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Intruduction: The aging process results in a progressive decline in physiological functions with age, including a decrease in productivity. Hypertension is a major problem in public health in Indonesia and in developing countries. Hypertension is a common cause of disturbed sleep patterns, due to structural and functional changes in the peripheral vascular system. The purpose of this study was the effect of health education with audiovisual methods and relaxation massage to reduce blood pressure and sleep quality disorders in the elderly. Materials and Methods: Experimental research (community trial) with pretest-posttest control group design. The target population in this study is the elderly who are included in the elderly age group, namely > 50 years in Selemadeg District, Tabanan Regency. The sample size is 90 elderly, determined based on the results of previous studies with a standard deviation (σ) = 0.51, the difference in the mean of cognitive changes (μ1- 2) = 0.30. divided into two groups, the treatment group and the control group. The independent variable is health education using audiovisual media and Relaxation Massage and the dependent variable is blood pressure. Data collection tools in the form of sphygmomanometer, observation sheet. Data analysis used independent t-test, paired t-test and Multivariate ANOVA test. Result: The blood pressure of the treatment group before the intervention mostly had grade I hypertension (53.3%), and after the intervention most of the blood pressure improved to normal (57.8%), and this result was statistically significant (0.000). In the treatment group before the intervention, many had poor sleep quality (46.7%), and after the intervention improved sleep quality in the good category (53.3%), and this result was statistically significant (0.000). Conclotion: It is concluded that the provision of health education with audiovisual methods and massage relaxation can reduce blood pressure and improve sleep quality in the elderly.

Obesity is characterized by increased infiltration of macrophages. Cytokines derived from these macrophages significantly induce inflammatory response and desensitize insulin action. Disturbed sleep pattern is also associated with release of the same kind of cytokines that could play a central role in the development of insulin resistance. A computer-based search of the literature indexed in PubMed was made using the keywords: glucose metabolism, insulin resistance, adipokines, adiponectin, interleukin-6 (IL-6), leptin, tumor necrosis factor alpha (TNF-α), monocyte chemo-attractant protein-1 (MCP-1), sleep deprivation, and sleep loss. In this review firstly we include the studies that have measured the relationship of cytokines with sleep duration and insulin resistance, and finally, we analyze the relationship of sleep duration with the development of insulin resistance and type 2 diabetes mellitus. IL-6, IL-1β, TNF-α, and MCP-1 are secreted by many cell types including macrophages, adipocytes, etc. They are released in response to many stimuli including sleep loss, tissue injury, and infection. Some evidence has suggested that these cytokines are molecular link between obesity, sleep disturbances, and insulin resistance, because similar types of alterations in plasma levels of these cytokines are found in patients with obesity and disturbed sleep having type 2 diabetes mellitus (DM-2) or insulin resistance. We conclude that both sleep loss and obesity contribute to the onset of insulin resistance and DM-2 with the help of the same kind of cytokines. The mechanisms involved in the impaired glucose metabolism seem to act via a decreased efficacy of the hypothalamic–pituitary–adrenal (HPA) axis and due to modified release of cytokines—especially IL-1β, IL-6, TNF-α, and MCP-1 from adipocytes following obesity and poor quality of sleep. The aforementioned biomarkers could provide a minimally invasive means for early detection and specific treatment of these disorders.

During the postpartum period, there were many difficulties in resting and disturbed sleep patterns in the first three days due to perineal pain, discomfort in the bladder and disorders of babies who often cry because of the transition period. in the postpartum period, the majority of mothers experience disturbed sleep patterns and sleep quality, namely sleep patterns and sleep duration. The aims of this study was to determine the differences in the quality of postpartum sleep that was given the Murratal Arrahman therapy with Klenengan music. The sample in this study were postpartum mothers on days 3 to 7 with normal type of delivery obtained from random simple sampling and this study was a quasy experiment with pre-test and post-test only with control group design and for the measurement of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Result study Sleep quality between the intervention group and the control group was not significantly different (P = 0.33). Likewise, the quality of sleep in each time interval between the intervention group and the control group showed a significant difference, where the P value 0.05 and conclusion there is a difference between the provision of arrahman and klenengan murratal therapy and it can affect the quality of sleep of postpartum mothers, namely the quality of sleep. postpartum mothers are better off.

StandyłoArkadiusz, Obuchowska Aleksandra, Wójcik Justyna, Ozga Alicja, Obuchowska Karolina, Trojanowski Piotr. Robotic Surgery in Obstructive Sleep Apnea-Hypopnoea Syndrome. Journal of Education, Health and Sport.2020;10(9):525-534. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.09.064 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.09.064 https://zenodo.org/record/4043431 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 16.09.2020. Revised: 21.09.2020. Accepted: 22.09.2020. Robotic Surgery in Obstructive Sleep Apnea-Hypopnoea Syndrome Arkadiusz Standyło1a, Aleksandra Obuchowska1b, Justyna Wójcik1c, Alicja Ozga1d, Karolina Obuchowska1e, Piotr Trojanowski2f 1Student Scientific Group at the Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego Street 8, 20-954 Lublin 2Chair and Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego Street 8, 20-954 Lublin aa.standylo@gmail.com; https://orcid.org/0000-0002-5154-4759 baobuchowska12@gmail.com; https://orcid.org/0000-0003-0464-2695 cjustynawojcik455@gmail.com; https://orcid.org/0000-0001-7163-6784 daozga1@gmail.com; https://orcid.org/0000-0003-1291-905X ekarolinaobuchowska99@gmail.com; https://orcid.org/0000-0003-4519-8236 ftroja23@gmail.com; https://orcid.org/0000-0001-9160-291X Summary Obstructive sleep apnoea-hypopnoea (OSAH) syndrome is a sleep disorder characterised by pauses in breathing (apnoea) or periods of reduced breathing (hypopnoea) during sleep. It results in cerebral hypoxia and a disturbed sleep pattern. The gold standard treatment for OSA is continuous positive airway pressure (CPAP). However, significant number of patients are not able to tolerate this device and approximately 50% of patients report inability to achieve long term usage to CPAP. Robotic surgery is an emerging technique for sleep surgery. TORS is an alternative treatment for OSA for patients who have failed CPAP treatment or conventional non-robotic sleep surgery. This technology is assisted by remote-controlled miniaturized surgical instruments and magnified visualization with a high-definition three-dimensional camera. Tongue base reduction (TBR) refers to the primary focus of this targeted surgery for obstructive sleep apnea (OSA). TORS approach for OSA may include 2 different surgical steps frequently combined in the same procedures according to the patient’s features: tongue base reduction and supraglottoplasty (SGP). In the light of the present results and of the literature, TORS tongue-base reduction appears to be effective. With the improved visualization and precise tissue removal provided by robotic surgery, TORS may become more widespread in the treatment of OSA in the coming years. There was an improvement in objective and subjective sleep measures. The comparison among pre-operative and post-operative parameters showed a significant decreasing in post-operative AHI, ESS and an increasing of the lowest SpO2value. Key words robotic surgery; obstructive sleep apnoea; da Vinci system; obesity

