Sleep profiles in epilepsy patients undergoing monotherapy and polytherapy: A comparative cross-sectional study.

OBJECTIVE: Sleep disturbances commonly reported among epilepsy patients have a reciprocal relationship with the condition; While epilepsy and anti-seizure medications (ASMs) can disrupt sleep structure, disturbed sleep can also exacerbate the frequency of seizures. This study explored subjective sleep disturbances and compared sleep profiles in patients who underwent ASM monotherapy and polytherapy. METHODS: We enrolled 176 epilepsy patients who completed a structured questionnaire containing demographic and clinical information and the Persian versions of the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Patient Health Questionnaire-9 (PHQ-9) to evaluate sleep quality, insomnia, excessive daytime sleepiness (EDS), and depressive symptoms, respectively. Chi-square and Mann-Whitney U tests were employed to analyze the association between variables, and logistic regression analysis was conducted to identify factors predicting sleep disturbances. RESULTS: Comparative analysis of mono/polytherapy groups revealed a significantly higher prevalence of insomnia and EDS among patients on polytherapy compared to monotherapy. However, no significant difference was found in sleep quality between the two groups. Logistic regression analysis revealed that a depressive mood serves as a robust predictor for sleep issues, whereas treatment type did not emerge as an independent predictor of sleep disturbances. CONCLUSION: Our findings suggest that an increased number of ASMs does not inherently result in a higher incidence of sleep issues. Therefore, multiple ASMs may be prescribed when necessary to achieve improved seizure control. Furthermore, this study underscores the importance of comprehensive management that addresses seizure control and treating affective symptoms in individuals with epilepsy.

Sleep traits and associated factors among people living with HIV/AIDS in Iran: a two-step clustering analysis.

Sleep plays an essential role in improving the quality of life of people living with HIV (PLWH); however, sleep traits in this population are not well studied. This study aims to evaluate the sleep traits and related associated factors among PLWH in Iran. A nationwide cross-sectional study was conducted with 1185 PLWH who attended Voluntary Counseling and Testing centers in 15 provinces in Iran between April 2021 and March 2022. The Berlin Obstructive Sleep Apnea questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index were used. A two-step clustering method was employed to identify the number of sleep clusters in PLWH. Prevalence of poor sleep quality, sleepiness and insomnia were 49.6%, 21.15% and 42.7% respectively. Three sleep trait clusters were identified: I. minor sleep problems (45.6%); II. Snoring & sleep apnea (27.8%), and III. poor sleep quality and insomnia (26.7%). Age (Odds Ratio (OR) 1.033, 95% Confidence Interval (CI) 1.017-1.050), academic education (OR 0.542, 95% CI 0.294-0.998) and HIV duration were associated with being in Snoring & sleep apnea cluster, while age (OR = 1.027, 95% CI 1.009-1.040) was associated with being in Poor sleep quality and insomnia cluster. PLWH with depression had higher odds of being in Poor sleep quality and insomnia cluster, and those with anxiety had higher odds of being in Snoring & sleep apnea cluster and Poor sleep quality and insomnia cluster. A significant proportion of PLWH have poor sleep quality, sleepiness, and insomnia. The identification of three distinct sleep trait clusters underscores the need for increased attention and tailored interventions to address the specific sleep issues experienced by PLWH.

An Evaluation of Obstructive Sleep Apnea Patient's Quality of life Following Continuous Positive Airway Pressure and Uvulopalatopharyngoplasty.

