The impact of the COVID-19 pandemic on nighttime room entries and sleep disruptions for pediatric patients

Objectives/backgroundSleep is critical to recovery, but inpatient sleep is often disrupted. During the COVID-19 pandemic, social distancing efforts to minimize spread may have improved hospitalized children's sleep by decreasing unnecessary overnight disruptions. This study aimed to describe the impact of these efforts on pediatric inpatient sleep using objective and subjective metrics.MethodsSleep disruptions for pediatric inpatients admitted prior to and during the COVID-19 pandemic were compared. Hand hygiene sensors tracking room entries were utilized to measure objective overnight disruptions for 69 nights pre-pandemic and 154 pandemic nights. Caregiver surveys of overnight disruptions, sleep quantity, and caregiver mood were adopted from validated tools: the Karolinska Sleep Log, Potential Hospital Sleep Disruptions and Noises Questionnaire, and Visual Analog Mood Scale.ResultsNighttime room entries initially decreased 36% (95% CI: 30%, 42%, p < 0.001), then returned towards baseline, mirroring the COVID-19 hospital census. However, surveyed caregivers (n_pre = 293, n_post = 154) reported more disrupted sleep (p < 0.001) due to tests (21% vs. 38%), anxiety (23% vs. 41%), and pain (23% vs. 48%). Caregivers also reported children slept 61 fewer minutes (95% CI: −12 min, −110 min, p < 0.001). Caregivers self-reported feeling more sad, weary, and worse overall (p < 0.001 for all).ConclusionsDespite a decrease in objective room entries during the pandemic, caregivers reported their children were disrupted more and slept less. Caregivers also self-reported worse mood. This highlights the effects of the COVID-19 pandemic on subjective experiences of hospitalized children and their caregivers. Future work targeting stress and anxiety could improve pediatric inpatient sleep.     

Relationship between sleep quality and the psychological status of patients hospitalised with COVID-19

AimWe explored the sleep quality of patients who required mental health and clinical interventions in our hospital after being diagnosed with COVID-19.MethodWe enrolled 189 patients hospitalised with COVID-19 in April and May of 2020, of whom 78 were female and 111 male. We evaluated sleep quality and related factors in terms of demographic characteristics, the duration of hospitalisation, and Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety-Depression Scale scores.ResultsAll participants were divided into two groups according to PSQI score: n = 102 (54%) patients with PSQI scores ≥5 and n = 87 (46%) patients with PSQI scores <5. No significant between-group difference was evident in terms of age, gender, marital status, educational level, or chronic disease history. The duration of hospitalisation (p = 0.002) and the depression rate (p = 0.010) were higher in the group exhibiting poor sleep quality (PSQI score ≥5).ConclusionThe duration of hospitalisation was longer in patients experiencing poor sleep quality. Therefore, improvement in sleep quality will reduce the length of hospital and intensive care unit stays.     

Fatigue correlates with LRRK2 G2385R variant in Chinese Parkinson's disease patients

IntroductionFatigue is common in patients with Parkinson's disease (PD). The leucine-rich repeat kinase 2 (LRRK2) G2385R variant predisposes individuals to develop PD in China. The aim of this study was to evaluate whether the LRRK2 G2385R variant is associated with fatigue in patients with PD.MethodsFatigue was evaluated by the Parkinson Fatigue Scale (PFS) in 329 PD patients and 180 controls, a cut-off score of ≥3.3 was used to define the presence of fatigue. All the enrolled PD patients were assessed by a comprehensive battery of motor and non-motor questionnaires. PD patients were genotyped for the G2385R variant. Associations of fatigue with the clinical assessments and with the G2385R variant in PD patients were analyzed by logistic regression.ResultsFatigue frequency was 55.62%. A logistic regression model found that the female sex (OR = 10.477; 95%CI: 2.806–39.120; p < 0.001), motor function (OR = 1.060; 95%CI: 1.012–1.110; p = 0.013), sleep disturbance (OR = 0.943; 95%CI: 0.910–0.976; p = 0.001) and depression severity (OR = 0.843; 95%CI: 0.736–0.965; p = 0.013) collectively predict the presence of fatigue in PD patients. After adjustment for demographics and associated clinical factors, the G2385R variant was associated with an increased risk for the presence of fatigue (OR = 10.699; 95% CI = 2.387–47.958; p = 0.002) in the PD population in this study.ConclusionWe confirm that fatigue in PD patients is common, and we have strengthened the associations between fatigue and female sex, motor severity and non-motor symptoms, particularly depression and sleep disturbances. Overall, we found that carriers of the G2385R variant were more prone to fatigue than non-carriers in PD patients.     

