The relationship between sleep disorders,anxiety, depression,and cognitive function with restless legs syndrome (RLS) in the elderly

Objectives

Restless legs syndrome (RLS) has a significant effect on sleep and quality of life. Delays in diagnosis and treatment are frequent due to a lack of awareness. In this study, a clinical analysis was performed to examine the relationship between sleep, mood, and cognitive function in RLS.

Methods

According to the Pittsburgh Sleep Quality Index score (PSQI), patients with RLS were divided into a sleep disorders group (SD, PSQI?>?7) and non-sleep disorders group (NSD, PSQI?≤?7). Healthy controls were selected as a control group matched for age, cultural background, and marital status. We compared differences between the three groups using the Hamilton Anxiety Scale (HAMA), Hamilton Depression (HAMD), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). The SD and NSD groups were also assessed with the Restless Leg Syndrome Rating Scale (RLSRS) and the severity of RLS between the two groups was compared. The analysis used t-test, ANOVA, and Pearson correlation.

Results

(1) Among the 54 RLS patients, 30 people in the control group, 35 patients with sleep disorders (SD, 65%), and 19 patients without sleep disorders (NSD, 35%), there were no significant differences in age, educational level, marital status, or trauma history. (2) The comparison results of the case group (SD and NSD) and the control group showed highly significant differences (P?<?0.01) in the PSQI–HAMA–HAMD score but no significant differences between the NSD group, the SD group, and the control group in MMSE score. There was no difference between the NSD group and the control group in the MoCA, but a significant difference (P?<?0.05) between the SD group and the control group was found. (3) The comparison between the NSD and the SD groups revealed significant differences in the RLSRS, HAMA, and HAMD scores (P?<?0.05), but there were no statistical differences (P?>?0.05) between two groups on MMSE and MoCA score. (4) Correlation and regression showed that there was a linear correlation between PSQI scores and RLSRS and HAMD scores in patients with RLS (P?<?0.05). The regression equation was PSQI?=????2.393?+?0.494 RLSRS?+?0.170 HAMD.

Conclusions

RLS patients were prone to sleep disorders, anxiety, and depression. Sleep disorders increased with the severity of the RLS and had some influence on the patient’s cognitive function. Sleep disorders were closely related to RLSRS and HAMD.

     

Prevalence of restless legs syndrome in Japanese patients with chronic liver disease

Aim: Sleep disturbance is a major complication in patients with chronic liver disease, but causes are unclear. The aim of this study was to clarify the prevalence of restless legs syndrome (RLS) in Japanese chronic liver disease patients and investigate the influence on sleep and quality of life. Methods: The study included 149 consecutive outpatients with chronic liver disease at Nagasaki University Hospital between September 2008 and March 2010. The presence of RLS was evaluated by a written survey using the questionnaire for the epidemiological surveillance of the international RLS research group in 2003. In addition, 89 cases, including all RLS patients, were evaluated for sleep quality and health-related quality of life. Sleep quality was evaluated by using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life was evaluated by the Japanese SF-36 Health Survey. Result: Twenty-five of the 149 patients (16.8%) fulfilled the diagnostic criteria for RLS. The median global PSQI score of the RLS group was significantly higher than the non-RLS group (9 vs 5, P < 0.01). The number of poor sleepers (global PSQI score, >5) in the RLS group was significantly higher than in the non-RLS group (P < 0.05). In SF-36, the mental component summary score of the RLS group was 43.8 ± 10.8, which was significantly lower than the non-RSL group (49.8 ± 10.5; P < 0.05). Conclusion: This is the first report that clarifies the prevalence of RLS in Japanese chronic liver disease patients. RLS worsens quality of sleep and life in chronic liver disease patients.     

