Relação entre apoio social e sono de pessoas idosas cuidadoras em vulnerabilidade social / Relationship between social support and sleep of elderly caregivers in social vulnerability / Relación entre apoyo social y sueño de adultos mayores cuidadores con vulnerabilidad social

Objetivo: analisar a relação entre apoio social e qualidade do sono de pessoas idosas que cuidam de outros idosos em ambiente de vulnerabilidade social. Método: estudo transversal realizado com 65 cuidadores entrevistados por meio de instrumento de caracterização, Índice de Katz, Escala de Lawton e Brody, Índice de Qualidade do Sono de Pittsburgh e Escala de Apoio Social do Medical Outcomes Study, com dados analisados com testes de comparação e de correlação. Resultados: a maioria eram mulheres, cônjuges do idoso cuidado e possuíam sono de má qualidade. Observou-se correlação fraca e inversa entre má qualidade do sono e a dimensão interação social positiva (Rho=-0,27; p=0,028). Identificou-se relação significativa entre: apoio material e disfunção diurna (p=0,034); apoio afetivo e eficiência do sono (p=0,026); interação social positiva e qualidade subjetiva do sono (p=0,001) e disfunção diurna (p=0,008). Conclusão: Quanto maior a interação social positiva, melhor é a qualidade do sono.

Objective: to analyze the relationship between social support and sleep quality of elderly individuals who care for other elderly individuals in a socially vulnerable environment. Method: a cross-sectional study conducted with 65 caregivers interviewed using a characterization instrument, Katz Index, Lawton and Brody Scale, Pittsburgh Sleep Quality Index, and Medical Outcomes Study Social Support Scale, with data analyzed using comparison and correlation tests. Results: the majority were women, spouses of the elderly being cared for, and had poor sleep quality. A weak and inverse correlation was observed between poor sleep quality and the positive social interaction dimension (Rho=-0.27; p=0.028). Significant relationships were identified between: material support and daytime dysfunction (p=0.034); emotional support and sleep efficiency (p=0.026); positive social interaction and subjective sleep quality (p=0.001), as well as daytime dysfunction (p=0.008). Conclusion: The higher the positive social interaction, the better the sleep quality.

Objetivo: analizar la relación entre el apoyo social y la calidad del sueño de personas mayores que cuidan de otras personas mayores en entornos socialmente vulnerables. Método: estudio transversal realizado con 65 cuidadores entrevistados mediante un instrumento de caracterización, Índice de Katz, Escala de Lawton y Brody, Índice de Calidad del Sueño de Pittsburgh y Escala de Apoyo Social del Medical Outcomes Study, los datos fueron analizados mediante pruebas de comparación y correlación. Resultados: la mayoría eran mujeres, cónyuges del adulto mayor que recibe el cuidado y tenían mala calidad del sueño. Se observó una correlación débil e inversa entre la mala calidad del sueño y la dimensión de interacción social positiva (Rho=-0,27; p=0,028). Se identificó que había relación significativa entre: apoyo material y disfunción diurna (p=0,034); apoyo afectivo y eficiencia del sueño (p=0,026); interacción social positiva y calidad subjetiva del sueño (p=0,001) y disfunción diurna (p=0,008). Conclusión: Cuanto mayor sea la interacción social positiva, mejor será la calidad del sueño.

Decreased DTI-ALPS index in delirium: a preliminary MRI study.