ObjectiveTo explore the causal relationships between sleep, major depressive disorder (MDD), and Alzheimer disease (AD).MethodsWe conducted bidirectional 2-sample Mendelian randomization analyses. Genetic associations were obtained from the largest genome-wide association studies currently available in UK Biobank (n = 446,118), Psychiatric Genomics Consortium (n = 18,759), and International Genomics of Alzheimer's Project (n = 63,926). We used the inverse variance–weighted Mendelian randomization method to estimate causal effects and weighted median and Mendelian randomization–Egger for sensitivity analyses to test for pleiotropic effects.ResultsWe found that higher risk of AD was significantly associated with being a “morning person” (odds ratio [OR] 1.01, p = 0.001), shorter sleep duration (self-reported: β = −0.006, p = 1.9 × 10−4; accelerometer based: β = −0.015, p = 6.9 × 10−5), less likely to report long sleep (β = −0.003, p = 7.3 × 10−7), earlier timing of the least active 5 hours (β = −0.024, p = 1.7 × 10−13), and a smaller number of sleep episodes (β = −0.025, p = 5.7 × 10−14) after adjustment for multiple comparisons. We also found that higher risk of AD was associated with lower risk of insomnia (OR 0.99, p = 7 × 10−13). However, we did not find evidence that these abnormal sleep patterns were causally related to AD or for a significant causal relationship between MDD and risk of AD.ConclusionWe found that AD may causally influence sleep patterns. However, we did not find evidence supporting a causal role of disturbed sleep patterns for AD or evidence for a causal relationship between MDD and AD.

Introduction: Internet addiction can cause unfulfilled hours of sleep, which if left unchecked will lead to disruption of sleep patterns often called insomnia. The purpose of the research was to determine the relationship between internet addiction and insomnia. Methods: The design of the research was descriptive-analytic with a cross-sectional approach. The population in the research consisted of as many as 217 respondents with a sample size of 141 respondents. The variables used in the research were insomnia as the dependent variable and internet addiction as the independent one. The instrument used was a questionnaire with a univariate and bivariate analysis. Results: The results of the study used the Spearman Rho test with a value of p = 0,000. Conclusion: From these results, it could be concluded that there is a relationship between internet addiction and the incidence of insomnia. Internet addiction can cause unfulfilled hours of sleep, which if left unchecked will lead to disturbed sleep patterns often called insomnia. The research suggests that students pay more attention to their health by limiting or reducing the use of the internet for unimportant issues as it can reduce learning productivity and academic value and cause insomnia.

Background: College life is a crucial period and at this age, students are more likely to get involved in unhealthy lifestyle behavior like poor dietary habits, physical inactivity, and use of substances, etc. Objectives: Study objectives were to determine the lifestyle behavior of budding healthcare professions and to determine the association of bio-physical profiles with their personal profile, activity, sleep, and dietary pattern. Settings and Design: The current study adopted a cross-sectional design and carried out during May - June 2019 among 284 participants of tertiary care institute. Methods and Material: Participants were selected through a proportionate stratified sampling technique. Self-structured questionnaire and Likert scale were used to assess the lifestyle behavior of participants. Descriptive and inferential statistics were used for data analysis. Results: Majority of participants (70.7%) preferred junk food as a substitute of meal. Significant number (68.3%) of students did not exercise regularly and 30.9% have disturbed sleep pattern. One-third of them (34.5%) were in pre-hypertensive stage and alarming number of them having unacceptable body mass index (BMI) (24.7%) and waist hip ratio (28.5%). Increased BMI was significantly associated with male gender (P = 0.01) and sleep deprivation (P = 0.03). Significantly more male participants were hypertensive and pre-hypertensive (P = 0.001). Conclusions: Study data indicated that having knowledge regarding health is not enough to ensure that health professionals will follow healthy lifestyle and it is important to motivate budding health care professionals to practice healthy lifestyle with an aim of health promotion and prevention of diseases.

Background: online game addiction is one form of addiction that is non-physical, indicated by unhealthy behavior with compulsiveness or continuous behavior in playing online games to get satisfaction so that it will be difficult to stop or limit it even though the behavior causes some social and emotional problems. Method: this study was conducted by Analytical Survey with Cross-Sectional approach. Research Results: there is a relationship between online game addiction and sleep patterns in adolescents aged 16-18 years (value p = 0.004

Objectives: The objectives of this study were focused on finding the influence of excessive mobile phone usage on academic performance of medical students and to find association between excessive mobile phone usage and anxiety in students of a medical University Karachi. Methods: It was a questionnaire based study, three different standardized questionnaires were used to assess the sleep pattern and anxiety, however academic performance were evaluated by their last attempted exam. Results: Excessive mobile phone usage was significantly (p-value = 0.001) associated with disturbed sleep pattern and sleep quality. But we did not had significant results for anxiety and academic performance. Conclusion: Excessive mobile phone use may disturb sleep pattern and quality of sleep but it does not affect academic performance and does not lead to anxiety.

Introducción: El sueño influye y regula funciones fisiológicas y respuestas conductuales, por lo tanto, la privación del sueño y descanso ha llevado a alteraciones del bienestar de las estudiantes universitarias que viven cambios en sus rutinas de vida, relacionado con las exigencias académicas, horarios de estudio, cumplimiento de roles, entre otros. El abordaje del sueño y descanso en las estudiantes universitarias permite generar información empírica para la toma de decisiones por las autoridades universitarias y como profesionales de enfermería orienta el diseño de las intervenciones para el bienestar de esta población. Objetivo: caracterizar el patrón de sueño y descanso de las estudiantes universitarias del área de la salud. Metodología: estudio descriptivo transversal, participaron 119 mujeres seleccionadas por muestreo aleatorio simple, inscritas en un programa del área de la salud y que firmaron el consentimiento informado. Se aplicó un instrumento exprofeso diseñado a partir de las características definitorias de la categoría diagnostica patrón de sueño alterado de NANDA 2018-2020. Para el análisis se obtuvo estadística descriptiva e inferencial. Resultados: sobre las características sociodemográficas 94.1% refirieron ser solteras, 5% reportó tener hijos, 66.4% cursaban cuarto año de la carrera de enfermería. Respecto al patrón de sueño y descanso 12.6% se sienten descansadas, 63% se despiertan durante la noche, 55.5% tardan en conciliar el sueño y 43.7% duermen menos de ocho horas, por la falta de horas de sueño refieren ansiedad (46.2%), letargo (50.4%), agresión (38.7%). Conclusión: las estudiantes tienen un patrón de sueño y descanso alterado.

Background To investigate whether children with Duchenne muscular dystrophy (DMD) have sleep disorders, and the sleep quality and daytime sleepiness of mothers who are primary caregivers. Methods Clinical data and gross motor functional status of 24 patients with DMD were measured using the gross motor function classification system (GMFCS). Sleep Disturbance Scale for Children scores were evaluated to determine their sleep features. The Pittsburgh Sleep Quality Index scores were used to measure sleep quality, and Epworth Sleepiness Scale scores were used to measure daytime sleepiness of 24 mothers. Results Sleep disturbances were observed in 62.5% (n = 15) of patients, 41.6% (n = 5) of those who were GMFCS I-II-III and in 83.3% (n = 10) who were IV-V level. A disturbed sleep pattern was observed in 3 (33.3%) of 9 patients who were younger than 10 and in 12 (80.0%) of 15 patients who were older than 10. Of mothers, 54.2% had low sleep quality, which was present in 83.3% of mothers with GMFCS IV-V children and 54.2% of those with GMFCS I-II-III children. Ten (41.6%) mothers had increased daytime sleepiness, which was present in 66.6% of mothers with GMFCS IV-V children and 16.6% of mothers with GMFCS I-II-III children. Conclusions Sleep disturbances increase in parallel to loss of gross motor functions in patients with DMD, which has had negative impact on the sleep quality and daytime sleepiness of the caregiver.

