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Study objectives: Isolated sleep paralysis is a benign but frightening condition characterised by a temporary inability to move at sleep onset or upon awakening. Despite the prevalence of this condition, little is known concerning its clinical features, associated demographic characteristics, and prevention as well as disruption strategies. Methods: An online cross-sectional study was conducted. The sample comprised 3523 participants who had reported at least one lifetime episode of ISP and 3288 participants without a lifetime episode. Participants answered a survey including questions about sleep quality, sleep paralysis, and sleep paralysis prevention/disruption techniques. Results: A total of 6811 participants were investigated (mean age = 46.9, SD = 15.4, age range = 18–89, 66.1% female). Those who reported experiencing ISP at least once during their lives reported longer sleep onset latencies, shorter sleep duration, and greater insomnia symptoms. Females (vs. male) and younger (vs. older) participants were more likely to experience ISP. Significant fear during episodes was reported by 76.0% of the participants. Most people (63.3%) who experienced ISP believed it to be caused by ‘something in the brain’. A minority endorsed supernatural causes (7.1%). Five prevention strategies (e.g., changing sleep position, adjusting sleep patterns) with at least 60.0% effectiveness, and five disruption strategies (e.g., physical/bodily action, making noise) with varying degrees of effectiveness (ranging from 29.5 to 61.8) were identified through open-ended responses. Conclusions: ISP is associated with shorter sleep duration, longer sleep onset latency, and greater insomnia symptoms. The multiple prevention and disruption techniques identified in this study support existing treatment approaches and may inform subsequent treatment development. Implications for current diagnostic criteria are discussed.

Background: Sleep–wake disturbance is prevalent in patients with liver cancer, but there is no direct evidence of its association and related biological mechanisms. Our study was to assess quality of sleep and to describe prevalence of sleep disturbances in patients with different etiologies of liver cancer, especially to explore whether sleep quality influences immune factors. Methods: A total of 210 patients with liver cancer from August 2015 to December 2015 were randomly divided into two groups including HBV cirrhosis and non-HBV cirrhosis. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate their sleep quality, and then 202 patients enrolled in this study were divided into two groups according to their PSQI scores: PSQI ≤ 5 and PSQI > 5. The association between sleep disturbances and immune factors was analyzed by logistic regression models. Results: A total of 56.9% of liver cancer patients experienced poor sleep quality (PSQI > 5). The prevalence of sleep disturbances was significantly higher in patients with liver cancer of non-hepatitis B virus (HBV) cirrhosis than with that evolving from HBV cirrhosis (66.7% vs. 50%, p = 0.018). In non-HBV cirrhosis liver cancer patients, the PSQI > 5 group had a higher percentage of CD3+ T cells (71.06 ± 11.07 vs. 63.96 ± 14.18, p = 0.014) and lower natural killer (NK) cells (14.67 ± 9.65 vs. 20.5 ± 10.77, p = 0.014) compared with patients with PSQI ≤ 5. Logistic regression further confirmed that liver cancer patients without HBV cirrhosis are more prone to experience poor sleep with increased CD3+ T cells (OR = 1.07, 95% CI = 1.01–1.13, p = 0.030) and decreased NK cells (OR = 0.92, 95% CI = 0.85–0.98, p = 0.014). Our results indicate that increased CD3+ T cells and decreased NK cells are both associated with sleep disturbances in patients with liver cancer of non-HBV cirrhosis. Conclusions: Most liver cancer patients suffer from sleep disturbances, especially evolving from non-HBV cirrhosis. A rise in CD3+ T cells and a reduction in NK cells are associated with sleep disturbances in patients with liver cancer of non-HBV cirrhosis.

Parkinson’s disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.

In patients with Parkinson's disease (PD), fatigue and sleep disturbances are important non-motor symptoms. In this study, we aimed to evaluate the relationship between fatigue and sleep disturbances in patients with Parkinson's disease (PD). A total of 93 outpatients with PD (age, 69.7 ± 8.9 years) and 93 healthy controls (age, 69.6 ± 10.2 years) were included in this study. The participants completed the Parkinson Fatigue Scale (PFS), Epworth Sleepiness Scale (ESS), Parkinson's disease sleep scale (PDSS) -2 and Beck Depression Inventory (BDI) -II. For PD patients, the PD Questionnaire (PDQ-39) was used to evaluate quality of life. Fatigue was defined as a PFS score of 3.3 or greater. Fatigue was observed in 7.5% of healthy controls and 44.0% of PD patients (p < 0.001). In the healthy control group, subjects with fatigue were older than those without fatigue, but there was no difference in the PDSS-2, ESS or BDI-II scores. PD patients with fatigue had significantly higher scores of the ESS, BDI-II, PDQ-39 and PDSS-2 and greater motor symptoms compared with those without fatigue. Fatigue was associated with the PDSS-2 sub-item 2 (Difficulty falling asleep), item 10 (Pain in arms or legs), item 13 (Tremor on waking), item 14 (Tired and sleepy after waking in the morning) and item 15 (Snoring or difficulties in breathing). Logistic regression analysis showed that the PDSS-2 subitem 14 (Tired and sleepy after waking in the morning) and the PDQ-39 summary index were significant determinants for fatigue. In conclusion, we showed the significant relationship between fatigue and various aspects of PD-related nocturnal problems. Our findings emphasize the importance of fatigue assessment in patients with PD.

Artificial light at night (ALAN) is known to create changes in animal behavior across invertebrates and vertebrates and can result in decreased fitness. ALAN effects have not been studied in European honey bees (Apismellifera), an important pollinator. Colonies can be exposed to ALAN in swarm clusters, when bees cluster outside the nest on hot days and evenings, and, in limited cases, when they build nests in the open. Forager bees maintained in incubated cages were subjected to constant light or dark and observed with infrared cameras. The bees maintained a regular sleep pattern for three days but showed a shift on the fourth day in the presence of continuous light. Bees under constant light demonstrated a 24.05-hour rhythm, compared to a 23.12-hour rhythm in the dark. After 95 hours, the light-exposed bees slept significantly less and experienced significantly more disturbances from their peers. They also preferred to sleep in the lower portion of the cages, which had lower light intensity. These findings suggest that ALAN can disrupt honey bees' sleep patterns, which may have implications for their behavior and overall colony health.

Background Disturbed sleep among people living with dementia in nursing homes is widespread and is associated with diseases and all-cause mortality. This study examined the sleep of people living with dementia from their perspectives in nursing homes and that of the nurses who care for people living with dementia. Methods A qualitative cross-sectional study was conducted. A total of 15 people living with dementia and 15 nurses in 11 German nursing homes were enrolled in this study. Data was collected between February and August 2021 through semistructured interviews, which were audio recorded and transcribed. Thematic analyses were performed by three independent researchers. Thematic mind maps and controversial findings were discussed with the Research Working Group of People with Dementia of the German Alzheimer Association. Results Thematic analysis identified five overarching themes from the nursing home participants regarding sleep patterns: (1) characteristics of good sleep, (2) characteristics of bad sleep, (3) personal influences of people living with dementia on sleep, (4) environmental factors on sleep, and (5) sleep strategies of people living with dementia. Analysis also identified five overarching themes from the nurses participants: (1) characteristics of good sleep, (2) characteristics of bad sleep, (3) personal influences on sleep, (4) environmental factors on sleep, and (5) interventions for sleep promotion. Conclusions The thematic analyses demonstrated that the perspectives of people living with dementia and nurses indicate the need to give more consideration to psychosocial factors and individual aspects of sleep in clinical practice. The results could also be helpful for the development of targeted assessment instruments and complex non-pharmacological interventions to promote sleep.