血液灌流对老年血液透析患者不安腿综合征和睡眠质量的影响

目的 了解老年维持性血液透析(maintenance hemodialysis,MHD)患者不安腿综合征(restless legs syndrome,RLS)的患病率、危险因素及其对睡眠质量的影响,观察血液灌流改善对老年血液透析患者不安腿症状和睡眠质量的有效性和安全性.方法 以118例因慢性肾衰竭进行MHD治疗的老年患者为研究对象.不安腿综合征的诊断采用国际不安腿综合征研究小组制定的诊断标准量表,以匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)进行睡眠质量评估.对伴有RLS老年MHD患者进行血液灌流治疗,疗程3个月,观察治疗前后患者RLS症状和PSQJ评分情况及不良反应.收集患者的临床和生化资料,进行t检验或x2检验,部分指标间进行相关分析和Logistic回归分析. 结果 (1)118例老年血液透析患者中,并存RLS者31例,患病率为26.3%,其中男性11例,女性20例;(2)RLS组患者透析龄(t=2.332,P=0.021)、性别比(女/男)(X2=15.343,P=0.000)、血磷(t=4.784,P=0.000)、β2-微球蛋白(t=13.124,P-0.000)和甲状旁腺激素水平(t=10.900,P=0.000)明显高于非RLS组,差异均有统计学意义.而在年龄(t=0.341,P=0.734)、干体质量(t=0.008,P=0.994)、透析器膜材料(X2=1.055,P=0.304)、血肌酐(t=0.051,P=0.960)、血尿素(t=0.899,P=0.370)、血红蛋白(t=0.912,P=0.364)、红细胞压积(t=0.601,P=0.549)、血钙(t=0.192,P=0.124)、铁蛋白(t=0.200,P=0.842)、转铁蛋白饱和度(t=1.094,P=0.276)等生化指标方面,两组差异均无统计学意义;Logistic回归分析结果 显示,血甲状旁腺激素和血β2-微球蛋白是老年MHD患者并发RLS的独立危险因素;(3)RLS组PSQI明显高于非RLS组,分别为10.7±2.7和4.9±2.5(t=10.948,P=0.000);睡眠差主要表现在主观睡眠质量、睡眠时间、习惯睡眠效应、日间功能等方面,且RLS严重程度与PSQI总分呈正相关(r=0.839,P<0.05);(4)经血液灌流治疗后,RLS患者血磷,血甲状旁腺激素、血β2-微球蛋白、RLS和PSQI评分均明显下降,与治疗前比较,差异有统计学意义;(5)患者在治疗过程中牛命体征平稳,无不良反应发生. 结论 老年MHD患者RLS的患病率较高,且普遍存在睡眠质量差等问题;血甲状旁腺激素和β2-微球蛋白是老年MHD患者并发RLS的独立危险因素,血液灌流能改善老年MHD患者的RLS和睡眠质量,且安全性好.     

Effects of α1‐Blockers for Lower Urinary Tract Symptoms and Sleep Disorders in Patients with Benign Prostatic Hyperplasia

Objectives: We evaluated the association of lower urinary tract symptoms (LUTS) and sleep disorders (SD) in patients with benign prostatic hyperplasia (BPH). We also examined improvement of SD following the α1‐blocker therapy for LUTS. Methods: Sixty‐eight male patients were enrolled in the study, consisting of 38 cases with LUTS and BPH (BPH group), and 30 men without significant LUTS or BPH (non‐BPH group). The degree of LUTS and SD was evaluated by the International Prostate Symptom Score and the Pittsburg Sleep Quality Index (PSQI), respectively. The patients of BPH group then were treated with α1‐blocker for 4 weeks, and were re‐examined by all the questionnaires to evaluate the therapeutic efficacies. Results: The correlation analyses showed a significant association of LUTS with SD in BPH group (r = 0.4995, P = 0.0068). Twenty cases (52.6%) in BPH group showed 5.5 or more PSQI scores. Following 4 weeks of α1‐blocker administration, the average PSQI decreased significantly from 6.3 to 4.8 points (P < 0.001). Significant improvement was observed in domains of “sleep quality” and “sleep disturbances” among PSQI (P = 0.0215 and 0.0391, respectively). Moreover, significant association between α1‐blocker induced improvements of nocturia and SD was identified in patients with 5.5 or more PSQI score at baseline (r = 0.445, P = 0.0334). Conclusion: These results suggested that SD is associated with LUTS among BPH patients and therapeutic effects of α1‐blockers on LUTS lead to improvements of SD.     