Many new disorders have come up in recent years due to rapid changes in lifestyle of people, collectively called as lifestyle disorders. According to the Ayurveda, man is said to be healthy whose Dosha, Dhatu, Mala & Agni are in the state of equilibrium along with mental, sensory and spiritual pleasantness and happiness. Ayurveda emphasizes on physical & mental fitness with prevention of disease & preservation of health in a comprehensive manner. There are many unhealthy practices followed by people in their day to day life which badly affect their health, one of them is lack of sleep or disturbed sleep pattern. “Early to bed & early to arise makes a man healthy, wealthy & wise.” This proverb has a great significance. Ayurveda believes in saying it. Trayopstambha ( Ahara, nidra, Brahmacharya) is key to health and disease on which our life and vitality is based. It focus on daily regimen (Dincharya) that can avoid lifestyle disorders. Nidra plays an important role in physical and mental health. Ayurveda has prescribed certain rules, in regard to diet and sleep, called seasonal regimen (Rutucharya). Present article emphasized on role of Nidra in promotion of maintenance of health and well being and prevention of lifestyle disorders.

Information support robots (ISRs) have the potential to assist older people living alone to have an independent life. However, the effects of ISRs on the daily activity, especially the sleep patterns, of older people have not been clarified, moreover, it is unclear whether the effects of ISRs depend on the levels of cognitive function. To investigate these effects, we introduced an ISR into the actual living environment and then quantified induced changes according to the levels of cognitive function. Older people who maintained their cognitive function demonstrated the following behavioral changes after using the ISR: faster wake-up times, reduced sleep duration, and increased amount of activity in the daytime (p &lt, 0.05, r = 0.77, p &lt, 0.05, r = 0.89, and p &lt, 0.1, r = 0.70, respectively). The results suggest that the ISR is beneficial in supporting the independence of older people living alone since living alone is associated with disturbed sleep patterns and low physical activity. The impact of the ISR on daily activity was more remarkable in the subjects with high cognitive function than in those with low cognitive function. These findings suggest that cognitive function is useful information in the ISR adaptation process. The present study has more solid external validity than that of a controlled environment study since it was done in a personal residential space.

Most people with dementia live at home supported by informal caregivers, but disturbed sleep patterns may induce a heavy burden of care. The beneficial effects of bright light on their sleep, health, and well-being have been demonstrated in clinical settings, but not in a home situation. We evaluated a dynamic lighting system in a real-life longitudinal single-case experimental design (SCED) with people with dementia living at home. Eleven people with dementia and their informal caregivers were included in this study with four 4-week periods of alternating exposure and nonexposure in an introduction–withdrawal setup (ABAB). Objective light exposure data were collected and analyzed. The used study design seems applicable for this population and suitable for home use. Participant dropout did occur, but was due to health conditions rather than participant burden. The lighting system led to more light in the homes of the participants, as well as to higher actual individual light exposures, although the latter increased only moderately and not consistently across all participants, seasons, and times of day. The participants appreciated the lighting system even after 6 months. We reflect on individual differences, seasonal and daypart influences, and differential light effects. Recommendations and lessons learned are discussed.

Made available in DSpace on 2021-06-25T10:18:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-10 Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has caused a global panic and public concern due to its mortality ratio and lack of treatments/vaccines. Reduced levels of physical activity have been reported during the outbreak, affecting the normal daily pattern. Objective: To investigate (i) the relationship of physical activity level with sleep quality and (ii) the effects of reduction physical activity levels on sleep quality. Methods: A Google form was used to address personal information, COVID-19 personal care, physical activity, and mental health of 1,907 adult volunteers. Binary logistic regression was used to verify the association of physical activity parameters and sleep quality. Results: Insufficient physical activity levels were a risk factor to have disturbed sleep pattern [OR: 1.28, 95% CI (1.01–1.62)]; however, when the BMI was added to the analysis, there was no more statistical difference [OR: 1.23, 95% CI (0.96–1.57)]. On the other hand, we found that the reduction of physical activity levels was associated with negative changes in sleep quality [OR: 1.73, 95% CI (1.37–2.18)], regardless all the confounders [OR: 1.30, 95% CI (1.01–1.68)], unless when feeling of depression was added in Model 6 [OR: 1.28, 95% CI (0.99–1.66)]. Conclusion: Disruption in daily physical activity routine, rather than physical activity level, negatively influences sleep quality during the COVID-19 quarantine. Department of Cell and Developmental Biology Institute of Biomedical Sciences University of São Paulo Department of Physical Education Universidade Estadual Paulista (UNESP) Department of Sport Exercise and Rehabilitation Northumbria University Human Movement Science and Rehabilitation Graduation Program Federal University of São Paulo Graduate Program in Medicine Universidade Nove de Julho Graduate Program in Rehabilitation Sciences Universidade Nove de Julho University of São Paulo California State University San Bernardino Department of Physical Education Universidade Estadual Paulista (UNESP)

Introduction Depression is more common among older adults, but there is a paucity of information about its association with spiritual intelligence. This study aimed to determine the prevalence and association of depressive symptoms with spiritual intelligence among older adults. Materials and methods This community-based cross-sectional analytical study was conducted among 292 older adults in a rural area of Puducherry, India. A structured questionnaire was used to collect each participant’s socio-demographic and behavioral factors; the presence of depressive symptoms was assessed by using Geriatric Depression Scale (short form), spiritual intelligence by the Spiritual Intelligence Self-Report Inventory-24 questionnaire and activities of daily living by Katz Index of Independence scale. Proportion for prevalence estimate, bivariate and multivariable log binomial regression analysis were done. Results The prevalence of depressive symptoms was 64.1 % (187/292; 95 % CI 58.3–69.3). Of total, 103 (35.3 %) had low, 92 (31.55 %) had moderate and 97 (33.2 %) had high spiritual intelligence. About 11 % (32/292) were partially or fully dependent. Depressive symptoms showed a significant association with marital status, education, sleep pattern, relationship with family members and spiritual intelligence in bivariate analysis. Depressive symptoms were high among those with low spiritual intelligence and disturbed sleep pattern with Adjusted Prevalence Ratio of 1.33 (95 %CI 1.26–1.4) and 1.06 (95 %CI 1.0–1.14) respectively. Conclusion Majority of the older adults had depressive symptoms and significantly more among those with low spiritual intelligence and disturbed sleep. This study gives new evidence on spiritual intelligence among older adults in a community setting and the magnitude of association of depressive symptoms with spiritual intelligence.