Aims: Obstructive sleep apnea (OSA) is characterized by episodic sleep state-dependent upper airway collapse. OSA can markedly decrease quality of life (QoL) and productivity. Continuous Positive Airway Pressure (CPAP) has been used as an effective treatment for OSA. Recently, uvulopalatopharyngoplasty (UPPP) treatment has emerged as effective management among patients with OSA, especially non-adherent ones to conventional therapies such as CPAP. Our aim was to determine whether CPAP and UPPP treatment could improve the quality of life in patients with moderate OSA. Design: Prospective. Setting: Patients with moderate OSA, confirmed by polysomnography from March 2019 to March 2020, participated. CPAP and UPPP treatments were considered for patients according to their preferences. The Sleep Apnea Quality of Life Index (SAQLI) questionnaire before and after treatment was completed. Methods: Change in their QoL was compared between the CPAP group and UPPP treatment. In addition, QoL was compared between these groups and patients who did not receive any of these treatment methods. Results: Seventy-eight patients were included in treatment groups, 40 using CPAP and 38 undergoing UPPP treatment. Furthermore, 10 patients who did not receive treatment were considered the control. Both methods of treatment significantly (p < 0.001) improved QoL, but UPPP treatment was superior (p = 0.042) to CPAP. There was a poor correlation between post-treatment BMI (0.037), Respiratory Disturbance Index (RDI) (0.096), age (0.022), and post-treatment SAQLI score. Conclusion: Based on these results, CPAP and UPPP treatment can improve QoL. UPPP treatment could be considered an effective arm of OSA management among the study population.

Global practice of sleep medicine: Iran.

STUDY OBJECTIVES: This study aimed to conduct a comprehensive review of sleep medicine in Iran, focusing on the country's advancements, challenges, and the global context. METHODS: We conducted a comprehensive review of sleep medicine in Iran, using various sources to ensure a thorough analysis. The national educational curriculum for sleep medicine and guidelines on sleep clinics issued by Iran's Ministry of Health served as a foundational resource. Additionally, we gathered information from the Iranian Sleep Medicine Society (ISM) website and relevant committee data sources. To enhance our understanding of the current research landscape, we performed a targeted search on PubMed using keywords related to sleep and Iran. RESULTS: The study presents a dynamic overview of sleep medicine in Iran, highlighting key advancements and challenges. Significant progress was observed in establishing standardized sleep medicine training and accredited sleep clinics. The ISM plays a pivotal role in spearheading these developments, contributing to implementing regional guidelines for sleep tests. However, challenges such as a limited number of trained specialists, a scarcity of certified sleep clinics, and obstacles to accessing sleep disorder treatments were identified. CONCLUSIONS: We advocate for the implementation of increased research initiatives, nationwide education and screening programs, and proactive measures to strengthen the landscape of sleep and circadian medicine in the country.

The effects of atomoxetine and trazodone combination on obstructive sleep apnea and sleep microstructure: A double-blind randomized clinical trial study.

STUDY OBJECTIVES: we aimed to compare the effects of atomoxetine and trazodone (A-T) in combination with placebo in patients with obstructive sleep apnea (OSA). METHODS: This randomized, placebo-controlled, double-blind, crossover trial study was conducted in adults with OSA referred to a Sleep Clinic. Participants with eligibility criteria were recruited. Patients were studied on two separate nights with one-week intervals, once treated with trazodone (50 mg) and atomoxetine (80 mg) combination and then with a placebo and the following polysomnography tests. RESULTS: A total of 18 patients with OSA completed the study protocol, 9(50%) were male, the mean age was 47.5 years (SD = 9.8) and the mean Body mass index of participants was 28.4 kg/m2 (SD = 3.4). Compared with the placebo, the A-T combination resulted in significant differences in AHI (28.3(A-T) vs. 42.7 (placebo), p = 0.025), duration of the REM stage (1.3%TST (A-T) vs. 13.1%TST (placebo), p = 0.001), and the number of REM cycles (0.8 (A-T) vs. 4.7 (placebo), p = 0.001), number of apneas (38.3 (A-T) vs. 79.3 (placebo), p = 0.011), number of obstructive apneas (37.2 (A-T) vs. 75.2 (placebo), p = 0.011), oxygen desaturation index (29.5 (A-T) vs. 42.3 (placebo), p = 0.022) and number of respiratory arousals (43.2 (A-T) vs. 68.5 (placebo), p = 0.048). This decrement effect did not change among those with a low-arousal phenotype of OSA. CONCLUSIONS: The A-T combination significantly improved respiratory events' indices compared with placebo in patients with OSA. This combination is recommended to be assessed in a large trial. It could be an alternative for those who do not adhere to the standard available treatments for OSA.

Characterization of risk factors for obstructive sleep apnea and its association with absenteeism among nurses.

