星状神经节阻滞对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐的影响

目的 观察超声引导下右侧星状神经节阻滞（SGB）对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐（PONV）的影响。
方法 选择择期行腹腔镜全子宫切除术患者98例,年龄42～74岁,BMI 19～25 kg/m ²,ASAⅠ或Ⅱ级。采用随机数字表法分为两组：全身麻醉联合SGB组（S组）和全身麻醉组（GA组）,每组49例。S组于麻醉诱导前在超声引导下行右侧SGB,注入 0.2%罗哌卡因5 ml,GA组不行SGB。两组采用相同的全身麻醉方法和麻醉药物。记录术前1 d、手术当日、术后1 d的匹兹堡睡眠质量指数（PSQI）。记录术后24 h PONV分级和止吐药补救情况。记录术后24 h活动时VAS疼痛评分、镇痛药补救情况、术后首次下床活动时间和术后住院时间。记录局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症发生情况。
结果 与GA组比较,S组手术当日、术后1 d PSQI评分、POSD发生率明显降低（P＜0.05）,PONV 0级、1级发生率明显升高,PONV 2级、3级、4级发生率、止吐药补救率明显降低（P＜0.05）,术后24 h活动时VAS疼痛评分明显降低（P＜0.05）,术后首次下床活动时间明显缩短（P＜0.05）。两组补救镇痛情况、术后住院时间差异无统计学意义。S组无一例出现局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症。
结论 右侧星状神经节阻滞可有效改善腹腔镜全子宫切除术患者的术后睡眠质量,降低术后恶心呕吐的发生率及严重程度,减轻术后疼痛。     

瑞马唑仑对老年患者脊柱手术后睡眠节律和谵妄的影响

目的： 探讨瑞马唑仑对接受脊柱手术的老年患者术后褪黑素分泌、睡眠节律和谵妄（POD）的影响。
方法： 选择2023年11月至2024年1月拟在全麻下行脊柱手术（腰椎椎体间融合术,后入路）的老年患者160例,男76例,女84例,年龄65～80岁,BMI 18.5～24.0 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：瑞马唑仑组（R组）和丙泊酚组（P组）,每组80例。R组予瑞马唑仑0.3 mg/kg进行麻醉诱导,后持续泵注瑞马唑仑0.3～0.8 mg·kg^-1·h^-1进行麻醉维持;P组予丙泊酚2.0 mg/kg进行麻醉诱导,后持续泵注丙泊酚4～6 mg·kg^-1·h^-1进行麻醉维持。记录手术当日、术后1、2、3 d凌晨04：00褪黑素和皮质醇浓度。记录术前1 d、术后1、2 d、出院前的匹兹堡睡眠质量指数（PSQI）和静息时VAS疼痛评分。记录POD和术后睡眠障碍（POSD）发生情况。记录拔管时间、PACU停留时间、镇痛泵总按压次数、镇痛泵有效按压次数、补救镇痛例数。记录术中低血压、术后恶心呕吐、头晕、呼吸抑制等不良事件发生情况。
结果： 与P组比较,R组拔管时间和PACU停留时间明显缩短（P＜0.05）;术后1 d 凌晨04：00褪黑素浓度明显升高,皮质醇浓度明显降低,PSQI明显降低（P＜0.05）;POD、POSD和术中低血压发生率明显降低（P＜0.05）。两组拔管时间、镇痛泵总按压和有效按压次数、补救镇痛率、术中低血压、术后恶心呕吐、头晕、呼吸抑制发生率差异无统计学意义。
结论： 瑞马唑仑用于行脊柱手术的老年患者,对术后褪黑素和皮质醇分泌节律和睡眠节律的影响较小,可降低POD发生率,缓解术后睡眠障碍。     