Prevalence of Restless Legs Syndrome and Its Effects on Sleep and Health-Related Quality of Life in Patients With Heart Failure

BackgroundRestless legs syndrome (RLS) is a neurological disorder characterized by leg restlessness and dysesthesia. Although the relationship between RLS and heart failure (HF) has been reported, the prevalence and clinical significance of RLS in patients with HF remain to be elucidated.Methods and ResultsWe enrolled consecutive patients with HF who were admitted to our institutions. RLS was diagnosed using the International Restless Legs Syndrome Study Group criteria. Subjective sleepiness, sleep quality, and quality of life (QoL) were assessed using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and 8-item Short Form (SF-8), respectively. Among the 133 patients, 18 (13.6%) had RLS and were younger than those without RLS (62.4±13.4 vs 70.0±12.2, P = .017). The RLS group had significantly disrupted sleep quality and QoL, with greater PSQI score (8.0±3.2 vs 5.9±3.3, P = .015) and lower SF-8 physical component summary (PCS) score (35.6±6.5 vs 40.7±9.5, P = .031), despite similar ESS and SF-8 mental component summary scores. In the multivariable regression analysis, RLS was associated with greater PSQI (β=0.211; P = .014) and lower PCS score (β=?0.177; P = .045).ConclusionIn the patients with HF, RLS was prevalent, and sleep quality and QoL may be disrupted by RLS.     

Sleep disorders in patients with psoriasis: a cross-sectional study using non-polysomnographical methods

Background

Psoriasis is a chronic inflammatory skin disease which can cause sleep disturbances due to the disease itself or due to its complications. In this study, we aimed to analyze the array of sleep disturbances caused by psoriasis and to evaluate the interaction between the quality of sleep and the duration and severity of psoriasis.

Methods

Study subjects included 60 patients with plaque psoriasis and 60 sex- and age-matched controls. The Psoriasis Area and Severity Index (PASI) was used to evaluate severity of disease. Body mass index (BMI), medication usage, and duration of disease were recorded. All subjects completed the Epworth Sleepiness Scale (EES), Pittsburgh Sleep Quality Index (PSQI), insomnia severity index (ISI), Berlin-sleep apnea questionnaire, and questions based on criteria of the International Restless Legs Syndrome Study Group indicating the presence of restless legs syndrome (RLS).

Results

There were statistically significant and clinically relevant differences between the patients and controls regarding day-time sleepiness (ESS 5.3 vs 4.1, p?=?0.037), sleep quality (PSQI 14.4 vs 4.9, p?<?0.001), insomnia (ISI 19.7 vs 14.4, p?<?0.001), sleep apnea (high risk 30% vs 7%, p?=?0.01), and RLS (high risk 32% vs 0%, p?<?0.001).

Conclusions

Patients with psoriasis experience poor sleep quality and are at markedly increased risk for insomnia, obstructive sleep apnea, and restless legs syndrome. These findings suggest the importance of evaluating patients with psoriasis for conditions that affect sleep. The study results further suggest that simple screening tools may be useful for this task.

     

Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis

Aim

We aimed to investigate sleep quality, mild hepatic encephalopathy, anxiety, and depression in patients with hepatitis B cirrhosis by using a variety of scales and questionnaires.

Method

A cohort of 341 patients with hepatitis B liver cirrhosis were categorized by Child–Pugh grading (A, B, and C) in this cross‐sectional study. Pittsburgh Sleep Quality Index (PSQI), Number Connection Test‐A (NCT‐A), and Hospital Anxiety and Depression (HAD) evaluated the questionnaires and statistically analyzed the intrinsic correlation. The control group included 50 healthy individuals. Of 341 patients, 213 had a PSQI index >5 points.

Results

The PSQI, NCT‐A, anxiety scale (HAD [a]), and depression scale (HAD [d]) of the patients were significantly different. The NCT‐A‐positive patients revealed 214 cases of possible minimal hepatic encephalopathy (MHE) during a preliminary screening of patients. The PSQI score of NCT‐A‐positive patients was significantly elevated compared to NCT‐A‐negative patients (P < 0.001). HAD (a) and HAD (d) were significantly different between the NCT‐A‐positive and NCT‐A‐negative groups (P = 0.002 and P = 0.006, respectively). Univariate Pearson's correlation analysis found that NCT‐A and HAD (a) were positively correlated with PSQI (P < 0.001 and P = 0.045, respectively); however, Child–Pugh score and HAD (d) were not correlated with PSQI (P = 0.061 and P = 0.059, respectively).