PURPOSE: Delirium is linked to brain abnormalities, yet the role of the glymphatic system is not well understood. This study aims to examine alterations in brain physiology in delirium by using diffusion-tensor imaging (DTI) to assess water diffusion along the perivascular space (ALPS) and to explore its correlation with clinical symptoms. METHODS: We examined 15 patients with delirium and 15 healthy controls, measuring water diffusion metrics along the x-, y-, and z-axes in both projection and association fibers to determine the DTI-ALPS index. We used a general linear model, adjusted for age and sex, to compare the DTI-ALPS index between groups. We also investigated the relationship between the DTI-ALPS index and clinical symptoms using partial correlations. RESULTS: Patients with delirium exhibited significantly lower DTI-ALPS indices compared to healthy controls (1.25 ± 0.15 vs. 1.38 ± 0.10, t = 2.903, p = 0.007; 1.27 ± 0.16 vs. 1.39 ± 0.08, 1.22 ± 0.16 vs. 1.37 ± 0.14, t = 2.617, p = 0.014; t = 2.719, p = 0.011; respectively). However, there was no significant correlation between the DTI-ALPS index and clinical symptoms. CONCLUSION: Our findings indicate a decreased DTI-ALPS index in patients with delirium, suggesting potential alterations in brain physiology that may contribute to the pathophysiology of delirium. This study provides new insights into the mechanisms underlying delirium.

Association between high risk of obstructive sleep apnea and inflammatory markers in a population sample of young and middle-aged adults in the Miami Heart Study.

STUDY OBJECTIVES: There are limited data depicting the association between high risk of OSA and the levels of inflammatory markers in a population-based sample free from CVD. In a large U.S. cohort enriched with a Hispanic population and free of cardiovascular disease (CVD), we aimed to assess the association between high risk of obstructive sleep apnea (OSA) and inflammatory markers. METHODS: We analyzed data for 2359 clinical CVD-free participants from the Miami Heart Study, aged 40-65 (May 2015 - Sept 2018). High risk of OSA included those with a high risk using the Berlin questionnaire. Poisson regression analyses were utilized to examine the associations between high risk of OSA (reference: low risk of OSA) and hs-CRP, IL-6, and TNF-α levels (continuous) in univariate and multivariate models (adjusting for age, sex, race/ethnicity, and BMI, diabetes, hypertension, high cholesterol, and smoking). RESULTS: 552 (28%) participants were categorized as having a high risk of OSA. Patients with a high risk of OSA had higher median values of hs-CRP (2.3 vs. 1.0), IL-6 (1.9 vs. 1.4), and TNF-α (1.2 vs. 1.1) when compared to those with a low risk of OSA (all p < 0.001). When adjusting for age, sex, and race/ethnicity, the mean difference between patients with high and low risk of OSA in hs-CRP was 2.04 (95% CI 1.85, 2.23), and 0.73 (95% CI 0.57, 0.89) in IL-6. These differences were attenuated when further adjusting for CVD risk factors but remained statistically significant for hs-CRP: (0.38, 95% CI 0.21, 0.55). CONCLUSIONS: After accounting for CVD risk factors, individuals at high risk of OSA had significantly higher levels of hs-CRP, suggesting that OSA screening identified subclinical inflammation in this population sample of individuals free of CVD.

Sleep benefits perceptual but not movement-based learning of locomotor sequences.

Practicing complex locomotor skills, such as those involving a step sequence engages distinct perceptual and motor mechanisms that support the recall of learning under new conditions (i.e., skill transfer). While sleep has been shown to enhance learning of sequences of fine movements (i.e., sleep-dependent consolidation), here we examined whether this benefit extends to learning of a locomotor pattern. Specifically, we tested the perceptual and motor learning of a locomotor sequence following sleep compared to wake. We hypothesized that post-practice sleep would increase locomotor sequence learning in the perceptual, but not in the motor domain. In this study, healthy young adult participants (n = 48; 18-33 years) practiced a step length sequence on a treadmill cued by visual stimuli displayed on a screen during training. Participants were then tested in a perceptual condition (backward walking with the same visual stimuli), or a motor condition (forward walking but with an inverted screen). Skill was assessed immediately, and again after a 12-h delay following overnight sleep or daytime wake (n = 12 for each interval/condition). Off-line learning improved following sleep compared to wake, but only for the perceptual condition. Our results suggest that perceptual and motor sequence learning are processed separately after locomotor training, and further points to a benefit of sleep that is rooted in the perceptual as opposed to the motor aspects of motor learning.

