The effect of weighted blankets on sleep and related disorders: a brief review.

Background: Sleep disorders such as insomnia can lead to a range of health problems. The high risk of side effects and drug abuse of traditional pharmacotherapy calls for a safer non-pharmacotherapy. Aims: To examine the use and efficacy of weighted blankets in improving sleep and related disorders in different populations and explore the possible mechanisms. Methods: A literature search was conducted using PubMed, Embase, Web of Science, MEDLINE, Cochrane Library and CNKI databases. Eligible studies included an intervention with weighted blankets and outcomes covering sleep and/or related disorders (behavioral disturbance, negative emotions and daytime symptoms). Studies using other deep pressure, compression, or exercise-related interventions were excluded. Conclusions: Most of the included studies showed that weighted blankets could effectively improve sleep quality and alleviate negative emotions and daytime symptoms in patients with sleep disorders, attention deficit hyperactivity disorder, autism spectrum disorder, and other related disorders, with a possible mechanism of deep pressure touch. Recommendations: Weighted blankets might be a promising tool for sleep interventions among individuals with sleep disorders in clinical settings. More high-quality and large-scale randomized controlled trials are needed to further validate the safety and efficacy of weighted blankets and explore precise mechanisms.

Clinical features, polysomnography, and genetics association study of restless legs syndrome in clinic based Chinese patients: A multicenter observational study.

STUDY OBJECTIVES: To systemically describe the clinical features, polysomnography (PSG) finding, laboratory tests and single-nucleotide polymorphisms (SNPs) in a clinic based Chinese primary restless legs syndrome (RLS) population. METHODS: This observational study, conducted from January 2020 to October 2021 across 22 sleep labs in China, recruited 771 patients diagnosed with RLS following the 2014 RLSSG criteria. Clinical data, PSG testing, and laboratory examination and SNPs of patients with RLS were collected. A total of 32 SNPs in 24 loci were replicated using the Asian Screening Array chip, employing data from the Han Chinese Genomes Initiative as controls. RESULTS: In this study with 771 RLS patients, 645 had primary RLS, and 617 has DNA available for SNP study. Among the 645 primary RLS, 59.7% were women. 33% had a family history of RLS, with stronger familial influence in early-onset cases. Clinical evaluations showed 10.4% had discomfort in body parts other than legs. PSG showed that 57.1% of RLS patients had periodic leg movement index (PLMI) of >5/h and 39.1% had PLMI >15/h, respectively; 73.8% of RLS patients had an Apnea-Hypopnea Index (AHI) > 5/h, and 45.3% had an AHI >15/h. The laboratory examinations revealed serum ferritin levels <75 ng/ml in 31.6%, and transferrin saturation (TSAT) of <45% in 88.7% of RLS patients. Seven new SNPs in 5 genes showed a significant allelic association with Chinese primary RLS, with one previously reported (BTBD9) and four new findings (TOX3, PRMT6, DCDC2C, NOS1). CONCLUSIONS: Chinese RLS patients has specific characters in many aspects. A high family history with RLS not only indicates strong genetic influence, but also reminds us to consider the familial effect in the epidemiological study. Newly developed sequencing technique with large samples remains to be done.

Functional profile of perilesional gray matter in focal cortical dysplasia: an fMRI study.

Objectives: We aim to investigate the functional profiles of perilesional gray matter (GM) in epileptic patients with focal cortical dysplasia (FCD) and to correlate these profiles with FCD II subtypes, surgical outcomes, and different antiseizure medications (ASMs) treatment response patterns. Methods: Nine patients with drug-responsive epilepsy and 30 patients with drug-resistant epilepsy (11 were histologically confirmed FCD type IIa, 19 were FCD type IIb) were included. Individual-specific perilesional GM and contralateral homotopic GM layer masks were generated. These masks underwent a two-voxel (2 mm) dilation from the FCD lesion and contralateral homotopic region, resulting in 10 GM layers (20 mm). Layer 1, the innermost, progressed to Layer 10, the outermost. Amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) analyses were conducted to assess the functional characteristics of ipsilateral perilesional GM and contralateral homotopic GM. Results: Compared to the contralateral homotopic GM, a significant reduction of ALFF was detected at ipsilateral perilesional GM layer 1 to 6 in FCD type IIa (after Bonferroni correction p < 0.005, paired t-test), whereas a significant decrease was observed at ipsilateral perilesional GM layer 1 to 2 in FCD type IIb (after Bonferroni correction p < 0.005, paired t-test). Additionally, a significant decrease of the ReHo was detected at ipsilateral perilesional GM layer 1 compared to the CHRs in FCD type IIb. Notably, complete resection of functional perilesional GM alterations did not correlate with surgical outcomes. Compared to the contralateral homotopic GM, a decreased ALFF in the ipsilateral perilesional GM layer was detected in drug-responsive patients, whereas decreased ALFF in the ipsilateral perilesional GM layer 1-6 and decreased ReHo at ipsilateral perilesional GM layer 1 were observed in drug-resistant patients (after Bonferroni correction p < 0.005, paired t-test). Conclusion: Our findings indicate distinct functional profiles of perilesional GM based on FCD histological subtypes and ASMs' response patterns. Importantly, our study illustrates that the identified functional alterations in perilesional GM may not provide sufficient evidence to determine the epileptogenic boundary required for surgical resection.