Conclusion

These results indicated that patients with hepatitis B liver cirrhosis have a disturbed sleep, which might be an MHE symptom, further causing considerable anxiety. Thus, the evaluation of sleep quality and psychological state of patients with hepatitis B liver cirrhosis necessitates further investigation to guide positive intervention.     

Determinants of sleep problems in patients with spondyloarthropathy

Objective: To characterize sleep complaints and identify biopsychosocial factors associated with sleep problems in patients with spondyloarthropathy (SpA). Methods: The sample comprised 125 patients with SpA. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants completed standardized questionnaires assessing depressed mood, perceived stress, leisure time physical activity, functional disability and disease activity. A series of hierarchical multiple regressions were computed to examine the determinants of the following sleep parameters: quality, latency, duration and efficiency. Results: The mean global PSQI score was 8.7 (SD = 5.0), with 69% of the sample classified as poor sleepers (PSQI global score >5). Worse functional status was associated with poorer sleep quality (p = 0.006), longer sleep latency (p = 0.004), shorter sleep duration (p = 0.001) and poorer sleep efficiency (p = 0.004). Higher depressed mood scores emerged in the multivariate analyses as a significant determinant of poorer sleep quality (p = 0.010), shorter sleep duration (p = 0.007) and poorer sleep efficiency (p = 0.006). Higher perceived stress was an independent contributor of poorer sleep quality (p = 0.033). The relationships between worse functional status and poorer sleep quality and shorter sleep duration were more pronounced for participants who completed the questionnaires in the English language. Conclusions: Sleep problems are prevalent among patients with SpA. Our findings suggest that multiple factors are associated with sleep complaints in persons with SpA with functional status, depressed mood and stress differentially contributing to specific sleep parameters. Multimodal interventions, which include non‐pharmacological methods targeting these biopsychosocial factors, require evaluation to optimize the management of sleep disruptions in SpA. Copyright © 2009 John Wiley & Sons, Ltd.     

Novel Inflammatory Marker in Dialysis Patients: YKL‐40

YKL‐40 has been introduced as a marker of inflammation in different clinical situations. The association between YKL‐40 and inflammation in chronic renal failure patients has not been researched currently. The objectives of this study were to establish serum YKL‐40 concentrations in dialysis patients with chronic renal failure compared to healthy subjects and to explore its relationships with a proinflammatory cytokine, interleukine‐6 (IL‐6) and an acute phase mediator, high sensitivity C‐reactive protein (hs‐CRP). The study population included hemodialysis patients (N = 43; mean age of 40.9 ± 14.5), peritoneal dialysis patients (N = 38; mean age of 45.8 ± 13.7) and healthy subjects (N = 37; mean age of 45.5 ± 10.6). Serum concentrations of YKL‐40, IL‐6, hs‐CRP and routine laboratory measures were evaluated. Compared to the healthy subjects, hemodialysis and peritoneal dialysis patients had higher concentrations of YKL‐40, IL‐6, hs‐CRP, as well as lower concentrations of hemoglobin, serum albumin and high density lipoprotein‐cholesterol (P < 0.001). YKL‐40 concentrations were positively correlated with serum creatinine (P < 0.001, r = 0.495), IL‐6 (P < 0.001, r = 0.306), hs‐CRP (P = 0.001, r = 0.306) levels and inversely correlated with hemoglobin (P = 0.002, r = ?0.285), serum albumin (P < 0.001, r = ?0.355) and high density lipoprotein‐cholesterol (P = 0.001, r = ?0.306). In multivariate regression analysis YKL‐40 was associated with creatinine, serum albumin and hs‐CRP concentrations after adjustments with covariates. Dialysis patients with chronic renal failure have elevated serum YKL‐40 concentrations. Associations with standard inflammatory parameters suggest that YKL‐40 might be a novel inflammatory marker in this population.     