Impact of home confinement during COVID-19 pandemic on sleep parameters in Parkinson's disease

BackgroundLiterature shows that home confinement during coronavirus disease 2019 (COVID-19) pandemic has significantly affected sleep. However, such information regarding subjects having Parkinson's disease (PD) is unavailable.MethodsThis cross-sectional study was conducted using a questionnaire, developed and validated by experts. PD subjects from nine centers across India were included. Questionnaire assessed presence as well as change in sleep-related parameters and PD symptoms during home confinement. Restless legs syndrome (RLS) and REM sleep behavior disorder (REMBD) was diagnosed using validated questionnaire. Additionally, changes in physical activity, adoption of new hobbies during home confinement and perceived quality of life were assessed.ResultsOf 832 subjects, 35.4% reported sleep disturbances. New-onset/worsening of sleep disturbances (NOWS) was reported by 23.9% subjects. Among those with sleep disturbances (n = 295), insomnia symptoms worsened in half (51.5%) and nearly one-fourth reported worsening of RLS (24.7%) and REMBD (22.7%) each. NOWS was common in subjects lacking adequate family support during home confinement (P = 0.03); home confinement > 60 days (P = 0.05) and duration of PD > 7 years (P = 0.008). Contrarily, physical activity >1 h/day and engagement in new hobbies during home confinement were associated with better sleep. NOWS was associated with worsening of motor as well as non-motor symptoms of PD (P < 0.001) and poorer life quality (P < 0.001).ConclusionHome confinement during COVID-19 pandemic was significantly associated with NOWS among PD subjects. NOWS was associated with global worsening of PD symptoms and poorer life quality. Physical activity >1 h/day and adoption of new hobbies during home confinement were associated with better sleep.     

The evaluation of sleep disturbances for Chinese frontline medical workers under the outbreak of COVID-19

ObjectiveTo evaluate sleep disturbances of Chinese frontline medical workers (FMW) under the outbreak of coronavirus disease 2019 (COVID-19), and make a comparison with non-FMW.MethodsThe medical workers from multiple hospitals in Hubei Province, China, volunteered to participate in this cross-sectional study. An online questionnaire, including Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS) and Visual Analogue Scale (VAS), was used to evaluate sleep disturbances and mental status. Sleep disturbances were defined as PSQI>6 points or/and AIS>6 points. We compared the scores of PSQI, AIS, anxiety and depression VAS, as well as prevalence of sleep disturbances between FMW and non-FMW.ResultsA total of 1306 subjects (801 FMW and 505 non-FMW) were enrolled. Compared to non-FMW, FMW had significantly higher scores of PSQI (9.3 ± 3.8 vs 7.5 ± 3.7; P < 0.001; Cohen's d = 0.47), AIS (6.9 ± 4.3 vs 5.3 ± 3.8; P < 0.001; Cohen's d = 0.38), anxiety (4.9 ± 2.7 vs 4.3 ± 2.6; P < 0.001; Cohen's d = 0.22) and depression (4.1 ± 2.5 vs 3.6 ± 2.4; P = 0.001; Cohen's d = 0.21), as well as higher prevalence of sleep disturbances according to PSQI > 6 points (78.4% vs 61.0%; relative risk [RR] = 1.29; P < 0.001) and AIS > 6 points (51.7% vs 35.6%; RR = 1.45; P < 0.001).ConclusionFMW have higher prevalence of sleep disturbances and worse sleep quality than non-FMW. Further interventions should be administrated for FMW, aiming to maintain their healthy condition and guarantee their professional performance in the battle against COVID-19.     

