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BackgroundNocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population.ObjectivesTo provide greater insight into the complex relationship between nighttime overactive bladder symptoms and sleep disruption, and to evaluate the effects of a guided slow-paced respiration intervention on sleep outcomes in women with overactive bladder.Study designWe conducted an ancillary study within a randomized trial of slow-paced respiration in women with overactive bladder symptoms. Ambulatory community-dwelling women who reported ≥3 episodes/day of urgency-associated voiding or incontinence were randomized to use either a portable biofeedback device (RESPeRATE; Intercure, Ltd) to practice guided slow-paced respiration exercises daily for 12 weeks (N=79) or an identical-appearing device programmed to play nonrhythmic music without guiding breathing (N=82). At baseline and after 12 weeks, bladder symptoms were assessed by voiding diary, sleep duration, and disruption were assessed by sleep diary corroborated by wrist actigraphy, and poor sleep quality was determined by a Pittsburgh Sleep Quality Index global score >5.ResultsOf the 161 women randomized, 31% reported at least twice-nightly nocturia, 26% nocturnal incontinence, and 70% poor sleep quality at baseline. Of the 123 reporting any nighttime awakenings, 89% averaged 1 or more nighttime awakenings, and 83% attributed at least half of awakenings to using the bathroom. Self-reported wake time after sleep onset increased with increasing frequency of nocturnal bladder symptoms (P=.01 for linear trend). However, even among women without nocturia, average sleep quality was poor (Pittsburg Sleep Quality Index global score mean of 7.3; 95% confidence interval, 6.0-8.6). Over 12 weeks, women assigned to slow-paced respiration (N=79) experienced modest improvements in mean nocturnal voiding frequency (0.4 fewer voids/night), sleep quality (1.1 point score decrease), and sleep disruption (1.5% decreased wake time after sleep onset). However, similar improvements were detected in the music control group (N=81), without significant between-group differences.ConclusionsMany women with overactive bladder syndrome experience disrupted sleep, but not all nocturnal awakenings are attributable to bladder symptoms, and average sleep quality tends to be poor even in women without nocturia. Findings suggest that clinicians should not assume that poor sleep in women with overactive bladder syndrome is primarily caused by nocturnal bladder symptoms. Guided slow-paced respiration was associated with modest improvements in nocturia frequency and sleep quality in this trial, but the results do not support clinician recommendation to use this technique over other behavioral relaxation techniques for improving sleep.

PurposeWe evaluated the effects of device guided, slow-paced respiration on urgency associated urinary symptoms, perceived stress and anxiety, and autonomic function in women with overactive bladder syndrome.Materials and methodsWe performed a randomized, parallel group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women who reported at least 3 voiding or incontinence episodes per day associated with moderate to severe urgency were randomized to use a portable biofeedback device to practice daily, slow, guided breathing exercises or a control device which appeared identical and was reprogrammed to play music without guiding breathing. During 12 weeks we evaluated changes in urinary symptoms by voiding diaries, perceived stress and anxiety by validated questionnaires, and autonomic function by heart rate variability and impedance cardiography.ResultsIn the 161 randomized participants, including 79 randomized to paced respiration and 82 randomized to the control group, the average ± SD baseline frequency of voiding or incontinence associated with moderate to severe urgency was 6.9 ± 3.4 episodes per day. Compared to controls the participants randomized to paced respiration demonstrated greater improvement in perceived stress (average Perceived Stress Scale score decrease 2.8 vs 1.1, p=0.03) but not in autonomic function markers. During 12 weeks the average frequency of voiding or incontinence associated with moderate to severe urgency, which was the study primary outcome, decreased by a mean of 0.9 ± 3.2 episodes per day but no significant between group difference was detected.ConclusionsAmong women with overactive bladder slow-paced respiration was associated with a modest improvement in perceived stress during 12 weeks. However, it was not superior to a music listening control for reducing urinary symptoms or changing autonomic function.

Forum papers are thought-provoking opinion pieces or essays founded in fact, sometimes containing speculation, on a civil engineering topic of general interest and relevance to the readership of the journal. The views expressed in this Forum article do not necessarily reflect the views of ASCE or the Editorial Board of the journal. [ABSTRACT FROM AUTHOR]

Cognitive radio networks offer an alternative to low spectral availability in some frequency bands due to their high demand for frequency channels. This article proposes to improve the spectral assignment based on the combinative distance-based assessment multicriteria algorithm. The metrics obtained are compared with a simple additive weighting algorithm and a RANDOM selection. To establish the algorithm's performance, five quality-of-service metrics are used: number of handoffs, number of failed handoffs, average bandwidth, average throughput, and cumulative average delay. From the analysis of the results obtained, combinative distance-based assessment (CODAS) presented the best result for the cost metrics with the lowest levels, and for the benefit metrics, the highest levels were obtained. [ABSTRACT FROM AUTHOR]

Electromyographic (EMG) signals exhibit complex interference patterns that comprise several single motor unit action potentials (SMUAPs). Evidence of a model that can generate EMG signals and considers intrinsic characteristics, such as long-range dependence (LRD) or shortrange dependence (SRD), or that supports the study of pathology-related signals is lacking. Therefore, the present study aimed to develop an EMG signal generator based on SRD or LRD derived from firing patterns. We used a dynamic model to parameterize up to 15 SMUAP waveforms of real EMG signals extracted from a database. Then, we used relative appearance rates for some signals based on the number of SMUAPs to generate the latter randomly. Furthermore, we complemented our model by generating a random firing pattern. The synthetic reconstruction of the signals indicated a displacement compared with their respective firing patterns, with the highest error rate being 4.1%. The model of the EMG signal generator in its current state could be useful for a specialist who intends to study the behavior of the signals, starting with the exploration of synthetic signals and then proceeding to the real signals. [ABSTRACT FROM AUTHOR]

Electromyographic (EMG) signals are biomedical signals that represent neuromuscular activities. The EMG signal is neither stationary nor periodic and exhibits complex interference patterns of several single motor unit action potentials (SMUAPs). This study aims to characterize EMG signals concerning firing patterns and other characteristics and to identify whether these MUAP firing patterns present short-range dependencies (SRD) or long-range dependencies (LRD). To do so, we characterized 208 EMG signals in terms of the number of phases, turns and combinations of phases. Then, we performed a statistical comparison of the (more efficient) Variance-time plot against the (less bias) Log-scale diagram for the estimation of the Hurst parameter and detection of LRD. Using these estimators, we managed to detect LRD in a sample taken with needle electrodes. In contrast, the tools used for the dependence identification on signals achieved with surface electrodes did not yield conclusive results on such dependence. [ABSTRACT FROM AUTHOR]