查看更多>>摘要：? 2021 Elsevier B.V.Objective: To evaluate the association between restless legs syndrome (RLS) and hypertension in men and women based on a community-based cohort of middle-aged and elderly participants. Methods: This cross-sectional observational study enrolled 4080 participants from the Sleep Heart Health study (SHHS). RLS was defined by positive responses on a self-administered questionnaire assessing the four diagnostic criteria, with symptoms occurring at least five times per month and associated with at least moderate distress. Hypertension was defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or current use of antihypertensive medication. Propensity score-matched (PSM) inverse probability treatment weighting (IPTW) analyses and multivariable logistic regression were used to examine the relationship between RLS and hypertension. Results: RLS was present in 6.8% of women (n = 152) and 3.2% of men (n = 59). In the primary cohort analysis, the odds ratio (OR) for hypertension was 1.60 [95% confidence interval (CI) 1.19–2.16, p < 0.001] for participants with RLS compared to those without RLS. In the PSM analyses, the OR for hypertension was 1.66 (95% CI 1.09–2.54, p = 0.019) for participants with RLS compared to those without RLS. In sex subgroup analyses, the association between RLS and hypertension persisted in women. In the PSM cohort, the ORs for hypertension were 1.67 (95% CI 1.01–2.81, p = 0.048) and 1.85 (95% CI 0.75–4.75, p = 0.191) in women and men, respectively. Similar results were found in IPTW cohort. Conclusions: This study revealed a positive association between RLS and hypertension in a community-based population; in sex subgroup analyses, the association persisted in women.
查看更多>>摘要：? 2021 Elsevier B.V.Background: Far from being benign, somnambulistic episodes can be frequent and/or severe and potentially injurious. Episodes may also be accompanied by sleep mentation with variable degrees of retrograde amnesia. The present study investigated how somnambulistic episodes unfold from childhood through adulthood, a topic that remains understudied. Methods: Adult sleepwalkers with a diagnosis of primary somnambulism and a childhood onset of the disorder (n = 113) were assessed for changes in frequency of their episodes, recall of episode-related sleep mentation and aggressive episodes during childhood, adolescence and adulthood. In addition, sleepwalkers (n = 52) with childhood-onset of sleep terrors were assessed for developmental changes in sleep terror frequency. Results: Results indicate that the frequency of somnambulistic episodes remains unchanged during childhood and adolescence before increasing during adulthood. An opposite trend was observed for sleep terrors. The frequency of aggressive somnambulistic episodes and of sleep mentation associated with somnambulism increased from childhood to adolescence and into adulthood. By contrast, the recall of sleep mentation associated with sleep terrors did not change over time. Additionally, a higher frequency of aggressive somnambulistic episodes predicted a higher frequency of sleep mentation associated with somnambulism. These patterns were similar across men and women. Conclusion: Our study demonstrates that in chronic sleepwalkers, sleep mentation associated with somnambulistic episodes increases with age while episodes worsen in frequency and severity from childhood to adulthood. These findings add to the limited literature in the field and provide valuable insights into how key clinical characteristics of somnambulism evolve across the lifespan.
查看更多>>摘要：? 2021 Elsevier B.V.Cervical dystonia (CD) is the most common adult-onset focal dystonia. Non-motor symptoms, such as insomnia, can greatly impact the quality of life in CD patients. CD can be treated with deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) although its effect on sleep is not yet fully understood. Here, we report a case of a 66-year-old female patient with cervical dystonia, who developed an unusual form of insomnia following her DBS surgery. Our patient reported recurrent episodes of visual symptoms (flashing lights), which would often wake her up at night. Following surgical revision of the extension wire, these visual symptoms completely resolved. This case provides an example of impedance oscillations caused by pressure on the pillow, which resulted in irregular delivery of current (according to Ohm's law) and recruitment of optic tract fibers secondary to excessive current.