Background: Quality of life (QoL) data of chronic intestinal failure (cIF) patients treated with the GLP-2 analogue teduglutide are scarce. This study aims to analyze QoL changes over time in teduglutide-treated patients and compare the results to a matched non-treated cIF control group in a real-world setting. Methods: QoL data (SF-36 and SBS-QoLTM) were obtained from adult cIF patients being treated with teduglutide and compared to previously collected QoL data from a PNLiver trial (DRKS00010993), during which patients had been therapy naive. The dataset was then extended by a pairwise matched control group (non-teduglutide-treated PNLiver trial patients) and follow-up data from this group were collected accordingly. Results: Median teduglutide treatment duration and the follow-up period of controls were both 4.3 years. SBS-QoLTM subscales and the SBS-QoLTM sum score showed significant improvements over time in teduglutide-treated patients, as well as for the SF-36 physical and mental component summary scores (all p < 0.02), while non-treated patients showed no significant changes in any of the mentioned scores. Significant differences of QoL changes between treated and non-treated patients were seen for both SF-36 summary scores (p = 0.031 and 0.012). Conclusions: We herein demonstrate for the first time that QoL significantly improved during teduglutide treatment in SBS-cIF patients in a real-world setting compared to individually matched non-treated SBS-cIF patients, indicating relevant clinical benefits.

Background and Objectives: Falls are frequent among the elderly, imply large social and economic costs, and have serious outcomes. The purpose of this study was to investigate the links between insomnia, comorbidities, multisite pain, physical activity, and fall risk in the elderly. Materials and Methods: This retrospective cross-sectional study included persons recruited from nursing homes for the elderly in Timisoara. We separated the participants into two groups by the absence (group I) or presence of fractures (group II) starting with the age of 65 years. Participants were asked how they feel about their sleep using one item on a 4-point scale from the Assessment of Quality of Life questionnaire. The risk of fall was evaluated using the Falls Risk Assessment Tool. Results: The study enrolled 140 patients with a mean age of 78.4 ± 2.4 years (range 65–98 years), 55 of them being males (39%). By comparing the two groups, we found that the elderly with a history of fractures had a greater number of comorbidities, a higher risk of fall, and more severe sleep disturbances. When using univariate logistic regression, the occurrence of fractures in the elderly was significantly associated with the number of comorbidities, the risk of fall, and the presence of sleep disturbances (p < 0.0001). The multivariate regression analysis selected four independent parameters significantly linked to fractures, and these were the number of comorbidities (p < 0.03), the risk of fall score (p < 0.006), and the sleep disturbances of type 3 (p < 0.003) and 4 (p = 0.001). Conclusions: A fall-risk score over 14 and a number of comorbidities over 2 were notably associated with the occurrence of fractures. We also found strong positive correlations between the type of sleep disturbance and the risk of fall score, the number of comorbidities, and the number of fractures in the elderly.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children’s functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017–2018, n = 1380) and another during COVID-19 pandemic (March–May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p 30 min during confinement.• Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children’s sleep based on the BISQ criteria. Supplementary information The online version contains supplementary material available at 10.1007/s00431-022-04376-0.

This study examined the association between post-stroke cognitive function and sleep status at 30 days post-stroke and evaluated the role of anxiety and depression as potential mediators of that association. The participants in this study were 530 acute ischemic stroke (IS) patients. Sleep disturbance at 30 days post-stroke was assessed by the Pittsburgh Sleep Quality Index. Basic patient information, cognitive function, depression, and anxiety status were assessed before discharge from the hospital. Stratified linear regression analysis models were fit to examine the associations between post-stroke sleep quality and the influencing factors. A structural equation model was developed to evaluate the role of anxiety and depression as potential mediators of sleep quality and cognitive function. At 30 days post-stroke, 58.7% of IS patients had sleep disturbance. Women and older IS patients were more likely to suffer poorer sleep quality (p < 0.05). A stratified linear regression analysis showed that the inclusion of cognitive function variables and indicators of depression and anxiety were statistically significant in predicting improvement in the sleep disturbance of AIS patients. Cognitive function, depression, anxiety, and sleep status were selected to construct a structural equation model. The total effect of cognitive function on sleep status was −0.274, with a direct effect of −0.097 and an indirect effect (through depression) of −0.177. The total effect of anxiety on sleep status was 0.235, with a direct effect of 0.186 and an indirect effect (through depression) of 0.049. IS patients often experience poor sleep quality. Depression in IS patients mediates two pathways: the pathway through which cognitive function affects sleep quality and the pathway through which anxiety affects sleep quality.

In this paper, an adaptive temporal-causal network model is presented for a normal night’s sleep and for how disturbances and their timing interfere with such a normal night of sleep. The goal of this computational model is to explore the area of how sleep disturbances influence a person’s health. This was achieved by simulating single and multiple sleep disturbances during sleep episodes and measuring the effect on light, deep, and REM sleep. The main finding from the simulated scenarios in this study is that disturbances, depending on their timing, can cause a lack of deep and/or REM sleep. This implies that sleep disturbances might lead to insufficient physical and/or emotional recovery.

Bakgrund: Demens är ett samlingsnamn på flera sjukdomar som påverkar hjärnans kognitiva funktion och drabbar främst äldre personer. Sömnsvårigheter är vanligt förkommande hos personer med demens. Sömnen är ett sätt för kroppen att koppla av och återhämta sig. Det finns olika faktorer som kan påverka sömnen och orsaka sömnsvårigheter hos den drabbade personen. Miljöfaktorer, smärta och substansanvändning kan påverka sömnen negativt. Syfte: Syftet var att kartlägga omvårdnadsåtgärder som kan främja sömnen hos personer med demenssjukdom. Metod: En litteraturöversikt enligt Friberg bestående av 12 artiklar varav 10 kvantitativa studier och två kvalitativa studier. Resultat: I resultatet lyfter olika omvårdnadsåtgärder upp som kan främja sömnen hos personer med demens. Analysen av artiklarna utmynnade i kategorierna: betydelsen av miljön, betydelsen av beröring och betydelsen av meningsfulla aktiviteter. Slutsats: Omvårdnadsåtgärderna i de olika kategorierna kan utifrån det som redovisas i resultatet användas för att främja sömnen hos personer med demens. Genom en personcentrerad och individanpassad vård kan sjuksköterskor tillgodose patienternas behov och önskemål. Bakgrund: Demens är ett samlingssubstantiv för flera sjukdomar som påverkar hjärnans kognitiva funktion och främst drabbar äldre. Sömnstörningar är vanliga hos personer med demens. Sömn är ett av kroppens sätt att slappna av och återhämta sig. Det finns olika faktorer som kan påverka sömnen och orsaka sömnstörningar hos personer med demens. Miljöfaktorer, smärta och droganvändning kan påverka sömnen negativt. Syfte: Syftet med denna studie var att kartlägga omvårdnadsåtgärder som kan främja sömn hos personer med demens. Metod: En litteraturöversikt genomfördes enligt Friberg bestående av tolv artiklar: tio kvantitativa studier och två kvalitativa studier. Resultat: Resultaten presenterar olika åtgärder som kan främja sömn hos personer med demens. Resultaten innehåller följande kategorier: miljöns betydelse, vikten av fysisk kontakt och betydelsen av meningsfulla aktiviteter. Slutsats: Omvårdnadsåtgärder kan användas för att främja sömn hos personer med demens. Sjuksköterskor kan möta patienters behov och önskemål genom en personcentrerad och individanpassad vård.

