Bayesian semiparametric joint modeling of longitudinal explanatory variables of mixed types and a binary outcome

Many prospective biomedical studies collect longitudinal clinical and lifestyle data that are both continuous and discrete. In some studies, there is interest in the association between a binary outcome and the values of these longitudinal measurements at a specific time point. A common problem in these studies is inconsistency in timing of measurements and missing follow-ups which can lead to few measurements at the time of interest. Some methods have been developed to address this problem, but are only applicable to continuous measurements. To address this limitation, we propose a new class of joint models for a binary outcome and longitudinal explanatory variables of mixed types. The longitudinal model uses a latent normal random variable construction with regression splines to model time-dependent trends in mean with a Dirichlet Process prior assigned to random effects to relax distribution assumptions. We also standardize timing of the explanatory variables by relating the binary outcome to imputed longitudinal values at a set time point. The proposed model is evaluated through simulation studies and applied to data from a cancer survivor study of participants in the Women's Health Initiative.     

Prevalence of reported sleeplessness in northern Norway in relation to sex, age and season

As part of a comprehensive population health survey in the municipality of Tromsø, north of the Arctic Circle, men between 20 and 54 years and women between 20 and 49 years were presented a questionnaire containing questions about sleeplessness and its possible association with season. Of the 14,667 respondents, 41.7% of the women and 29.9% of the men said they were sometimes bothered by insomnia. Insomnia not associated with any special time of the year was reported by 16.9% of women and 16.2% of men; insomnia in the "dark period" (midwinter insomnia) was reported by 17.6% of women and 9.0% of men; insomnia in the midnight-sun period or in spring or autumn was much less common. Difficulty falling asleep was the most common type of insomnia, especially in winter and summer. Overall, the frequency of insomnia increased with increasing age, but with some notable differences with regard to type (initial insomnia showed little relation to age, whereas middle and late insomnia increased markedly with age) and seasonal type (insomnia in the midnight-sun period decreased with age, whereas the other seasonal types increased with age).     

Factors associated with insomnia symptoms: A cross-sectional study during a Covid-19 fully restrictive lockdown

Insomnia is the most frequent sleep disorder and a public health concern that increased during the Covid 19 pandemic. Fully restrictive lockdowns during Covid are interesting periods to examine the impact of environmental and behavioural changes on the emergence of insomnia symptoms. In this cross-sectional study we aimed to (1) determine the main factors associated with insomnia symptoms during a Covid-19 fully restrictive lockdown examining the associated daily life alterations and (2) create a predictive model of insomnia symptoms. We used the data drawn from the “Covid-RythmE” study that reached volunteers from the general French population through an online survey during the last 2 weeks of the 2 month full lockdown. Associations with insomnia symptoms were tested and significant associations were entered in a Backward Stepwise Logistic Regression (BSLR) to assess the best combination to classify individuals with or without insomnia symptoms. From the 1624 participants, 50.64% suffered from mild to severe insomnia symptoms as assessed by the ISI. The best combination for explaining insomnia symptoms with 74.26% of accuracy included: age (OR = 1.15), females (OR = 1.26), smaller home sizes (OR = 0.77), environmental noises (OR = 1.59), anxiety symptoms (OR = 1.24), depressive symptoms (OR = 1.15), regularity of sleep–wake schedules (OR = 1.25), exposure to screen during the morning (OR = 1.13), and LED light during the evening (OR = 1.17). Thus, lifestyle schedule and exposure to natural synchronizers such as light, are primordial in considering in insomnia physiopathology, prevention and treatment, as well as the associated mental health status.     

K-complexes: are they signs of arousal or sleep protective?

