Notes

Minimizing out-patient gastrostomy tv difficulties.
Poor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes, such as multiple chronic conditions (multimorbidity) and reduced longevity. Our objective was to examine the relationship between sleep behaviours and multimorbidity in Canada.

We analysed data from the Canadian Longitudinal Study on Aging (CLSA), a cross-sectional national health survey of community-dwelling adults over the age of 45 years. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short <6h; normal 6-8h; long >8h) and sleep quality (dissatisfied/very dissatisfied; neutral; satisfied/very satisfied). Multimorbidity was defined using two definitions (public health and primary care) and two cut-points (2 or more and 3 or more chronic conditions).

Approximately 70% were living with multimorbidity using the primary care definition (females 67.9%; males 57.9%), whereas approximately 30% were living with multimorbidity using the public health definition (females 30.9%; males 24.0%). Adjusted analyses indicated that the odds of multimorbidity were higher for participants who selfreported either short or long sleep duration, as well as dissatisfaction with sleep quality. Associations were stronger among younger age groups (45-54 years and 55-64 years).

Disrupted sleep may be a risk factor for multimorbidity across sexes and age groups. It is necessary to understand the potential impact of sleep on the risk of multimorbidity to inform both clinical and public health guidelines for the prevention and management of this major health issue.
Disrupted sleep may be a risk factor for multimorbidity across sexes and age groups. It is necessary to understand the potential impact of sleep on the risk of multimorbidity to inform both clinical and public health guidelines for the prevention and management of this major health issue.
Obstructive sleep apnea (OSA) is known to be highly associated with reflux diseases. There is evidence that continuous positive airway pressure (CPAP) can decrease the clinical symptoms of gastroesophageal reflux (GER) in OSA patients, but whether CPAP can decrease nocturnal laryngopharyngeal reflux (LPR) episodes is still lack of strong evidence.

To investigate the efficiency of CPAP on LPR and the relationship between LPR, GER and OSA.

retrospective study.

Forty adult patients who had confirmed OSA by polysomnography and suspected LPR were enrolled. Their results of synchronous polysomnography and 24h esophageal and oropharyngeal Dx-pH monitoring were analyzed. Twenty-seven OSA patients were treated with CPAP on the second night. The nocturnal reflux parameters with and without CPAP treatment were compared.

15.0% and 42.5% of OSA patients were associated with LPR and GER through Dx-pH monitoring respectively. Nevertheless, more than one reflux attack falling below pH6.0 of oropharynx during sleep time was detected in 80.0% patients. There was a significant inverse correlation between the lowest/mean pH values of oropharynx and obstructive apnea index (OAI), so was the lowest pH values of esophagus. Significant positive correlation was calculated between the total number of reflux episodes below pH6.0 of oropharynx and apnea-hypopnea index (AHI)/OAI/hypopnea index (HI). A similar positive correlation was also significant between AHI/OAI and GER parameters. The assessment of the efficacy of CPAP treatment showed significant difference both in GER and LPR related parameter.

OSA patients have a higher incidence of nocturnal LPR and GER. CPAP treatment can effectively reduce both GER and LPR attacks while disordered sleep events reduced in OSA patients.
OSA patients have a higher incidence of nocturnal LPR and GER. CPAP treatment can effectively reduce both GER and LPR attacks while disordered sleep events reduced in OSA patients.Sleep bruxism (SB) is characterized by recurrent masticatory muscle activity during sleep with occasional tooth grinding. Rutin SB can be concomitant with sleep apnea although its association with insomnia is understudied.
Assess the strength of the associations between SB, insomnia and sleep apnea in a general population.

Data from the 2007 EPISONO general population study (n=1042; Sao Paulo, Brazil) were reused for the present analyses. The data was collected from polysomnography (PSG) and from a questionnaire. SB could only be assessed as "possible" with self-report questionnaires, but as "definitive" with both self-reports and PSG. Logistic regression and decision tree analyses were performed.

Logistic regression analyses revealed that being male, overweight, obese, having an apnea/hypopnea index (AHI) above 30 and insomnia syndrome are among risk factors for SB (prevalence ratio (PR) 1.5-3.3). A high AHI and insomnia syndrome had similar PRs, 2.7 and 2.8, respectively. Decision tree analysis showed that insomnia syndrome contributed to the predictive accuracy of SB self-report (88%). A similar estimate (91%) was observed with SB PSG data. Correspondence analysis illustrated three age profiles in participants (1) good sleepers aged 20-35 years, (2) females aged 35-50 years with SB and concomitant insomnia syndrome, and (3) participants aged≥50 years with obesity and sleep apnea.

Insomnia is likely a condition associated with SB, especially in middle-age females, while sleep apnea seems age and gender dependent. Such overlap may influence the treatment decision to achieve best outcomes.