International audience; Background: The use of alcohol and nicotine can negatively impact the course of bipolar disorder (BD), but there is limited knowledge about how symptoms and sleep disturbances is related to concurrent nicotine use and non-pathological use of alcohol.Methods: We investigated how nicotine use and non-pathological use of alcohol relates to affective symptoms and sleep disturbances in 453 participants with BD without substance use disorders. Manic symptoms were assessed with the Young Mania Rating Scale, and depressive symptoms with The Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C). Sleep-related questions from IDS-C were used to create proxy variables for sleep disturbances, including Insomnia and Hypersomnia. Multinomial regression analysis was conducted to investigate the associations between nicotine use and sleep disturbances, controlling for possible confounders such as current use of illicit drugs and psychopharmacological treatment.Results: Depressive and manic symptoms were not associated with the concurrent level of alcohol or nicotine use. Individuals with medium and high levels of daily nicotine use had higher risk of insomnia than those without. Non-pathological alcohol use was not associated with sleep disturbances.Limitations: Sleep disturbances were based on items from the IDS-C questionnaire.Conclusion: We found an elevated risk for insomnia in individuals with BD and medium or high levels of daily nicotine use. We found no association between the level of affective symptoms and the level of use of alcohol or nicotine. The direction of the relationship between nicotine use and insomnia needs clarification, as it is highly relevant for treatment planning.

Aims and objectives Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing. Materials and methods A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of

Study Objectives The aim of this study was to; (1) explore whether adolescents use technology as distraction from negative thoughts before sleep, (2) assess whether adolescents who perceive having a sleep problem use technology as distraction more compared to adolescents without sleep complaints, and (3) collect qualitative information about which devices and apps adolescents use as a distraction. Methods This study used a mixed-methods cross-sectional design, where 684 adolescents (M = 15.1, SD = 1.2, 46% female) answered both quantitative and qualitative questions about their sleep (perceived sleep problem, sleep onset time (SOT), and sleep onset latency [SOL]) and technology use as distraction from negative thoughts. Results The majority of adolescents answered “yes” or “sometimes” using technology as a distraction from negative thoughts (23.6% and 38.4%). Adolescents who answered “yes” to using technology as distraction were more likely to report having a sleep problem, longer SOL, and later SOT, compared to adolescents who answered “no”. The most popular device to distract was the phone, because of its availability, and the most common apps used for distraction included YouTube, Snapchat, and music apps. Conclusions This study shows that many adolescents use technology to distract themselves from negative thoughts, which may help them manage the sleep-onset process. Thus, distraction may be one mechanism explaining how sleep affects technology use, rather than vice versa.

Background: While there is sufficient evidence that children and adolescents who stutter reported more impaired sleep compared to children and adolescents who did not stutter, findings among adults who stutter (AWS) were scarce. Furthermore, stuttering is associated with issues related to verbal communication in a social context. As such, it was conceivable that AWS reported higher scores for social anxiety, compared to adults who do not stutter (AWNS). In the present study, we tested whether AWS reported higher sleep complaints compared to AWNS. We further tested whether scores for social anxiety and stuttering independently predicted sleep disturbances. Methods: A total of 110 AWS (mean age; 28.25 years, 27.30% females) and 162 AWNS (mean age; 29.40 years, 51.20% females) completed a series of self-rating questionnaires covering sociodemographic information, sleep disturbances and social anxiety. Adults with stuttering further completed a questionnaire on stuttering. Results: Compared to AWNS, AWS reported a shorter sleep duration, a lower sleep efficiency, higher scores for drug use in terms of sleep-promoting medications (significant p-values and medium effect sizes), and an overall higher PSQI score (significant p-values and large effect size), when controlling for age and social anxiety. Next, while p-values were always significant for subjective sleep quality, sleep disturbances, and daytime functioning, when controlling for age and social anxiety, their effect sizes were trivial or small. For sleep latency, the p-value was not significant and the effect size was trivial. Among AWS, higher scores for stuttering and older age, but not social anxiety, predicted higher sleep disturbances. The association between higher sleep disturbances and higher stuttering severity was greatest among those AWS with highest scores for social anxiety. Conclusions: When compared to AWNS, AWS self-reported higher sleep disturbances, which were associated with older age, and higher scores for stuttering severity, but not with social anxiety. Adults who stutter might be routinely asked for their sleep quality.

Background Sleep disturbances are common non-motor symptoms of Parkinson’s Disease (PD). Methods The aim of this study was to investigate the polysomnographic correlates of sleep changes, as investigated by the Parkinson’s Disease Sleep Scale-2 (PDSS-2), in a cohort of sixty-two consecutive de novo, drug naïve PD patients (71.40 ± 7.84 y/o). Results PDSS-2 total score showed a direct correlation with stage shifts (p = 0.008). Fragmented sleep showed an inverse correlation with sleep efficiency (p = 0.012). Insomnia symptoms showed an inverse correlation with wake after sleep onset (p = 0.005) and direct correlation with periodic leg movements (p = 0.006) and stage shift indices (p = 0.003). Motor Symptoms showed a direct correlation with Apnoea-Hypopnoea (AHI; p = 0.02) and awakenings indices (p = 0.003). Dream distressing showed a direct correlation with REM without atonia (RWA, p = 0.042) and an inverse correlation with AHI (p = 0.012). Sleep quality showed an inverse correlation with RWA (p = 0.008). Conclusion PDSS-2 features are significantly correlated with polysomnography objective findings, thus further supporting its reliability to investigate sleep disturbances in PD patients.

Objective:This study aimed to evaluate sleep disturbance in patients with ankylosing spondylitis (AS) and to analyse the relationship between disease activity, anxiety/depression and pain level.Materials and Methods:Disease activity was assessed using the Bath ankylosing spondylitis disease activity index (BASDAI), sleep disturbance was evaluated by the Epworth sleepiness scale (ESS), pain level was evaluated by the visual analogue scale and emotional state was evaluated by the Beck depression inventory (BDI), state-trait anxiety inventory (STAI) I and STAI II. Data were examined using independent samples t-tests and Pearson’s correlation analysis.Results:Daytime sleepiness, depressive mood and anxiety levels were higher in patients with AS than in healthy controls. The ESS score correlated with BASDAI, BDI, STAI I and STAI II. Patients with AS had a considerably impaired sleep quality compared with the healthy controls, and a strong correlation was found between sleep and mood. A positive correlation was also noted between disease activity/pain severity and sleep quality.Conclusion:Measuring sleep quality and mood is important for the comprehensive evaluation of the health status of patients with AS, which could provide valuable evidence for improving the management of disease and treatment decisions.

Sleep disturbances are among the common nonmotor symptoms in patients with Parkinson’s disease (PD). Sleep can be disrupted by nocturnal motor and nonmotor symptoms and other comorbid sleep disorders. Rapid eye movement sleep behavior disorder (RBD) causes sleep-related injury, has important clinical implications as a harbinger of PD and predicts a progressive clinical phenotype. Restless legs syndrome (RLS) and its related symptoms can impair sleep initiation. Excessive daytime sleepiness (EDS) is a refractory problem affecting patients’ daytime activities. In particular, during the COVID-19 era, special attention should be paid to monitoring sleep problems, as infection-prevention procedures for COVID-19 can affect patients’ motor symptoms, psychiatric symptoms and sleep. Therefore, screening for and managing sleep problems is important in clinical practice, and the maintenance of good sleep conditions may improve the quality of life of PD patients. This narrative review focused on the literature published in the past 10 years, providing a current update of various sleep disturbances in PD patients and their management, including RBD, RLS, EDS, sleep apnea and circadian abnormalities.