Clustering of methamphetamine users based on personality characteristics and self-efficacy in the west of Iran.

With the substantial increase in the use of stimulants, especially methamphetamine, in recent years, the present study aimed to cluster methamphetamine users based on personality traits and self-efficacy, and compare their mental health, sleep quality, and the risk of relapse in the identified clusters. This cross-sectional study was conducted through convenience sampling on 501 methamphetamine users in addiction treatment centers in Kermanshah, western Iran. The data were collected using the Schwarzer General Self-Efficacy Scale, Zuckerman-Kuhlman Personality Questionnaire, Goldberg and Hiller General Health Questionnaire (GHQ), Zuckerman-Kuhlman Personality Questionnaire, and Stimulant Relapse Risk Scale (SRRS). A total of 501 methamphetamine users were distinguished into three clusters with frequencies of 111 (22.2%), 298 (59.5%), and 92 (18.4%) members through hierarchical cluster analysis. The participants in the first cluster were characterized by low self-efficacy, high neuroticism, sensation seeking, and aggressiveness, along with low extroversion and activity, low positive health, high negative health, low sleep quality, and high risk of drug relapse. The participants in the second cluster reported moderate levels of self-efficacy, neuroticism, sensation seeking, activity, and aggressiveness, high extroversion, and moderate levels of mental health, sleep quality, and the risk of relapse. Moreover, the participants in the third cluster reported the highest level of self-efficacy, the lowest level of neuroticism, sensation seeking, and aggressiveness, moderate extroversion and high activity, low relapse risk, high sleep quality, as well as high positive and low negative health symptoms. The third cluster was significantly different from the other two clusters in terms of the mentioned factors. The findings of this study suggest that low self-efficacy and the presence of neuroticism, sensation seeking, and high aggressiveness contribute to reduced mental health and sleep quality, as well as an increased risk of relapse in methamphetamine users.

Sleep disorder experienced by healthcare nurses after terminating Zero-COVID-19 policy.

OBJECTIVE: Medical staff, especially nurses, suffered great anxiety and stress from the COVID-19 pandemic, which negatively affected their sleep quality. In this study, we aimed to analyze the sleep quality of nursing staff after terminating the Zero-COVID-19 policy in China. METHODS: 506 participants were involved in our study. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep status of the participants. Binary regression was performed to evaluate the impact factors related to sleep difficulty. RESULTS: The majority of participants (96.44%) suffered from sleep disturbances. There were significant differences in age, education level and front-line activity between participants with good sleep quality and sleep difficulty. Younger age (16-25 years old) was independently associated with less sleep difficulty, while front-line activity was independently associated with severe sleep difficulty. CONCLUSION: Sleep disorder was very common among nurses after ending the Zero-COVID-19 policy in China. More front-line nurses suffered severe sleep difficulty in particular, which should be worthy of attention.

Patient Reported Outcome Measures used in Surgical Evaluation of Obstructive Sleep Apnea: A Systematic Review.

OBJECTIVE: To identify patient-reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)-related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM. DATA SOURCES: PubMed, Web of Science, Embase, PsychINFO, and CINAHL. REVIEW METHODS: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Disease-specific instruments assessing sleep-related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality. RESULTS: A total of 2494 abstracts were retrieved, and 216 underwent full-text review. Seven PROMs assessing sleep-related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as "adequate" for content validity. Two PROMs utilized patients with sleep-disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and six (86%) included data on test-retest reliability. CONCLUSION: Several PROMs are utilized in sleep-related quality-of-life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA-related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 2024.

Caregivers' Internet-Delivered Insomnia Intervention Engagement and Benefit: SHUTi-CARE Trial Primary Quantitative Analysis.