右美托咪定经鼻喷雾治疗术后睡眠障碍的效果

目的 观察右美托咪定经鼻喷雾治疗术后睡眠障碍的临床效果。
方法 选择全麻气管插管下行颌面外科手术患者78例，男12例，女66例，年龄18～40岁，ASAⅠ或Ⅱ级。将患者随机分为两组：对照组（C组）和右美托咪定组（D组），每组39例。术后当天21:30 C组和D组分别给予生理盐水0.01 ml/kg和右美托咪定1 μg/kg经鼻喷雾。采用多导睡眠监测仪（PSG）记录术后当天N1期、N2期、N3期、REM期睡眠时间、清醒时间、觉醒次数和睡眠效率。采用匹兹堡睡眠质量指数（PSQI）量表评估术前1个月及术后当天的睡眠情况。记录术后当天补救镇静镇痛情况。
结果 与C组比较，术后当天D组N2期睡眠明显延长（P＜0.05），清醒时间明显缩短（P＜0.05），觉醒次数明显减少（P＜0.05），睡眠效率明显提高（P＜0.05）。与术前1个月比较，术后当天两组PSQI总分明显升高（P＜0.05），与C组比较，术后当天D组PSQI总分明显降低（P<0.05）。术后当天两组补救镇静镇痛率差异无统计学意义。
结论 通过右美托咪定经鼻喷雾，可有效延长颌面外科手术患者术后当天的N2期睡眠，缩短清醒时间，减少觉醒次数，明显提高睡眠效率。     

蒙药额尔敦-乌日勒对老年患者胸科手术后睡眠质量的影响

目的 探讨蒙药额尔敦-乌日勒对老年患者胸科手术后睡眠质量的影响。
方法 选择择期行胸科手术的老年患者60例,男31例,女29例,年龄≥65岁,BMI 18~24 kg/m²,ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：对照组(C组)和蒙药额尔敦-乌日勒组(E组),每组30例。C组于术前3 d至术后3 d每日晨起后口服淀粉胶囊;E组在相同时间点口服蒙药额尔敦-乌日勒15粒(每粒2 g)。采用匹兹堡睡眠质量指数量表(PSQI)评估术前3 d和术后1个月患者夜间睡眠质量。采用理查兹-坎贝尔睡眠量表(RCSQ)评估术前3 d和术后第1天夜间睡眠质量。采用ELISA法检测术前3 d服药前、术后第1、4天血浆褪黑素(MT)、γ-氨基丁酸(GABA)和肿瘤坏死因子-α(TNF-α)浓度。采用术后恢复质量量表(QoR-40)评估患者恢复质量。
结果 与C组比较,E组术后1个月PSQI量表评分明显降低,术后第1天RCSQ量表评分明显增高(P＜0.05),术后第1、4天MT浓度和GABA浓度明显升高,TNF-α浓度明显降低(P＜0.05),术后第1天情绪状态、身体舒适度、自理能力和总分明显升高(P＜0.05)。
结论 围术期服用蒙药额尔敦-乌日勒有助于改善患者术后睡眠质量,促进患者术后快速康复。     