Circadian rhythm and autonomic dysfunction in presymptomatic and early Huntington's disease

IntroductionSleep and circadian rhythm disturbances are common in patients with neurodegenerative diseases such as Huntington's disease (HD). The aim of this study was to evaluate variability in circadian blood pressure (BP) to determine the association between abnormal circadian BP and sleep quality in patients with HD.MethodsCross-sectional, multicenter study of 38 HD mutation carriers (23 premanifest and 15 early stage patients) who were compared to 38 age- and sex-matched controls. BP was evaluated by ambulatory blood pressure monitoring (ABPM). Based on the percentage decrease in nocturnal BP, subjects were classified as either dippers (≥10%) or non-dippers (<10%). Sleep quality and daytime sleepiness were measured, respectively, using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Daytime Sleepiness Scale (ESS) and the scores on these indices were correlated with the ABPM findings.ResultsSixty-three percent HD mutation carriers were non-dippers (86.7% of the symptomatic and 47.8% of the premanifest patients) versus 23.7% of controls (p = 0.001). In the HD group, sleep quality was significantly more impaired (PSQI>5) (p = 0.016) with more excessive daytime sleepiness (ESS>9) (p = 0.001) than in the control group. Nocturnal non-dipping was associated with worse sleep quality in patients (p = 0.011) but not in controls.ConclusionThese results show that patients with HD present early disturbances in the circadian rhythm of BP and that this altered nocturnal BP is associated with poor sleep quality. These findings suggest the potential role of subtle hypothalamic dysfunction in this population.     

Temporomandibular disorder severity and diagnostic groups: Their associations with sleep quality and impairments

ObjectivesThis study evaluated the impact of TMD severity on sleep quality and established the associations between TMD diagnostic groups/pain subtypes and sleep impairments.MethodsA total of 1151 patients from a tertiary Dental Hospital were screened for eligibility. Consenting subjects who met the inclusion criteria were directed to complete a general/health questionnaire, the Fonseca Anamnestic Index (FAI), Diagnostic Criteria for Temporomandibular disorders (DC/TMD) Symptom Questionnaire, and Pittsburgh Sleep Quality Index (PSQI) at their intake visit. Patients who screened positive for TMDs with the FAI were subjected to a protocolized physical examination and TMD diagnostic groups/subtypes were subsequently derived based on the DC/TMD “diagnostic tree” and algorithms. Statistical analyses were conducted using non-parametric methods and logistic regression (α = 0.05).ResultsThe final sample consisted of 845 subjects with TMDs and 116 TMD-free controls. The mean age of the TMD and TMD-free subjects were 33.17 ± 13.55 and 31.66 ± 9.50 years. Subjects with severe and moderate TMDs had significantly greater global PSQI scores than those with mild and no TMDs (p < 0.001). Those with pain-related, intra-articular, and combined TMDs reported significantly poorer sleep quality than those with no TMDs (p < 0.001). Moreover, subjects with myalgia and myalgia plus arthralgia presented significantly greater sleep impairments than their counterparts with intra-articular disorders (p < 0.001). Multivariate logistic regression indicated that pain-related (OR = 3.23; CI = 1.69–6.14) and intra-articular TMDs (OR = 1.91; CI = 1.15–3.16) were most related to poor sleep.ConclusionsSleep quality worsened with increasing TMD severity and the presence of painful and intra-articular TMDs increased the likelihood of poor sleep.     

Sufficient sleep attenuates COVID-19 pandemic-related executive dysfunction in late adolescents and young adults

PurposeTo investigate the interaction between (1) sleep and the COVID-19 pandemic; and (2) social cumulative risk and COVID-19 pandemic on executive function (EF).MethodsForty late adolescents/young adults (19.25 ± 1.12 y.o.) completed sleep questionnaires and the Behavior Rating Inventory of Executive Function- Adults (BRIEF-A) before and during the COVID-19 pandemic, yielding 80 observations for data analysis. Multilevel random-effects models with interaction terms were used to estimate the associations.ResultsCompared to pre-pandemic sleep, participants slept 24 min longer (t = −2.07, p = 0.03) and also had increased sleep latency (t = −1.83, p = 0.07) during COVID-19. Mid-sleep times shifted 40 min later (t = −3.22, p = 0.003), and BRIEF-A scores increased (indicating greater dysfunction), during the pandemic (p < 0.05). The worsening in EF during the pandemic was attenuated by increasing sleep duration (B = -4.38, p = 0.04) and magnified by social cumulative risk (B = 3.19, p = 0.04). Poor sleep quality was independently associated with increase in EF problems (p < 0.05).ConclusionSufficient sleep may represent a resilience factor against EF decline during this unprecedented crisis.     