PURPOSE: To characterize risk factors associated with obstructive sleep apnea (OSA) and its relationship with nurses' absenteeism. METHODS: A cross-sectional study was conducted from 2018 to 2020 at a 1,000-bed academic hospital complex and biomedical research facility in Tehran, Iran. Participants were selected through consecutive sampling after obtaining ethical approval and informed consent. Data on demographics, medical conditions, occupational characteristics, and absenteeism were collected through face-to-face interviews. The STOP-Bang questionnaire was utilized to assess the probability of OSA. Statistical tests included the Mann-Whitney U, t-test, Chi-square, and multivariable regression. RESULTS: In this study involving 304 nurses, the majority were female (81.3%), with an average age of 35. About 27 participants (8.9%) had a high probability of OSA, with male sex, older age, higher body mass index, neck circumference, and diastolic BP identified as the main determinants of OSA. Additionally, shift work and night shifts were associated with increased absenteeism, while sex showed no significant association with absenteeism rates among nurses. CONCLUSION: Male sex, neck circumference (obesity), night shifts, and diastolic BP can predict OSA risk. However, unauthorized absence from work is not associated with a high risk for OSA (STOP-BANG ≥3) or the individual risk factors of OSA.

Identifying Affecting Factors on Acceptance with CPAP on the First Night of PAP Titration in Sleep Clinic on Patients with Obstructive Sleep Apnea.

Introduction: This research examined the causes of low acceptance with Continuous Positive Airway Pressure Continuous Positive Airway Pressure (CPAP) especially anatomical causes and if eliminating them would result in increasing its adherence. Materials and Methods: This cross sectional study was performed on patients with moderate to severe Obstructive Sleep Apnea Obstructive Sleep Apnea (OSA) undergoing PAP titration in the sleep clinic. CPAP acceptance was evaluated by visual analog scale (VAS) about mask and sleep satisfaction and the possibility of using CPAP in the future, mask complications, physical examination of the upper airway and polysomnographic (PSG) results before and after titration. Results: participants were divided into three groups of non-acceptant, semi-acceptant and acceptant with CPAP based on the satisfaction of the mask and sleep. There were no significant differences between groups based on age, gender, education, BMI and polysomnographic variables. With a study of mask complication, there were significant differences among groups for dry mouth, mask leakage and cold air. (p<0.05) The severity of septal deviation, high arch palate, mallampati, retrognathia and maxillary hypoplasia in the acceptant group was less than the other two groups, but it was not statistically significant. Conclusions: Satisfaction with the sleep and the mask on the first night of titration will significantly increase the likelihood of using CPAP in the future. A number of the pathological physical examinations were lower in the acceptant group than two other groups, but were not significant.

A nationwide study on the prevalence and contributing factors of obstructive sleep apnea in Iran.

Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as "sleepy," "insomnia," and "restless legs syndrome (RLS)." The prevalence of OSA was 28.7% (95%CI: 26.8-30.6). The prevalence of "sleepy," "insomnia," and "RLS" phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. "Sleepy" and "insomnia" phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, "sleepy" phenotype was associated with youth and unmarried status but not in women. The "insomnia" phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. "RLS" phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes.

The need to promote sleep health in public health agendas across the globe.

Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded.

Non-communicable disease comorbidities in HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue.

The present study evaluates the non-communicable disease (NCD) patterns and related risk factors among people living with HIV (PLWH) in Iran. This national cross-sectional survey study was conducted on 1173 confirmed PLWHs with a mean age of 35.35 (56.82 Over 50 years old, 33.90 Under 50 years old) admitted from 15 different provinces in the country. Logistic regression was used to analyze the association of factors with having at least one NCD comorbidity. From 1173 PLWH, 225(19.18%) participants experienced at least one NCD (15.20% and 38.69% among under- and over-50-year-old patients, respectively). The prevalence of heart disease, hypertension, diabetes, and sleep apnea among all patients was 1.59%, 2.05%, 1.55%, and 10.26%, respectively. The similar prevalence for each NCD among those over 50 years was 10.11%, 15.71%, 9.01%, 25.44%, and 1.01%, 1.12%, 1.04%, and 9.23% among those under 50 years, respectively. The odds of being at risk of at least one NCD stood higher in patients over 50 years (ORadj = 2.93, 95% CI 1.96-4.37), married (ORadj = 2.48, 95% CI 1.41-4.35), divorced or widowed (ORadj = 2.78, 95% CI 1.48-5.20), and obese (ORadj = 3.82, 95% CI 2.46-5.91). According to our findings regarding the prevalence of NCDs among patients under 50 years of age, we recommend that policymakers give greater consideration to this group in the screening and care programs for NCDs since adults and the elderly are both vulnerable to the risk factors for developing NCDs.