Stress symptoms, Facebook addiction, and sleep disturbances have important effects on the health of every individual. However, very few studies have examined the association between stress symptoms, Facebook addiction, and sleep disturbances. This study investigated the mediating effect of Facebook addiction on the association between stress symptoms and sleep disturbances among Facebook users in Vietnam. Three hundred fifty-four Facebook users in Vietnam have completed measures to assess symptoms of stress, levels of Facebook addiction, and sleep disturbances. In the sample, stress was positively associated with sleep disturbances and Facebook addiction partially mediated the association between stress and sleep disturbance (stress was positively associated with Facebook addiction and Facebook addiction was positively associated with sleep disturbances). Thus, our findings demonstrate that stressful individuals tend to be addicted to Facebook, which increase the risk of sleep disturbances. Therefore, interventions aimed at improving sleep quality for Facebook users should focus on reducing stress and reducing dependence on Facebook.

Background: Vitamin A deficiency (VAD) and sleep disturbances have been reported in children with autism spectrum disorder (ASD). The influence of vitamin A (VA) on sleep regulation and sleep disturbances in ASD has garnered increased attention. This study aims to characterize the effect of VA levels and sleep disturbances on children with ASD.Methods: This cross-sectional study compared children with ASD (n=856) to typically developing children (TDC; n=316). The Children’s Sleep Habits Questionnaire assessed sleep disturbances, Childhood Autism Rating Scale evaluated the severity of autism symptoms, and Autism Behavior Checklist and Social Responsiveness Scale assessed autism behaviors. VA levels in blood samples were measured using high-performance liquid chromatography. Multivariable linear regression and two-way ANOVAs were performed to investigate the effect of VAD and sleep disturbances in children with ASD.Results: Children with ASD had lower serum VA levels and a higher prevalence of sleep disturbances than TDC. VAD and sleep disturbances in children with ASD corresponded to the severity of autism symptoms. Importantly, VA levels were negatively correlated with sleep disturbances among children with ASD, and the interaction of VAD and sleep disturbances were related to the severity of autism symptoms.Conclusion: VAD and sleep disturbances exacerbated autism symptoms in children with ASD, providing a novel target for treatment.Trial registration: Chinese Clinical Trial Registry, registration number: ChiCTR-ROC-14005442

The world is currently facing an unprecedented pandemic crisis. The highly contagious coronavirus, or COVID-19, first occurred in Wuhan (China) in December 2019. The outbreak of the virus quickly spread all over the world, reaching Europe in January 2020. The first case in Germany was reported to be diagnosed on January 27. This study focuses on assessing the mental health consequences of the German public during COVID-19 outbreak. Psychological discomfort, generalized anxiety disorder, sleep disturbances, depressive symptoms and threat perception are especially investigated with respect to demographics, security importance and negative affectivity. The psychological vulnerabilities that go along with the pandemic are evaluated in detail. The cross-sectional online survey conducted in Germany reveals a prevalence of depressive symptoms, psychological discomfort, threat perception, generalized anxiety disorder and sleep disturbances associated with the pandemic crisis. The results also indicate a relationship between mental health issues and negative affectivity as well as the perception of threat. This paper gives an outlook on long-term consequences and what could be the strategies to mitigate the negative mental health outcomes of the crisis.

22q11.2 deletion syndrome (22q11DS) contributes dramatically increased genetic risk for psychopathology, and in particular schizophrenia. Sleep disorders, including obstructive sleep apnea (OSA), are also highly prevalent, making 22q11DS a unique model to explore their impact on psychosis vulnerability. Still, the contribution of sleep disturbances to psychosis vulnerability remains unclear.We characterized the sleep phenotype of 69 individuals with 22q11DS and 38 healthy controls with actigraphy and sleep questionnaires. Psychiatric symptoms were measured concomitantly with the baseline sleep assessment and at longitudinal follow-up, 3.58±0.85 years later. We used a novel multivariate partial-least-square-correlation (PLSC) approach to identify sleep patterns combining objective and subjective variables, which correlated with psychiatric symptoms. We dissected longitudinal pathways linking sleep disturbances to psychosis, using multi-layer-network-analysis.22q11DS was characterized by a non-restorative sleep pattern, combining increased daytime fatigue despite longer sleep duration. Non-restorative sleep combined with OSA symptoms correlated with both emotional and psychotic symptoms. Moreover, a sleep pattern evocative of OSA predicted longitudinal worsening of positive and negative symptoms, by accentuating the effects of emotional dysregulation. These results suggest that sleep disturbances could significantly increase psychosis risk, along an affective pathway. If confirmed, this suggests that systematic screening of sleep quality could mitigate psychosis vulnerability in 22q11DS.

Objective The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems. Methods A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined. Results The reliability of the ISI was very good (Cronbach’s alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs). Conclusions The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies.

Xiaoyun Liu,1,* Liling Yang,1,* Yuxiang Han,1 Jingjing Xu,2 Zaiying Pang,1 Yifeng Du,1 Yabo Feng,1,* Youting Lin1,* 1Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, Shandong Province, 250021, People’s Republic of China; 2Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, Shandong Province, 250021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yabo Feng; Youting LinDepartment of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250021, People’s Republic of ChinaTel/Fax +86-531‐68776354Email fyb-sd@hotmail.com; youtinglin2019@126.comObjective: The purpose of this study was to illustrate the electrophysiological features of sleep disturbances in patients with anti-leucine-rich glioma-inactivated protein 1 (anti-LGI1) encephalitis in both active and recovery stages.Methods: Retrospectively filed video electroencephalogram (VEEG) and polysomnography (PSG) data in 24 patients with anti-LGI1 encephalitis were analyzed in comparison with that in 20 individuals without sleep disorders as control group.Results: Sleep efficiency (SE) and total sleep time involving REM and NREM sleep were significantly decreased in patients with anti-LGI1 encephalitis during the active stage compared to that during the recovery stage and in the control group. Imbalanced sleep structure was found, demonstrated by elevated N1, decreased N3 and REM components, as well as abnormal N2 structure characterized with significantly lower spindle duration and density during the active stage. These findings were independent of the presence of nocturnal episodic events or sleep hyperkinetic movements (HMs). HMs were present in 11/23 patients throughout NREM and REM sleep (nonspecific in sleep stages) during the active stage. During the recovery stage, SE and sleep structures were dramatically improved, including the percentage of N3 and REM sleep, spindle duration and density. Ten of 11 patients with HMs were followed up. HMs were totally remitted in 3 patients and still persistent in 1, while evolved into REM sleep behavior disorder (RBD) in 4 with comorbid periodic limb movement syndrome (PLMS) in 3/4, and only PLMS in 2.Conclusion: Sleep disturbances were remarkable and intrinsic features in active anti-LGI1 encephalitis, marked by overall disruptions of both NREM and REM sleep, as well as the presence of HMs, which tend to evolve into RBD or PLMS during the recovery stage. Long-term follow-up with PSG is needed, especially for those patients with severe sleep disturbances during the active phase.Keywords: anti-leucine-rich glioma-inactivated protein 1 encephalitis, video electroencephalogram, polysomnography, sleep disturbances, REM sleep behavior disorder, periodic limb movement in sleep

