children and adolescents with hemiplegic cerebral palsy (HCP). METHODS: MEDLINE, CENTRAL, Scopus, PEDro, and Web of Science were systematically searched. PEDro scale  was used for the quality assessment of included trials. Risk of Bias assessment was done using Cochrane Risk-of-bias tool version 2. Meta-analysis was performed on four of the seven studies included. RESULTS & CONCLUSION: The majority of the trials included in this review found MT efficacious in improving motor function in HCP. Quantitative analysis of the included trials using QUEST scores for evaluation of quality of upper extremity function revealed positive but non-significant difference between the groups (MD = -0.12; 95% CI = -2.57,2.33; Z = 0.09, p = .92). Pooled analysis of the included trials using BBT, however, favored control (MD = 4.98; 95% CI = 2.32,7.63; Z = 3.67, p = .0002).

Prevalence of poor sleep quality among physicians and nurses in a tertiary health care center.

Objectives: Sleep quality among tertiary healthcare professionals in KSA has not been well studied. Therefore, in this study, we aimed to assess sleep quality among physicians and nurses in a tertiary care center in Jeddah City and to identify the associated factors. Methods: In this quantitative, analytical, cross-sectional study, an online, self-administered questionnaire was distributed to all physicians and nurses working at King Abdulaziz University Hospital (KAUH). A total of 395 healthcare professionals participated in this study. The questionnaire included the participants' demographic characteristics and Pittsburgh Sleep Quality Index (PSQI) values. Results: The mean age and body mass index of the participating healthcare professionals were 37.74 ± 10.35 years and 26.32 ± 4.97 kg/m2, respectively. Most participants were women (70.4%) and expatriates (55.4%). The prevalence of poor sleep quality was high: 70.4% of the participants had a PSQI score >5. Several factors, such as female sex (adjusted odds ratio (AOR) = 2.03; 95% confidence interval (CI) = 1.11-3.74), shift work (AOR = 1.87; 95% CI = 1.01-3.45), physical inactivity (AOR = 2.43; 95% CI = 1.01-5.85), and current smoking (AOR = 4.64; 95% CI = 1.68-12.80), were associated with poor sleep quality among healthcare professionals. Conclusions: Our findings are consistent with those from previous studies indicating high prevalence of poor sleep quality among healthcare professionals. Furthermore, female sex, shift work, smoking, and physical inactivity were identified as risk factors for poor sleep quality.

Exploring the Mediating Role of Sleep Deficit-Related Functional Status in Subacute Stroke Survivors.

Background: Understanding post-stroke fatigue (PSF) and its associated factors is crucial for effective therapy and rehabilitation. This study aimed to assess the mediating role of the excessive daytime sleepiness-related functional status (SFS) on the relationship between sleep and the severity of fatigue in subacute stroke survivors. Methods: Subacute stroke survivors (n = 50; male = 38; female = 12), completed a cross-sectional study involving the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the insomnia severity index (ISI), the functional outcome of the sleep questionnaire (FOSQ), and the fatigue severity scale (FSS). Results: The SFS mediated the association between the severity of fatigue and sleep problems. The PSQI and FOSQ (b = -0.37, p < 0.001), and the FOSQ and FSS were correlated (b = -0.18, p < 0.05), with a significant indirect effect of the PSQI on the FSS. The ISI correlated with the FOSQ (b = -0.20, p < 0.001), with significant direct (b = 0.15, p < 0.001), as well as indirect, effects of the ISI on the FSS. The ESS correlated with the FOSQ (b = -0.23, p < 0.001), with a significant indirect effect of the ESS on the FSS. Conclusions: In subacute stroke survivors, fatigue and sleep are linked. Increased understanding of sleep-PSF may help in exploring new targets for supplement therapy.

Effect of plyometric versus complex training on core strength, lower limb, and upper limb power in male cricketers: a randomized controlled trial.