Characterization of Long COVID and Its Contributing Factors among a Population of Health Care Workers in a 6-Month Follow-up.

Background: Health care workers (HCWs) are at the frontline of the fight against the coronavirus disease 2019 (COVID-19). Long COVID is defined as "the persistence of some symptoms of COVID-19, more than 4 weeks after the initial infection." The aim of the present study was to investigate the prevalence of long COVID status among HCWs in the largest hospital complex of Iran. Methods: In this cross-sectional study, all patients with COVID-19 who had taken sick leave were included in the study (n = 445). Data regarding sick leave characteristics were collected from the records of the nursing management department of the hospital. Study variables included demographic and occupational information, variables related to mental health assessment, organ systems involved in COVID-19, and duration of symptoms. Frequencies, percentage distributions, means, standard deviation, and range (minimum, maximum) were used as descriptive analysis methods. Associations between symptoms' persistency and clinical characteristics were assessed by logistic and linear regressions. Results: Age, N95 mask use, and respiratory protection significantly contributed to the persistence of COVID-19 symptoms (P < 0.05). The prevalence of long COVID among HCWs was 9.44% among 445 participants. The loss of taste persisted longer than the other symptoms before returning to normal. Among the postrecovery complications asked, anxiety was the most common persistent mental symptom (58.5%), followed by gloomy mood (46.3%) and low interest (46.2%), respectively. Conclusion: HCWs with COVID-19 symptoms had prolonged symptoms of COVID-19 that can affect their work performance, thus, we recommend evaluating COVID-19 symptoms in HCWs with infection history.

Sputnik V vaccine-related complications and its impression on inflammatory biomarkers in healthcare providers.

PURPOSE: The current pandemic made scientists create new platforms of vaccines to fight against SARS-CoV-2. Without a doubt, the new forms of present vaccines could develop a diversity of unknown complications. Sputnik V vaccine with two different adenovirus vectors (Ad26 priming and Ad5 boost) was first announced safe and effective by Russia. However, there are controversies surrounding this vaccine such as the possible decline of its immunogenicity and diminished neutralizing capacity against some Covid-19 variants. In addition, its impression on serum biomarkers is not clearly surveyed. The present study aimed to evaluate the frequency of Sputnik V vaccine-related complications and its impression on inflammatory and hematologic biomarkers. MATERIALS &METHODS: An observational cohort study was performed to evaluate the side effects and serum biomarkers changes in healthcare workers receiving Sputnik V vaccine. The vaccine adverse events were recorded daily within 60 days. The blood samples were obtained before vaccination, and on the10th day after each dose of vaccination. The prevalence of all complications and inflammatory biomarkers levels were compared between two doses. All analyses were performed using SPSS software version 22.0. RESULTS: Totally, 126 participants completed the study. The mean age was 37.19 â€‹± â€‹7.73 years. The prevalence of all complications was higher following the first dose than the second dose. The most common side effects were pain at the injection site, body pain, fever, headache, weakness, vertigo, sore throat and sleep disorder. The hematocrit, mean corpuscular volume of red blood cells and neutrophils count declined following vaccination significantly (P-value; 0.04, 0.039, 0.000 respectively). CONCLUSION: It seems the side effects of Sputnik-V vaccine are mild and decrease significantly after the second dose. The decreasing level of hematocrit, MCV and neutrophil count was found significant following vaccination.

Population-based cross-sectional study of sex-specific dose-response associations between night sleep duration and hypertension in Islamic Republic of Iran.