经皮穴位电刺激对睡眠障碍老年患者全髋关节置换术后疲劳及谵妄的影响

目的 观察经皮穴位电刺激(TEAS)对睡眠障碍老年患者全髋关节置换术(THA)后疲劳及谵妄的影响。
方法 选择 2020年5—12月择期行单侧THA且术前匹兹堡睡眠质量指数(PSQI)>5分的老年患者100例,男56例,女44例,年龄65～80岁,BMI 19～28 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法分为两组：经皮穴位电刺激组(TEAS组)和非电刺激组(NS组),每组50例。两组均采用超声引导下髂筋膜阻滞联合蛛网膜下隙阻滞,TEAS组在麻醉开始后30 min及术后1、2、3 d的8:00 PM于印堂穴、双侧合谷穴和内关穴行TEAS;NS组不予以电刺激。记录术前1 d、出院当日和术后1个月PSQI评分。记录术前1 d和术后1、2、3、4 d睡眠评分、快动眼（REM）睡眠比例和觉醒次数。记录术前1 d和术后1、3、5 d Christensen疲劳评分,术后1、3、5 d采用意识模糊评估法（CAM）评估谵妄,并于术前1 d和术后1、3、5 d 检测C反应蛋白(CRP)浓度。记录术前1 d和术后1、2、3 d VAS疼痛评分、镇痛泵按压次数、首次下床活动时间、恶心呕吐的发生情况。
结果 出院当日和术后1个月TEAS组PSQI总分明显低于NS组（P＜0.05）。术后1、2、3、4 d TEAS组睡眠评分、REM睡眠比例明显高于NS组,睡眠觉醒次数明显少于NS组（P＜0.05）。术后1、3、5 d TEAS组CAM谵妄评分和CRP浓度明显低于NS组（P＜0.05）。术后3、5 d TEAS组Christensen疲劳评分明显低于NS组（P＜0.05）。两组不同时点VAS疼痛评分差异无统计学意义。两组镇痛泵按压次数和首次下床活动时间差异无统计学意义。两组均未发生恶心呕吐等不良反应。
结论 围术期经皮穴位电刺激可明显改善睡眠障碍老年患者全髋关节置换术后疲劳状态和谵妄的发生,可能与改善术后睡眠状态、降低术后炎症反应有关。     

术前连续髂筋膜间隙阻滞对老年髋部骨折患者围术期睡眠质量及术后谵妄的影响

目的 探讨术前超声引导下连续髂筋膜间隙阻滞对老年髋部骨折患者围术期睡眠质量及术后谵妄的影响。
方法 选择老年髋部骨折患者121例,男55例,女66例,年龄65~90岁, BMI 18.5~25.0 kg/m²,ASA Ⅰ—Ⅲ级,采用随机数字表法分为两组：超声引导下连续髂筋膜间隙阻滞组（F组,n=61）和对照组（C组,n=60）。F组于入院后给予经超声引导下连续髂筋膜间隙阻滞,C组常规术前处理。两组采用相同的椎管内麻醉方案实施侧入路股骨头置换术,术后采用相同的术后镇痛方案。采用简易精神状态检查表（MMSE）评估入院后基础认知状态;采用匹兹堡睡眠质量指数（PSQI）评估入院前1个月整体睡眠质量。记录入院时（T1）、髂筋膜间隙阻滞后30 min（C组为入院后相同时间点）（T2）、入室时（T3）、摆放体位时（T4）的疼痛数字评分（NRS）。记录术前及术后7 d每天的里兹睡眠问卷（LSEQ）评分,记录术后7 d内谵妄的发生情况及术后住院时间。记录术后恶心、呕吐、日间嗜睡等不良反应的发生情况。
结果 与C组比较,F组T2—T4时NRS评分明显降低（P<0.05）,术前及术后1~3 d LSEQ评分明显升高（P<0.05）,术后7 d内谵妄发生率明显降低(P<0.05),谵妄持续时间、术后住院时间明显缩短(P<0.05),日间嗜睡发生率明显降低(P<0.05)。
结论 术前超声引导下连续髂筋膜间隙阻滞可改善老年髋部骨折患者围术期睡眠质量,降低术后谵妄发生率及缩短谵妄持续时间。     