SUMMARY  The number of K-complexes recorded at the central-temporal EEG derivation (C3-T3) during 5 min periods for both the ascending and descending phase of Stage 2 of NREM sleep for cycles 1,2… etc. were counted in 10 subjects for each of the following five groups: normal persons, patients with a primary generalized form of epilepsy, narcolepsy, insomnia and obstructive sleep apnoea. The differences in time spent in different stages of sleep were as expected for these types of patients. A 2-within, 1-between factors, repeated measure ANOVA was applied to the data on K-complexes. Overall, there was no significant difference between the number of K-complexes observed during the ascending and descending phases of the different sleep cycles. Patients with a sleep disorder had significantly less well-defined K-complexes than the normals and the patients with a primary form of generalized epilepsy: for insomnia ( P = 0.035), for apnoea ( P = 0.011) and for narcolepsy ( P = 0.001). There was a significant, but very low correlation coefficient between the number of K-complexes observed during Stage 2 of NREM sleep and the time spent during that stage for all groups combined (Rho 0.27, P = 0.002) and for the narcoleptic patients (Rho 0.44, P = 0.017). In all, the findings lend support to the hypothesis that a K-complex can be seen as a 'defensive response', or has a sleep protective function.     

Bright light treatment for night-time insomnia and daytime sleepiness in elderly people: comparison with a short-acting hypnotic

Night-time bright light (BL) treatment and triazolam (0.125 mg/day) were given to three healthy elderly people in a cross-over design. They kept a daytime sleepiness test and a sleep log, and their wrist-activity was monitored simultaneously. Subjectively, BL increased daytime sleepiness and naps, and decreased night-time sleep. Triazolam decreased daytime sleepiness and naps, and increased night-time sleep. Actigraphic night-time sleep and naps on the first day were similar to these results. However, on the fourth day night-time insomnia induced by BL had recovered, and naps were shorter than the baseline. Triazolam increased actigraphic naps as the days passed.     

Prevalence of nocturia among Japanese adults

The prevalence of nocturia among Japanese community-dwelling adults was associated with insomnia, taking into account other correlates of insomnia.     

针药结合治疗失眠症的临床研究

目的 :观察针药结合与单纯中药治疗失眠症的临床疗效。方法 :90例患者均以国际通用SPIEGEL睡眠量表检测 ,设针药结合组 (治疗组 )与中药组 (对照组 )各 4 5例。结果 :治疗组疗效优于对照组 (P <0 0 5 )。结论 :针药并用 ,内外兼治 ,疗效显著 ,且远期疗效好。     

从肝论治顽固性失眠病案举偶

整理王翘楚老师治疗顽固性失眠病案三则,以说明治肝为中心,从肝论治,统顾五脏,标本兼治顽固性失眠确有良效,并能在改善病人睡眠的同时递减或使部分病人停服镇静催眠药。     

浅针治疗围绝经期失眠症的对照研究

目的观察浅针治疗围绝经期失眠症的临床疗效和睡眠改善情况。方法将60例患者随机分为浅针组和体针组,每组30例,浅针组使用浅针手法刺激山根、额中、镇静、定神、印堂,体针组使用体针疗法刺激神门、内关、百会、安眠,两组均每日治疗1次,共治疗10次,分别于治疗前后以匹兹堡睡眠质量指数(PSQI)评定睡眠状况,并比较两组临床疗效。结果两组治疗后PSQI评分与同组治疗前比较,差异均具有统计学意义(P0.01),治疗后治疗组PSQI评分与对照组比较,差异无统计学意义(P0.05),两组治疗后疗效评定比较差异无统计学意义(P0.05)。结论使用浅针治疗围绝经期失眠症可以和体针发挥一样的疗效,且浅针无创伤、无痛苦、无不良作用,值得临床推广使用。     

不寐方组方配伍历史沿革

系统分析历代不寐方发展演变及组方选药的特点。汉唐时期组方以清热泻火药和滋阴养血药为主,宋金元时期以清心安神、补气养心、养血安神药为主,又出现气血双补、交通心肾、滋阴潜阳、补益肝肾类方剂,在治法上取得了突破性进展;明清时期以养血安神方、重镇安神方、祛痰化饮方、交通心肾方为主,和胃消食方、理气解郁方、活血化瘀方的出现进一步完善了不寐证的治疗思路。