Objectives: Disturbed sleep patterns might alter the autonomic tone and may lead to various cardiovascular morbidities. This study aimed to determine sleep patterns (quality, duration, efficiency and day time sleepiness) and explore their association with blood pressure (BP) and heart rate variability (HRV) in young apparently healthy young Saudi females. Methods: This cross-sectional study was conducted in the Physiology department, ------University, Saudi Arabia. Self-reported Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires were used to collect data from 98 female participants. Participant’s blood pressure was recorded with Finometer® and HRV was measured from ECG using PowerLab®. Based on the cut-off values of sleep quality, duration, efficiency and daytime sleepiness scores, students were categorized into groups. HRV and BP were compared between the groups by t test/One-way ANOVA. Results: Poor sleep patterns (quality, duration, efficiency) were observed but no association was found in BP and HRV parameters among groups of different sleep quality, duration, and efficiency. Systolic blood pressure was significantly increased in moderate to severe day time sleepiness group (P=0.039). Dozing off as a passenger in a car doze, in afternoon and after lunch were negatively correlated with HRV parameters (P < 0.05). Conclusion: Sleep quality, duration and efficiency were not found to be statistically significant, but various doze off situations were associated with HRV parameters. Day time sleepiness may augment sympathetic response in apparently healthy female participants. Keywords: sleep patterns, day time sleepiness, blood pressure, heart rate variability, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale.

During Ramadan, dehydration and disturbed sleep patterns are common, so accurate reliable methods for the assessment of hydration and sleep of athletes are necessary to maintain performance. The purpose of this review is: (1) to identify appropriate tools/methods for monitoring hydration status and sleep in sports people; (2) to discuss which of these tools/methods can be confidently used by sport scientists and trainers during Ramadan; and (3) to discuss the possible link that may exist between sleep and hydration status. Several markers of hydration status are currently used and include body mass, plasma/serum osmolality, dilution techniques, and neutron activation analysis. Used in an appropriate context, all can be indicative of the hydration status in the laboratory. In the field, monitoring hydration status in physically active individuals and athletes may be performed using a combination of body mass with some measure of urine concentration (e.g. urine osmolality, urine-specific gravity, urine color) and sensation of thirst. During Ramadan, appropriate timing of sample collection and the use of reference methods in future studies are warranted. In the field, careful use of body mass in conjunction with urine indices may be used to monitor the hydration status of subjects practicing physical activity during Ramadan. There is a need for the use of polysomnography or actigraphy for sleep assessment during Ramadan in future laboratory-based studies of athletes. However, in the field, monitoring sleep–wake patterns may be performed using actigraphy and/or the PSQI questionnaire.

Disruption of the circadian clock has been associated with pathological conditions including obesity, type 2 diabetes mellitus, cancer, depression and neurodegenerative diseases. Disturbed sleep patterns have now been associated with reduced erectile function. The mechanisms behind this effect are unclear but could include hypoxia signalling and low testosterone.

Objective: to analyze the content of the defining characteristics of the Disturbed Sleep Pattern Nursing Diagnosis (00198) in patients with Acute Coronary Syndrome. Method: content analysis performed by specialists who achieved a score equal to or greater than five, according to established criteria: clinical experience, teaching and/or research; participation in research groups; doctorate degree; master's degree; specialization and/or residency in cardiology and/or sleep and/or nursing classifications. Eight defining characteristics were evaluated for their relationship to population, relevance, clarity and accuracy. Descriptive statistics were performed to characterize the sample, binomial statistical test to establish if there is agreement between the experts and chi-square and Fisher's exact to establish associations between the evaluated items and the experts' variables. Results: 54 experts participated in the study. The defining characteristics validated by the experts were the following: dissatisfaction with sleep, feeling unrested, sleep deprivation, alteration in sleep pattern, unintentional awakening, difficulty initiating sleep and daytime sleepiness. There was a statistically significant association between evaluated items and the variables time of training, time of operation and punctuation. Conclusion: seven of the eight defining characteristics were considered valid after the application of binomial test. This study will contribute to the refinement of the Disturbed Sleep Pattern Nursing Diagnosis (000198) and may enable the improvement of the quality of care of patients hospitalized with Acute Coronary Syndrome regarding changes in sleep pattern. The content analysis stage will support the next stage of the validation process of the present diagnosis, the clinical validation.

Objective To clinically validate the nursing diagnosis, disturbed sleep pattern (00198), in patients with acute coronary syndrome. Data collection A clinical validation study using the patient history, Visual Analog Sleep scale, and diagnostic inference. Accuracy techniques were performed. Synthesis of data There were 75 patients: 76.00% were men, and 82.66% had a myocardial infarction. The defining characteristic, changes in sleep pattern, presented a sensitivity of 0.900 and specificity of 0.9714. Conclusion Changes in sleep pattern was a predictor of the nursing diagnosis. Implications for practice Results will contribute to the identification of sleep disturbances, by nurses, emphasizing the importance of improving sleep during hospitalization. Objetivo Validar clinicamente o Diagnostico de Enfermagem Padrao de Sono Prejudicado (00198) em pacientes com Sindrome Coronariana Aguda. METODOS: Estudo de validacao clinica, utilizando Historico de Enfermagem, Escalas Visuais Analogas do Sono e inferencia diagnostica. Realizada medidas de acuracia. Resultados 75 pacientes, 76,00% homens e 82,66% com Infarto do Miocardio. A caracteristica definidora Alteracao do Padrao de Sono teve 0,900 de Sensibilidade e 0,9714 de Especificidade. CONCLUSOES: Alteracao do padrao de sono foi preditora do diagnostico de enfermagem. IMPLICACOES PARA A PRATICA: Contribuira na identificacao de disturbios do sono, pelos enfermeiros, ressaltando a importância da melhoria do sono durante a internacao.

Deficiency of the sleep-wake cycle can accelerate the progression of Huntington’s disease (HD) and exacerbate symptoms making it a target of investigation to better understand the molecular pathology of the disorder. In this study we analyzed sleep defects in a Drosophila model of HD and investigated whether disturbed sleep coincides with alterations in the molecular mechanism controlling circadian rhythm. To analyze sleep defects we recorded the daily activity of flies in 12:12 hours light:dark entrainment and in regard to the underlying molecular mechanism measured circadian “clock” gene expression. In HD flies we observed reduced amount of sleep, sleep fragmentation and prolonged sleep latency. We found changes in gene expression patterns of both transcriptional feedback loops of circadian regulation. We detected prolonged expression of the core feedback loop components period and timeless, whilst the secondary feedback loop member vrille had lower expression rates in general. Our results show that the Drosophila HD model recapitulates most of the sleep related symptoms reported in patients therefore it can be a potential tool to study the molecular background of sleep defects in HD. Altered expression of circadian “clock” genes suggests that disturbed sleep pattern in HD might be the consequence of disturbed circadian regulation.