Night‐time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis

Background: Sleep–wake disturbances are common in patients with cirrhosis and are generally attributed to the presence of hepatic encephalopathy. Aim: To determine the relationship between sleep and neuropsychiatric disturbances in patients with cirrhosis. Methods: The study population comprised 87 patients, classified as neuropsychiatrically unimpaired or as having minimal/overt hepatic encephalopathy. Nineteen healthy volunteers served as controls. Validated questionnaires were used to assess sleep quality [Pittsburgh sleep quality index (PSQI)], day‐time sleepiness [Epworth sleepiness scale (ESS)] and diurnal preference. Health‐related quality of life (H‐RQoL) was assessed using the 36‐item short form health profile (SF‐36v1) and the chronic liver disease questionnaire. Results: Patients slept significantly less well than the healthy volunteers (PSQI score: 8.4 ± 4.9 vs. 4.6 ± 2.5, P<0.01) and had more pronounced day‐time sleepiness (abnormal ESS: 21 vs. 0%; χ²=3.8, P=0.05). No significant relationships were observed between sleep indices and the presence/degree of hepatic encephalopathy. H‐RQoL was significantly impaired in the patients (SF‐36v1 physical score: 36 ± 15 vs. 50 ± 10, P<0.001; SF‐36v1 mental score: 46 ± 11 vs. 50 ± 10, P<0.01); night‐time sleep disturbance was an independent predictor of poor H‐RQoL (P<0.01). Conclusions: Sleep–wake abnormalities are common in patients with cirrhosis; they significantly affect H‐RQoL but are not related to the presence of hepatic encephalopathy.     

Prevalence of restless legs syndrome in a tertiary cohort of ambulant patients with chronic liver disease

A cross‐sectional survey of 188 ambulant patients with chronic liver disease was performed to determine the prevalence of restless legs syndrome (RLS) using a validated patient completed questionnaire. Patient responses were verified by standardised telephone interview. RLS was identified in 64 (34%) patients. Significantly, more patients with cirrhosis had RLS than patients without RLS (43.9 vs 23.3%, P = 0.003, respectively). Cirrhotic patients with a history of hepatic encephalopathy were also more likely to have RLS than patients without hepatic encephalopathy (odds ratio = 4.33, 95% confidence interval = 1.40–13.37, P = 0.011). Patients with chronic liver disease may be at risk for RLS; early detection and treatment may improve patient outcomes.     

Evaluation of latent links between irritable bowel syndrome and sleep quality

AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this study.Data on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Q...     

The effect of melatonin, magnesium, and zinc on primary insomnia in long-term care facility residents in Italy: a double-blind, placebo-controlled clinical trial

OBJECTIVES: To determine whether nightly administration of melatonin, magnesium, and zinc improves primary insomnia in long‐term care facility residents. DESIGN: Double‐blind, placebo‐controlled clinical trial. SETTING: One long‐term care facility in Pavia, Italy. PARTICIPANTS: Forty‐three participants with primary insomnia (22 in the supplemented group, 21 in the placebo group) aged 78.3±3.9. INTERVENTION: Participants took a food supplement (5 mg melatonin, 225 mg magnesium, and 11.25 mg zinc, mixed with 100 g of pear pulp) or placebo (100 g pear pulp) every day for 8 weeks, 1 hour before bedtime. MEASUREMENTS: The primary goal was to evaluate sleep quality using the Pittsburgh Sleep Quality Index. The Epworth Sleepiness Scale, the Leeds Sleep Evaluation Questionnaire (LSEQ), the Short Insomnia Questionnaire (SDQ), and a validated quality‐of‐life instrument (Medical Outcomes Study 36‐item Short Form Survey (SF‐36)) were administered as secondary end points. Total sleep time was evaluated using a wearable armband‐shaped sensor. All measures were performed at baseline and after 60 days. RESULTS: The food supplement resulted in considerably better overall PSQI scores than placebo (difference between groups in change from baseline PSQI score=6.8; 95% confidence interval=5.4–8.3, P<.001). Moreover, the significant improvements in all four domains of the LSEQ (ease of getting to sleep, P<.001; quality of sleep, P<.001; hangover on awakening from sleep, P=.005; alertness and behavioral integrity the following morning, P=.001), in SDQ score (P<.001), in total sleep time (P<.001), and in SF‐36 physical score (P=.006) suggest that treatment had a beneficial effect on the restorative value of sleep. CONCLUSION: The administration of nightly melatonin, magnesium, and zinc appears to improve the quality of sleep and the quality of life in long‐term care facility residents with primary insomnia.     