远端缺血预处理对老年患者胃肠道恶性肿瘤根治术后早期心肌损伤的影响

目的 探讨远端缺血预处理（RIPC）对老年患者胃肠道恶性肿瘤根治术后早期心肌损伤的影响。
方法 选择行胃肠道恶性肿瘤根治术的老年患者59例，男43例，女16例，年龄65～85岁，BMI 18～35 kg/m²，ASA Ⅱ或Ⅲ级。将患者随机分为两组：远端缺血预处理组（RIPC组，n=27）和对照组（C组，n=32）。RIPC组于麻醉后、手术开始前进行3个循环的RIPC，每个循环行单侧下肢缺血5 min，再灌注5 min；C组不做处理。两组麻醉方案和手术操作均相同。记录术后24、48 h的肌钙蛋白I（cTnI）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、丙二醛（MDA）、超氧化物歧化酶（SOD）、内皮型一氧化氮合成酶（eNOS）、诱导型一氧化氮合成酶（iNOS）浓度，以及术后48 h D-二聚体、纤维蛋白降解产物（FDP）浓度。记录心肌损伤（cTnI≥0.2 μg/L）以及术后30 d内的主要心血管不良事件的发生情况。
结果 与C组比较，RIPC组术后24、48 h cTnI明显降低，术后24 h CRP、IL-6明显降低，术后24、48 h MDA明显降低，术后48 h eNOS、iNOS明显升高，D-二聚体、FDP浓度明显降低（P＜0.05）。两组心肌损伤、术后30 d主要心血管不良事件的发生率差异无统计学意义。
结论 远端缺血预处理能降低胃肠道恶性肿瘤根治术后早期心肌损伤标志物cTnI的释放，减轻术后炎症反应、氧化应激、高凝状态并改善血管内皮功能，但不能降低心肌损伤以及术后30 d内主要心血管不良事件的发生率。     

维生素C注射液联合右美托咪定对口腔颌面部恶性肿瘤术后炎症反应和氧化应激的影响

目的 探讨维生素C注射液联合右美托咪定对口腔颌面部恶性肿瘤患者术后炎症反应和氧化应激的影响。
方法 选择择期行口腔颌面部恶性肿瘤根治术患者72例,男47例,女25例,年龄29~82岁,BMI 20~31 kg/m²,ASA Ⅰ或Ⅱ级,所有患者术毕保留气管导管或气切套管入中心ICU。采用随机数字表法分为两组：观察组和对照组,每组36例。所有患者术后给予常规机械通气、镇痛镇静、预防性抗感染、消肿、营养支持等治疗,对照组10 min内静脉泵入右美托咪定0.5 μg/kg,继之以0.4 μg·kg^-1·h^-1持续静脉泵入,维持3 d后停药;观察组在对照组的基础上静脉滴注维生素C注射液3 g（以5%葡萄糖注射液500 ml稀释）,每日1次,连续3 d。于用药前、用药后1、3、7 d检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）、丙二醛（MDA）、超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH-Px）浓度。记录术后出血、术区感染、胃肠道功能紊乱、低血压、心动过缓、头晕、晕厥等并发症的发生情况。
结果 与用药前比较,用药后1、3、7 d两组血清TNF-α、CRP浓度明显降低（P＜0.05）,用药后7 d两组血清IL-6浓度明显降低（P＜0.05）。与对照组比较,用药后1、3、7 d观察组血清TNF-α、IL-6、CRP浓度明显降低（P＜0.05）。与用药前比较,用药后1、3、7 d两组血清MDA浓度明显降低（P＜0.05）,血清SOD、CAT、GSH-Px浓度明显升高（P＜0.05）。与对照组比较,用药后1、3、7 d观察组血清MDA浓度明显降低（P＜0.05）,血清SOD、CAT、GSH-Px浓度明显升高（P＜0.05）。与对照组比较,观察组术后出血、术区感染、胃肠道功能紊乱发生率明显降低（P＜0.05）。两组低血压、心动过缓、头晕等发生率差异无统计学意义。
结论 与单用右美托咪定比较,联合使用维生素C注射液和右美托咪定治疗可有效降低口腔颌面部肿瘤术后患者炎症反应和氧化应激反应,减少术后并发症的发生。     