BACKGROUND: Complex training is found effective in improving physical performance in various sports. There is a paucity of research evidence comparing the efficacy of complex vs. plyometric training in cricket players. The study aimed to compare the efficacy of complex and plyometric training on physical performance parameters in cricket players. METHODS: Participants (n = 42 Male; age group = 18-26 years) were randomly allocated into three groups, complex training group (CTG) (n = 14; BMI = 20.51 ± 2.23), plyometric training group (PTG) (n = 14; BMI = 20.57 ± 2.82), and control group (CG) (n = 14; BMI = 20.51 ± 2.23). CTG and PTG received their respective training twice weekly, and CG received routine training for four weeks. Pre and post-intervention assessments of core muscle strength (CM), multistage fitness (MF), push-up (PU), lateral cone jump (LCJ), and stationary vertical jump (SVJ) were performed. This study has been registered in clinicaltrials.gov (ID: NCT05646914, on 05/12/2022). RESULTS: A significant difference was observed between CTG vs. CG for CM (p ≤ 0.01), LCJ (p < 0.05), and SVJ (p ≤ 0.01), similarly in PTG vs. CG for CM (p-value), LCJ (p ≤ 0.05) and SVJ (p ≤ 0.01). However, No significant difference was found between PTG vs. CTG for any variables (p ≥ 0.05). Also, No significant difference in MF and PU was found between the groups (p ≥ 0.05). CONCLUSIONS: Complex training has been found to have effects similar to plyometric training alone. Therefore, either of the two strategies can be used to improve the performance of male cricket players.

Correlation of HbA1c Level with Lipid Profile in Type 2 Diabetes Mellitus Patients Visiting a Primary Healthcare Center in Jeddah City, Saudi Arabia: A Retrospective Cross-Sectional Study.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) patients are at high risk of dyslipidemia, which in turn is associated with macrovascular diseases, such as heart diseases and stroke, and microvascular diseases, such as neuropathy and nephropathy. There are contradictory findings in the literature regarding the relationship between glycated hemoglobin (HbA1c) and the lipid profile among T2DM patients. This study was performed to investigate the association between HbA1c level and the lipid profile in elderly T2DM patients at a primary care hospital in Jeddah City, Saudi Arabia. METHODS: This study is a retrospective cross-sectional study conducted at the Prince Abdul Majeed Healthcare Center (PAMHC) in Jeddah, Saudi Arabia. The sociodemographic and clinical data of the T2DM patients who had visited the PAMHC from 1 January 2020 to 31 December 2021, were collected from the data registry of the PAMHC and analyzed for publication. RESULTS: The study included a total of 988 T2DM patients (53.3% male). Of the participants, 42.9% were aged between 55 and 64 years. Dyslipidemia parameters were presented as high LDL-c (in 60.3% cases), low HDL-c (in 39.8% cases), high triglycerides (in 34.9% cases), and high total cholesterol (in 34.8% cases). The correlation of HbA1c with total cholesterol (TC) and triglycerides (TGs) was positively significant, thereby highlighting the important link between glycemic control and dyslipidemia. A mean increase of 4.88 mg/dL and 3.33 mmHg in TG level and diastolic blood pressure, respectively, was associated with the male gender, in comparison to the female gender. However, the male gender was significantly associated with the reduction in the mean cholesterol level, BMI, HbA1c, HDL-c, and LDL-c by 11.49 mg/dL, 1.39 kg/m2, 0.31%, 7.47 mg/dL, and 5.6 mg/dL, respectively, in comparison to the female gender. CONCLUSIONS: The results of this study show that HbA1c was significantly associated with cholesterol and triglyceride levels in the T2DM patients included in the study. Our findings highlight the important relationship between glycemic control and dyslipidemia.

Does fear of re-injury affect the self-perceived level of lower limb functionality among soccer players with ACL reconstruction?: A cross-sectional study.

The fear of re-injury may persist after anterior cruciate ligament (ACL) reconstruction (ACLR) in professional soccer players (PSPs) even after a successful return to sport (RTS). This study aimed to determine the extent of this fear of re-injury and the impact of demographic variables and this fear of re-injury on the lower extremity functional scale (LEFS) scores in PSPs who had completed a successful RTS following ACLR. A cross-sectional survey design was used. Sixty-seven PSPs who had successfully RTS after ACLR, completed a demographic information sheet, the Athlete Fear-Avoidance Questionnaire (AFAQ), and the LEFS. The average AFAQ scores indicated low fear (M = 10.2, SD = 6.7), while high LEFS scores were observed (M = 67.1, SD = 12.4). There were significant strong negative correlations between LEFS and body mass index (BMI; rs [65] = -0.501, P = .001) and AFAQ and BMI (rs [65] = -0.378, P = .001). A hierarchical linear regression analysis found AFAQ to be a significant predictor of LEFS (b = -0.92, s.e. = 0.19, P = .001), with a total variance (adjusted R2) of 32.9%. PSPs' fear of re-injury post-ACLR significantly reduced their perceived levels of lower limb functionality. This study highlights the need to further explore and develop strategies to manage PSP fear of re-injury to improve sports-related performance post-ACLR.