DTP-Net: Learning to Reconstruct EEG Signals in Time-Frequency Domain by Multi-Scale Feature Reuse.

Electroencephalography (EEG) signals are prone to contamination by noise, such as ocular and muscle artifacts. Minimizing these artifacts is crucial for EEG-based downstream applications like disease diagnosis and brain-computer interface (BCI). This paper presents a new EEG denoising model, DTP-Net. It is a fully convolutional neural network comprising Densely-connected Temporal Pyramids (DTPs) placed between two learnable time-frequency transformations. In the time-frequency domain, DTPs facilitate efficient propagation of multi-scale features extracted from EEG signals of any length, leading to effective noise reduction. Comprehensive experiments on two public semi-simulated datasets demonstrate that the proposed DTP-Net consistently outperforms existing state-of-the-art methods on metrics including relative root mean square error (RRMSE) and signal-to-noise ratio improvement ( ∆SNR). Moreover, the proposed DTP-Net is applied to a BCI classification task, yielding an improvement of up to 5.55% in accuracy. This confirms the potential of DTP-Net for applications in the fields of EEG-based neuroscience and neuro-engineering. An in-depth analysis further illustrates the representation learning behavior of each module in DTP-Net, demonstrating its robustness and reliability.

Association of serum uric acid with all-cause and cardiovascular mortality in obstructive sleep apnea.

The study investigated the association between Serum Uric Acid (SUA) levels and all-cause as well as cardiovascular mortality in patients with Obstructive Sleep Apnea (OSA). This prospective cohort study enrolled participants with OSA from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008, and 2015-2018. A weighted Cox proportional hazards model was used to assess adjusted hazard ratios (aHRs) and their corresponding 95% confidence intervals (CI) for all-cause and cardiovascular mortality. Additionally, multivariable logistic regression and restricted cubic splines (RCS) models were employed to examine nonlinear relationships between SUA and all-cause and cardiovascular mortality. Among the 5,584 OSA participants included in the study, covering the four NHANES cycles and with a median follow-up of 4.333 years, a total of 537 deaths were observed, including 108 deaths attributed to cardiovascular disease. Comparing the fourth quartile (Q4) of uric acid levels, both the fifth quartile (Q5) (aHRs = 1.51, 95% CI [1.08, 2.12]) and the second quartile (Q2) (aHRs = 1.53, 95% CI [1.04, 2.25]) of uric acid levels were independently associated with an increased risk of all-cause mortality. Furthermore, comparing the fourth quartile (Q4) of uric acid levels, the second quartile (Q2) (aHRs = 2.40, 95% CI [1.08, 5.35]) of uric acid levels were independently associated with an increased risk of cardiovascular mortality. The RCS model demonstrated a U-shaped pattern in the association between SUA and all-cause mortality in OSA, with an inflection point observed at 5.83 mg/dl. The findings of this study suggest a U-shaped association between serum SUA levels and all-cause mortality and nonlinearity association between serum SUA levels and all-cause mortality. Further studies are warranted to determine the causal relationship between SUA levels and all-cause and cardiovascular mortality.

Exploring the causes of augmentation in restless legs syndrome.