Parkinson's disease patients report disturbed sleep patterns long before motor dysfunction. Here, in parkin and pink1 models, we identify circadian rhythm and sleep pattern defects and map these to specific neuropeptidergic neurons in fly models and in hypothalamic neurons differentiated from patient induced pluripotent stem cells (iPSCs). Parkin and Pink1 control the clearance of mitochondria by protein ubiquitination. Although we do not observe major defects in mitochondria of mutant neuropeptidergic neurons, we do find an excess of endoplasmic reticulum-mitochondrial contacts. These excessive contact sites cause abnormal lipid trafficking that depletes phosphatidylserine from the endoplasmic reticulum (ER) and disrupts the production of neuropeptide-containing vesicles. Feeding mutant animals phosphatidylserine rescues neuropeptidergic vesicle production and acutely restores normal sleep patterns in mutant animals. Hence, sleep patterns and circadian disturbances in Parkinson's disease models are explained by excessive ER-mitochondrial contacts, and blocking their formation or increasing phosphatidylserine levels rescues the defects in vivo. ispartof: NEURON vol:98 issue:6 pages:1155-+ ispartof: location:United States status: published

Background: Patients with carpal tunnel syndrome often suffer from fragmentary sleep. This study was designed to assess the effectiveness of treatment with ultramicronized palmitoylethanolamide in reducing pain intensity and improving quality of sleep in patients with neuropathic pain due to carpal tunnel syndrome. Methods: An open, controlled study was conducted on 42 patients awaiting carpal tunnel syndrome surgery, suffering from sleep disorders and painful symptoms and randomized into two groups. One group received ultramicronized palmitoylethanolamide (600 mg twice daily) during the pre- and postsurgery periods, while the other group did not receive any treatment except surgical therapy. The primary outcome measure was sleep quality assessment by the Pittsburgh Sleep Quality Index, with secondary outcome as painful symptomatology intensity evaluated by the Numeric Rating Scale. Results: At the end of the pre-surgery period (T1) there was a highly significant improvement (p Conclusion: Disturbed sleep patterns are very common in patients suffering from neuropathic pain due to carpal tunnel syndrome. Our results, albeit preliminary, suggest that ultramicronized palmitoylethanolamide administration favors a clear improvement of sleep quality, confirming a correlation between sleep disorders and pain intensity.

Objetivo Identificar a frequência dos diagnósticos de enfermagem em pacientes de clínica cirúrgica. Métodos Estudo transversal, descritivo e exploratório, de abordagem quantitativa, com dados referentes a 28 pacientes. O instrumento de coleta de dados foi desenvolvido pelos pesquisadores, com base em padrões funcionais de saúde. Resultados Foram encontrados 301 diagnósticos de enfermagem, com média de 12 por paciente. Somente quatro diagnósticos apresentaram frequência acima de 50%. Os mais frequentes foram: “risco de infecção”, “integridade da pele/tissular prejudicada”, “disposição para bem-estar espiritual”, “disfunção sexual” e “padrão do sono perturbado”. Diagnósticos que se enquadram no domínio 13 (Crescimento/Desenvolvimento) não foram documentados nesta amostra. Conclusão Os achados demostraram ampla variedade de diagnósticos na população estudada, reflexo da diversidade de cuidados a serem prestados. A identificação das necessidades de cuidados favorece a implantação de intervenções específicas, contribuindo para a qualidade da assistência de enfermagem. Objective To identify the frequency of nursing diagnosis in patients in surgical clinic. Methods A transverse, descriptive and exploratory study of quantitative approach, with data referring to 28 patients. The data collection instrument was developed by the researchers based on health functional patterns. Results In total, 301 nursing diagnosis were found, with an average of 12 per patient. Only four diagnoses showed frequency above 50 percent. The most frequent were ‘risk for infection’, ‘impaired skin/tissue integrity’, ‘readiness for enhanced spiritual well-being’, ‘sexual dysfunction’ and ‘disturbed sleep pattern’. The diagnoses that fit in domain 13 (Growth/Development) were not documented in this sample. Conclusion The findings demonstrated a wide variety of diagnoses in the study population, a reflex of the diversity of care provided. Identifying the care needs favors the implantation of specific interventions, contributing to the quality of nursing assistance.

Aim Pilot study to examine the impact of long work hours and shift work on cognitive errors in nurses. Background Twelve-hour shifts are more commonly used in hospital settings and there is growing concern over the impact that extended and irregular work hours have on nurses' well-being and performance. Method Twenty-eight nurses working different shifts (8-hr days and 12-hr rotation) participated in this study. Nurses were assessed at the beginning of four consecutive shifts using actigraphy, a sleep diary and an after work questionnaire. Results Nurses working 12-hr rotations had less total sleep time and less sleep efficiency than 8-hr day nurses. Twelve-hour rotation nurses also napped more than their counterparts. There were no differences between the two groups with respect to cognitive errors. Conclusions Twelve-hour rotations have a negative effect on nurses' sleep patterns. There is no evidence indicating 12-hr rotations increased errors. Implications for nursing management Nurse managers can implement specific strategies, such as greater shift work flexibility and designated quiet time, to reduce the effects of disturbed sleep patterns in nurses.

Disturbed sleep pattern is a common symptom after head trauma and its prevalence in acute traumatic brain injury (TBI) is less discussed. Sleep has a profound impact on cognitive function recovery and the mediating effect of disturbed sleep on cognitive function recovery has not been examined after acute TBI.To identify the prevalence of disturbed sleep in mild, moderate, and severe acute TBI patients, and to determine the mediating effects of sleep on the relationship between brain injury severity and the recovery of cognitive function.A prospective study design.Neurosurgical wards in a medical center in northern Taiwan.Fifty-two acute TBI patients between the ages of 18 and 65 years who had received a diagnosis of TBI for the first time, and were admitted to the neurosurgical ward.The severity of brain injury was initially determined using the Glasgow Coma Scale. Each patient wore an actigraphy instrument on a non-paralytic or non-dominated limb for 7 consecutive days. A 7-day sleep diary was used to facilitate data analysis. Cognitive function was assessed on the first and seventh day after admission based on the Rancho Los Amigos Levels of Cognitive Functioning.The mild (n=35), moderate (n=7) and severe (n=10) TBI patients exhibited poorer sleep efficiency, and longer total sleep time (TST) and waking time after sleep onset, compared with the normative values for the sleep-related variables (P.05 for all). The severe and moderate TBI patients had longer daytime TST than the mild TBI patients (P.001), and the severe TBI patients had longer 24-h TST than the mild TBI patients (P=.001). The relationship between the severity of brain injury and the recovery of cognition function was mediated by daytime TST (t=-2.65, P=.004).Poor sleep efficiency, prolonged periods of daytime sleep, and a high prevalence of hypersomnia are common symptoms in acute TBI patients. The duration of daytime sleep mediates the relationship between the severity of brain injury and the recovery of cognition function.

The purpose of this study was to gain an insight into nurses' experiences of incorporating aromatherapy into the care of residents suffering from dementia, anxiety and disturbed sleep patterns. Twenty-four residents and twelve nurses from four nursing homes participated in an action research study. The use of lavender augustofolia essential oil diffused nightly was perceived as an effective care modality reducing insomnia and anxiety in this patient cohort. Nurses experienced some negative attitudes among colleagues because they considered aromatherapy as not evidence based. Nurses require greater access to evidence based use of Aromatherapy. Further research is needed to study how smell can enhance dementia care.