Background: Several studies have suggested that sleep disorders have adverse effects on blood pressure. However, the findings remain controversial and only a few studies have investigated the association between sleep duration and hypertension among all age and sex subgroups. Aim: To evaluate the dose-response association between sleep duration and blood pressure in the Iranian population using the Ravansar non-communicable disease cohort study. Methods: This was a cross-sectional study of 9865 participants aged 35-65 years from the 2014-2017 Ravansar non-communicable disease cohort study. Night sleep duration was classified as ≤5 hours, 6 hours, 7 hours, 8 hours, 9 hours, and ≥10 hours. The association between self-reported sleep duration and hypertension was examined using multivariable logistic regression in STATA version 14. Restricted cubic spline analysis showed the dose-response association between sleep duration and hypertension. Results: The age-adjusted prevalence of hypertension was 16.50% among men, 24.20% among women and 20.50% in the total population. Compared with reference sleep duration (7 hours) in the total population, the multivariable odds ratio [OR (95% CI)] for hypertension was 0.70 (0.55-0.88) for the group with 9 hours sleep duration and 0.90 (0.74-1.09) for the group with ≤5 hours sleep duration. Among pre-menopausal women, we observed an inverse association between 9 hours sleep duration and hypertension [0.62 (0.42-0.90)]. The age-adjusted cubic spline suggested a linear inverse association between sleep duration and prevalence of hypertension among men and the total population and a non-linear association among women. Conclusion: Longer sleep duration (from 9 hours) had a negative association with hypertension. Further studies are needed to identify the risk factors associated with sleep duration and hypertension among the general population in the Islamic Republic of Iran.

Prevalence of short and long sleep duration: Ravansar NonCommunicable Disease (RaNCD) cohort study.

BACKGROUND: Prevalence of short and long sleep duration varies in different countries and changes over time. There are limited studies on Iranians' sleep duration, and we aimed to evaluate the prevalence of short and long sleep duration and associated factors among people living in Kermanshah, Iran. METHODS: This population-based cross-sectional study was conducted between November 2014 and February 2017. Data was collected from 10,025 adults aged 35 to 65 years using census sampling, and we evaluated the short and long sleep duration (≤ 6 and ≥ 9 h, respectively) and its relation with the socio-demographic factors and health-related status of the participants. RESULTS: Mean age of participants was 48.1 years (standard deviation = 8.2), and 47.4% of participants were male. Of our participants, 11.6% had short, and 21.9% had long sleep duration. Age ≥ 50 years, female gender, being single, mobile use for longer than 8 h per day, working in night shifts, moderate and good levels of physical activity, BMI ≥ 30, past smoking, and alcohol use were associated with short sleep duration (P < 0.05). Female gender and living in rural areas were associated with long sleep duration (P < 0.05). CONCLUSION: In the Ravansar population, short and long sleep duration are prevalent, with long sleep duration having higher prevalence. People at risk, such as night shift workers, as well as modifiable factors, such as mobile phone use, can be targeted with interventions to improve sleep hygiene.

Sleep microstructure and clinical characteristics of patients with restless legs syndrome.

STUDY OBJECTIVES: Restless legs syndrome (RLS) is a sleep-related movement disorder, often accompanied by sleep disruption. Obstructive sleep apnea (OSA) has a controversial prevalence among patients with RLS. We evaluated the clinical and sleep features of patients who attended our sleep clinic considering RLS and OSA. METHODS: In this cross-sectional study, we obtained health records of 1,497 patients during 2015-2019 who underwent polysomnography (PSG). Baseline characteristics, sleep-related and RLS questionnaires, and sleep microstructure were assessed. Descriptive and analytical assessments were performed. RLS was assessed according to the International Restless Legs Syndrome Study Group criteria. RESULTS: RLS was found in 19.4% of patients, with more prevalence among women (26.9% vs 16.4%). RLS affected 19.1% of patients with OSA. Patients with RLS were significantly older with higher insomnia and depression and worse PSG results. As the respiratory disturbance index increased, the odds of RLS slightly decreased (adjusted odds ratio [95% confidence interval]: 0.80 [0.67-0.94]). The odds of OSA (respiratory disturbance index ≥ 5) was not affected by RLS. OSA in patients with RLS was significantly associated with a higher limb movement index. RLS in patients with OSA was significantly associated with higher insomnia, depression, and limb movement index (men and women), higher wake after sleep onset and percentage of N1 sleep (men), and lower sleep efficiency (men). CONCLUSIONS: Patients with RLS had worse PSG results, higher insomnia, and depression. Although men with OSA+/RLS+ had worsened PSG results, PSG parameters in women with OSA+/RLS+ did not differ from the OSA+/RLS- group. Patients with either OSA or RLS should be evaluated for possible comorbidities, including insomnia and depression. Notably, sex-specific characteristics need more consideration in sleep clinics. CITATION: Amirifard H, Jameie M, Akbarpour S, et al. Sleep microstructure and clinical characteristics of patients with restless legs syndrome. J Clin Sleep Med. 2022;18(11):2653-2661.