BACKGROUND: Delivering insomnia treatment by the Internet holds promise for increasing care access to family caregivers, but their ability to adhere to and benefit from such fully-automated programs has not been rigorously tested. PURPOSE: This fully-powered, single-group trial tested whether characteristics of the caregiving context influence high-intensity caregivers' engagement with and benefit from an empirically validated Internet intervention for insomnia. METHODS: At baseline, caregivers providing unpaid time- and responsibility-intensive care who reported insomnia (N = 100; age M = 52.82 [SD = 13.10], 75% non-Hispanic white, 66% ≥college degree) completed questionnaires about caregiving context and sleep, then 10 prospectively-collected online daily sleep diaries. Caregivers then received access to SHUTi (Sleep Healthy Using the Internet), which has no caregiver-specific content, for 9 weeks, followed by post-assessment (questionnaires, diaries). Engagement was tracked by the SHUTi delivery system. RESULTS: Sixty caregivers completed SHUTi, 22 initiated but did not complete SHUTi, and 18 did not initiate SHUTi. Caregivers were more likely to use SHUTi (than not use SHUTi) when their care recipient (CR) had worse functioning, and were more likely to complete SHUTi when supporting more CR activities of daily living (ADL; ps < .03). Higher caregiver guilt, more CR problem behaviors, and being bedpartners with the CR related to more improved sleep outcomes, whereas supporting more CR instrumental ADL related to less improvement (ps < .05). CONCLUSIONS: Factors associated with greater caregiving burden, including greater CR impairment and caregiving guilt, were generally associated with better engagement and outcomes. Caregivers with substantial burdens can adhere to and benefit from a fully automated insomnia program without caregiver-specific tailoring.

This study examined how family caregivers, who often have trouble sleeping due to their responsibilities, used an online insomnia treatment program. The goal was to determine if certain aspects of caregiving would influence how caregivers engage with or benefit from the program. Researchers surveyed 100 caregivers with insomnia about their caregiving situation and sleep, and caregivers also kept online sleep diaries for 10 days. Afterward, caregivers used an online insomnia program with no caregiver-specific content called Sleep Healthy Using the Internet (SHUTi) for 9 weeks. Caregivers' usage was monitored, and they repeated measures of sleep outcomes and 10 online sleep diaries. Sixty caregivers completed SHUTi, 22 partially completed the program, and 18 did not initiate the program. Caregivers who cared for individuals with more severe functional limitations were more likely to use and complete SHUTi. Additionally, caregivers experiencing more guilt and those who managed more challenging behaviors from the person they cared for tended to report greater improvements in their sleep. This study suggests that caregivers, even those with significant care responsibilities, can use and benefit from an online insomnia treatment program like SHUTi, even when it has not been specifically tailored for caregivers.

Association between hemoglobin and non-alcoholic fatty liver disease (NAFLD) in United States adults: Results from NHANES 2017-2020.

Background: Non-alcoholic fatty liver disease (NAFLD), a chronic liver condition of increasing prevalence, is closely related to various metabolic disorders. Hemoglobin, a protein that transports oxygen in red blood cells, is the focus of this study, which seeks to investigate its potential association with NAFLD. Methods: We selected 6,516 eligible adult participants from the United States using the 2017-2020 National Health and Nutrition Examination Survey database for cross-sectional analyses. We analyzed the association of hemoglobin with NAFLD using weighted logistic regression models. Results: The study performed a weighted logistic regression modeling analysis, which verified that hemoglobin levels were positively associated with NAFLD, especially in the higher hemoglobin quartile groups. Subgroup analyses revealed no significant interactions, demonstrating the robustness of the model. The analysis of mediation effects showed that Gamma-Glutamyl Transferase, Alanine Aminotransferase, and triglycerides were important mediating variables in the relationship between hemoglobin and NAFLD. Conclusion: Increased hemoglobin levels were found to be significantly and independently associated with an increased NAFLD risk. This insight is crucial for the risk assessment and early detection of NAFLD, underscoring the need for heightened vigilance in individuals with higher hemoglobin levels.

Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic.

Common psychiatric disorders (CPDs) and depression contribute significantly to the global epidemic of type 2 diabetes (T2D). We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs, promotes the establishment of emotional eating, activation of the reward system, onset of overweight and obesity and, ultimately the increased risk of developing T2D. The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexone-bupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction, but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction. We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.

Best evidence summary of sleep protection in premature infants in the neonatal intensive care unit: a narrative review.

Background and Objective: Sleep influences the interaction between infants and their environment, as well as the achievement of crucial milestones in motor and language development. This is particularly significant for preterm infants in vulnerable positions. However, prematurely born infants in the neonatal intensive care unit (NICU) are exposed to various stimuli such as noise and light, which disrupt their normal sleep patterns. This study assesses and consolidates the existing evidence on non-pharmacological strategies for protecting and promoting sleep in preterm infants. By providing an evidence-based data repository, it offers a valuable reference for clinical interventions. Methods: We conducted computer-based searches using various databases and resources, including UpToDate, BMJ Best Practice, Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), Joanna Briggs Institute (JBI), World Health Organization (WHO), Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and China Biology Medicine disc (CBM). The search period spanned from January 2014 to May 2024. Key Content and Findings: We have included a total of 22 articles in our review, comprising two guidelines, 11 systematic reviews, 1 evidence summary, 1 technical report, 2 practice recommendations, and 5 randomized controlled trials. The evidence was synthesized from eight domains: sleep team construction, risk factor assessment, sleep assessment tools, positional management, noise control, light management, sensory stimulation, and hospital-home transition sleep management, resulting in 27 pieces of evidence. Conclusions: This study summarizes the optimal evidence for the management of sleep in premature infants, providing empirical support for standardizing the management of sleep in premature infants. It is recommended that healthcare professionals judiciously apply the best evidence while considering the clinical context, thus promoting safe sleep for premature infants.

Rate and Associated Factors of Fatigue in Chinese Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Survey.

Purpose: Fatigue was a common symptom of non-alcoholic fatty liver disease (NAFLD), which seriously affected patients' quality of life. The aim of this study was to detect fatigue rate and to evaluate factors associated with fatigue in NAFLD patients. Patients and Methods: A cross-sectional study was carried out from the Huadong Sanatorium between April 2022 and May 2023, and 133 NAFLD patients were included in this study. They completed Fatigue Severity Scale to assess fatigue, the Hospital Anxiety and Depression Scale to estimate psychological status, and the Pittsburgh Sleep Quality Index for sleep quality. Data were analyzed by independent samples t-tests, χ2 tests and logistic regression models. Results: We found that 51.1% of NAFLD patients had fatigue. Exercise, anxiety, depression, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disorders, daytime dysfunction and overall sleep quality were related to fatigue among NAFLD patients. Moreover, logistic regression models indicated anxiety, habitual sleep efficiency and sleep disorders as important predictors of fatigue. Conclusion: This was the first time to explore demographic, clinical, psychological and sleeping correlated factors for fatigue in Chinese NAFLD patients. Our study showed that more than half of NAFLD patients had fatigue, and anxiety, habitual sleep efficiency and sleep disorders were significantly associated with fatigue in NAFLD. The findings indicated that it was very necessary to pay more attention to fatigue of NAFLD patients, especially those with negative emotions and poor sleep quality by favorable intervention to relieve fatigue symptoms, so as to improve quality of life.

The Limitations of Using the Pittsburgh Sleep Quality Index to Assess Athletes' Sleep Quality: Evidence from Reliability and Validity in Chinese Professional Athletes.