查看更多>>摘要：? 2021 Elsevier B.V.Objectives: The first-night effect (FNE) affects the accuracy of polysomnography (PSG) findings. However, the levels of FNE in different ages are unclear. Methods: We searched PubMed, Cochrane Library, Embase and Web of Science. The studies that reported sleep parameters by PSG for at least 2 consecutive nights from healthy individuals were included. The weighted mean differences were used to assess the effect size of differences in each sleep parameters between the first and second nights, as well as between the second and the third. Results: A total of 53 studies from 1422 subjects with mean age of 9.2–85.5 years were included. Meta-analyses showed that prolonged sleep onset latency, wake time after sleep onset and rapid eye movement sleep (REM) latency, accompanied by decreased total sleep time, sleep efficiency, and REM and increased non-rapid eye movement sleep stage 1 (N1) during the first night compared to the second (all P-value ≤ 0.001). No significant differences were observed in N2 and slow wave sleep, apnea–hypopnea index or periodic limb movement index (all P-value > 0.5). A non-linear association between FNE and age was observed: young adults (age 20–29 years) had the lowest level of FNE compared to other age ranges. Moreover, no significant differences were observed in most sleep parameters between the second and third night except more N2 and less REM in the second night (both P-value < 0.05). Conclusions: The FNE exists in most cases but only in the first night of PSG recording and is less pronounced among young adults.
Charles L.E.Mnatsakanova A.Fekedulegn D.Violanti J.M....
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查看更多>>摘要：? 2021Background: Adverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. Methods: ACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures. Results: The mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7–89.6 vs. 90.2%, 89.2–91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8–89.7 vs. 90.1%, 88.9–91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs. Conclusion: Exposure to ≥1 ACE was associated with worse sleep measures.
查看更多>>摘要：? 2021 Elsevier B.V.Objectives: This study aimed to evaluate the glymphatic system function in patients with obstructive sleep apnea (OSA) compared to healthy controls using diffusion tensor imaging (DTI) with the perivascular space (DTI-ALPS) method. Our hypothesis is that patients with OSA may have glymphatic system dysfunction, which is correlated with OSA severity. Methods: We enrolled 24 patients with OSA and 24 healthy controls. All participants underwent DTI magnetic resonance imaging (MRI) using the same 3T MRI scanner, and we calculated the DTI-ALPS index from the DTI. We evaluated the differences in the DTI-ALPS index between patients with OSA and healthy controls. In addition, we conducted a correlation analysis between the DTI-ALPS index and clinical characteristics. Results: The DTI-ALPS index was significantly different between the groups. The DTI-ALPS in patients with OSA was significantly lower than in healthy controls (1.30450 vs. 1.61600, p = 0.0006). Furthermore, the DTI-ALPS index was significantly negatively correlated with the apnea–hypopnea index in sleep stage N (r = ?0.427, p = 0.042) and oxygen desaturation index during sleep N (r = ?0.497, p = 0.036). Conclusion: We successfully demonstrated glymphatic system dysfunction in patients with OSA. In addition, glymphatic system dysfunction is well correlated with OSA severity, especially during sleep stage N. Thus, these findings can explain the effects of OSA on increased risk of developing dementia and highlight the importance of OSA treatment.
查看更多>>摘要：? 2021 Elsevier B.V.Objective/Background: Brief behavioural sleep interventions have been shown to be effective in treating sleep problems in children with ADHD. Little research, however, has focused on the translational aspects of these programs from the consumer perspective. This study aimed to explore clinician and parent views of a brief training program in managing sleep problems in children with ADHD. Participants: Fifty-nine community-based clinicians (32 paediatricians, 27 psychologists) were trained to deliver a brief behavioural sleep intervention as part of the Sleeping Sound with ADHD translational trial; 183 families were allocated to receive the sleep intervention and 115 provided follow-up data. Methods: Clinicians reported on competency, confidence and perceived barriers pre- and post-training. Parents reported on usefulness of the program and frequency of sleep strategy use at 3 months post-randomisation. Parent-report of severity of the child sleep problem was also measured at 3 and 6 months post-randomisation. Results: Clinicians’ feelings of competency and confidence in managing sleep difficulties increased from pre-to post-training, while perceptions of barriers decreased. Parent-reported usefulness of the program and frequency of sleep use varied by program domain and sleep strategy. Increased parent-reported use of sleep strategies was associated with improved sleep at 3 and 6 months post-randomisation. Conclusions: A brief sleep training program leads to improvements in clinician confidence and competence in managing sleep problems in children with ADHD and positive parent perspectives. The findings highlight the potential for the Sleeping Sound with ADHD program to be optimized to better help parents in their implementation of sleep strategies.
NSTL
Elsevier