Sleep apnea increased incidence of primary central nervous system cancers: a nationwide cohort study

IntroductionObstructive sleep apnea (OSA) was associated with increased incidence of all cancers. We aimed to determine the risk for primary central nervous system (CNS) cancers in patients with sleep apnea syndrome.MethodsA total of 23,055 incident cases of newly diagnosed sleep apnea syndrome (sleep apnea group) were identified between 2000 and 2003 in the medical claims database of Taiwan’s National Health Institute (NHI) program and were matched by age and gender to patients without OSA (comparison group) in the same period. The occurrence of primary malignant CNS cancers was measured 2 years after the index date over a 10-year period.ResultsThe incidence density of primary CNS cancers (per 10,000 individual-years) was 2.14 and 1.28, respectively, for the OSA and comparison groups. The overall risk for developing primary CNS cancers was significantly higher in the OSA group (adjusted hazard ratio [HR], 1.54; P = 0.046) after adjusting for age, gender, and obesity, among other variables. Subgroup analysis revealed a significantly higher risk for primary brain cancers but not primary spinal cord cancers in the OSA subgroup (adjusted HR, 1.71; P = 0.027). The analysis also revealed a significantly higher risk for primary CNS cancers in the insomnia with OSA subgroup (adjusted HR, 2.20; P = 0.001) and in the OSA without surgical treatment subgroup (adjusted HR, 1.831; P = 0.003).ConclusionsOSA, especially with insomnia, may increase the risk for primary CNS cancer development, though surgical treatment may reduce this risk in participants with OSA.     

Associations between specific technologies and adolescent sleep quantity,sleep quality,and parasomnias

ObjectiveWe tested the hypothesis that weekday bedtime use of six technologies would be significantly associated with eight sleep parameters studied relating to sleep quantity, sleep quality, and parasomnias.MethodsIn our cross-sectional study, we previously administered validated age-appropriate questionnaires (School Sleep Habits Survey, Technology Use Questionnaire). Participating adolescents (n = 738; 54.5% boys) were aged 11–13 years and were from the Midlands region of the United Kingdom in 2010.ResultsFrequent use of all technology types was significantly inversely associated with weekday sleep duration (hours). Frequent music listeners and video gamers had significantly prolonged sleep onset (β = 7.03 [standard error {SE}, 2.66]; P < .01 and β = 6.17 [SE, 2.42]; P < .05, respectively). Frequent early awakening was significantly associated with frequent use of all technology types. The greatest effect was observed in frequent television viewers (odds ratio [OR], 4.05 [95% confidence interval {CI}, 2.06–7.98]). Difficulty falling asleep was significantly associated with frequent mobile telephone use, video gaming, and social networking, with music listeners demonstrating the greatest effect (OR, 2.85 [95%CI, 1.58–5.13]). Music listeners were at increased risk for frequent nightmares (OR, 2.02 [95%CI, 1.22–3.45]). Frequent use of all technologies except for music and mobile telephones was significantly associated with greater cognitive difficulty in shutting off. Frequent television viewers were almost four times more likely to report higher sleepwalking frequency (OR, 3.70 [95% CI, 1.89–7.27]).ConclusionsFrequent weekday technology use at bedtime was associated with significant adverse effects on multiple sleep parameters. If confirmed in other samples and longitudinally, improving sleep hygiene through better management of technology could enhance the health and well-being of adolescent populations.     

Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study

ObjectiveTo identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.MethodsSleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire – Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.ResultsAs expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.ConclusionThese preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.     

Attribution,cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy

ObjectivesInsomnia patients complain that mental events keep them awake. This study investigates how cognitive behavioural therapy (CBT) affects such events and considers how attributional, cognitive and psychopathological symptoms may mediate sleep improvement.MethodA pragmatic, parallel-group randomized controlled trial of 164 adults (120 F: (mean 49 years (18–78 years)) meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for insomnia disorder, assigned to CBT (n = 55; 40 F), imagery relief therapy (IRT placebo; n = 55; 42 F), or treatment as usual (TAU; n = 54; 38 F), was conducted. CBT/IRT comprised six online sessions delivered by an animated therapist, with automated web/e-mail support. CBT users had access to a moderated community. TAU comprised ‘usual care’. Participants completed the Sleep Disturbance Questionnaire (SDQ), Glasgow Content of Thoughts Inventory (GCTI), Depression Anxiety and Stress Scales (DASS) and Sleep Condition Indicator (SCI) at baseline, post treatment and 8-week follow-up.ResultsThe sample was characterised by mental arousal, notably ‘trying too hard’ to sleep (SDQ), and by ‘sleep and sleeplessness’ and ‘rehearsal and planning’ thoughts (GCTI). Treatment effects were observed for all SDQ domains (e.g., CBT vs. IRT: d = 0.76 for ‘trying too hard’). CBT was also superior to IRT on the GCTI (e.g., ‘rehearsal and planning’, d = 0.62; ‘sleep and sleeplessness’, d = 0.74). CBT vs. TAU comparisons yielded larger effects, whereas placebo effects (IRT vs. TAU) were small to moderate. Hierarchical regression demonstrated partial mediation of SCI improvement by attributional and cognitive factors (R² = 21–27%) following CBT. Improvement in sleep efficiency appears to be independent of such factors.ConclusionOnline CBT modifies sleep-related attributions, night-time thought content and psychopathology. This process partly mediates improvement in DSM-5-defined insomnia.     