Reliability generalization meta-analysis of the Athens Insomnia Scale and its translations: Examining internal consistency and test-retest validity.

The Athens Insomnia Scale (AIS) is a widely used self-report measure to evaluate insomnia symptoms based on the International Classification of Diseases criteria version 10 (ICD-10). Despite its extensive use in clinical and research settings, the reliability of the AIS has not been systematically investigated. This systematic review reports a reliability generalization meta-analysis study to assess the internal consistency and the test-retest reliability of the AIS across various populations and settings. A systematic literature search was conducted to identify studies reporting Cronbach's alpha and test-retest coefficients for the AIS. Pooled estimates of reliability, along with moderator analyses, were calculated. The AIS has an excellent internal consistency of 0.84 (95% CI: 0.81 to 0.86), and re-test reliability of 0.86 (95% CI: 0.80 to 0.92). The significant heterogeneity levels support the recommendation that future studies using the AIS include and discuss reliability estimates based on their own data.

The mediating role of attention deficit in relationship between insomnia and social cognition tasks among nurses in Saudi Arabia: A cross-sectional study.

Purpose: Insomnia-related affective functional disorder may negatively affect social cognition such as empathy, altruism, and attitude toward providing care. No previous studies have ever investigated the mediating role of attention deficit in the relationship between insomnia and social cognition. Methods: A cross-sectional survey was carried out among 664 nurses (Mage = 33.03 years; SD ± 6.93 years) from December 2020 to September 2021. They completed the Scale of Attitude towards the Patient (SAtP), the Athens Insomnia Scale (AIS), a single-item numeric rating scale assessing the increasing severity of attention complaints, and questions relating to socio-demographic information. The analysis was carried out by examining the mediating role of attention deficit in the relationship between insomnia and social cognition. Results: The prevalence of insomnia symptoms was high (52% insomnia using the AIS). Insomnia was significantly correlated with attention problems (b = 0.18, standard error (SE) = 0.02, p < 0.001). Attention problems were significantly negatively correlated with nurses' attitudes towards patients (b = -0.56, SE = 0.08, p < 0.001), respect for autonomy (b = -0.18, SE = 0.03, p < 0.001), holism (b = -0.14, SE = 0.03, p < 0.001), empathy (b = -0.15, SE = 0.03, p < 0.001), and altruism (b = -0.10, SE = 0.02, p < 0.001). Attention problems indirectly mediated the effect of insomnia on attitudes toward patients (99% CI = -0.10 [-0.16 to -0.05]), respect for autonomy (99% CI = -0.03 [-0.05 to -0.02]), holism (99% CI = -0.02 [-0.04 to -0.01]) empathy (99% CI = -0.03 [-0.04 to -0.01]), and altruism (99% CI = -0.02 [-0.03 to -0.01]). Conclusion: Nurses with insomnia-related attention problems are likely to have poor explicit social cognition such as attitude toward patients, altruism, empathy, respect for autonomy, and holism.

Sleep duration during the COVID-19 pandemic in Bangladesh: A GIS-based large sample survey study.

Although several studies have been conducted in Bangladesh regarding sleep problems during the COVID-19 pandemic, none have utilized a large nationwide sample or presented their findings based on nationwide geographical distribution. Therefore, the aim of the present study was to explore the total sleep duration, night-time sleep, and daily naptime and their associated factors as well as geographic information system (GIS) distribution. A cross-sectional survey was carried out among 9730 people in April 2020, including questions relating to socio-demographic variables, behavioral and health factors, lockdown, depression, suicidal ideation, night sleep duration, and naptime duration. Descriptive and inferential statistics, both linear and multivariate regression, and spatial distribution were performed using Microsoft Excel, SPSS, Stata, and ArcGIS software. The results indicated that 64.7% reported sleeping 7-9 h a night, while 29.6% slept less than 7 h nightly, and 5.7% slept more than 9 h nightly. 43.7% reported 30-60 min of daily nap duration, whereas 20.9% napped for more than 1 h daily. Significant predictors of total daily sleep duration were being aged 18-25 years, being unemployed, being married, self-isolating 4 days or more, economic hardship, and depression. For nap duration, being aged 18-25 years, retired, a smoker, and a social media user were at relatively higher risk. The GIS distribution showed that regional division areas with high COVID-19 exposure had higher rates of non-normal sleep duration. Sleep duration showed a regional heterogeneity across the regional divisions of the country that exhibited significant associations with a multitude of socioeconomic and health factors.