Xiaoyun Liu,1,* Liling Yang,1,* Yuxiang Han,1 Jingjing Xu,2 Zaiying Pang,1 Yifeng Du,1 Yabo Feng,1,* Youting Lin1,* 1Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, Shandong Province, 250021, People’s Republic of China; 2Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, Shandong Province, 250021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yabo Feng; Youting LinDepartment of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250021, People’s Republic of ChinaTel/Fax +86-531‐68776354Email fyb-sd@hotmail.com; youtinglin2019@126.comObjective: The purpose of this study was to illustrate the electrophysiological features of sleep disturbances in patients with anti-leucine-rich glioma-inactivated protein 1 (anti-LGI1) encephalitis in both active and recovery stages.Methods: Retrospectively filed video electroencephalogram (VEEG) and polysomnography (PSG) data in 24 patients with anti-LGI1 encephalitis were analyzed in comparison with that in 20 individuals without sleep disorders as control group.Results: Sleep efficiency (SE) and total sleep time involving REM and NREM sleep were significantly decreased in patients with anti-LGI1 encephalitis during the active stage compared to that during the recovery stage and in the control group. Imbalanced sleep structure was found, demonstrated by elevated N1, decreased N3 and REM components, as well as abnormal N2 structure characterized with significantly lower spindle duration and density during the active stage. These findings were independent of the presence of nocturnal episodic events or sleep hyperkinetic movements (HMs). HMs were present in 11/23 patients throughout NREM and REM sleep (nonspecific in sleep stages) during the active stage. During the recovery stage, SE and sleep structures were dramatically improved, including the percentage of N3 and REM sleep, spindle duration and density. Ten of 11 patients with HMs were followed up. HMs were totally remitted in 3 patients and still persistent in 1, while evolved into REM sleep behavior disorder (RBD) in 4 with comorbid periodic limb movement syndrome (PLMS) in 3/4, and only PLMS in 2.Conclusion: Sleep disturbances were remarkable and intrinsic features in active anti-LGI1 encephalitis, marked by overall disruptions of both NREM and REM sleep, as well as the presence of HMs, which tend to evolve into RBD or PLMS during the recovery stage. Long-term follow-up with PSG is needed, especially for those patients with severe sleep disturbances during the active phase.Keywords: anti-leucine-rich glioma-inactivated protein 1 encephalitis, video electroencephalogram, polysomnography, sleep disturbances, REM sleep behavior disorder, periodic limb movement in sleep

Previous research has demonstrated that sleep disturbances are positively correlated with sensory sensitivities in children with ASD. Most of these studies, however, were based on cross-sectional analyses, where the relationship across symptom domains was examined at a single time-point. Here, we examined the development of 103 pre-school children with ASD over a 1-3-year period. The results revealed that spontaneous longitudinal changes in sleep disturbances were specifically correlated with changes in sensory sensitivities and not with changes in other sensory processing domains nor with changes in core ASD symptoms. These finding demonstrate a consistent longitudinal relationship between sleep disturbances and sensory sensitivities, which suggests that these symptoms may be generated by common or interacting underlying physiological mechanisms.

Alterations in sleep and wakefulness affect negatively on mood, memory and psychomotor performance of individuals. Instruments for scaling the quality of these factors should be available for clinical evaluation. The aim of this study was to translate and to culturally adapt the PROMIS® Domains of Sleep Disturbances‟ and Wake Disturbances‟ into the Portuguese language. The process of translation and cultural adaptation followed the guidelines of the FACIT organization. This methodology includes: translation, reconciliation, back translation, review by the developers of PROMIS®, review by independent reviewers, pre-test version, pre-test, incorporation of the results of the pre-test in the translation process. The pre-test verifies the comprehension of the translated version of the instrument, while the retrospective interview aims to analyze the pre-test version of the instrument items, through a cognitive interview, ie, participants are asked about the comprehension and about the existence of irrelevant items in the instrument. In the translation process of Sleep Disturbances‟ and Wake Disturbances‟ items there were some inconsistencies between the translations and between the back translation and the original items. The pre-test version was applied in a convenience sample of 10 individuals aged 18 to 55 years who had no history of sleep and wake problems, mostly female, single, with educational level varying from 1st grade to college. All the translated items were well understood by participants in the pre-test. None of the participants needed assistance for explanations or had difficulty in interpreting the items of the two banks, whose translation into Portuguese language was approved by the administrators of PROMIS® and thus considered equivalent to the English version. The Portuguese version has a semantic, idiomatic, cultural and conceptual equivalence with the items in the source language. Alterações no sono e na vigília repercutem negativamente no estado de humor, na memória e no desempenho psicomotor do indivíduo. Instrumentos de avaliação da qualidade desses fatores devem estar disponíveis para a avaliação clínica. O objetivo deste trabalho foi traduzir e adaptar culturalmente os domínios Distúrbios do Sono‟ e Distúrbios da Vigília‟ do Patient-Reported Outcomes Measurement Information System (PROMIS®) para a língua portuguesa. O processo de tradução e adaptação transcultural seguiu as orientações da organização Functional Assessment of Chronic Illness Therapy (FACIT). Essa metodologia visa: tradução; reconciliação; retro tradução; revisão pelos administradores do PROMIS® e pelos revisores independentes; versão pré-teste; pré-teste; incorporação dos resultados do pré-teste ao processo de tradução. O pré-teste verifica a compreensão da versão traduzida do instrumento, já, a entrevista retrospectiva analisa a versão pré-teste dos itens do instrumento, por meio da entrevista cognitiva, ou seja, os participantes são questionados sobre a compreensão e a existência de itens irrelevantes no instrumento. No processo de tradução dos bancos de itens Distúrbios do Sono‟ e Distúrbios da Vigília‟, houve algumas inconsistências entre as traduções e entre a retro tradução e os itens originais, as quais foram ajustadas nas fases seguintes do processo de tradução. A versão pré-teste foi aplicada em uma amostra de conveniência de 10 indivíduos com idade entre 18 e 55 anos, que não tinham histórico de problemas com o sono e vigília, sendo a maioria do sexo feminino, solteiros e com grau de escolaridade que variou do Ensino Fundamental ao Ensino Superior. Todos os itens traduzidos foram bem compreendidos pelos participantes no pré-teste. Nenhum participante necessitou de auxílio para esclarecimentos, não apresentou dificuldade de interpretação ou de entendimento dos itens dos dois bancos que foi superior a 90%, sendo aprovada pelos administradores do PROMIS® e, assim, considerada equivalente à versão em inglês. A versão para a língua portuguesa apresenta equivalência semântica, idiomática, cultural e conceitual dos itens com a língua de origem. Mestre em Ciências da Saúde

International audience; Sleep disturbances and changes of activity patterns are not uncommon in anxiety disorders, but they are rarely the object of attention. Actigraphic monitoring of day and night activity patterns could provide useful data to detect symptom worsening, prevent risk periods, and evaluate treatment efficacy in those disorders. Thus, we have conducted a systematic search of the scientific literature to find any original study using actigraphic monitoring to investigate activity and sleep patterns in patients affected by any type of anxiety disorder according to the definition of the DSM-5. We found only six studies fulfilling these criteria. Three studies report significant findings in patients suffering from anxiety disorders. Overall, the samples and methods are heterogeneous. Although the authors support the interest of actigraphic monitoring in anxiety disorders, the evidence to date is very limited.

Woorim Kim,1,* Yeong Jun Ju,2,3,* Soon Young Lee3 1Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea; 2Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea*These authors contributed equally to this workCorrespondence: Soon Young LeeDepartment of Preventive Medicine and Public Health, Ajou University School of Medicine 206 World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of KoreaTel +82-31-219-5301Fax +82-31-219-5084Email solee@aumc.ac.krIntroduction: Although women commonly report deterioration of sleep quality postpartum, this relationship has been less studied in East Asian countries. This study investigated the association between recent experience of childbirth and sleep quality in South Korean women and additionally examined how healthy practice behavior interplays in the stated relationship.Methods: Data from the 2018 Community Health Survey were used. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI). Women who responded to have given birth in the past year were categorized as having a recent experience of childbirth. The general characteristics of the study population were investigated using chi-square test. The association between the dependent and independent variables was analyzed using multivariate logistic regression analysis.Results: Of a total of 41,708 study participants, 16,877 (40.5%) individuals reported poor sleep quality. Poor sleep quality was more common in women with a recent experience of childbirth (48.4%) than those without (40.0%). Compared to individuals without a recent experience of childbirth, those with such an experience were more likely to show poor sleep quality (OR 1.50, 95% CI 1.34– 1.68). Such differences were reduced in individuals with a healthy lifestyle.Conclusion: Recent experience of childbirth was associated with higher likelihoods of poor sleep quality in women. The degree of risks found was reduced in individuals practicing a healthy lifestyle habit. The findings infer the need to monitor and address sleep-related disturbances commonly reported among postpartum women.Keywords: sleep quality, sleep disturbances, postpartum, childbirth experience, healthy practice behavior