Serum Receptor Activator of Nuclear Factor‐κ B Ligand,Osteoprotegrin, and Intact Parathyroid Hormone in Hemodialysis and Renal Transplant Patients

Serum receptor activator of nuclear factor‐κ B ligand and osteoprotegrin are mediated to vascular calcification in the general population. Our knowledge is very sparse in hemodialysis and renal transplant patients. Receptor activator of nuclear factor‐κ B ligand, osteoprotegrin, intact parathyroid hormone, calcium, and phosphorus were measured in blood samples of 45 hemodialysis and 45 age‐matched renal transplant patients. Osteoprotegrin (P = 0.001) and intact parathyroid hormone (P = 0.001) levels in the hemodialysis patients were higher than the renal transplant recipients. Osteoprotegrin had positive correlation with duration of dialysis and age in the hemodialysis (r = 0.88, P = 0.001 and r = 0.34, P = 0.02, respectively) and renal transplant patients (r = 0.92, P = 0.001 and r = 0.46, P = 0.001, respectively). Hemodialysis patients have higher osteoprotegrin levels than the renal transplant recipients. It may act as a protective factor for renal osteodystrophy or only as a secondary phenomenon of advanced renal failure.     

Hepatitis C virus‐related symptoms,but not quality of life,were improved by treatment with direct‐acting antivirals

Aim

Direct‐acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection have a significantly high sustained virologic response rate after a short treatment course and do not have any severe adverse effects. Patient‐reported outcomes (PROs) have become increasingly important to assess the total impact of a chronic disease. We aimed to evaluate the changes in symptoms of patients with HCV infection treated with DAAs by using PROs.

Methods

A total of 107 patients with chronic HCV infection were treated with DAAs. Daclatasvir/asunaprevir or sofosbuvir/ledipasvir was used for HCV 1B infection, and sofosbuvir/ribavirin for HCV 2A/2B infection. The PROs measured at the start of treatment and 1 year after the start of treatment were cirrhosis‐related symptom score (CSS), presence of restless legs syndrome (RLS), Epworth sleepiness scale (ESS), Pittsburg sleep quality index (PSQI), Kessler 6 score (K‐6), and the SF‐36 to measure quality of life (QOL). All patients had a sustained virologic response rate of 24.

Results

The CSS, PSQI, K‐6, and RLS scores were improved 1 year after beginning treatment. However, QOL had not recovered. Changes in total CSS were correlated with HCV genotype, sex, hypertensive drug use, serum low‐density lipoprotein, and ESS at the start of treatment and RLS 1 year after the start of treatment. The factors that contributed to worsening of CSS were HCV genotype 2B and RLS 1 year after the start of treatment.

Conclusion

Treatment with DAAs eliminated HCV‐RNA and improved most symptoms, but QOL did not recover.     

Age,Body Mass Index,and Daytime and Nocturnal Hypoxia as Predictors of Hypertension in Patients With Obstructive Sleep Apnea

A growing body of evidence links obstructive sleep apnea (OSA) with hypertension. The authors performed a retrospective cohort study using the University Hospital of Larissa Sleep Apnea Database (1501 patients) to determine predictors of in‐laboratory diagnosed OSA for development of hypertension. Differences in continuous variables were assessed via independent samples t test, whereas discrete variables were compared by Pearson's chi‐square test. Multivariate analysis was performed via discriminant function analysis. There were several significant differences between hypertensive and normotensive patients. Age, body mass index, comorbidity, daytime oxygen saturation, and indices of hypoxia during sleep were deemed the most accurate predictors of hypertension, whereas apnea‐hypopnea index and desaturation index were not. The single derived discriminant function was statistically significant (Wilk's lambda=0.771, χ²=289.070, P<.0001). Daytime and nocturnal hypoxia as consequences of chronic intermittent hypoxia play a central role in OSA‐related hypertension and should be further evaluated as possible severity markers in OSA.     