Purpose: This study aimed to assess the structural validity of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Chinese professional athletes and examine its test-retest reliability and convergent validity across different timeframes. Methods: 581 Chinese professional athletes participated. Exploratory and confirmatory factor analyses were conducted on the Chinese version of the PSQI. Test-retest reliability was assessed over 2 weeks, 1 week, and 2-3 days within a 1-month timeframe. Additional reliability analysis over a 2-day interval was conducted within a 1-week timeframe. Convergent validity was assessed using Chinese versions of the Insomnia Severity Index (ISI), the Athlete Sleep Screening Questionnaire (ASSQ), and actigraphy. A 1-month tracking was conducted, with weekly completion of the PSQI using a one-week timeframe, supplemented by assessments in the second and fourth week using two-week and one-month timeframes. Relationships between weekly results and those over two weeks and one month examined, along with convergent validity, using sleep diary and actigraphy. Results: The PSQI exhibited a two-factor structure (sleep quality and sleep efficiency), with good model fit (CFI = 0.960, AGFI = 0.924, TLI = 0.925, RMSEA = 0.085). Test-retest reliability was satisfactory for intervals of one week or more (r = 0.721 ~ 0.753). Using a one-week timeframe, the total score and two dimensions exhibited good reliability (r = 0.769 ~ 0.881), but only the total score and sleep quality showed high correlations with ISI and ASSQ (r = 0.701 ~ 0.839). Throughout the tracking, monthly responses correlated well with the most recent weeks (r = 0.732 ~ 0.866). Conclusion: The PSQI demonstrates a two-factor structure in Chinese athletes, with sleep quality being predominant. Test-retest reliability within a one-month timeframe is unstable, suggesting a one-week timeframe performs better. Distinguishing between the two dimensions, employing shorter timeframes, and incorporating objective measures are recommended.

A flexible and dissolving traditional Chinese medicine microneedle patch for sleep-aid intervention.

About a quarter of the world's population suffers from insomnia, and the number of the insomniacs is gradually increasing. However, the current drug therapy and non-drug therapy sleep-aid methods have certain limitations. In general, the sleep-aid effect of drug therapy is better than that of Non-drug therapy, but western medicine may lead to some side effects and drug abuse. Although the side effects of Chinese Herbal Medicine (CHM) are relatively small, making the herbal decoction is complex and time-consuming. Therefore, exploring a novel sleep-aid method is very significant. In this paper, a flexible and dissolving Traditional Chinese Medicine (TCM) microneedle patch is proposed for sleep-aid intervention. The TCM microneedle patch is a micrometer-scale intrusive object, and the herbal extracts are carried by the patch. The materials, design method, and fabrication process of the microneedle patch have been described in detail. Besides, the mechanical characteristics of the microneedle patch, sleep-aid effect evaluation method, and experimental scheme have been presented. Three microneedle tips with radii of 5 µm, 15 µm, and 22 µm are selected for simulation analysis. Abaqus simulation results indicate that the smaller the radius of the microneedle tip, the smaller the piercing force. Considering that the microneedle should easily penetrate the skin without buckling, that is, the piercing force should be larger than the buckling force, thus 15 µm, instead of 5 µm or 22 µm, is more suitable to be adopted as the radius of the microneedle tip. For the microneedle with the radius of 15 µm, the piercing force is 0.033 N, and the difference between the piercing force and buckling force is 0.036 N. Experimental results demonstrate that the fracture force of the microneedle is about 0.29 N, which is far larger than the piercing force and buckling force. The single-lead EEG signals of the frontal lobe are used to evaluate the sleep-aid effect of the TCM microneedle patch. After sleep-aid intervention on the Anmian and Yintang acupoints using the patches, for most subjects, the ratios of the low-frequency brain wave energies to the high-frequency brain wave energies are increased obviously, indicating that the proposed sleep-aid method is effective.

Effects of serum inflammatory factors, health index and disease activity scores on ankylosing spondylitis patients with sleep disorder.