Woorim Kim,1,* Yeong Jun Ju,2,3,* Soon Young Lee3 1Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea; 2Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea*These authors contributed equally to this workCorrespondence: Soon Young LeeDepartment of Preventive Medicine and Public Health, Ajou University School of Medicine 206 World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of KoreaTel +82-31-219-5301Fax +82-31-219-5084Email solee@aumc.ac.krIntroduction: Although women commonly report deterioration of sleep quality postpartum, this relationship has been less studied in East Asian countries. This study investigated the association between recent experience of childbirth and sleep quality in South Korean women and additionally examined how healthy practice behavior interplays in the stated relationship.Methods: Data from the 2018 Community Health Survey were used. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI). Women who responded to have given birth in the past year were categorized as having a recent experience of childbirth. The general characteristics of the study population were investigated using chi-square test. The association between the dependent and independent variables was analyzed using multivariate logistic regression analysis.Results: Of a total of 41,708 study participants, 16,877 (40.5%) individuals reported poor sleep quality. Poor sleep quality was more common in women with a recent experience of childbirth (48.4%) than those without (40.0%). Compared to individuals without a recent experience of childbirth, those with such an experience were more likely to show poor sleep quality (OR 1.50, 95% CI 1.34– 1.68). Such differences were reduced in individuals with a healthy lifestyle.Conclusion: Recent experience of childbirth was associated with higher likelihoods of poor sleep quality in women. The degree of risks found was reduced in individuals practicing a healthy lifestyle habit. The findings infer the need to monitor and address sleep-related disturbances commonly reported among postpartum women.Keywords: sleep quality, sleep disturbances, postpartum, childbirth experience, healthy practice behavior

Objective Up to 20% of patients treated for epileptic seizures experience psychogenic nonepileptic paroxysms (PNES). These patients present a significant burden for the health care systems because of poor treatment outcomes. The presented review aims to summarize the current state of knowledge on sleep disturbances in patients with nonepileptic seizures. Methods Articles were acquired via PubMed and Web of Science, and papers between January 1990 and March 2020 were extracted. Inclusion criteria were (1) published in a peer-reviewed journal: (2) studies in humans only; or (3) reviews on a related topic; (4) English language. The exclusion criteria were: (1) abstracts from conferences; (2) commentaries; (3) subjects younger than 18 years. From primary assessment, 122 articles were extracted; after obtaining full texts and secondary articles from reference lists, 45 papers were used in this review. Results Limited data are available regarding sleep disorders in PNES patients, over the last 30 years only nine original research papers addressed sleep problems in patients with PNES with only six studies assessing objectively measured changes in sleep. Current literature supports the subjective perception of the sleep disturbances with mixed results in objective pathophysiological findings. Conflicting results regarding the REM phase can be found, and studies reported both shortening and prolonging of the REM phase with methodological limitations. Poor sleep quality and shortened duration have been consistently described in most of the studies. Conclusion Further research on a broader spectrum of patients with PNES is needed, primarily focusing on objective neurophysiological findings. Quality of life in patients suffering from PNES can be increased by good sleep habits and treatment of comorbid sleep disorders.

Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta-analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta-analysis was conducted with 10 randomized controlled trials with passive control conditions (N = 2,408). The overall mean effect size (Hedges’ g) of all sleep-related outcomes within each trial was moderate to large (g = 0.61; 95% confidence interval: 0.41−0.81; numbers-needed-to-treat = 3). Effect sizes for global measures of sleep disturbances were g = 0.79; 95% confidence interval: 0.52−1.06; and for sleep-onset latency g = 0.65; 95% confidence interval: 0.36−0.94. The follow-up analyses revealed an effect size of g = 0.56; 95% confidence interval: 0.45−0.66 for the combined sleep-related outcomes based on three studies. No significant covariates were identified. These results should be interpreted cautiously due to an overall substantial risk of bias, and in particular with regard to blinding of participants and personnel. Nevertheless, they provide evidence that psychological interventions for improving sleep are efficacious among college students. Further research should explore long-term effects and potential moderators of treatment efficacy in college students.

This study aimed to examine the relationships between occupational stressors, mental health problems, and sleep difficulty, and the mediating roles of cognitive fusion and cognitive reappraisal on the relationships in Chinese nurses. A total of 323 nurses (mean age = 32.11 ± 6.75 years) from 25 hospitals in China participated a cross-sectional online survey. Participants were asked to refer to the period during the severest time of the COVID-19 pandemic in China (January to March 2020) when assessing the psychological variables. The direct links from occupational stressors to cognitive fusion, cognitive reappraisal, mental health and sleep difficulty were significant. Cognitive fusion and cognitive reappraisal mediated the links from occupational stressors to mental health problems, while cognitive fusion and mental health problems mediated the links from occupational stressors to sleep difficulty. The sequential mediation via cognitive fusion and mental health problems as well as via cognitive reappraisal and mental health problems on the links from occupational stressors to sleep difficulty were also significant. Findings from the current study indicate that intervention strategies focusing on the reduction of cognitive fusion and improvement of cognitive reappraisal could help better prepare nurses to alleviate mental health problems and sleep difficulties that are related to COVID-19 and potentially similar pandemics in the future.

Background: Disturbances in sleep could affect normal growth as well as behavior of children. It could also impair their cognitive development. Sleep problems have been increasing over the past few years. However, there is a gap regarding information about sleep practices and sleep problems among Indian children. Aim: A sleep questionnaire was designed and validated to assess the frequency of sleep practices and sleep problems in 500 children. Materials and Methods: The study was conducted in 5 local schools in South Kanara district by administering the questionnaire to the parents/caretakers under the guidance of a trained investigator. We also sought to examine the association of demographics, medical/behavior/academic performance, sleep patterns, and home environment to sleep problems in these children. Statistical Analysis: Descriptive statistics were recorded as mean and standard deviation for quantitative data and in frequency and percentage for qualitative data. Results: We found a high prevalence of bedroom sharing (92.4%) and bed-sharing (91.2%). 46.4% of the children exhibited at least one sleep problem, the most prevalent being bed-wetting (17%). Sleep problems were considerably greater in older children and in children with behavioral problems. Practices such as watching TV and using computer after 8 pm/at bedtime were significantly associated with all sleep problems. Conclusion: Our study revealed definite and significant presence of sleep problems in the children of South Kanara. Strong associations were observed between certain sleep practices and problems.

Taking into account the modern life expectancy, a third of their lives, on average, women live in conditions of estrogen deficiency, which negatively affects the quality of life and the level of morbidity in older people. For doctors of other specialties, besides ObGyn, the climacteric period is strongly associated exclusively with hot flashes. However, early menopausal symptoms include sleep disturbances, mood changes, the risk of depression and decrease in self-esteem, sexual dysfunction. The predominance of vegetative symptoms makes the patient seek help not only from the gynecologist, but also from other specialists, however, the lack of knowledge in menopause medicine leaves them unsatisfied. In this regard, a therapeutic approach requires a comprehensive understanding of the problem.The “gold standard” for managing patients with climacteric complaints is menopausal hormone therapy. However, there are women with contraindications to this group of drugs or the predominance of vegetative symptoms, when only hormonal correction is not enough. Among alternative non-hormonal agents, inhibitors of serotonin reuptake, in particular the most popular drug venlafaxine, hold a strong leadership with proven efficacy against a complex of symptoms. Also, other medications have been studied that can stop both vasomotor and vegetative symptoms of menopause. The review presents the literature data on the role of alternative agents in the correction of vasomotor symptoms of menopause, along with the known efficacy against autonomic complaints for increasing the effectiveness of counseling for older women.