围术期经皮穴位电刺激对妇科腹腔镜手术患者术后恢复质量的影响

目的 观察围术期经皮穴位电刺激(TEAS)对行妇科腹腔镜手术患者术后胃肠功能紊乱(PGID)及术后恢复质量的影响。

方法 选择喉罩全麻下行妇科腹腔镜手术患者66例，年龄18～64岁，BMI 18～30 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：TEAS组(T组)和对照组(C组)，每组33例。T组于麻醉诱导前30 min、术后1、2 d选择双侧足三里穴、上巨虚穴、内关穴、三阴交穴行TEAS，时间持续30 min；C组在相同时点和穴位贴电极片，不进行刺激。术后3 d采用进食-恶心-呕吐-查体-症状持续时间评分系统(I-FEED)进行评分。记录术后首次肛门排气时间、术后首次排便时间和肠鸣音恢复时间。记录术后2、6、12 h恶心呕吐、腹痛腹胀VAS评分。记录术前1 d和术后2 d血浆胃动素和胃泌素浓度。记录术前1 d、术后1、2 d、术后1个月QoR-15评分、失眠严重指数(ISI)评分和术后睡眠障碍（POSD）发生情况。记录手术时间、麻醉时间、拔除喉罩时间、术中输液量、出血量和尿量。

结果 与C组比较，T组I-FEED评分、PGID发生率、术后2、6、12 h恶心呕吐、腹痛腹胀VAS评分、术后2 d血浆胃动素和胃泌素浓度、术后1、2 d ISI评分和POSD发生率明显降低（P＜0.05），术后首次肛门排气时间、术后首次排便时间和肠鸣音恢复时间明显缩短（P＜0.05），术后1、2 d QoR-15评分明显升高(P＜0.05)。

结论 围术期TEAS能降低妇科腹腔镜手术患者PGID发生率，减轻恶心呕吐和腹痛腹胀程度，缩短术后首次肛门排气时间、术后首次排便和肠鸣音恢复时间，升高血浆胃动素和胃泌素浓度，提高术后恢复质量。     

颊针疗法对腹腔镜结肠癌根治术患者围术期镇痛效果的影响

目的： 观察颊针疗法对腹腔镜结肠癌根治术患者围术期镇痛效果的影响。
方法： 选择择期行腹腔镜结肠癌根治术的患者60例,男32例,女28例,年龄45～74岁,BMI 18.5～25.0 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：颊针组和对照组,每组30例。颊针组麻醉诱导前给予颊针疗法1次,术后每日上午9点行颊针疗法1次,每次留针30 min,连续治疗3 d;对照组不行颊针治疗。记录术中丙泊酚、瑞芬太尼、术后48 h内舒芬太尼用量和镇痛泵按压次数。记录术后1、4、24、48 h VAS疼痛评分。分别于入室时及术后1、2、3 d采集静脉血,检测血浆C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的浓度。记录术后48 h内不良反应的发生情况。
结果： 与对照组比较,颊针组术中丙泊酚、瑞芬太尼、术后48 h内舒芬太尼用量及镇痛泵按压次数明显减少（P＜0.05）,术后1、4、24、48 h VAS疼痛评分明显降低（P＜0.05）,术后1、2、3 d CRP、IL-6、TNF-α浓度明显降低（P＜0.05）,术后48 h内恶心呕吐、喉痉挛及咽喉不适发生率明显降低（P＜0.05）。
结论： 对腹腔镜结肠癌根治术患者围术期运用颊针疗法,可以有效减轻疼痛,抑制炎症反应,减少术后不良反应。     

Sleep: an important factor in stress‐health models

A growing body of literature supports the notion that psychological stress negatively impacts physical health. In parallel to this programme of stress/health investigations, researchers are demonstrating the deleterious health effects of poor sleep. The current study simultaneously examines the association of both stress and sleep with health. Two hundred and eighteen subjects completed an anonymous survey packet that included stress, sleep and health measures. Psychological stress (as assessed by both life‐events and by self‐perceived stress), daytime sleepiness and poor sleep quality, but not sleep quantity, were all negatively associated with health. A regression model that integrated both stress measures was a statistically significant predictor of health. Adding the sleep measures to the stress‐health model accounted for a statistically significantly greater proportion of the variance in health scores, with the stress + sleep model accounting for 39–56 per cent of the variance in health scores depending on the health measure used. These results suggest that studies of stress and health may benefit from the inclusion of sleep measures and that, from a practical standpoint, poor sleep might be best understood not simply as a sequela of psychological stress but rather as a factor that should be actively addressed as part of the treatment programme. Copyright © 2010 John Wiley & Sons, Ltd.     