Prevalence of Upper Limb Musculoskeletal Disorders and Their Association with Smartphone Addiction and Smartphone Usage among University Students in the Kingdom of Saudi Arabia during the COVID-19 Pandemic-A Cross-Sectional Study.

This study aimed to investigate the prevalence of upper limb musculoskeletal disorders (MSDs) and their association with smartphone addiction and smartphone usage among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic. A total of 313 university students aged 18 years and older who owned a smartphone and used it during the preceding 12 months participated in this cross-sectional study. The prevalence of upper limb MSDs, smartphone addiction/overuse, and levels of physical activity were recorded using the standardized Nordic musculoskeletal questionnaire, the smartphone addiction scale (short version), and the international physical activity questionnaire (short form), respectively. Data collection was performed on campus between March and May 2021. Binary logistic regression was used to determine the association between the prevalence of upper limb MSDs and smartphone addiction/overuse and levels of physical activity. The 12-month prevalence of MSDs of the shoulder, elbow, and wrist/hand regions due to smartphone use among participants was found to be 20.13%, 5.11%, and 13.42%, respectively. Shoulder (odds ratio (OR) = 11.39, 95% confidence interval (CI) = 4.64−27.94, p < 0.001), elbow (OR = 15.38, 95% CI = 1.92−123.26, p = 0.01), and wrist/hand MSDs (OR = 7.65, 95% CI = 2.75−21.22, p < 0.001) were more prevalent among participants who were categorized as having smartphone addiction/overuse measures. Promoting awareness about the healthy use of smartphones, including postural education and decreasing screen time, is necessary to reduce smartphone-related MSDs.

Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial.

BACKGROUND: Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke. METHODS: A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer's scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session. RESULTS: Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η2 = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η2 = 0.38) in the experimental group compared to the control group while controlling for baseline scores. CONCLUSIONS: Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.

Neuropsychiatric Consequences of COVID-19 Pandemic: A Synthetic Review from a Global Perspective.

Some research suggests that distress, secondary to isolation and fear following COVID-19 infection, can negatively affect the long-term more than the COVID-19 infection itself. This narrative review aims to provide a global view on the neuropsychiatric consequences of COVID-19 that can be ascribed to several factors, ranging from the direct effect of infection, to the body's responses against the infection, or to the psychological sequelae of social isolation, unemployment, and fear for one's health and livelihood. Current findings show that the more severe the respiratory infection, the more likely are central nervous system (CNS) complications regarding the infection itself. The immune reactions to the infection may result in symptoms similar to chronic fatigue as well as neurocognitive deficits, which last long after the infection is gone. An increase in symptoms of depression, anxiety, and trauma-related stress may also follow upon economic fears and isolation from friends and family. The consequences of the pandemic are not limited to adults; children learning remotely and away from classmates and routine activities may develop adjustment disorders, acute stress disorder, and a variety of manifestations of grief. A summary of case reports suggests that COVID-19-related stress, economic recession, and political unrest increase the risk of suicidal behaviors and acts of violence. However, it is unknown whether manifestations of mental disorders result from social causes or whether CNS complications may be responsible.

Prevalence of rheumatoid arthritis and diagnostic validity of a prediction score, in patients visiting orthropedic clinics in the Madinah region of Saudi Arabia: a retrospective cross-sectional study.

Introduction: In Saudi Arabia, the epidemiology of rheumatoid arthritis (RA) is not well studied and is marked by inconsistencies in clinical diagnosis. Therefore, in this study, we explored the prevalence, clinical characteristics, and diagnostic validity of a prediction score based upon disease markers in orthropedic clinics' patients in the Madinah region of Saudi Arabia. Method: The clinical data for this retrospective cross-sectional study were retrieved from the database registry of orthopedic clinics in selected hospitals of the Medinah province of Saudi Arabia. Sociodemographic features, disease markers and the clinical characteristics were collected for a period of 6 months, from December 1, 2020, to May 31, 2021. The prediction score was generated from the sum of disease markers, coded as dichotomous variables. Results: The total sample size of our study was 401. The prevalence of RA in the study subjects (n = 401) was 14.46% (n = 58). Among RA patients, the majority were females (60.3%). Painful joints (69%) and swollen joints (51.7%) were the most common clinical complaints among RA patients. RA patients suffered from arthritis (51.7%) and experienced fatigue (46.6%), weight loss (44.8%), and loss of appetite (41.4%). Diabetes (55.2%) was the most common comorbidity in the RA patients. The sensitivity and specificity of the prediction score at the criterion score of 2.5 were 67.3% and 63.0%, respectively. The area under the curve was 0.69 (95% CI [0.62-0.76]). Conclusion: There was a moderately high prevalence of RA in patients visiting the orthropedic clinics of the selected hospitals of Madinah region of Saudi Arabia. The diagnostic validity of the prediction score, though promising, was slightly lower than the acceptable range.

Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis.

Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.

Poor Sleep in Community-Dwelling Polysubstance Users: Association With Khat Dependence, Metacognition, and Socio-Demographic Factors.

Purpose: Poor sleep and cognitive deficits are often associated with increased drug use. However, no study has addressed the relationship between poor sleep, substance dependence, and metacognitive deficit in polysubstance users. Methods: This was a cross-sectional study with a simple random sampling involving community-dwelling polysubstance users (n = 326, age = 18-43 years) in Mizan, Ethiopia. Participants completed a brief sleep questionnaire, severity of dependence on khat (SDS-Khat), a brief meta-cognition questionnaire, and a socio-demographic survey. Results: Majority (56.4%) of the polysubstance users had sleep disturbance. Chronic health conditions [adjusted odds ratio (AOR) = 2.52, 95% confidence interval (CI) 1.31-4.85], chronic conditions in the family (AOR = 2.69, 95% CI 1.40-5.20), illiterate-primary level of educational status (AOR = 2.40, 95% CI 1.30-4.04), higher SDS-Khat score (AOR = 1.39, 95% CI 1.13-1.72), and lower meta-cognition score (AOR = 0.90, 95% CI 0.84-0.97) predicted poor sleep in the polysubstance users. Moreover, low metacognition score and high SDS score also predicted additional sleep disturbances like chronic sleep insufficiency, lethargy and restlessness after nighttime sleep, socio-occupational dysfunctions, and daytime disturbances in polysubstance users. Conclusion: Poor sleep, severe khat dependence, and metacognitive deficits are common in community polysubstance users. Moreover, poor sleep is associated with higher khat dependence, lower metacognitive ability, lower educational status, and the presence of chronic conditions in polysubstance users or their families.

Physical activity questionnaire for older children (PAQ-C): Arabic translation, cross-cultural adaptation, and psychometric validation in school-aged children in Saudi Arabia.

The validity of the Physical Activity Questionnaire for Older Children (PAQ-C) has been mostly studied in North America and Europe. We investigated the psychometric validation of the Arabic version of the PAQ-C in students in Saudi Arabia. The students (n = 327, age = 8-14 years) of six primary schools in the Majmaah region participated in the study. Participants completed the PAQ-C, and their demographics were recorded. The PAQ-C scores satisfied the following factor analysis assumptions: diagonal elements of the anti-image correlation matrix (>0.5), Bartlett's test of sphericity (p < 0.001), determinant (>0.00001), Kaiser-Meyer-Olkin test of sampling adequacy (>0.8), and communality (all values > 0.2). Exploratory factor analysis results were inconclusive, with two measures favoring a 2-factor solution (Kaiser's criteria (Eigenvalue ≥ 1), and cumulative variance rule (>40%)); whereas, the scree test and the Monte Carlo parallel analysis favored a 1-factor structure. The confirmatory factor analysis favored a 1-factor solution: highest CFI, lowest RMSEA, non-significant χ2 statistics, and lowest χ2/df. The values of item-total correlation, corrected item-total correlation, and Cronbach's alpha if an item was deleted, ranged from 0.20-0.57, 0.42-0.64, and 0.70-0.75, respectively. The PAQ-C showed a Cronbach's alpha of 0.74. A 1-factor structure of the Arabic version of the PAQ-C had adequate psychometric validity in schoolchildren in Saudi Arabia.

Psychometric Validation of the Athens Insomnia Scale Among Nurses: A Robust Approach Using Both Classical Theory and Rating Scale Model Parameters.