Long-term drug treatment for Restless Legs Syndrome (RLS) patients can frequently result in augmentation, which is the deterioration of symptoms with an increased drug dose. The cause of augmentation, especially derived from dopamine therapy, remains elusive. Here, we review recent research and clinical progress on the possible mechanism underlying RLS augmentation. Dysfunction of the dopamine system highly possibly plays a role in the development of RLS augmentation, as dopamine agonists improve desensitization of dopamine receptors, disturb receptor interactions within or outside the dopamine receptor family, and interfere with the natural regulation of dopamine synthesis and release in the neural system. Iron deficiency is also indicated to contribute to RLS augmentation, as low iron levels can affect the function of the dopamine system. Furthermore, genetic risk factors, such as variations in the BTBD9 and MEIS1 genes, have been linked to an increased risk of RLS initiation and augmentation. Additionally, circadian rhythm, which controls the sleep-wake cycle, may also contribute to the worsening of RLS symptoms and the development of augmentation. Recently, Vitamin D deficiency has been suggested to be involved in RLS augmentation. Based on these findings, we propose that the progressive reduction of selective receptors, influenced by various pathological factors, reverses the overcompensation of the dopamine intensity promoted by short-term, low-dose dopaminergic therapy in the development of augmentation. More research is needed to uncover a deeper understanding of the mechanisms underlying the RLS symptom and to develop effective RLS augmentation treatments.

Association between obstructive sleep apnea and risk for post-stroke anxiety: A Chinese hospital-based study in noncardiogenic ischemic stroke patients.

OBJECTIVE: This study explored the role of obstructive sleep apnea (OSA) in post stroke anxiety (PSA) in noncardiogenic ischemic stroke patients. METHODS: 180 patients with noncardiogenic ischemic stroke were consecutively enrolled from January 2019 to December 2019. All patients underwent polysomnography (PSG) to assess for OSA. OSA severity was identified based on the apnea hypopnea index (AHI), i.e., no OSA (AHI <5), mild OSA (5 = AHI <15), and moderate to severe OSA (AHI ≥15). Neuropsychological assessments were performed at acute phase and 6 months later to evaluate anxiety (Chinese version of the Zung self-rating anxiety scale [SAS], and Beck Anxiety Inventory [BAI]), depression (Patient Health Questionnaire-9, [PHQ-9]), and cognition (Mini-mental state examination, [MMSE], and Montreal Cognitive Assessment, [MOCA]). Clinical diagnoses of PSA were made based on interviews and the anxiety scales. The correlations between PSA and OSA were investigated in Logistic regression analysis. RESULTS: The prevalence of acute-phase and 6-month PSA were 27 (15%) and 52 (28.9%) respectively. Moderate to severe OSA and post-stroke depression (PSD) were the influencing factors of acute-phase PSA. 6-Month PSA was not associated with OSA but was associated with acute-phase anxiety, education status and MOCA. Logistic regression analysis including respiratory and sleeping parameters showed that AHI and micro-arousal index contributed to acute-phase PSA. CONCLUSIONS: Acute-phase PSA was associated with OSA severity, potentially through OSA-caused sleep discontinuity. While 6-month PSA was associated with acute-phase anxiety, highlighting the need for integration of screening for and management of OSA and PSA at acute phase.

Peripheral Iron Metabolism is Associated with Leg Movements on Polysomnography but Not with the Severity of Restless Legs Syndrome or Its Impact on Patients.

Purpose: This study investigated the associations of peripheral iron status with different manifestations of restless legs syndrome (RLS), including leg movements (LMs) on polysomnography (PSG), disease severity, and impact on patients. Patients and Methods: In this cross-sectional study, 108 patients with RLS were enrolled at Sir Run Run Shaw Hospital's Center for Sleep Medicine. Demographic information, disease characteristics, RLS severity, and impact on patients were assessed through a semi-structured questionnaire. Peripheral iron indicators [serum ferritin, iron, and transferrin concentrations; unsaturated iron-binding capacity (UIBC) and total iron-binding capacity (TIBC); transferrin saturation (TSAT)] were measured following PSG to assess sleep stages, respiratory events, microarousals and LM parameters. Data from patients with and without ferritin concentration < 50 µg/L were compared in crude analyses, and Spearman correlations of other iron indicators with RLS data were examined. An ordinal logistic regression model was used to adjust for age, sex, body mass index, years of education, age at the time of RLS onset, prior treatment (yes/no), C-reactive protein (CRP)/hemoglobin level, total sleep time and apnea-hypopnea index. Results: Multivariate analysis showed that periodic LMs during sleep (PLMS) and other LM parameters were significantly associated with a ferritin concentration < 50 µg/L, UIBC, TIBC, and serum transferrin concentration, but not serum iron or TSAT. By contrast, the severity and impact of RLS were not associated with a ferritin concentration < 50 µg/L or other peripheral iron indicators in the multivariate model. Conclusion: In this study, peripheral iron status was associated mainly with motor components (LMs on PSG) rather than sensory components (severity and impact of RLS) after adequately controlling for potential confounders, such as CRP and hemoglobin levels. Commonly used peripheral iron metabolism indicators may therefore not be ideal biomarkers of RLS severity or impact on patients.