Health-related quality of life and sleep quality among North Indian type 2 diabetes mellitus patients: evidence from a cross-sectional study

ObjectiveThe objective of this study is to measure the relationship between sleep quality and health-related quality of life (HRQOL), in Indian population with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study, included a total of 300 patients with T2DM. All participants were responding to the Pittsburgh Sleep Quality Index (PSQI) and European Quality of Life-5 Dimensions Questionnaire (EQ-5D). A PSQI global score ≥5 was defined as poor sleep quality. EQ-5D visual analogue scale (VAS), determining the overall health status. Logistic regression analysis was used to examine the association between PSQI and EQ-5D. All the study data were analysed using the SPSS software version 20.0. Values of p < 0.05 were considered statistically significant.ResultsThe mean age of included participants were 55.29. Majority of the participants (55.3%) were identified as “poor sleepers” and female (31.3%) contributing higher proportion. Poor sleepers had significantly lower the HRQoL (p < 0.001). After adjustment, poor sleep quality was significantly associated with a lower HRQoL; EQ-5D index (OR = 1.080, 95%, CI: 1.015–1.148, p < 0.05), and EQ-5D VAS (OR = 1.092, 95%, CI: 1.021–1.176, p < 0.01). Overall, the EQ-5D index and EQ-5D VAS were found to be an independent predictors of sleep quality.ConclusionsPoor sleep quality is prevalent in Indian T2DM population, and it imparts negative impact on several dimensions of EQ-5D that characterising the daily activities performance. Therefore, further real-world studies are needed to determine the causal relationship between T2DM patients and measure of objective sleep and their impact on health.     

Characteristics,correlates, and assessment of psychosis in Parkinson disease without dementia

IntroductionConsidering that psychosis in Parkinson disease (PD) is associated with worse outcomes, including dementia, we aimed to study the characteristics, correlates, and assessment of PD psychosis in those without dementia.Methods101 PD subjects without dementia (Montreal Cognitive Assessment ≥21/30) were recruited to participate in a study of neuropsychiatric symptoms in PD. This study included a baseline standard neurological exam and common PD symptom assessments. Using the Scale for the Assessment of Positive Symptoms (SAPS) and separate assessment of visual illusions and sense of presence, NINDS-NIMH criteria for PD psychosis were applied.ResultsOf the 33 (32.7%) PD subjects who met diagnostic criteria for psychosis in PD, visual illusions were most common (72.7%), followed by visual hallucinations (39.4%). Adjusted for presence of REM sleep behavior disorder (RBD) (p = 0.097), use of dopamine agonists (OR = 3.7, p = 0.012) and greater autonomic symptom burden (OR = 1.1 (per 1-unit change in score on SCOPA-AUT), p = 0.012) were associated with greater risk of psychosis. Use of dopamine agonists (OR = 5.0, p = 0.007), higher MDS-UPDRS Part II score (OR = 1.1, p = 0.010), and presence of RBD (OR = 4.8, p = 0.012) were independent predictors of visual hallucinations and visual illusions. MDS-UPDRS item 1.2 score ≥1 had highly correlated with the SAPS score (r = 0.65, p < 0.0001), but was 42% sensitive and 96% specific for identifying psychosis.ConclusionThis study confirms the association between dopamine agonists and psychosis in PD patients without dementia. The association of RBD, autonomic symptoms, and MDS-UPDRS Part II scores with psychosis underscore its link to brainstem dysfunction and greater PD motor symptom severity.     