The predictors of central and obstructive sleep apnoea in haemodialysis patients.

BACKGROUND: Sleep apnoea (SA) is often observed in haemodialysis patients, but there have been few studies on types of SA and their predictors. We therefore investigated the prevalence and types of SA and the associations between types of SA and clinical factors in haemodialysis patients. METHODS: We initially examined nocturnal oxygen desaturation index (ODI) (desaturation of >4%/events per hour) in 119 haemodialysis patients (68 males, mean age of 61.4 years). Patients with ODI of more than five were diagnosed as having SA. Then, 30 patients underwent polysomnography and we measured Apnoea-hypopnoea index (AHI), which was calculated as the number of apnoeas plus hypopnoeas per hour of sleep. Clinical characteristics were examined in all patients. RESULTS: Forty-one (34.5%) of the 119 patients had SA. Twenty-seven (22.7%) of the 119 patients had SA with subjective symptoms such as daytime somnolence and snoring. There was a significant difference between body mass index (BMI) in patients with SA and that in patients without SA (22.5 vs 19.8 kg/m2, P<0.001). There were significantly higher prevalences of hypertension (85.4 vs 66.7%, P<0.05) and diabetes mellitus (36.6 vs 10.3%, P<0.01) in patients with SA than those in patients without SA. Multivariable analysis showed that BMI was independently associated with the occurrence of SA (OR 1.20, 95% CI 1.05-1.38). Mean AHI of 30 patients who underwent polysomnography was 53.2+/-28.9 [central apnoea, 4.1+/-5.6 (8%); obstructive apnoea, 21.7+/-21.5 (42%); mixed apnoea, 4.9+/-8.0 (9%); hypopnoea, 21.4+/-15.5 (41%)]. The number of obstructive apnoea events per hour was significantly correlated with BUN (r=0.490, P<0.01), Cr (r=0.418, P<0.05) and BMI (r=0.489, P<0.01) and was inversely correlated with serum bicarbonate (r=-0.646, P<0.01) and brain natriuretic peptide (BNP) (r=-0.481, P<0.01). The number of central apnoea events per hour was correlated inversely with PaO2 (r=-0.393, P<0.05) and PaCO2 (r=-0.388, P<0.05) and tended to be correlated with cardiothoracic ratio (CTR) (r=0.347, P=0.060). CONCLUSIONS: There is a high prevalence of SA in haemodialysis patients. The dominant type of SA in haemodialysis patients is obstructive sleep apnoea (OSA). Uraemia (BUN, Cr), metabolic acidosis (serum bicarbonate) and BMI are good predictors of OSA. PaO2, PaCO2 and CTR are good predictors of central sleep apnoea (CSA). Good management of these factors might improve SA in haemodialysis patients.     

睡眠管理培训对ICU护士睡眠管理能力及患者睡眠的影响

目的提高ICU护士对患者睡眠的管理能力,以及改善患者睡眠质量的效果。方法对40名ICU护士进行患者睡眠管理培训。将89名患者按照入住ICU的时间分成对照组和干预组,对照组实施常规护理措施,干预组在此基础上由接受睡眠管理培训的护士进行睡眠管理。结果培训后ICU护士的睡眠管理能力测评得分由培训前的(59.87±13.63)分上升至(80.89±15.02)分(P<0.01);干预组患者睡眠质量评分为(8.98±3.11)分,显著低于对照组的(11.27±4.01)分(P<0.01)。结论对ICU护士实施患者睡眠管理培训可以提高其睡眠管理的能力,对患者的睡眠状况进行正确评价,采取改善睡眠的措施,进而提高患者的睡眠质量。     