Effects of anti-seizure therapies on sleep in patients with epilepsy: A literature review.

Sleep disorder is common in epilepsy. With a recent rapid development in sleep medicine, it has been increasingly recognized that anti-seizure therapies, either anti-seizure medications (ASMs) or non-pharmaceutical approaches, can take direct or indirect influence on sleep in patients with epilepsy. Here, we systematically review the effect of anti-seizure treatments on sleep. ASMs targeting at different sites exerted various effects on both sleep structure and sleep quality. Non-pharmaceutical treatments including resective surgery, ketogenic diet, and transcranial magnetic stimulation appear to have a positive effect on sleep, while vagus nerve stimulation, deep brain stimulation, and brain-responsive neurostimulation are likely to interrupt sleep and exacerbate sleep-disordered breathing. The potential mechanisms underlying how non-pharmacological approaches affect sleep are also discussed. The limitation of most studies is that they were largely based on small cohorts by short-term observations. Further well-designed and large-scale investigations in this field are warranted. Understanding the effect of anti-seizure therapies on sleep can guide clinicians to optimize epilepsy treatment in the future.

Trends in Prescriptions for Insomnia in a Province in China Between 2015 and 2019.

Background: The inappropriate use of pharmacological treatments for insomnia may increase patients' risk of serious adverse events. However, few epidemiological studies on the use of medications for insomnia in China have been conducted to date. Objective: We aimed to investigate the current pharmacological treatments for insomnia and guide the rational use of drugs. Methods: The prescription data of outpatients with insomnia between 2015 and 2019 in Zhejiang province were extracted from the Hospital Prescription Analysis Cooperative Project of China and evaluated. The demographic characteristics of insomnia and the proportion and prescription trends of different drugs were analyzed along with multidrug combinations for insomnia. Results: The number of patients with insomnia who were prescribed medications for insomnia increased from 2,385 in 2015 to 3,919 in 2019, with an increase of 64.32%, whereas the mean age of these patients decreased from 64.07 years to 60.94 years. There were nearly 1.42 times as many female patients prescribed medications for insomnia as male patients, and female patients tended to be younger than male patients. Benzodiazepines (53.99%) were the most common type of medicine for insomnia. The incidence of benzodiazepine usage decreased significantly yearly (P < 0.01), whereas the incidences of non-benzodiazepine receptor agonist (nBZRA) and antidepressant usage increased (P < 0.05). The most common benzodiazepine, nBZRA, antidepressant, and antipsychotic were estazolam, zolpidem, trazodone, and olanzapine, respectively. A total of 13.97% of outpatients with insomnia were prescribed multiple drugs for insomnia, even though nearly half of the drug combinations had similar pharmacological mechanisms. Conclusions: Benzodiazepines remained the most common medication for insomnia, but the prescription rates of nBZRAs and antidepressants increased. Attention should be paid to multidrug combinations for insomnia, which may lead to an increased risk of serious adverse effects.

Augmentation in patients with restless legs syndrome receiving pramipexole therapy: a retrospective study in a single center from China.

PURPOSE: Augmentation is a major complication of long-term pramipexole treatment of restless legs syndrome (RLS). However, there have been no studies on augmentation in Chinese patients with RLS. We therefore investigated the clinical characteristics of augmentation in RLS patients treated with pramipexole in a real-world Chinese setting. METHODS: This study was an observational, retrospective assessment of 103 patients with RLS, who had been continuously treated with pramipexole for at least one month between January 2016 and December 2018 in a tertiary hospital in East China. Demographic data and disease and drug treatment information were collected from electronic medical records and telephone interviews to analyze the rate and clinical features of augmentation. Augmentation was confirmed by Max Planck Institute criteria. Comparisons were made between patients with and without augmentation. RESULTS: Fifteen patients (15%) were classified as having augmentation. Compared to RLS patients without augmentation, more patients with augmentation switched from other dopaminergic drugs (P<0.05) and had a longer duration of RLS symptoms before pramipexole treatment (P<0.05). In addition, patients with augmentation had a longer duration (P<0.05) and higher dosage (P<0.05) of pramipexole than those without augmentation. Augmentation was possibly associated with pramipexole tolerance (P<0.01). CONCLUSION: The augmentation rate of the Chinese RLS patients in our study was 15%. Augmentation may be associated with switching from other dopaminergic drugs, long disease duration before pramipexole use, the dose and duration of pramipexole, and tolerance to pramipexole.