Objectives. Patients with diabetic peripheral neuropathy (DPN) is the most common complication. However, patients are usually suffering from not only diverse sensory deficit but also neuropathy-related discomforts. The aim of this study is to identify distinct groups of patients with DPN with respect to its clinical impacts on symptom patterns and comorbidities. Methods. A hierarchical cluster analysis and factor analysis were performed to identify relevant subgroups of patients with DPN (n=1338) and symptom patterns. Results. Patients with DPN were divided into three clusters: asymptomatic (cluster 1, n=448, 33.5%), moderate symptoms with disturbed sleep (cluster 2, n=562, 42.0%), and severe symptoms with decreased quality of life (cluster 3, n=328, 24.5%). Patients in cluster 3, compared with clusters 1 and 2, were characterized by higher levels of HbA1c and more severe pain and physical impairments. Patients in cluster 2 had moderate pain levels but disturbed sleep patterns comparable to those in cluster 3. The frequency of symptoms on each item of MNSI by “painful” symptom pattern showed a similar distribution pattern with increasing intensities along the three clusters. Conclusions. Cluster and factor analysis endorsed the use of comprehensive and symptomatic subgrouping to individualize the evaluation of patients with DPN.

Obstructive sleep apnea (OSA) is a highly common, yet often under recognized, chronic sleep disorder characterized by transient, repetitive partial or complete disruptions of breathing due to upper airway obstruction during sleep. It is usually associated with disturbed sleep pattern, snoring, daytime fatigue, and poor concentration. The full metabolic derangement caused by OSA is unknown, but there is a growing body of evidence to suggest that sleep apnea is a chronic inflammatory systemic disease suggesting interplay between chronic disorders such as coronary artery disease and chronic kidney disease (CKD). OSA can result in direct kidney injury through hypoxia. It can also accelerate the deterioration of kidney function in patients with CKD indirectly by increasing systemic blood pressure, producing inflammatory cytokines, inducing endothelial dysfunction and increasing sympathetic activation. Better understanding of etiology and mechanisms is crucial to early diagnosis and aggressive management, as OSA has been associated with worse clinical outcomes and may be an independent predictor of all-cause mortality, hypertension, diabetes, left ventricular dysfunction, atrial fibrillation, stroke, and more recently, sudden cardiac death. The aim of this chapter is to describe and help readers better understand sleep apnea as a systemic disease and elucidate possible pathophysiological interactions between OSA and CKD in predisposing individuals to adverse cardiovascular events.

It is increasingly recognized that sleep disturbances and Alzheimer's disease (AD) share a bidirectional relationship. AD patients exhibit sleep problems and alterations in the regulation of circadian rhythms; conversely, poor quality of sleep increases the risk of development of AD. The aim of the current study was to determine whether chronic sleep restriction potentiates the brain impact of amyloid-β oligomers (AβOs), toxins that build up in AD brains and are thought to underlie synapse damage and memory impairment. We further investigated whether alterations in levels of pro-inflammatory mediators could play a role in memory impairment in sleep-restricted mice. We found that a single intracerebroventricular (i.c.v.) infusion of AβOs disturbed sleep pattern in mice. Conversely, chronically sleep-restricted mice exhibited higher brain expression of pro-inflammatory mediators, reductions in levels of pre- and post-synaptic marker proteins, and exhibited increased susceptibility to the impact of i.c.v. infusion of a sub-toxic dose of AβOs (1pmol) on performance in the novel object recognition memory task. Sleep-restricted mice further exhibited an increase in brain TNF-α levels in response to AβOs. Interestingly, memory impairment in sleep-restricted AβO-infused mice was prevented by treatment with the TNF-α neutralizing monoclonal antibody, infliximab. Results substantiate the notion of a dual relationship between sleep and AD, whereby AβOs disrupt sleep/wake patterns and chronic sleep restriction increases brain vulnerability to AβOs, and point to a key role of brain inflammation in increased susceptibility to AβOs in sleep-restricted mice.

Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement with length of stay (LOS)3 days. The primary endpoint was REM sleep duration on the first postoperative night compared with before operation.Ten subjects (≥60 yr) receiving spinal anaesthesia and multimodal opioid-sparing postoperative analgesia for total hip or knee arthroplasty were included. Ambulatory polysomnography was performed one night before operation at home, continuously during hospitalization, and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated.The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean of 18.2 (9.5-23.5)% of total sleep time to 1.2 (0-5.8)% on the first postoperative night (P=0.002); awake time increased from 19.1 (3.7-44.4)% to 44.3 (12.2-70.6)% (P=0.009); and sleep architecture on the first postoperative night was more disturbed than before operation. Sleep architecture normalized on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern.Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated on the first postoperative night after fast-track orthopaedic surgery but returned to pre-admission levels when at home on the fourth postoperative night.

Background: Liver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. Methods: This study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. Results: Our results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4 ± 2.6 vs 11.1 ± 1.8, P = 0.0001; 10.9 ± 8.5 vs 2.4 ± 1.6, P = 0.005 and 3.1 ± 3.1 vs 1.1 ± 0.9, P = 0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9 ± 12.9 vs 73.1 ± 7.6 (P = 0.02)]. Also, the percentages of S1, S3–S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group (P = 0.01, 0.02 and 0.06, respectively) while the percentage of S2 was significantly lower (P = 0.02). Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B (P = 0.001 for all). Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. Conclusion: This study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis.

Background There is a diagnostic overlap between the clinical presentations of both major depressive disorder (MDD) and somatoform disorder (SD). Similar to MDD patients, SD patients usually have a disturbed sleep pattern. Aim The aim of this study was to assess the sleep profile of SD patients and compare it with that of MDD patients using sleep as a biological marker. Methods We investigated the sleep profile of 40 SD patients, in comparison with 40 MDD patients, and 40 healthy controls, by polysomnographic recordings of their sleep after a subjective assessment using an SCID1 Questionnaire, the Taylor Anxiety scale, the Beck Depression Inventory, the Toronto Alexithymia scale, and finally a sleep questionnaire. Results Both MDD and SD patients had, in comparison with healthy controls, significantly decreased sleep efficiency, increased sleep latency and arousal index, increased stage 1 non rapid eye movement sleep, decreased stages 3 and 4 non rapid eye movement sleep, and thus decreased slow wave sleep, besides increased slow wave sleep latency. In addition, they had increased rapid eye movement (REM) percentage, first REM duration, and decreased REM latency. Conclusion Although not identical, the similar changes in the sleep patterns in both SD and MDD may suggest a common or a shared biological basis for both disorders.

Sleep disturbances are prevalent in patients with Alzheimer’s disease (AD), being one of the most troubling symptoms during the progression of disease. However, little research has been made to determine if impaired sleep patterns appear years before AD diagnosis. This study tries to shed light on this issue by performing polysomnographic recordings in healthy elders and patients with mild cognitive impairment (MCI). We further investigated whether changes in sleep patterns parallel memory decline as well as its relationship with the Apolipoprotein E (ApoE) e 4 genotype. Results showed a significant shortening of rapid eye movement (REM) sleep together with increased fragmentations of slow-wave sleep in MCI patients relative to healthy elders. Interestingly, we further showed that reduction of REM sleep in MCI patients with ApoE e 4 was more noticeable than in e 4 non-carriers. Contrary to our initial hypothesis, changes in sleep patterns were not correlated with memory performance in MCI patients. Instead, increased REM sleep accompanied enhanced immediate recall in MCI e 4 non-carriers. Taken together, these results suggest that sleep disruptions are evident years before diagnosis of AD, which may have implications for early detection of dementia and/or therapeutic management of sleep complaints in MCI patients.