Prevalence of sleep disorders among ESRD patients

Abstract

Sleep disorders are common among the patients undergoing dialysis in end stage renal disease (ESRD). Although variable, their prevalence has been reported to be higher when compared to the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). The aim of this study was to assess the prevalence of sleep disorders in end stage renal disease patients on regular hemodialysis (group I with 30 patients) and CKD patients (group II with 30 patients) in comparison to 30 normal population (control group). In addition to laboratory investigations which included creatinine clearance using Cockroft and Gault formula, hemoglobin level (Hb), blood urea, serum creatinine, serum albumin, serum calcium and phosphorus and lipid profile, all subjects underwent one night of laboratory-based polysomnography (PSG) consisting of a standard montage of electroencephalography (EEG) (C3/A1 and O2/C3 or O1/C4), monopolar left and right electrooculography (EOG) referenced to the opposite mastoid, surface mentalis electromyography (EMG), respiratory airflow (measured by thermistor) and effort (piezoelectric sensors), electrocardiography (ECG), anterior tibialis EMG and pulse oximetry. For hemodialysis subjects, this study was performed on a night immediately following hemodialysis treatment. The results showed that patients on hemodialysis have sleep disorders, and that sleep disorders are common in group I and II than control group. The percentage of sleep disorders in hemodialysis patients were as follows: insomnia (69%), followed by obstructive sleep apnea syndrome OSAS (24%), RLS and periodic limb movement PLM (18%), nightmares (13%), EDS (12%), sleepwalking (2%), possible rapid eye movement behavior disorders RED (2%), possible narcolepsy (1.4%). While the percentage of sleep disorders in CKD patients were as follows: insomnia (54%), followed by RLS (19%), PLM (12%), OSAS (16%), nightmares (15%), EDS (15%), sleepwalking (4%), possible RBD (3%), possible narcolepsy (1%). There was inverse correlation between sleep disorders and Hb, albumin and creatinine clearance; also there was positive correlation between sleep disorder and phosphorus. We concluded that the sleep disorders are common in CKD patients either on conservative management or on regular hemodialysis. Treatment of anemia, hyperphosphatemia and hypoalbuminemia may improve sleep disorders among those patients.     

Links between well-being and sleep while awaiting breast biopsy results

Poor sleep is associated with several negative consequences, including poor health, depression, anxiety, and memory deficits, among others. Although the link from sleep to health and well-being is well-established, fewer studies have examined the reverse relationship. The current study examined the role of one particular challenge to well-being, stressful uncertainty, in the association between well-being and sleep quantity and quality. Female patients (n = 120 for the purpose of analyses) awaiting the results of a breast biopsy participated in an initial interview at their biopsy appointment and then completed daily surveys at home each day until they received their results. Patients who reported poorer well-being on various measures also reported poorer and less sleep on average during the wait for biopsy results, even after controlling for individual differences and well-being at the biopsy appointment. However, when patients experienced positive emotions on a given day, they tended to sleep better that night. Our findings suggest that stressful uncertainty about one's health may have detrimental effects on sleep, but positive emotions may improve sleep during stressful waiting periods.     

Running wheel accessibility affects the regional electroencephalogram during sleep in mice