Neurological and psychiatric presentations associated with COVID-19.

The objective is to investigate coronavirus disease 2019 (COVID-19)-associated neurological and psychiatric effects and explore possible pathogenic mechanisms. This study included 77 patients with laboratory-confirmed COVID-19 in Wuhan, China. Neurological manifestations were evaluated by well-trained neurologists, psychologists, psychiatric presentations and biochemical changes were evaluated using the Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire-9, Brief Psychiatric Rating Scale, and electronic medical records. Eighteen (23.4%) patients presented with neurological symptoms. Patients with neurological presentations had higher urea nitrogen, cystatin C, and high-sensitivity C-reactive protein levels and lower basophil counts. Among them, patients with muscle involvement had higher urea nitrogen and cystatin C levels but lower basophil counts. In addition, patients with psychiatric presentations were older and had higher interleukin (IL)-6 and IL-10 levels and higher alkaline phosphatase, R-glutamate transferase, and urea nitrogen levels. Moreover, patients with anxiety had higher IL-6 and IL-10 levels than those without, and patients with moderate depression had higher CD8 + T cell counts and lower CD4 + /CD8 + ratios than other patients. This study indicates that the central nervous system may be influenced in patients with COVID-19, and the pathological mechanisms may be related to direct virus invasion of the central nervous system, infection-mediated overreaction of the immune system, and aberrant serum pro-inflammatory factors. In addition, basophils and cystatin C may also play important roles during these pathological processes. Our findings suggest that neurological and psychiatric presentations should be evaluated and managed in patients with COVID-19. Further studies are needed to investigate the underlying mechanisms.

[Advances in treatment of narcolepsy].

Narcolepsy is the most common cause of excessive daytime sleepiness (EDS) following obstructive sleep apnea. Its treatment aims to reduce EDS and cataplexy, improve nighttime sleep disturbance, sleep paralysis and sleep-related hallucinations. Pitolisant (a histamine H3 receptor antagonist) and solriamfetol (a norepinephrine reuptake inhibitor) have recently been approved effective for narcolepsy in the United States and the European Union. Pitolisant has proved to be effective for both EDS and cataplexy. Besides being effective on EDS, solriamfetol seems to have advantages in abuse potential and withdrawal syndrome. As potential treatments for EDS and cataplexy associated with narcolepsy, several new drugs are being developed and tested. These new drugs include new hydroxybutyrate preparations (controlled release sodium hydroxybutyrate FT218, low sodium hydroxybutyrate JZP-258), selective norepinephrine reuptake inhibitor (AXS-12), and modafinil combined with astroglial junction protein inhibitor (THN102). This paper reviews the recently approved drugs and potential treatments for narcolepsy.

[Advances in sleep-related hypermotor epilepsy].

Sleep-related hypermotor epilepsy (SHE), formerly known as nocturnal frontal epilepsy, is characterized by asymmetrical tonic or complex hypermotor seizures during sleep, with transient, frequent and clustering attack. The accurate incidence is not known but somehow low, which is estimated about 1.8/100 000. The differential diagnosis between SHE and parasomnias may be challenging due to possible similarities between the two sleep-related manifestations. In a majority of patients, the etiology is unknown. Identified etiologies are heterogeneous and structural abnormalities,which are involved in the severity and prognosis of SHE. In terms of treatment, it mainly includes pharmacological therapy and surgery. Carbamazepine seems to be the drug of choice in SHE patients, and epilepsy surgery provides excellent results in selected drug-resistant SHE cases. This review will focus on diagnosis, pathogenesis, treatment and prognosis of SHE, aiming to promote its early diagnosis and appropriate treatment.

[Abnormal eye movements in patients with idiopathic rapid eye movement sleep behavior disorder].