Summary Sleep and circadian rhythm disruption has been widely observed in neuropsychiatric disorders including schizophrenia [1] and often precedes related symptoms [2]. However, mechanistic basis for this association remains unknown. Therefore, we investigated the circadian phenotype of blind-drunk (Bdr), a mouse model of synaptosomal-associated protein (Snap)-25 exocytotic disruption that displays schizophrenic endophenotypes modulated by prenatal factors and reversible by antipsychotic treatment [3, 4]. Notably, SNAP-25 has been implicated in schizophrenia from genetic [5–8], pathological [9–13], and functional studies [14–16]. We show here that the rest and activity rhythms of Bdr mice are phase advanced and fragmented under a light/dark cycle, reminiscent of the disturbed sleep patterns observed in schizophrenia. Retinal inputs appear normal in mutants, and clock gene rhythms within the suprachiasmatic nucleus (SCN) are normally phased both in vitro and in vivo. However, the 24 hr rhythms of arginine vasopressin within the SCN and plasma corticosterone are both markedly phase advanced in Bdr mice. We suggest that the Bdr circadian phenotype arises from a disruption of synaptic connectivity within the SCN that alters critical output signals. Collectively, our data provide a link between disruption of circadian activity cycles and synaptic dysfunction in a model of neuropsychiatric disease., Graphical Abstract Highlights ► A mouse Snap-25 mutant shows abnormal circadian behavior reminiscent of schizophrenia ► The phase advance of activity is mirrored by SCN output and corticosterone release ► Importantly, the core molecular clock of the Snap-25 mutant is not affected ► We discuss a link between neurotransmission, circadian defects, and schizophrenia

IntroductionAttention-deficit-hyperactivity-disorder (ADHD) is a frequent psychiatric disorder present in childhood, where sleep-problems are a prominent, pervasive and clinically important feature. However, our understanding of whether sleep-problems mimic or exacerbate daytime ADHD-symptom expression remains insufficient.ObjectiveResearch examining sleep and daily activity in toddlers with early signs of ADHD might help identify early risk factors.AimsTo investigate whether disturbed sleep patterns and daily activity level is associated with early signs of ADHD in toddlers.MethodsTwenty-four toddlers from the Danish Odense Child Cohort scoring above the 93rd percentile on the ADHD scale of the Child Behaviour Checklist for ages 1½–5 were categorized as cases and compared to 25 age and gender-matched controls scoring below the 50th percentile. Daytime and nocturnal activity for 49 toddlers were assessed through seven days of actigraphy. Parents completed Children's Sleep Habits Questionnaire (CSHQ) and the ADHD Rating Scale IV Preschool Version (ADHD-RS).ResultsActigraphic data revealed an increased night-to-night variability, prolonged total sleep time, fewer sleep interruptions and fewer minutes in moderate-to-vigorous-physical activity (MVPA) in cases compared to controls. Increased night-to-night variability was found significantly associated with higher total scores on both the CSHQ and ADHD-RS. Further, fewer minutes in MVPA were associated with a higher parent-reported motor activity on the ADHD-RS.ConclusionFindings show that early signs of ADHD are associated with irregular sleep patterns and lower daytime activity, as illustrated by actigraphy. Studies investigating early ADHD risk factors could lead to a preschool ADHD risk index to help guide future early intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Disturbed sleep patterns and increased levels of confusion, agitation and behavioural problems in the evening (‘sundowning’) can cause the person with dementia and his or her caregivers great distress. Sometimes, clinicians respond to such problems by prescribing sedatives that can make problems worse. It is important that staff are able to understand why people with dementia develop such problems. Staff should use non-drug treatments whenever possible to improve quality of life ( Ballard et al, 2008 ). This paper explains how disturbed sleep patterns and sundowning affect the person with dementia and how to reduce the incidence of sleep disturbance and distressing behaviours.

A variety of features of autism can be simulated in rodents, including the core behavioral hallmarks of stereotyped and repetitive behaviors, and deficits in social interaction and communication. Other behaviors frequently found in autism spectrum disorders (ASD) such as neophobia, enhanced anxiety, abnormal pain sensitivity and eye blink conditioning, disturbed sleep patterns, seizures, and deficits in sensorimotor gating are also present in some of the animal models. Neuropathology and some characteristic neurochemical changes that are frequently seen in autism, as well as alterations in the immune status in the brain and periphery are also found in some of the models. Several known environmental risk factors for autism have been successfully established in rodents, including maternal infection and maternal valproate administration. Also under investigation are a number of mouse models based on genetic variants associated with autism or on syndromic disorders with autistic features. This review briefly summarizes recent developments in this field, highlighting models with face and/or construct validity, and noting the potential for investigation of pathogenesis and early progress towards clinical testing of potential therapeutics. Wherever possible, reference is made to reviews rather than primary articles.

Aims. This study explored the inter-rater and intra-rater reliability to evaluate the consistency of nursing process records for patients with schizophrenia. Background. By writing accurate and complete nursing process records, nurses can quickly communicate the care that has been delivered. However, little is known about the accuracy of nursing records to reflect the patients’ problems, especially in psychiatry. Design. A prospective observational study. Methods. Two nurses with similar work experience in psychiatric wards assessed patient records produced by 14 psychiatric nurses to compute inter-rater reliability of nursing diagnoses and their defining characteristics. Collecting the records and the time spans between the first and the second data collection took one month to compute the intra-reliability of the nursing diagnoses by the same nurse. Results. The greatest intra-rater consistency was in identifying ‘disturbed thought processes’ (kappa = 0·77, 95% CI: 0·56–0·98). A moderate level of inter-rater agreement among nurses was observed for the nursing diagnoses of ‘disturbed thought process’ and ‘disturbed sleep pattern’ from 0·41–0·53. Furthermore, the inter-rater agreement of among nurses with less work experience (less than four years) showed greater higher consistency on ‘disturbed thought process’ (kappa = 0·56, 95% CI: 0·23–0·89) and ‘disturbed sleep pattern’ (kappa = 0·41, 95% CI: 0·07–0·73) than that observed among nurses with more work experience (more than four years). Conclusions. Overall, intra-rater reliability was greater than inter-rater reliability for psychiatric nursing process records. Furthermore, more inter-rater and intra-rater agreement were observed among records from less experienced nurses than among records produced by more experienced ones. To evaluate the consistency of nursing process records, both the intra-rater reliability and the inter-rater reliability show the importance of using standardised terms and more detailed nursing records. Relevance to clinical practice. Our results clearly indicate that using standardised terms to describe patient symptoms and more detailed descriptions of the nursing process could improve the accuracy of nursing records.