BACKGROUND: Patients with ankylosing spondylitis (AS) frequently suffer from comorbid sleep disorders, exacerbating the burden of the disease and affecting their quality of life. AIM: To investigate the clinical significance of serum inflammatory factors, health index and disease activity scores in patients with AS complicated by sleep disorders. METHODS: A total of 106 AS patients with comorbid sleep disorders were included in the study. The patients were grouped into the desirable and undesirable prognosis groups in accordance with their clinical outcomes. The serum levels of inflammatory factors, including C-reactive protein, erythrocyte sedimentation rate, interleukin (IL)-6, tumour necrosis factor-α and IL-1ß, were measured. Disease activity scores, such as the Bath AS functional index, Bath AS disease activity index, Bath AS metrology index and AS disease activity score, were assessed. The health index was obtained through the Short Form-36 questionnaire. RESULTS: The study found significant associations amongst serum inflammatory factors, health index and disease activity scores in AS patients with comorbid sleep disorders. Positive correlations were found between serum inflammatory factors and disease activity scores, indicating the influence of heightened systemic inflammation on disease severity and functional impairment. Conversely, negative correlations were found between disease activity scores and health index parameters, highlighting the effect of disease activity on various aspects of health-related quality of life. Logistic regression analysis further confirmed the predictive value of these factors on patient outcomes, underscoring their potential utility in risk assessment and prognostication. CONCLUSION: The findings demonstrate the intricate interplay amongst disease activity, systemic inflammation and patient-reported health outcomes in AS patients complicated by sleep disorders. The results emphasise the need for comprehensive care strategies that address the diverse needs and challenges faced by these patients and underscore the potential relevance of serum inflammatory factors, health index and disease activity scores as prognostic markers in this patient population.

Exploring the association between sleep and health performance of migrant home care workers and elderly care recipients in Taiwan.

This study, conducted in June and July 2022 through purposive sampling, aimed to explore the relationship between sleep and health performance in 33 pairs of elderly individuals and their migrant caregivers in southern Taiwan. Participants completed a structured questionnaire and wore an Actiwatch for seven days. Pearson correlation and independent t-test were used for analysis. Nearly 50% of foreign home care workers suffered from insomnia, and 80% of elderly care recipients with disabilities experienced sleep disorders. The number of chronic illnesses and/or dementia among the elderly and insomnia among care workers were associated with poor self-perceived health (r = -0.667, p < .001) and sleep disorders among the elderly (r = 0.368, p = .035). The problem of caregiving should be addressed. Future studies should increase the sample size and extend the duration of the study to enhance the generalizability of the findings.

Early-life manipulation of the serotonergic system exacerbates the harmful effects of sleep deprivation on cognitive functions.

Serotonin is a monoamine neurotransmitter that plays a main role in regulating physiological and cognitive functions. Serotonergic system dysfunction is involved in the etiology of various psychiatric and neurological disorders. Therefore, the present study was designed to investigate the effects of early-life serotonin depletion on cognitive disorders caused by sleep deprivation. Serotonin was depleted by para-chlorophenylalanine (PCPA, 100 mg/kg, s.c.) at postnatal days 10-20, followed by sleep deprivation-induced through the multiple platform apparatus for 24 h at PND 60. After the examination of the novel object recognition and passive avoidance memories, the hippocampi and prefrontal cortex were dissected to examine the brain-derived neurotrophic factor (BDNF) mRNA expression by PCR. Our findings showed that postnatal serotonin depletion and sleep deprivation impaired the novel object recognition and passive avoidance memories and changed the BDNF levels. In the same way, the serotonin depletion in early life before sleep deprivation exacerbated the harmful effects of sleep deprivation on cognitive function and BDNF levels. It can be claimed that the serotonergic system plays a main role in the modulation of sleep and cognitive functions.

The effect of perceived social support on fatigue in mothers having twin infants: the mediating role of sleep quality.