OBJECTIVE: To analyze the characteristics of eye movements in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). METHODS: Twenty two patients with iRBD and 20 controls were enrolled between January 2017 and May 2019 from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Clinical data including polysomnogram (PSG) results were collected. Videonystagmography (VNG) including spontaneous nystagmus, gaze, saccade, tracking and optokinetic test were performed. The difference of VNG results between iRBD patients and controls were analyzed. The factors related to the abnormal VNG results were analyzed by using logistic regression analysis. RESULTS: No significant differences were found between the iRBD and control groups in the spontaneous nystagmus, gaze nystagmus, square wave jerk, involuntary eye movement, saccade and optokinetic nystagmus (all P>0.05). In smooth pursuit of 0.4-0.5 Hz and 0.6-0.7 Hz, iRBD patients had more type Ⅲ-Ⅳ curve than controls (χ2=5.177 and 5.301, both P<0.05). Logistic regression analysis indicated that less sleep time of N3 stage was related to the abnormal results in smooth pursuit of 0.4-0.5 Hz (OR=0.963, P<0.05). iRBD patients with Ⅲ-Ⅳ type curve in smooth pursuit of 0.4-0.5 Hz had less N3 sleep time than iRBD patients with Ⅰ-Ⅱ type curve (52±28 min vs. 76±23 min, t=2.197, P<0.05). CONCLUSIONS: Abnormal smooth pursuit was found in iRBD patients, which might be related to the pathological mechanism of iRBD.

[Relationship between sleep architecture and severity of obstructive sleep apnea].

OBJECTIVE: To investigate the effect of obstructive sleep apnea (OSA) on different sleep stages, and the relationship between N3 stage of non-rapid eye movement sleep and respiratory abnormal events. METHODS: A total of 188 adult patients who underwent overnight polysomnography(PSG)monitoring in Sir Run Run shaw Hospital of Zhejiang University from June 24th to December 26th 2019 were enrolled in the study. OSA patients were classified into 3 groups (mild, moderate and severe) according to the apnea-hypopnea index (AHI). PSG data, AHI and the lowest SPO2 in each stage of sleep were compared among three groups. RESULTS: There was no significant difference in total sleep time and sleep efficiency among patients with different severity of OSA (all P>0.05). The proportion of N3 stage in moderate and severe OSA groups were significantly smaller than that in mild OSA group (all P<0.05). The proportion of N3 stage in severe OSA group was also smaller than that in moderate OSA group (P<0.05). In addition, severe OSA group had a longer latency of N3 stage than mild and moderate OSA groups (all P<0.05). The latency of N3 stage in moderate OSA group was longer than that in mild OSA group (P<0.05). The AHI in N3 stage was markedly lower than that in other sleep stages (all P<0.01), regardless of the severity of OSA. Supine AHI in N3 stage in mild and moderate groups was significantly lower than that in N1, N2 and rapid eye movement (REM) stages (all P<0.01). Supine AHI in N3 stage in severe group was also lower than that in N2 and REM stages (P<0.05 or P<0.01). The lowest SPO2 in N3 stage was significantly higher than that in N1, N2 and REM stages (P<0.05 or P<0.01), regardless of the severity of OSA. CONCLUSIONS: s The proportion of N3 stage is lower in OSA patients, and N3 stage has less sleep respiratory events than non-N3 stages. The results suggest that the increased N3 stage proportion may indicate less severity of OSA.

[Correlation between suicidal ideation and polysomnography parameters in late-life depression patients].

OBJECTIVE: To investigate the relationship between sleep parameters and suicidal ideation in patients with late-life depression (LLD). METHODS: Seventy-seven LLD patients over 60 years old from Sir Run Run Shaw Hospital of Zhejiang University during July 2017 and July 2018 were included in the study. All patients were assessed with Hamilton Depression Rating Scale (HAMD) and polysomnography (PSG) overnight. The suicidal score of item 3 in HAMD (HAM-D3)was used to define whether there was a suicidal ideation. Participants were subsequently grouped according to endorsement of presence (HAM-D3 score ≥1, n=46) versus absence (HAM-D3 score=0, n=31) of suicidal ideation symptoms. The sleep efficiency, total sleep time, wakefulness after sleep onset, rapid eye movement percent/latency, and non-rapid eye movement sleep stages 1-3 (N1-N3) were assessed. ANOVA analyses were conducted to explore the correlation of sleep parameters with suicidal ideation between the groups with and without suicidal ideation. In model 1, the HAM-D3 constituted the independent variable in separate ANOVA tests; in model 2 the impact of depressive symptoms were assessed as a covariate with sleep parameters. RESULTS: There was less stage N3 [(55±41)min, t=-4.731, P<0.05] and the reduced percentage of N3 [(15±11)%, t=-4.194, P<0.05] in LLD patients with suicidal ideation, compared with the LLD patients without suicidal ideation [(104±49) min, (26±11)%]. Correlation analyses revealed that there was a significant correlation between the suicidal ideation and the percentage of stage N3 and sleep time of stage N3 (both P<0.05). CONCLUSIONS: Suicidal ideation is associated with less N3 sleep in LLD patients.