Sleep disorders in Wilson's disease

Background/objectivesWilson's disease (WD) is a rare genetic disorder that leads to copper overload, mainly in the liver then, in the brain. Patients with WD often complain about sleep disorders. We aimed to explore them.Patients/methodsSleep complaints and disease symptoms were compared in 40 patients with WD (20 patients with hepatic phenotype matched to 20 neurologic one) and 40 age, sex and BMI matched healthy controls.ResultsPatients with WD had more frequently (32.5 vs 10.0%, p < 0.05) and more severe (10.5 ± 6.0 vs 7.6 ± 4.8, p < 0.01) insomnia than controls and insomnia was more severe in neurologic than hepatic form of the disease (12.25 ± 5.89 vs 8.73 ± 5.8, p < 0.05). Insomnia severity was correlated with the severity of depressive symptoms (r = 0.53, p < 0.001). Compared to controls, patients reported more difficulties staying asleep and more consequences of insomnia on their quality of life. REM sleep behavior disorder was more frequent in WD (20 vs 0%, p = 0.005) than controls. Patients complained more frequently of nycturia (22.8 vs 7.6%, p = 0.003) than controls. Patients did not differ from controls for sleepiness, restless legs syndrome and obstructive sleep apnea syndrome. Patients did not report cataplexia.ConclusionIn patients with WD, insomnia and REM sleep behavior disorder are the two main sleep complaints. Insomnia is more frequent in neurologic than hepatic form of the disease. Severity of insomnia is associated with the severity of depressive symptoms.     

A quantitative analysis of the effect of bilateral subthalamic nucleus-deep brain stimulation on subjective and objective sleep parameters in Parkinson's disease

ObjectiveTo explore how subjective and objective sleep parameters respond to bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD).MethodsThirty DBS sleep studies were included by searching PubMed, Embase, and the Cochrane Library, and only 21 prospectively designed studies, including 541 patients, were eligible for the main analysis. We evaluated sleep disturbance using 1 objective measurement, polysomnography (PSG), and 4 subjective scales, including PD Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and restless legs syndrome (RLS). We pooled data using the standard mean difference (SMD). The primary outcome was a change in sleep parameters 6 months postoperatively. Outcomes from <12 months to ≥12 months follow-up were compared in the subgroup analysis. Meta-regression was further conducted.ResultsSTN-DBS significantly improved all 4 subjective sleep scales in the 6-month follow-up: ESS (SMD = 0.234), PDSS (SMD = 0.724), PSQI (SMD = 1.374) and RLS (SMD = 1.086), while most PSG parameters remained unchanged, except for shortened rapid eye movement sleep latency (RSL) (SMD = 0.520). In the over-12-month follow-up, improvement persisted in PDSS but not in ESS. Dopamine drug reduction (p = 0.009) and motor improvement (p = 0.036) were correlated with ESS improvement and PDSS improvement, respectively.ConclusionsBilateral STN-DBS continuously improved subjective nocturnal sleep, while its effect on ESS lasted for only 1 year. Medication reduction and motor improvement may contribute to improved daytime sleepiness and better subjective nocturnal sleep, respectively. Except for a shortened RSL, STN-DBS did not change PSG parameters, including sleep efficiency and sleep architecture.RegistrationOpen Science Framework: DOI 10.17605/OSF.IO/3EGRC.     

An investigation of potential coronaphobia-related factors in adults and sleep quality relations

BackgroundThe study aimed to investigate potential coronaphobia-related factors in adults and to assess the relationship between coronaphobia and sleep quality.MethodsThis cross-sectional study was conducted in 1262 participants. The Covid-19 Phobia Scale (C19P-S) and Jenkins Sleep Scale (JSS) were used to measure outcomes. Univariate and multivariate logistic regression analyses were constructed to determine risk factors for coronaphobia. Pearson correlation coefficient was used to assess the correlation between C19P-S and JSS.ResultsThe following risk factors were found to be associated with coronaphobia: gender, marital status, presence of chronic disease, staying home, and sleep disturbances. Female gender (OR = 2.23 and OR = 2.12), being married (OR = 1.31 and OR = 1.45), chronic disease status (OR = 1.39 and OR = 1.27), staying home (OR = 1.72 and OR = 1.35) and sleep disturbances (OR = 2.63 and OR = 2.49) were found to be associated with the likelihood of having a higher coronaphobia score (p < 0.05). Weak positive correlations were found between C19P-S and its subscales and JSS scores (p < 0.001).ConclusionsFemale gender, being married, having chronic diseases, staying home, and having sleep disturbances were found to be risk factors for having high coronaphobia scores. Moreover, the severity of coronaphobia was associated with sleep disturbances. These results should be considered in the management of coronaphobia.     