The aim of this study is to investigate the mediating role of sleep quality in the relationship between multidimensional perceived social support and fatigue among mothers of twin infants. One hundred and six (106) twin mothers participated in this cross-sectional study, who completed the Descriptive Information Form, Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Checklist Individual Strength. The scale score averages of the mothers in the study are as follows: social support, 61.41 ± 23.86; fatigue, 77.64 ± 28.68; and sleep quality, 8.26 ± 2.38. According to the path model, perceived social support has a negative effect on poor sleep quality (p = .001, Beta = -0.411), and poor sleep quality has a positive effect on fatigue (p = .001, Beta = 0.335). Sleep quality also mediates the effect of multidimensional perceived social support on mothers' fatigue levels (p = .001, Beta = -0.138). The study results suggest that the perceived social support and fatigue levels of twin mothers are moderate, while their sleep quality is poor. Therefore, mothers of twin infants may benefit from increased social support to alleviate fatigue and enhance sleep quality.

Differential effects of sleep deprivation on sleepwalking: Role of demographic and clinical profiles.

BACKGROUND: Although sleepwalking is one of the most prevalent and potentially injurious of the NREM parasomnias, it is still diagnosed primarily based on the patient's clinical history. Early pilot work suggested that sleep deprivation protocols could help obtain a polysomnographically-based (PSG) diagnosis of sleepwalking, but larger studies remain lacking. METHODS: We compared baseline PSG recordings with those obtained after 25hrs of sleep deprivation in a cohort of 124 consecutively assessed adult sleepwalkers. RESULTS: When compared to baseline recordings, post-sleep deprivation PSG assessments resulted in nearly twice as many somnambulistic episodes being recorded in the laboratory and significantly increased the proportion of patients (from 48 % to 63 %) experiencing at least one lab-based episode. Moreover, while 17 % of patients experienced a sleepwalking event exclusively during recovery sleep, only 2 % of patients did so solely at baseline. Sleep deprivation had similar facilitating effects on patents' somnambulistic events regardless of age of onset and positive versus negative family history for sleepwalking. Younger age and higher home episode frequency both predicted a positive response to sleep deprivation. A separate group of 17 patients with comorbid sleep disorders showed a similar increase in their proportion experiencing at least one episode during recovery sleep. CONCLUSION: The results from this large series of sleepwalkers provide strong support for the use of sleep deprivation in facilitating the occurrence of somnambulistic events in the sleep laboratory.

Sleep, hopelessness, and suicidal ideation: An ecological momentary assessment and actigraphy study.

Recent research shows that sleep disturbances are linked to increased suicidal ideation. In the present longitudinal cohort study, we used subjective (ecological momentary assessment, EMA) and objective (actigraphy) measures to examine the effects of sleep parameters on next-day suicidal ideation. Further, we examined hopelessness as a mediator between insufficient sleep and increased suicidal ideation. Individuals with current suicidal ideation (N = 82) completed 21 days of EMA and actigraphy to estimate suicidal ideation, hopelessness and sleep parameters. Multilevel linear-mixed models were used to examine the effects of sleep parameters on next-day suicidal ideation, as well as for the mediating effect of hopelessness (in the morning) on the association between previous night's sleep and suicidal ideation levels the next day. Significant concordance existed between subjective and objective sleep measures, with moderate-to-large correlations (r = 0.44-0.58). Lower subjective sleep quality and efficiency, shorter total sleep time and increased time awake after sleep onset were significantly associated with increased next-day suicidal ideation (controlling for previous-day suicidal ideation). Actigraphy-measured sleep fragmentation was also a significant predictor of next-day ideation. Hopelessness mediated the effects of the subjective sleep parameters on suicidal ideation, but did not account for the association with sleep fragmentation. Therefore, individuals' psychological complaints (hopelessness, suicidal ideation) were better predicted by subjective sleep complaints than by objective sleep indices. Increased hopelessness following from perceived insufficient sleep appears an important explanatory factor when considering the link between sleep disturbances and suicidal ideation.