Demographic and Clinical Characteristics of Patients with Restless Legs Syndrome in Spine Clinic

Objective

The restless legs syndrome (RLS) is a common disorder affecting up to 5% to 15% of the general population, in which the incidence increases with age, and includes paresthesia in the legs. The purpose of this study is to investigate the incidence of RLS in spine center and to review clinical manifestations of this syndrome and its current treatments.

Methods

Over a period of a year, retrospective medical record review and lumbar magnetic resonance images were performed on 32 patients with RLS in spine clinic who were diagnosed by National Institutes of Health criteria. Affected limbs were classified as five. Two grading systems were used in the evaluation of neural compromises.

Results

The incidence of RLS was 5.00% (32/639). There were 16 males (50%) and 16 females (50%). The median age at diagnosis was 55.4 years (range, 25-93 years). There are no correlation between the affected limbs of RLS and neural compromises on the lumbar spine.

Conclusion

The RLS is a clearly common neurologic disorder of the limbs, usually the legs. The awareness of this syndrome can help reduce diagnostic error; thereby, avoiding the morbidity and expense associated with unnecessary studies or inappropriate treatments in RLS patients.     

以颈部推拿为主治疗失眠症的研究概况

颈部不适患者常见失眠症的发生,其病机不仅与走行于颈部的经络相关,更与颈部的神经肌肉分布有着一定联系。本文综述了以颈部为主要作用部位,单纯推拿和以推拿为主的综合疗法在失眠症临床实践过程中的研究概况,总结特点及优劣,以暨为失眠症的推拿治疗提供新的思路和有益参考。     

穴位注射联合舒肝解郁胶囊治疗缺血性中风后肝郁不寐的临床研究

目的 探讨穴位注射红花黄色素针联合口服疏肝解郁胶囊治疗缺血性中风后肝郁不寐的临床疗效。方法 收集脑梗死后出现失眠症状的患者90例,经辨证分型为肝郁化火型,按随机数字表分三组,每组30例,治疗28天(4疗程)总结疗效。常规西药组予右佐匹克隆片治疗,联合治疗组采用穴位注射红花黄色素针联合口服疏肝解郁胶囊。穴位注射组予红花黄色素针穴位注射。三组的睡眠质量指数量表(PSQI)评分在治疗14天(2疗程)、28天(4疗程)后进行前后比较,三组组间两两比较。治疗结束后三组疗效比较。结果 联合治疗组总有效率为90%,明显高于右佐匹克隆组的56.67%和穴位注射组的60%(P＜0.05);治疗2、4疗程后,但观察组相比对照组睡眠障碍、神经功能缺损改善效果更佳,且随着疗程的延长,改善越明显(均P＜0.05)。结论 穴位注射红花黄色素针联合口服疏肝解郁胶囊有效改善卒中后睡眠障碍及神经功能缺损,并且随着疗程的延长,改善越明显。     

2009—2019年中药专利复方治疗失眠的用药规律

目的：分析治疗失眠中药复方的组方用药配伍规律。方法：以国家知识产权局专利检索及分析系统为数据来源,检索治疗失眠的中药复方;采用古今医案云平台 (V1.5.7)、SPSS Clementine 12.0软件、SPSS 22.0软件分别进行频次统计、中药四气五味及归经统计、关联分析、聚类分析、主成分分析等挖掘探讨失眠中药专利组方用药规律。结果：通过检索和筛选,得到中药复方528首,中药327味,平均每首复方包含12.77味中药;山东省地区申请最多为171项,约占总体1/3;得到30种高频中药,以养心安神、补气、补血、补阴药等最常用,四气以平、温、微寒为主,五味以甘、苦、辛味为多见,归经以心、肝经最多。关联规则分析共得到76条,包括药对52条,三味及四味药组20条和4条。聚类分析得到9个药组,主成分分析得到特征值>1的主成分有12个。结论：本文所得结果有一定应用价值及创新性,但因专利质量等问题存在一定局限。     

Association of insomnia with mania in Lebanese patients with bipolar disorder

ObjectiveTo assess: (1) the association between insomnia experienced at admission, sociodemographic and other patients’ characteristics and mania; and (2) the variation of insomnia and mania before and after treatment in bipolar patients with manic episodes (type I).MethodsSixty-two patients were interviewed shortly after their admission to the hospital (after 3 to 5 days). The current symptoms experienced by the patients were assessed upon admission and again at discharge from the hospital.ResultsA poorer quality of sleep (higher PSQI scores) (Beta = 0.590) was significantly associated with higher mania, whereas the intake of SSRIs (Beta = ?5.952) and TCAs (Beta = ?8.181) was significantly associated with lower mania. Furthermore, highly significant reductions were reported in the PSQI scores (4.96 vs. 2.75, P < 0.001), ISI scores (8.30 vs. 3.45, P < 0.001) and YMRS scores (8.60 vs. 3.06, P < 0.001) between admission to and discharge from the hospital.ConclusionInsomnia in patients with bipolar disorder type I is associated with mania, with a significant reduction of sleep problems seen during a period of approximately 20 days of hospitalization. Further longitudinal studies are needed to confirm the validity of our results and identify the causes. In the meantime, this research recommends a strategy to improve sleeplessness experienced during inter-episode phases may be helpful in preventing manic episodes in BD.