Relationship Among Coping Strategies,Quality of Life,and Anxiety and Depressive Disorders in Hemodialysis Patients

Patients with hemodialysis face many physical and emotional stressors; yet little is known regarding coping strategies and their effects on patients' quality of life (QOL) and anxiety and depressive disorders. A total of 117 patients were enrolled in this cross‐sectional study between October 2016 and April 2017. This study assessed QOL (Medical outcome short form 36—MOS 36), coping (Assessment Scale for Coping Attitudes—COPE) and psychiatric comorbidities in hemodialysis patients. Beck Depression Scale and Beck Anxiety Scale were also applied. Differences between groups were evaluated using Student's t‐tests and anova . Correlations among parameters were performed. Patients with any depressive disorder (22.2%, n = 26) and patients with any anxiety disorder (19.6%, n = 23) reported more impaired QOL. The most frequently used coping strategy in all patients was religious coping. Use of instrumental social support, humor, and positive reinterpretation scores were lower in patients with any depressive disorder (P = 0.009, P = 0.034, P = 0.047).The total score of emotion‐focused coping strategies was lower with patients with any depressive disorder (P = 0.021) and emotion‐focused coping strategies were positively correlated with QOL scores. Younger age and longer duration of hemodialysis have significant negative correlation with emotion‐focused coping strategies' total score (P = 0.01, P = 0.02). Patients with hemodialysis use variety of coping strategies. The use of emotion‐focused coping was associated with better QOL and reducing the risk of depressive disorder. Interventions to facilitate the use of adaptive coping strategies may improve patients' QOL and mood.     

Impaired Sleep Reduces Quality of Life in Chronic Obstructive Pulmonary Disease

Disturbed sleep is reportedly common in chronic obstructive pulmonary disease (COPD), but the impact of quality of sleep on health-related quality of life (HRQL) has not been previously investigated in these individuals. The purpose of this study was to assess the impact of quality of sleep on HRQL in patients with COPD. In 30 clinically stable patients with moderate to very severe COPD, we evaluated subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and HRQL using the Saint George’s Respiratory Questionnaire. Additionally, lung function was assessed by spirometry, severity of dyspnea by the Modified Medical Research Council scale, and functional exercise capacity by the Six-Minute Walk Test. Twenty-one (70%) patients showed poor quality of sleep (PSQI > 5). HRQL was significantly correlated with quality of sleep (P = 0.02), post-bronchodilator FEV1 (P = 0.04), and severity of dyspnea (P < 0.01). Multiple regression analysis showed that quality of sleep was the best predictor of quality of life in our subjects. Our data suggest that quality of sleep is major determinant of HRQL in COPD. Increased efforts to diagnose and treat sleep problems, including measures to improve factors that adversely affect sleep should receive great attention in the daily management of these patients.     

Relation of serum hepcidin levels and restless legs syndrome in chronic hemodialysis patients

Background

Iron deficiency anemia, pregnancy, and end-stage renal disease (ESRD) are common causes of secondary restless legs syndrome (RLS). Serum ferritin is considered the most specific test associated with the total amount of body iron stores. However, due to the increase of serum ferritin secondary to inflammation in chronic hemodialysis (HD) patients, serum ferritin test results do not fully reflect decreased iron stores in these patients. The present study evaluates the serum hepcidin levels, as the main regulator of iron metabolism, and its relationship with RLS in chronic HD patients.

Methods

The present cross-sectional study involved 72 patients (36 with and 36 without RLS) who received chronic HD treatment between April 2014 and April 2015. Demographic and biochemical data were evaluated in all patients, and statistical analyses were performed.

Results

The mean age and mean dialysis vintage of all patients (56% women) included in the study were 65.3?±?11.6 years and 41.5?±?36.5 months, respectively. Serum hepcidin, hemoglobin A1C (HbA1C), and ferritin levels were significantly higher in patients with RLS (p =?0.001, p?= 0.032, p?= 0.042, respectively). In addition, a positive correlation was found between International Restless Legs Syndrome Study Group severity scale score and serum hepcidin levels, HbA1C, and ferritin (r?= 0.387, p?= 0.001; r?= 0.426, p?= 0.034; r?= 0.240, p?= 0.046, respectively). A multivariate linear regression analysis revealed hepcidin and HbA1C to be independently associated with the presence of RLS.

Conclusion

A significant relationship was detected between RLS and increased serum hepcidin levels in chronic HD patients, and uncontrolled diabetes was noted to contribute to this association.