Purpose: Few studies have investigated the validity of the Athens insomnia scale (AIS) using a robust approach of both classical theory and the rating scale model. Therefore, in this study, we investigated psychometric validation of the AIS using both of these approaches in nurses. Methods: Nurses (n= 563, age= 33.2±7.1 years) working in health facilities in Saudi Arabia participated in a cross-sectional study. Participants completed the AIS, socio-demographics tool, and sleep health-related questions. Results: Confirmatory factor analysis (CFA) favored a 2-factor structure with both comparative fit index (CFI), and incremental fit index (IFI) having values above 0.95. The 2-factor model had the lowest values of Akaike information criterion (AIC), root mean square error of approximation (RMSEA), χ 2, and χ 2/df. This 2-factor structure showed configural invariance (CFI more than 0.95, RMSEA less than 0.08, and Χ2/df less than 3), and metric, scalar, and strict invariance (based on Δ CFI ≤-0.01, and Δ RMSEA ≥ 0.015 criteria). No ceiling/floor effects were seen for the AIS total scores. Infit and outfit mean square values for all the items were within the acceptable range (<1.4, >0.6). The threshold estimates for each item were ordered as expected. Cronbach's α for the AIS tool, factor-1 score, factor-2 score was 0.86, 0.82, and 0.72, respectively. AIS factor scores-1/2 were significantly associated with a habitual feeling of tiredness after usual night sleep (p<0.001), Impairment of daytime socio-occupational functioning (p<0.05), and with a feeling of daytime fatigue, irritability, and restlessness (p<0.05). Conclusion: The findings favor the validity of a 2-factor structure of the AIS with adequate item properties, convergent validity, and reliability in nurses.

Pro-inflammatory markers in patients with obstructive sleep apnea and the effect of Continuous Positive Airway Pressure therapy.

Objectives: To evaluate the association of obstructive sleep apnea (OSA) with high-sensitivity C-reactive protein (CRP) and fibrinogen levels and to assess the effect of short-term therapy using continuous positive airway pressure (CPAP). Material and Methods: A prospective, open-label, controlled trial was conducted among clinically referred patients at risk for OSA undergoing diagnostic polysomnography (PSG). After PSG, the patients were divided into 3 groups: OSA treatment group (TG) (n=21), untreated OSA group (UOG) (n=19), and non-OSA healthy control group (HCG) (n=24). CRP and fibrinogen levels were measured at baseline and one month after treatment. Repeated-measures (RM) ANOVA and ANCOVA were used to compare changes in CRP and fibrinogen levels among the three groups by analyzing between-subject and within-subject effects as functions of time and adjusting for significant covariates. Results: At baseline, OSA subjects had significantly higher CRP [t(52.37)=-2.46, p=0.02)] and fibrinogen levels [t(57)=-2.00, p=0.05)] than HCG subjects. No significant differences in CRP levels [(F(2,58)=2.29, p=0.11)] or fibrinogen levels [(F(2, 58)=1.28, p=0.29)] emerged between TG and HCG subjects after adjusting for the pretest levels. Conclusion: CPAP therapy for one month does not affect CRP and fibrinogen levels among moderate-to-severe OSA patients. However, OSA is associated with elevated levels of these inflammatory biomarkers.

Sleep quality and mental health in coronavirus disease 2019 patients and general population during the pandemic.

OBJECTIVE: Sleep problems during the coronavirus disease 2019 (COVID-19) pandemic commonly affected general populations. Data on the effect of the COVID-19 pandemic on sleep quality in Saudi Arabia are scarce. Thus, the aim of our study was to evaluate sleep quality and assess the psychological burden of the pandemic in COVID-19 patients and the general population. METHODS: This was a multicenter, observational, cross-sectional survey. Participants with COVID-19 were recruited from different health-care centers in the western region during the lockdown period from May 13, 2020 to September 2, 2020. All participants completed a validated online survey. The control group comprised individuals from the general public who responded to the online survey through social media. Demographic data, COVID-19 status, and history of chronic diseases were collected. Sleep quality, depression, and insomnia were assessed using validated questionnaires. RESULTS: In total, 1091 participants were surveyed and 643 (58.9%) were positive for COVID-19. Poor sleep quality was reported in 66.1% of COVID-19 patients (mean score ± standard deviation [SD] 6.9 ± 4.0) and 72.8% of controls (mean score ± SD 7.6 ± 4.3). Insomnia affected 50.5% of COVID-19 patients (mean score ± SD 6.5 ± 5.5) and 58.5% of controls (mean score ± SD 7.6 ± 5.5). Depression was diagnosed in 39.5% of COVID-19 patients (mean score ± SD 4.7 ± 4.6) and 70.1% of controls (mean score ± SD 8.9 ± 6.7). CONCLUSIONS: The COVID-19 pandemic had a great impact on mental health and sleep quality in both COVID-19 patients and the general population but more pronounced in the general population.