EPISONO study; Clinical trials.gov ID # NCT00596713.
EPISONO study; Clinical trials.gov ID # NCT00596713.
To investigate (1) the effect of different scoring rules on leg movement (LM) classification in patients with obstructive sleep apnea (OSA); (2) determinants of respiratory event related leg movements (rLM); and (3) to relate LM parameters to clinical outcomes.

(1) LM classification was compared between the World Association of Sleep Medicine (WASM) 2006 and the WASM 2016 rules in 336 participants with apnea hypopnea index (AHI)≥5; (2) determinants and features of rLM were investigated with logistic mixed regression in 172 participants with AHI≥10 and respiratory disturbance index (RDI)≥15, and (3) LM parameters were compared for patients with and without cardiovascular events and related to continuous positive airway pressure (CPAP) adherence.

WASM-2016 scoring significantly reduced periodic limb movements of sleep (PLMS) frequency in OSA participants even when only considering the new periodicity criteria. Probability of rLM was strongly increased when respiratory events ended with an arousal, but rLMory driven LM, and that the presence of non-respiratory PLMS is instrumental in distinguishing between the two.
The relationship between alopecia areata (AA) and sleep disorders remains uncertain. This study aims to investigate the bidirectional association between AA and sleep disorders.

To assess the risk of developing sleep disorders, we recruited 5648 patients with AA and 22,592 matched controls from the National Health Insurance Research Database (NHIRD) in Taiwan. Similarly, risk of developing AA was assessed in 93,130 patients with sleep disorders (including 7310 patients with obstructive sleep apnea [OSA] and 85,820 patients with non-apnea insomnia) and 372,520 matched controls. Cox regression model was used for the analysis.

AA patients had a significantly increased risk of developing OSA (adjusted hazard ratio [aHR] 3.80; 95% confidence interval [CI] 2.53-5.71) and non-apnea insomnia (aHR 4.20; 95% CI 3.68-4.79). Conversely, presence of sleep disorders significantly increased the risk of AA development (aHR 4.70; 95% CI 3.99-5.54). Both OSA (aHR 3.89; 95% CI 2.46-6.16) and nonapnea insomnia (aHR 4.77; 95% CI 4.03-5.64) were associated an increased risk of developing AA.

Patients with AA have a higher risk of developing sleep disorders compared to controls, and vice versa. Further studies are needed to investigate the shared pathogenic mechanism underlying these two conditions.
Patients with AA have a higher risk of developing sleep disorders compared to controls, and vice versa. Further studies are needed to investigate the shared pathogenic mechanism underlying these two conditions.
The objective of this study is to emphasize the importance of the clinical suspicion of Restless Legs Syndrome (RLS) among patients with chronic insomnia.

We conducted a retrospective study referring to the period 2009-2018. All patients presenting with the complaint of insomnia and fulfilling the criteria of Chronic Insomnia (C.I.) were enrolled. In this group we estimated how many patients finally had the diagnosis of RLS. Demographic and clinical characteristics (sleep related problems, fatigue, daytime sleepiness and psychological profile) were recorded and analyzed between C.I. and RLS patients using logistic regression models.

A total of 532 patients presented with C.I. Among them 83 proved to have RLS. No differences in frequencies or odds were observed concerning the type of insomnia, daily fatigue, daytime sleepiness and depression. RLS is more frequent in women (p=0.01) and in older patients (p=0.05) who present with the picture of C.I. Anxiety levels are higher in the RLS group (p=0.004).

RLS and C.I. patients demonstrate a very similar profile which complicates the differential diagnosis. Physicians and especially psychiatrists who deal with insomnia must have increased clinical suspicion for RLS as RLS and insomnia have a totally different therapeutic approach.
RLS and C.I. patients demonstrate a very similar profile which complicates the differential diagnosis. Physicians and especially psychiatrists who deal with insomnia must have increased clinical suspicion for RLS as RLS and insomnia have a totally different therapeutic approach.
Poor sleep is a major complaint of people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and undergoing methadone maintenance therapy (MMT). We tested the impact of three different sleep-improving interventions (trazodone; sleep hygiene training; sleep hygiene training+trazodone) on sleep, psychological functioning and biomarkers in males with HIV and undergoing MMT.

A total of 75 male outpatients (mean age 39.6 years) participated in a 12 week intervention. Participants were randomly assigned to one of the following conditions trazodone 50mg/d (TRAZ); sleep hygiene training (SHT); sleep hygiene training and trazodone (SHT+TRAZ). At baseline, and six and 12 weeks later, participants completed questionnaires covering subjective sleep and daytime sleepiness, and symptoms of depression and anxiety. In parallel, their cognitive performance (working memory; sustained attention) was assessed. Biomarkers (cortisol, BNDF, CD4
) were assessed at baseline and at the end of tults.
In males with HIV and undergoing MMT, treating sleep disturbances over a period of six to 12 weeks had a positive impact on aspects of sleep disturbance, symptoms of depression and anxiety, and cognitive performance. The results indicate that sleep hygiene training, either as stand-alone or in combination with trazodone, can produce positive results.
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