Background Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Methods Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline ( Results Moderate–severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate–severe sleep disturbances and neuropsychiatric (ß/year = 0.041, p = 0.016) and musculoskeletal (ß/year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. Conclusion The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.

Background: Sleep quality and disturbances have been suggested to play an important role in cardiovascular disease risk. Objective(s): The aim of the present study is to investigate the possible relationship between quality of sleep, sleep disturbances, and cardiovascular disease risk in adults. Methods: This cross-sectional study was conducted in the Family Medicine Outpatient Clinic at Cairo University, Kasr Alainy Hospital. The participants of this study were 124 adults who were subjected to be interviewed with sleep questionnaires, including the Pittsburgh Sleep Quality Index, Epworth Sleepiness scale, Berlin Questionnaire, and Restless Legs Syndrome Rating Scale. Their blood pressure and body mass index were measured, along with the fasting blood glucose and lipid profile assessment. Moreover, atherosclerotic cardiovascular disease (ASCVD) risk was calculated. The participants were then classified into two groups according to their estimated risk of ASCVD: low- or borderline-risk group and intermediate- or high-risk group. Results: In both groups, the comparison of the results of the Pittsburgh Sleep Quality Index (PSQI) showed a significant difference: total score (about 40% of bad sleepers and 20% of good sleepers had intermediate to high ASCVD risk), subjective sleep quality, sleep efficiency, and the use of sleep medications (p values = 0.015, 0.023, and 0.023, respectively). Moderate positive correlations were observed between the ASCVD risk score and total PSQI score (r = 0.4, p < 0.001), subjective sleep (r = 0.332, p < 0.001), sleep latency (r = 0.3, p = 0.006), sleep duration (r = 0.4, p < 0.001), sleep efficiency (r = 0.4, p = 0.001), sleep disturbance (r = 0.218, p = 0.016), and the use of sleep medications (r = 0.24, p = 0.002). In both groups, a significant difference was observed in the severity of restless legs syndrome (p value = 0.012). Conclusion: Based on the results of the study, the overall sleep quality was linked to a higher estimated risk of developing cardiovascular events. A significant positive moderate correlation was found between sleep quality scores and cardiovascular risk, especially sleep efficiency and duration.

Background The COVID-19 pandemic impacts the whole world. So far, nothing is known about the course of psychological disturbances, such as fear, anxiety, and sleep disturbances of this pandemic over time in Europe. Methods Aim of this web-based survey was to assess the mental health burden of the German public over a period of 50 days after the COVID-19 outbreak. 16,245 individuals responded regarding sleep disturbances, COVID-19-fear, and generalized anxiety disorder (GAD-7). Data were put in relation to infection rates, number of deaths and the German stock index. Results The specific fear increased rapidly in concordance with infection numbers. However, no relation to the number of deaths was found, COVID-19-fear developed reversed to the stock index. Initially, 13.5% of the respondents reported a reduced sleep quality, and 7.2% a moderate generalized anxiety; proceeding simultaneously with high peaks. Finally, more than twice as many respondents showed psychological burdens. Conclusion The COVID-19-fear decreased within six weeks to the level before the shutdown, indicating a habituation to the threatening situation. However, generalized anxiety remained elevated over time. Sleep disturbances, generalized anxiety as well as economical stock alterations develop in advance to infectiological trends which demands consequent and comprehensible information policies., Graphical abstract Image 1, Highlights • Highly topical issue of mental health aspects of COVID-19 pandemic. • During pandemic, sleep disturbances are related to generalized anxiety (GAD). • High peaks of GAD and sleep disturbances when political landmarks occur. • COVID-19-fear is inversely related to German stock index DAX in time curse. • Sleep complaints are not associated with reported new COVID-19 cases or deaths.

Background: Besides hot-flushes, sleep disturbances increase around menopause, impacting on the quality of life. When hormone replacement therapy is contraindicated, it is necessary to provide alternative treatments. Objectives: This study aimed to observe the effects of an herbal remedy from pollen extracts and soy isoflavones for menopausal complaints, particularly on sleep disorders. Methods: A six-month prospective observational study was performed in women in natural menopause suffering from menopausal symptoms and sleep disturbances. Three groups were compared: 57 women receiving two tablets/ day containing herbal remedy from pollen extracts (group A), 60 women receiving one tablet/day containing isoflavones 60 mg (group B), 47 women not receiving any treatment (group C). At 3 (T3) and 6 months (T6), the daily number of hot-flushes, Kupperman index for menopausal symptoms, the Pittsburgh Sleep Quality Index (PSQI) test were assessed. Results: Both groups A and B showed a significant improvement of hot flushes (p Conclusions: Non-hormonal treatments can effectively be used in symptomatic menopausal women: among these, after six months of treatment, pollen extracts might achieve a better improvement of hot flushes, sleep disturbances and menopause-related symptoms than soy isoflavones. Herbal remedy from pollen extracts is mainly effective when the quality of sleep is the most disturbing complaint.

Background Sleep disturbances can lead to many health problems in school-aged children, including hypertension and obesity. However, a lack of consensus about the etiology of these conditions is due to conflicting reports on the possible effects of sleep disturbances. Objective To assess for possible associations between sleep disturbances and blood pressure as well as body mass index in school-aged children. Methods This cross-sectional study involved primary school children in the 4th-5th grades. Subjects’ blood pressure, body weight, and body height were measured and their parents completed the Sleep Disturbances Scale for Children (SDSC) questionnaire. Results Of the 816 children enrolled, 503 (61.6%) children had sleep disturbances. The most common type of sleep disturbance was initiating and maintaining sleep. Bivariate analysis revealed a significantly increased risk of hypertension among subjects with sleep disturbances (PR 15.06; 95%CI 8.13 to 27.90) and increased risk of obesity (PR 22.65; 95%CI 12.28 to 41.78). Conclusion The most common type of sleep disturbance is initiating and maintaining sleep. Sleep disturbances are significantly associated with hypertension and obesity in children.

AIM: To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients. METHODS: Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed. Validated questionnaires: the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered prospectively. Subjects with non-glaucomatous optic neuropathy or concomitant retinal pathology were excluded. Glaucoma severity was based on HVF 24-2 perimetry. Binocular single vision was represented based on the better eye. Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared. RESULTS: A total of 79 primary open angle glaucoma (POAG), 27 primary angle-closure glaucoma (PACG) patients, and 89 controls were recruited. PACG patients had higher median PSQI scores (P=0.004) and poorer sleep quality (P

Background In all epidemics, healthcare staff are at the centre of risks and damages caused by pathogens. Today, nurses and physicians are faced with unprecedented work pressures in the face of the COVID-19 pandemic, resulting in several psychological disorders such as stress, anxiety and sleep disturbances. The aim of this study is to investigate the prevalence of sleep disturbances in hospital nurses and physicians facing the COVID-19 patients. Method A systematic review and metanalysis was conducted in accordance with the PRISMA criteria. The PubMed, Scopus, Science direct, Web of science, CINHAL, Medline, and Google Scholar databases were searched with no lower time-limt and until 24 June 2020. The heterogeneity of the studies was measured using I2 test and the publication bias was assessed by the Egger’s test at the significance level of 0.05. Results The I2 test was used to evaluate the heterogeneity of the selected studies, based on the results of I2 test, the prevalence of sleep disturbances in nurses and physicians is I2: 97.4% and I2: 97.3% respectively. After following the systematic review processes, 7 cross-sectional studies were selected for meta-analysis. Six studies with the sample size of 3745 nurses were examined in and the prevalence of sleep disturbances was approximated to be 34.8% (95% CI: 24.8-46.4%). The prevalence of sleep disturbances in physicians was also measured in 5 studies with the sample size of 2123 physicians. According to the results, the prevalence of sleep disturbances in physicians caring for the COVID-19 patients was reported to be 41.6% (95% CI: 27.7-57%). Conclusion Healthcare workers, as the front line of the fight against COVID-19, are more vulnerable to the harmful effects of this disease than other groups in society. Increasing workplace stress increases sleep disturbances in the medical staff, especially nurses and physicians. In other words, increased stress due to the exposure to COVID-19 increases the prevalence of sleep disturbances in nurses and physicians. Therefore, it is important for health policymakers to provide solutions and interventions to reduce the workplace stress and pressures on medical staff.