Low Incidence of Maternal Near-Miss in Zhejiang, a Developed Chinese Province: A Cross-Sectional Study Using the WHO Approach.

BACKGROUND AND AIM: Maternal near-miss (MNM) surveillance has been developed to identify severe complications in pregnancy since 2011 in China. However, very little is known about MNM in China. This study aims to explore the prevalence of MNM, the risk factors, and perinatal outcomes using the WHO near-miss approach in a developed Chinese province. MATERIALS AND METHODS: We used data from China's National Maternity Near Miss Obstetrics Surveillance System for the period 2012 to 2017, which included 18 hospitals in Zhejiang Province. Chi-squared tests were used to compare the socio-demographic factors, obstetric complications and perinatal outcomes between women with and without MNM. Logistic regression was used to examine the independent risk factors for MNM. RESULTS: A total of 612,264 pregnant women were recruited. There were 3208 MNM cases and 34 maternal deaths. The MNM incidence ratio was low at 5.9 per 1,000 live births, with an MNM mortality ratio of 98:1 and mortality index of 1.1%. Among 3208 women with MNM, postpartum hemorrhage was the commonest cause at 76.3% followed by severe anemia at 23.7% and placenta previa at 23.0%. Embolism was identified as having the highest risk for MNM (AOR 46.0; 95% CI 19.1-110.7), followed by postpartum hemorrhage (AOR 41.0; 95% CI 35.7-47.0), and severe anemia (AOR 36.6; 95% CI 16.0-84.1). MNM cases were significantly associated with severe perinatal outcome, including premature birth, low birth weight, multiple fetuses, stillbirth rates and neonatal mortality. CONCLUSION: Overall near-miss indicators suggested a relatively high quality of maternal health care in a developed province of China. The identified risk factors may be helpful in developing targeted interventions for improving maternal safety.

[Restless legs syndrome in ischemic stroke patients: clinical features and significance].

OBJECTIVE: To investigate the clinical features and implication of restless legs syndrome (RLS) in ischemic stroke patients. METHODS: A total of 199 ischemic stroke patients were enrolled and assessed by polysomnography (PSG). RLS was identified according to criteria of International Restless Legs Syndrome Study Group. Epworth Sleepiness Scale (ESS), Mini-mental State Examination (MMSE) and Patient Health Questionnaire (PHQ-9) were used to evaluate the sleep quality, cognitive function and post-stroke depression, respectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the neurological function 3 months after stroke onset. Gender-and age-matched non-ischemic stroke patients with RLS (primary PLS) were selected as controls. RESULTS: Twenty-two cases of RLS were identified among 199 ischemic stroke patients (11.1%). Generalized linear model and logistic regression showed that low serum ferritin level (ß=-133.3 mg/L, 95%CI:-200.4--0.1, P<0.01), subcortical infarction (OR=4.05, 95%CI:1.15-14.18, P<0.05) and female (OR=2.54, 95%CI:1.04-6.23, P<0.05) were identified as the risk factors of RLS in ischemic stroke patients. Compared with ischemic stroke patients without RLS, ESS increased by 4.37 (95%CI:2.33-6.41, P<0.01), PHQ-9 increased by 2.17 (95%CI:0.39--3.94, P<0.05), and reduced NIHSS from the baseline deceased by 0.97 (95%CI:-1.79--0.15, P<0.05) in ischemic stroke patients with RLS. In addition, the incidence of moderate-severe depression increased (OR=4.27, 95%CI:1.40-13.10, P<0.05) in ischemic stroke patients with RLS. The index of periodic leg movements of sleep (PLMS) with arousal in ischemic stroke patients with RLS was significantly higher than that in patients with primary RLS (ß=12.85, 95%CI:2.04-23.67, P<0.05). CONCLUSIONS: RLS is common in ischemic stroke patients and has adverse influences on patients.