Parkinson's disease may worsen outcomes from coronavirus disease 2019 (COVID-19) pneumonia in hospitalized patients: A systematic review,meta-analysis,and meta-regression

BackgroundParkinson's Disease (PD) is among one of the common comorbidities in older patients. People with PD may be more vulnerable to severe pneumonia, due to the impairment of pulmonary function. Currently, the association between PD and COVID-19 is not yet established. This study aims to analyze the relationship between PD and in-hospital outcomes of COVID-19.Materials and methodsWe systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 25th, 2020. All articles published on COVID-19 and Parkinson's Disease were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional studies. Statistical analysis was done using Review Manager 5.4 software.ResultsA total of 12 studies with 103,874 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that Parkinson's Disease was associated with poor in-hospital outcomes [[OR 2.64 (95% CI 1.75–3.99), p < 0.00001, I² = 81%] and its subgroup which comprised of severe COVID-19 [OR 2.61 (95% CI 1.98–3.43), p < 0.00001, I² = 0%] and mortality from COVID-19 [RR 2.63 (95% CI 1.50–4.60), p = 0.0007, I² = 91%]. Meta-regression showed that the association was influenced by age (p = 0.05), but not by gender (p = 0.46) and dementia (p = 0.23).ConclusionsExtra care and close monitoring should be provided to Parkinson's Disease patients to minimize the risk of infections, preventing the development of severe and mortality outcomes.     

A prospective controlled study about sleep disorders in drug resistant epilepsy

ObjectiveTo evaluate sleep disorders and chronotype in patients with drug resistant focal and generalised epilepsy compared to healthy controls.MethodsSixty four patients with focal and six with generalised, drug resistant epilepsy were included and compared to 70 age- and gender-matched healthy controls. Patients with any relevant comorbidity were excluded. Sleep disorders and chronotype were investigated by validated questionnaires. The impact of epilepsy on quality of life was also documented in patients.ResultsThe median Pittsburgh Sleep Quality Index (PSQI) was 4 in patients and 3 in controls (median [range], IQR; patients: 4 [1–17], 3–6; controls: 3 [0–11], 2–4; p = 0.024). Self-reported confusional arousals and probable REM sleep behaviour disorder (RBD) were more frequent in patients (30.4% vs. 8.6%, p = 0.036 and 10.6% vs. 1.4%, p = 0.030, respectively). A higher risk for possible sleep apnea was identified in patients (22.9% vs. 5.7%, p = 0.042), whereas Epworth Sleepiness Score was normal in both groups (p = 1). Chronotype, assessed by the midsleep on free days, did not differ between groups (p = 0.540). Quality of life was worse in patients with PSQI scores >5 (p = 0.016).ConclusionSelf-reported confusional arousals, probable RBD and a high risk for sleep apnea occurred significantly more often in patients with drug resistant epilepsy. Sleep quality differed significantly between both groups. Whether these results are due to motor activity during nocturnal epileptic seizures, parasomnia episodes, or sleep-related breathing disorder, needs further evaluation via video-polysomnography. We could confirm, at least in some cases, the previously reported mutual relationship between sleep disorders and epilepsy.     

Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan,China

ObjectivesThe aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization.MethodsIn a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates.ResultsHigher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%.ConclusionsPoorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables.     

Personality and addictive behaviours in early Parkinson's disease and REM sleep behaviour disorder

IntroductionChanges in personality have been described in Parkinson's disease (PD), with suggestion that those with established disease tend to be risk averse with a disinclination for addictive behaviour. However, little is known about the earliest and prodromal stages. Personality and its relationship with addictive behaviours can help answer important questions about the mechanisms underlying PD and addiction.Methods941 population-ascertained PD subjects within 3.5 years of diagnosis, 128 patients with rapid eye movement sleep behaviour disorder (RBD) and 292 control subjects were fully characterised for motor symptoms, non-motor symptoms and across the following 5 personality domains: 1) neuroticism 2) extraversion 3) conscientiousness 4) agreeableness 5) openness using the Big Five Inventory.ResultsPatients with early PD were more neurotic (p < 0.001), less extraverted (p < 0.001) and less open than controls (p < 0.001). RBD subjects showed the same pattern of being more neurotic (p < 0.001), less extraverted (p = 0.03) and less open (p < 0.001). PD patients had smoked less (p = 0.02) and drunk less alcohol (p = 0.03) than controls, but caffeine beverage consumption was similar. Being more extraverted (p < 0.001), more open (p < 0.001), and less neurotic (p < 0.001) predicted higher alcohol use, while being more extravert (p = 0.007) and less agreeable (p < 0.001) was associated with smoking more.ConclusionsA similar pattern of personality changes is seen in PD and RBD compared to a control population. Personality characteristics were associated with addictive behaviours, suggestive of a common link, but the lower rates of addictive behaviours before and after the onset of motor symptoms in PD persisted after accounting for personality.     