Association of sleep characteristics and respiratory symptoms at a smelting factory.

BACKGROUND: Sleep disturbance including insomnia and poor sleep quality has been shown to be a major health determinant in occupational settings. Specific occupational exposures to hazards in most workplaces can lead to various health problems, especially sleep problems. OBJECTIVE: The study aimed to investigate sleep characteristics, and their relationships with work-related exposures, demographics, and other related variables in workers of a smelting factory. METHODS: This cross-sectional study was carried out on workers in a 40-year smelting factory located in the East of Tehran Province. A total of 200 male participants were included in the study. Among them, 51 workers were from the production process staff and the rest were office workers. Their shifts were from 6 AM to 5 PM. All participants were asked about demographic characteristics and exposure to respiratory pollutants. All participants answered validated Persian versions of the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The means (SD) of age and BMI were 39.1 (8.9) years and 26.8 (4.5) kg/m2, respectively. Among all participants, 51 (25.5%) experienced exposure to a respiratory pollutant. Among all workers, 96 (48%) experienced poor sleep quality and 87 (43.5%) and 10 (5%) had subthreshold and clinical insomnia, respectively. The mean (SD) night sleep duration was 6.4 (0.96) hours. Data analysis illustrated a significant positive relationship between exposure to respiratory pollutants and insomnia (p-value = 0.03). Howewer, this association between sleep quality and exposure to repiratory pollutants was not significant (p-value = 0.25). Further analysis with binominal regression showed participants with exposure to respiratory pollutants were more susceptible to clinical insomnia (p-value = 0.02, exp(B) = 0.213), and after regressing out the effect of smoking, participants with exposure to respiratory pollutants remained susceptible to clinical insomnia. A lower night sleep duration was observed among participants with exposure to inhalational material (p-value = 0.05). CONCLUSIONS: Occupational exposures to hazardous material, including inhalational exposures, could cause sleep disturbance, which warrants more attention paid by sleep specialists.

COVID-19 Fear Association with Depression, Anxiety, and Insomnia: A National Web-Based Survey on the General Population.

Objective: COVID-19 pandemic has influenced almost every country worldwide. Being in a pandemic situation can cause psychological distress to people, which can lead to sleep disorders. The present study aimed to assess prevalence of depression, anxiety, and insomnia among Iranian people and their relations with COVID-19 fear in the early stages of COVID-19 pandemic. Method: A cross-sectional and population-based online study was designed. We created an online form and used Fear of COVID-19 scale (FCV-19), Generalized Anxiety Disorder 2 scale (GAD-2), Patient Health Questionnaire-2 (PHQ-2), and Insomnia Severity Index (ISI), to assess fear of COVID-19, anxiety, depression, and insomnia, respectively. We sent the link to the online survey to Iranians interested in participating in the study via social media, and 1223 Iranian completed the form. Results: A total of 1223 individuals with a mean age of 39.82 ± 10.75 years participated in the study. Prevalence of insomnia, depression and anxiety among our participants were 55.2%, 61.5%, and 50.9%, respectively. The mean FCV-19 score among the participants was 19.70 ± 5.08. Insomnia was more common among those who were 50 years or older. Fear of COVID-19 was related to a more risk of progression toward depression, anxiety, and insomnia. Conclusion: Fear of COVID-19 has a considerable association with depression, anxiety, and insomnia in the pandemic, and strategies to reasonably decrease people's fears can help to reduce incidence of psychological issues during the pandemic.

Sleep characteristics of Iranian people and their effects on daytime functioning: a population-based study.