Objectives Sleep status can affect the body's immune status and mental health. This study aims to investigate the sleep status of Chinese residents during the outbreak of Coronavirus Disease 2019 (COVID-19) and to evaluate its related risk factors. Methods This research carried out a cross-sectional survey in February 2020 (during the COVID-19 outbreak) to investigate the sleep status of residents nationwide in the form of an online questionnaire. Of the 8151 respondents, 6437 were eventually included in the analysis. Logistic regression is applied to analyze the associated factors affecting residents' sleep quality. Results During the COVID-19 outbreak, the incidence of sleep disturbances in residents was 17.65%. Increased risk of sleep disturbances was found to be associated with older age, female gender, and poor self-reported health status. Moreover, the odds ratios (ORs) were 1.42 (95% CI: 1.1–2.64), 1.35 (95% CI: 1.16–1.59), 5.59 (95% CI: 4.32–7.23), respectively. Those residents who believed COVID-19 had caused a high number of deaths or who thought COVID-19 was not easy to cure were more likely to experience sleep disorders, and the ORs were 1.73 (95% CI: 1.43–2.09), 1.57 (95% CI: 1.29–1.91), respectively. Regular exercise was a protective factor for sleep disturbances, OR = 0.77 (95% CI: 0.63–0.93). Conclusions During the outbreak of COVID-19, nearly one-fifth of participants had sleep disorders. It is necessary to pay more attention to people at high risk for sleep disturbances during the outbreak, adopt effective risk communication methods, enhance residents' rational understanding of COVID-19, and develop practical indoor exercise programs for general public to improve sleep quality., Highlights • Nearly one-fifth of participants had sleep disorders during the COVID-19 outbreak. • People's perceptions of the death toll affect their sleep. • People's perceptions of treatment difficulty of COVID-19 affect their sleep. • It is necessary to pay attention to the elderly and those in poor health.

BACKGROUND:Determine the effect of personal anxiety, sleep disorders on the 15-year risk of developing (RR) diabetes mellitus (DM) type 2 among men (M) 45-69 years in Russia / Siberia (Novosibirsk). METHODS:In 2003–2005 As part of the IV screening of the international epidemiological study “HAPIEE”, a representative sample of m 45–69 years was examined (n=781 M, mean age-56.48±0.20 years, response – 61.00%). The level of personal anxiety (PA) was assessed using the Spielberger scale (HPA – high, MPA – medium, LPA – low). With the help of the scale “Knowledge and attitude to one’s health”, the level of sleep disorders (SD) was assessed. The period of observation of the cohort was 15 years. To check the statistical significance of the differences between the groups, the Pearson χ2test was used. For risk assessment, Cox-regression single-factor and multivariate regression proportional hazards model was used (Cox-­regression). RESULTS:Among persons with the first occurrence of DM type 2, HPA at the screening was 59.50%, and 63.30% had SD. The combination of HPA and SD was significant among M with the first-onset diabetes mellitus. During the 15-year period, among M with HLA, the risk of developing type 2 diabetes was 1.60 times higher than without. Among people with SD, therisk of developing type 2 diabetes was 2.40 times higher than without. In Cox – the proportional multifactor model, each variable had its own independent influence. HPA increased the RR DM of the 2nd type by 1.90 times, and SD – by 2.80 times. CONCLUSION:It was established that a high level of PA and SD are independent predictors of type 2 diabetes, moreover, with SD, the risk of developing type 2 diabetes is higher than with a high level of PA.

Sleep disturbances are common in the pediatric population and should primarily be treated non-pharmacologically. Most medicines for sleep disturbances are not approved for pediatric use and data on long-term safety is scarce. In Sweden, melatonin is classified as a prescription medicine. The aim of the present study was to characterize the prevalence and incidence of dispensed melatonin prescriptions, long-term treatment, concomitant dispensation of psychotropic medication, and psychiatric comorbidity, in children and adolescents aged 0–17 years living in Sweden during 2006–2017. Data was retrieved by linking the national population-based registers, the Swedish Prescribed Drug register and the National Patient register. In 2017, nearly 2% of the pediatric population 0–17 years was dispensed at least one prescription of melatonin, which was more than a 15-fold increase for girls and a 20-fold increase for boys, when compared to 2006. Among the children in the age group 5–9 who initiated a melatonin treatment in 2009, 15% of girls and 17% of boys were found to be continuously prescribed melatonin 8 years later. Nearly 80% of all children with dispensed melatonin had concomitant dispensations of psychotropic medications. The most common combination was melatonin together with centrally acting sympathomimetic medicines (23% of girls and 43% of boys). About half of the children (47% of girls and 50% of boys) had at least one registered diagnosis of mental or behavioral disorders. The most common diagnosis was attention deficit hyperactive disorder, across all age groups and genders. The continuous increase of use of melatonin in children, often concomitant with other psychotropic medications, together with a high proportion of younger children with prescriptions of melatonin on a long-term basis, suggests the need for further structured follow up studies, in particular of long-term use.

Background and aim Melatonin is used to treat sleep disturbances (SDs). The aim of this study was to investigate the safety and efficacy of low‐dose melatonin for SDs in early‐stage cirrhosis. Methods In a single‐center, randomized, double‐blind, placebo‐controlled, cross‐over clinical trial, patients with early‐stage (Child‐Turcotte‐Pugh [CTP] class A or B) cirrhosis with SDs, without hepatic encephalopathy, were randomized to placebo or 3 mg of melatonin for 2 weeks. After 2 weeks, the patients were given a washout period of 1 week and crossed over to melatonin or placebo for a further 2 weeks. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to measure sleep quality and daytime sleepiness, respectively. Analysis of results was based on intention to treat, and linear mixed‐effect models were used to evaluate the effect of melatonin. Analysis was conducted using R‐programming language 3.5.1. Results Seventy one patients were recruited (mean age: 61.9 ± 8.7 years, males: 46 [64.8%], and CTP Class A = 52 [73.2%] and Class B = 19 [26.8%]). Sixty patients completed the study (mean age: 61.7 ± 8.8 years, males: 40 [66.6%], and CTP Class A = 45 [75.0%] and Class‐B = 15 [25.0%]). Two patients dropped out due to adverse events. Nine patients were lost to follow up. Patients given melatonin had a significantly lower PSQI and ESS compared to both pretreatment (P, This is a single‐centre, randomized, double‐blind, placebo‐controlled, cross‐over clinical trial, on patients with early‐stage [Child‐Turcotte‐Pugh class A or B] cirrhosis with sleep disturbances and without hepatic encephalopathy. The aim of this study was to assess the safety and efficacy of administrating 3mg of melatonin for two weeks on improving sleep disturbances. Melatonin seems safe and effective for use in patients with sleep disturbances in early‐stage cirrhosis, in the short term.