This study aims to investigate the impact of sensory hypersensitivity in children with atopic dermatitis (AD) and to evaluate a possible relationship between sensory hypersensitivity, sleep quality and disease severity in AD. Fifty-seven AD patients and 37 healthy children, aged 3-10 years, participated in this study. Disease severity was assessed using the Severity Scoring of Atopic Dermatitis (SCORAD) Score. The sensory profile was assessed using the Short Sensory Profile (SSP) and sleep characteristics were evaluated using the Children's Sleep Habits Questionnaire (CSHQ). The AD group demonstrated significantly worse sleep quality compared with the controls in the following CSHQ subscales: sleep duration; parasomnias; sleep disordered breathing and daytime sleepiness. Sensory hypersensitivity was correlated with lower sleeping quality. Severity Scoring of Atopic Dermatitis Scores was positively correlated with sleep anxiety and with parasomnias. Sensory hypersensitivity and disturbed sleep patterns were common in the children with AD that participated in this study. A possible common underlying mechanism of hyper-arousability may account for both phenomena. Evaluation of AD children should also refer to their sensory processing abilities and sleep habits to create optimal intervention programs that will be better focused on the child and family needs.

Sleep a vital biological process is essential for physical & psychological restoration. Owing to their hectic schedules, medical students, in particular, are known to have erratic sleep patterns and suffer from sleep disturbances, fatigue and mood changes. This study was designed to analyze the sleep patterns and to correlate sleep deprivation with incidence of anxiety, depression, daytime sleepiness and performance among 100 students of 1st year MBBS by means of a validated questionnaire. 44% students reported sleeping >8 Hrs and only 51% were regular in their sleep schedule. Females (32%) were found to follow a more regular sleep schedule compared to males (68%) and reported better performance and lesser level of anxiety and depression in those sleeping for more than 8 hrs. Day scholars had a better and a regular schedule compared to hostellers and they also had significantly (p =0.034) better performance. This study found that an old saying “early to bed and early to rise makes man healthy, wealthy and wise” holds true. Those following regular schedule, sleeping early and rising early in the morning have better academic performance and lower levels of anxiety and depression. This study highlights the prevalence of disturbed sleep patterns as a significant cause of poor performance and mood disturbances in medical students.

OBJECTIVES: To evaluate the sleep–wake patterns of community-dwelling patients with dementia and their primary caregivers before, during, and after 2-week periods of institutional respite care. DESIGN: Prospective case series. SETTING: Four community hospital units in East Midlands, United Kingdom. PARTICIPANTS: Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for dementia and caregivers completed baseline assessments; 33 of these dyads completed the full protocol. INTERVENTION: A 2-week period of institutional respite care during which patients were admitted to community hospitals (and received routine care) while caregivers remained at home. MEASUREMENTS: For patients and caregivers, primary sleep outcomes were derived from 6 weeks of continuous wrist actigraphy (2 weeks baseline; 2 weeks respite; 2 weeks follow-up) using the Actiwatch system. For caregivers, actigraphic measures were augmented with assessments of quality of life (using the Medical Outcomes Study 36-item Short Form survey) and quality of sleep (using the Pittsburgh Sleep Quality Index) at baseline and by daily sleep diaries and weekly Epworth Sleepiness Scale ratings throughout the study. RESULTS: At baseline, caregivers and patients showed profiles of clinically significant sleep disturbance. For caregivers, respite periods were associated with significant (P

The renin–angiotensin–aldosterone system raised attention in several studies due to its connection to sleep patterns. In primary aldosteronism (PA), aldosterone secretion is enhanced significantly. Our aim was to investigate sleep patterns between patients suffering from PA in comparison to healthy volunteers (HV). We compared 18 patients with untreated PA with 18 HVs matched according to age. After confirming diagnosis of PA in our hospital, patients’ polysomnographies were recorded during two consecutive nights. Polysomnographic parameters were scored in 30-sec epochs. Multivariate analyses of variance showed significant group differences concerning the parameters latency of wake after sleep onset (LWSO), light sleep (LS) and sleep period time (SPT). The duration (in epochs) of SPT in the 2nd night half (PA: 469.33 vs. HV: 495.72; p = 0.025) and LS in both whole night (PA: 520.11 vs. HV: 567.67; p = 0.043) and 2nd night half (PA: 261.83 vs. HV: 303.89; p = 0.026) were diminished significantly in patients with PA compared to HV. Moreover, LWSO was raised significantly in patients with PA (PA: 73.11 vs. HV: 31.61; p = 0.028). Our data demonstrate that patients with PA suffer from disturbed sleep patterns. Whereas in healthy subjects, the aldosterone and cortisol peaks occur synchronously during the early morning, aldosterone peaks in PA are present during day-time. The diminished SPT in the PA group in the morning hours might be related to the dysregulated aldosterone secretion.

Neuropsychiatric or cognitive disturbances are common complications after traumatic brain injury. They are commonly regarded as irreversible sequelae of organic brain injuries. We report a case of hypopituitarism in a 77-year-old man who presented with long-term neuropsychiatric disturbances, including cognitive impairment, disturbed sleep patterns, personality change, loss of affect, and visual and auditory hallucinations after a traumatic subdural hemorrhage. The treatment response to hormone replacement therapy was nearly complete. Hypopituitarism is rarely considered in patients who sustain traumatic brain injury and the neuropsychiatric manifestations of posttraumatic hypopituitarism have rarely been reported. This case highlights the importance of hypopituitarism as a potential reversible cause of neuropsychiatric disturbances after traumatic brain injury.

Objective: The α-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who exhibited the α-EEG sleep anomaly with pain-free psychiatric and medical patients who also were found to exhibit the α-EEG anomaly. Methods: The α-EEG sleep was identified in the polysomnographic records of 5% of over 1000 consecutive sleep patients. Objective sleep parameters, daytime sleepiness and psychological characteristics (Minnesota Multiphasic Personality Inventory [MMPI] scores) of patients exhibiting this anomaly were examined. Results: The α-EEG anomaly was identified in only 5% of the total patient sample. Patients with the α-EEG anomaly could be further classified into three diagnostic subgroups: chronic pain, psychiatric and other medical/sleep disorders, The subgroups were compared on sleep parameters and psychological characteristics. Less than 40% of the patients exhibiting the α-EEG anomaly experienced chronic pain. Chronic pain patients evidenced disturbed sleep patterns and psychological characteristics that were for the most part similar to those observed in some pain-free medical and psychiatric patients. Only the medical subgroup exhibited objective daytime sleepiness. The α-EEG sleep disturbance was not accounted for by psychological characteristics. Conclusions: These findings challenge the notion that α-EEG sleep is of direct etiological significance in producing the pain complaint among patients with chronic pain since the α-EEG sleep was not a sufficient condition for pain.

This chapter presents normative data on healthy sleep, as measured by polysomnography (PSG), from “supernormal” subjects across the age range from 20 to about 90 years. The data originates from the SIESTA project database established in the late 1990s. While that data has been published and used in research in many ways, the novelty of the current analysis is (a) the focus on normative data following the latest sleep staging standard (AASM 2012), and (b) the results after narrowing down the data set by excluding outliers due to disturbed sleep pattern that can occur in a sleep lab and are thus not examples of “normal” sleep. Results demonstrate interesting dependencies of sleep architecture on age, in particular a reduction in total sleep time and changes in sleep stage distributions toward lighter sleep, which differ in detail between the two genders.