Regional aspects of sleep homeostasis were investigated in mice provided with a running wheel for several weeks. Electroencephalogram (EEG) spectra of the primary motor (frontal) and somatosensory cortex (parietal) were recorded for three consecutive days. On a single day (day 2) the wheel was locked to prevent running. Wheel running correlated negatively with the frontal-parietal ratio of slow-wave activity (EEG power between 0.75 and 4.0 Hz) in the first 2 h after sleep onset (r = -0.60; P < 0.01). On day 2 frontal EEG power (2.25-8.0 Hz) in non-rapid eye movement sleep exceeded the level of the previous day, indicating that the diverse behaviors replacing wheel-running elicited more pronounced regional EEG differences. The frontal-parietal power ratio of the lower frequency bin (0.75-1.0 Hz) in the first 2 h of sleep after dark onset correlated positively with the duration of the preceding waking (r = 0.64; P < 0.001), whereas the power ratio in the remaining frequencies of the delta band (1.25-4.0 Hz) was unrelated to waking. The data suggest that in mice EEG power in the lower frequency, corresponding to the slow oscillations described in cats and humans, is related to local sleep homeostasis.     

Diabetes,sleep apnea,obesity and cardiovascular disease: Why not address them together?

Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on obtaining blood pressure, body mass index, and placing importance on screening for signs and symptoms pointing towards cardiovascular disease. Symptoms related to sleep, or screening for sleep apnea has been overlooked by cardiac, diabetic, pulmonary and general medicine clinics despite recommendations for screening by several societies. In recent years, there is mounting data where obesity and obstructive sleep apnea sit at the epicenter and its control can lead to improvement and prevention of diabetes and cardiovascular complications. This editorial raises questions as to why obstructive sleep apnea screening should be included as yet another vital sign during patient initial inpatient or outpatient visit.     

Are diabetic patients being screened for sleep related breathing disorder?

Prevalence of both diabetes mellitus and obstructive sleep apnea(OSA)is high among general population.Both of these conditions are associated with significant morbidity.OSA affects approximately 25%of men and 9%of women,and its prevalence is even higher among obese,Hispanics,African American and diabetic patients.Diabetes on the other hand besides having high prevalence in general population has even higher prevalence among ethnic populations as Hispanics and African American.Despite the availability of several simple screening tools for OSA,as Berlin questionnaire,STOP-BANG questionnaire,NAMES Criteria,the utility for screening of OSA among the diabetic population remains marginal.This in turn can lead to significant morbidity and complications related to OSA as well as worsening of diabetes mellitus and increase in diabetic complications due to untreated sleep related breathing disorder.It is therefore imperative for the primary care giver to screen for OSA among the diabetic population as a part of their routine evaluation to prevent worsening of diabetes,and its cardiovascular,renal,ophthalmologic and neurological complications.     

Relationship between sleep complaints and proinflammatory cytokines in haemodialysis patients

BACKGROUND: Sleep complaints are common in end-stage renal disease. We aimed to investigate the relationship between sleep-related complaints and inflammatory cytokines in haemodialysis (HD) patients, and also the effects of HD on sleep patterns and cytokine levels. METHODS: Predialysis serum interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha) levels in nine patients with sleep complaints were compared with those of nine patients without sleep complaints and nine healthy controls. Patients with sleep complaints underwent polysomnography the night after HD and the following night. RESULTS: Patients with sleep complaints had significantly higher predialysis IL-1beta levels compared with those without and healthy controls (P=0.004 and P=0.000, respectively). They also had higher predialysis IL-6 and TNF-alpha levels than those without sleep complaints; however, the difference was not significant. Patients without sleep complaints had higher mean IL-6 and TNF-alpha and similar mean IL-1beta levels compared with healthy controls (P=0.001, P=0.024, P=0.26, respectively). Obstructive sleep apnoea syndrome (OSAS) was found in six out of nine (66%) patients with sleep complaints. Sleep architecture and cytokine levels did not differ between the two nights. The mean serum IL-1beta, IL-6 and TNF-alpha levels did not differ in the pre- and post-polysomnographic samples. There was no correlation between IL-1beta, IL-6 or TNF-alpha levels and the apnoea-hypopnoea index. CONCLUSIONS: Proinflammatory cytokines, IL-1beta in particular, might be associated with sleep complaints in HD patients. OSAS is not uncommon in HD patients with sleep-related complaints and sleep architecture does not appear to be effected by the HD procedure itself.