Bilateral associations between sleep duration and depressive symptoms among Chinese adolescents before and during the COVID-19 pandemic

Depression is one of the most prevalent psychiatric disorders and the leading cause of disability among adolescents, with sleep duration as its vital influential factor. Adolescents might be mentally sensitive to the stress caused by the COVID-19 pandemic. Yet, the alteration of adolescents' sleep duration, depression, and their associations within the context of the COVID-19 pandemic have not been well documented. We conducted a longitudinal study, recruiting 2496 adolescents from 3 junior high schools to examine the alteration of their sleep duration and depressive symptoms before and during the pandemic, and to explore their potential association(s). Data were collected before (December 2019) and during the pandemic (July 2020). Paired samples t-test revealed a significant decrease in sleep duration and a significant increase in depressive symptoms during the COVID-19 pandemic. Higher grades, COVID-19 infection history, higher CES-DC score, and the COVID-19 pandemic itself might contribute to decreased sleep duration, while longer exercise duration during the pandemic might be a protective factor. According to the cross-lagged analysis, the existence of depressive symptoms before the pandemic was significantly associated with a shorter sleep duration during the pandemic (β = −0.106, p < 0.001). Previously shortened sleep duration was significantly associated with a greater likelihood of depressive symptoms during the pandemic (β = −0.082, p < 0.001). Our findings revealed that the COVID-19 pandemic has a negative influence on adolescents’ mental health and sleep. Mental preparedness should be highlighted to mitigate the psychosocial influences of any possible public emergencies in the future. Sleep duration represents a viable home-based intervention for depressive symptoms.     

Sleep duration and architecture in non-intubated intensive care unit patients: an observational study

Objective/backgroundSleep disturbances are very common and associated with severe complications in patients admitted to intensive care units (ICU). Commonly, sedatives like propofol or benzodiazepines have been demonstrated to increase sleep duration but worsen sleep architecture. Dexmedetomidine seems to positively affect both sleep aspects.Patients/methodsThe present study aimed to investigate sleep characteristics in non-intubated patients admitted to intensive care unit. The subgroups consisted of those without sedation (NO-DEX), and those which received dexmedetomidine infusion (DEX), titrated to a Richmond Agitation–Sedation Scale target of −1/−2, were also explored. An auto-staged electroencephalographer was used to measure sleep duration and architecture. The Richard-Campbell-Sleep questionnaire was administered to all patients.ResultsA multivariate analysis conducted in the overall population showed that dexmedetomidine infusion was the only variable independently associated with N2 increase (p < 0.001). DEX (n = 36) versus NO-DEX (n = 36) group showed longer N2 stage [68.9% (57.5–80.9) versus 49.5% [35.7–61.4]; p < 0.0003]; longer Total Sleep Time [6.5 h (5.7–7.7) versus 3.4 h (1.8–4.9); p < 0.0001, and higher Sleep Efficiency [84.2% (71.3–92.6) versus 47.7% (23.4–60.9); p < 0.0001]; shorter N1 (percentage of Total Sleep Time) [10.5% (7.8–20.0) and 38.8% (25.6–50.3); p < 0.0001]; longer N3 stage [13.6% (1.9–23.3) versus 4.3% (0.4–14.0); p = 0.058]; fewer Cortical Arousals [15 episodes/hour (8.1–24.6) versus 48.7 episodes/hour (29.7–80.4); p < 0.0001]. The questionnaire showed better values in DEX-group in all explored items (p < 0.0001).ConclusionsAbnormal sleep is common in intensive care unit patients who have not received sedation. Dexmedetomidine, titrated to reach an appropriate sedation level, may optimize sleep duration and architecture.