Sleep characteristics vary between populations. Detrimental sleep habits have cognitive consequences leading to daytime functioning debilitation. Until now no study has been done to investigate sleep characteristics in Iran thoroughly. In this study, we aimed to evaluate Iranians' sleep characteristics and their association with daytime functioning. We conducted a population-based study from January 2017 to May 2019 on people more than 18 years old who lived in 11 urban destricts and 3 rural areas of Tehran, Iran. We randomly selected the participants using a multistage random stratified clustered sampling method. We obtained the participants' demographic and anthropometric characteristics and details of bedtime, sleep duration, sleep onset latency, wake-up time and sleep impact on daytime functioning. Logistic regression model was used to assess the relationship between sleep characteristics) and daytime functioning. In total, 1830 people with a mean age of 40.83 years participated in the study. The gender distribution of the participants was even, and 70.98% of them were married. After adjusting for age and sex, the following three factors had a significant impact on daytime functioning: bedtime, sleep onset latency, and sleep duration. (OR = 1.12, P < 0.038, OR = 1.01, P < 0.011, and OR = 0.99, P = 0.01, respectively). We also found that longer sleep onset latency (P = 0.004) and shorter sleep durations (P = 0.029) significantly interfere with daytime functioning. Iranians' sleep characteristics, especially their sleep duration and sleep onset latency, are associated with their daytime function. Interventions on people's sleep hygiene are warranted to promote healthier sleep behaviors among Iranians, considering the high impact of current sleep characteristics on their daily lives.

Effect of Otolaryngology Residency Program Training on Obstructive Sleep Apnea Practice.

According to the importance of management of obstructive sleep apnea syndrome by otolaryngologists, this study was designed to investigate knowledge, attitudes and practice of junior and senior residents of otolaryngology and evaluate the effect of current residency training program on choosing the first lines of treatment. A total of 110 residents of otolaryngology were selected. Our study tools were obstructive sleep apnea knowledge and attitudes (OSAKA and OSAKA-KIDS) questionnaires. The participants were classified as junior and senior. Senior residents had significantly higher total knowledge score for OSAKA based on independent t test (12.73 Vs. 10.52). No significant difference was observed for OSAKA-KIDS (11.31 Vs. 10.69). The most frequent choice for the first line was CPAP (63.8%) and weight loss (41.5%) among junior and senior residents, respectively. Although the knowledge of otolaryngology residents increased during their program, the choice of first line treatment in obstructive sleep apnea was different between junior and senior residents. We found a need for further multidisciplinary education for residents especially in the management of sleep apnea particularly toward CPAP usage and this syndrome in pediatrics.

Patients with Obstructive Sleep Apnea Symptoms Referral to Otolaryngologists in Iranian Residency Entrance Examination Volunteers: The Effect of Source of Education and Level of Knowledge.

Obstructive sleep apnea (OSA) has various complications for individuals' health. This study aimed to evaluate the factors for referring obstructive sleep apnea patients to otolaryngologists in Iranian residency entrance examination volunteers. This cross-sectional study recruited volunteer participants from the Iranian Residency Entrance Examination on March 2, 2018. The Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA)/the Obstructive Sleep Apnea Knowledge and Attitudes in Children (OSAKA-KIDS) Questionnaires were distributed among residents attending exam preparation. Number of years working as a physician, number of adult and pediatric patients visited during the academic rank in residency examination, and the main specialty during general physician education in which they get familiar with obstructive sleep apnea were documented. The effect of the mentioned variables evaluated on patient referral preference specialty. Of the 95 volunteers, 57.9% were female; mean age was 29.6 ± 3.3 years. The overall knowledge score of the OSAKA questionnaire was 9.85 ± 3.9 and for the OSAKA-KIDS questionnaire was 9.2 ± 4.9. In patients under 18 years of age, the most frequent referrals were from otolaryngology specialists (51.2%). The only factor which had positive significant effect on adult patient referral preference was source of obstructive sleep apnea knowledge during general physician taring (p < 0.001). Given the low awareness about OSA in candidates for the residency entrance exam and the high importance of this treatable disease, the need for comprehensive training courses during residency is warranted and the adequacy of sleep apnea education through all involved specialty during general physician education should be improved.