Sleep disturbances and psychomotor retardation in the prediction of cognitive impairments in patients with major depressive disorder

BACKGROUND Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder(MDD).Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients.We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments.We also hypothesize that anxiety symptoms,especially psychic anxiety,is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors.AIM To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode.METHODS A comprehensive neurocognitive test battery assessed executive function,attention,processing speed,and memory in 162 medication-free MDD patients and 142 matched healthy controls.The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms,and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms.Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms,as well as their interactions,on cognitive impairments.RESULTS Among the depressive symptoms,sleep disturbances were associated with poorer executive function(P=0.004),lower processing speed(P=0.047),and memory impairments(P<0.001),and psychomotor retardation(PR)was associated with lower processing speed in patients with MDD(P=0.019).Notably,PR was found to mediate the impact of sleep disturbances on the processing speed.Regarding anxiety symptoms,psychic anxiety,rather than somatic anxiety,was associated with cognitive impairments in all aspects.Sleep disturbances mediated the effect of psychic anxiety on executive function[β=-0.013,BC CI(-0.027,-0.001)]and memory[β=-0.149,BC CI(-0.237,-0.063)],while PR mediated its effect on processing speed(β=-0.023,BC CI(-0.045,-0.004)].CONCLUSION Sleep disturbances may be a key predictor of poorer executive function,lower processing speed,and memory loss,while PR is crucial for lower processing speed during a depressive episode.Psychic anxiety contributes to all aspects of cognitive impairments,mediated by sleep disturbances and PR.

Anti-leucine-rich glioma inactivated protein 1 encephalitis with sleep disturbance as the first symptom: A case report and review of literature

BACKGROUND Anti-leucine-rich glioma inactivated protein 1(anti-LGI1) encephalitis is an infrequent type of autoimmune encephalitis(AE) characterized by acute or subacute cognitive and psychiatric disturbance, facio-brachial dystonic seizures(FBDSs), and hyponatremia. Anti-LGI1 AE has increasingly been considered a primary form of AE. Early identification and treatment of this disease are clearly very important.CASE SUMMARY Here, we report that a male patient developed severe anti-LGI1 encephalitis, which was initially misdiagnosed as a sleep disturbance. He was hospitalized for epileptic seizures and typical FBDSs half a month after he developed sleep disturbances. LGI1 antibodies were detected in his cerebrospinal fluid and serum(1:100 and 1:3.2, respectively), which led to the diagnosis of classic anti-LGI1 AE. No obvious abnormality was observed on brain computed tomography images. T2-weighted fluid-attenuated inversion recovery and T2-weighted scans of brain magnetic resonance imaging(MRI) showed slightly elevated signals within the left basal ganglia area. No tumor was detected within the brain of this patient using MRI. After hormone and antiepileptic drug treatment, the patient’s symptoms improved significantly.CONCLUSION Anti-LGI1 antibody-associated encephalitis has characteristic clinical manifestations, such as cognitive impairment, psychiatric symptoms, seizures, sleep disorders, hyponatremia, and FBDSs. LGI1 antibodies are present in the serum and/or cerebrospinal fluid, but their production is sensitive to immunosuppressants, and this disease has a relatively good prognosis. In particular, we should be aware of the possibility of anti-LGI1 antibody-associated encephalitis in adolescents with sleep disorders to avoid missed diagnoses and misdiagnoses.

The Effect of Sleep and Cognition Enhancement Multimodal Intervention for Mild Cognitive Impairment with Sleep Disturbance in the Community-Dwelling Elderly

Dementia prevalence has soared due to population aging. In Mild Cognitive Impairment (MCI) as a pre-dementia stage, sleepdisturbances have raised much interest as a factor in a bidirectional relationship with cognitive decline. Thus, this studydeveloped the Sleep and Cognition Enhancement Multimodal Intervention (SCEMI) based on Lazarus’ multimodal approachand conducted a randomized controlled experiment to investigate the effects of the novel program on sleep and cognition inMCI elderly. The participants were 55 MCI elderly with sleep disturbances at two dementia care centers located in S-city,Gyeonggi-do, South Korea (n = 25 in the experimental group and n = 30 in the control group). The study period was fromNovember 01 to December 27, 2022. The experimental group received 8 sessions of SCEMI, 60 min per session once a week.The control group received general education and guidance using a simplified booklet on the sleep and cognitive improvement.For data collection, a self-reported questionnaire was used to investigate sleep quality, presleep arousal, cognitive function,stress, and depression. The results showed that, compared to the control group, the experimental group had significantlyimproved across all variables: sleep quality (U = 109.50, p < 0.001), presleep arousal (U = 11.50, p < 0.001), cognitive function(U = 72.00, p < 0.001), stress (U = 139.00, p < 0.001), and depression (U = 231.50, p = 0.015). Thus, the SCEMI appears topositively affect symptomatic improvement and delays the progression to dementia as an integrated intervention to enhancesleep and cognition in community-dwelling MCI elderly with sleep disturbances.

Sleep disturbance in patients with cancer

Patients diagnosed with cancer often experience sleep disturbance in the form of poor sleep patterns or insomnia that can start on diagnosis and continue until the end of the individual’s life.The aim of this review is to discuss current definitions and theories of sleep disturbance,its prevalence,the underlying physiological and psychological correlates,measurement scales,and possible intervention and management strategies.Equally important,regular assessment is worthwhile for sleep disturbance and quality of life among cancer patients.Therefore,it is advisable for health‑care professionals to conduct regular assessment of sleep disturbance for cancer patients and provide appropriate management.

A COMPARATIVE STUDY OF IMOVANE AND ESTAZOLAM TREATMENT ON SLEEP DISTURBANCES

Twentysix Patients with sleep disturbances who had completed therapy with hypnotics were observed under single-blind and self-comparable method for 7 days each. We found that patients treated with imovane or estazolam had no statistical differences with respect to sleep time onset. total sleep time. nocturnal awakening. feeling after awakening, dream, drug side effects and sleep qualirty.Imovane performed better than estazolam in sleep time onset and total sleep time. From this study, imovane can he recommended as a new hypuotic to treat patients with sleep disturbances.

Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances:a 3-month longitudinal study

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 infections.Previous studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019(COVID-19).However,neuroimaging studies on sleep disturbances caused by COVID-19 are scarce,and existing studies have primarily focused on the long-term effects of the virus,with minimal acute phase data.As a result,little is known about the pathophysiology of sleep disturbances in the acute phase of COVID-19.To address this issue,we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection,and verified the results using 3-month follow-up data.A total of 26 COVID-19 patients with sleep disturbances(aged 51.5±13.57 years,8 women and 18 men),27 COVID-19 patients without sleep disturbances(aged 47.33±15.98 years,9 women and 18 men),and 31 age-and gender-matched healthy controls(aged 49.19±17.51 years,9 women and 22 men)were included in this study.Eleven COVID-19 patients with sleep disturbances were included in a longitudinal analysis.We found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain lobes.The cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index scores.Additionally,we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy controls.The 3-month follow-up data revealed indices of altered cerebral structure(cortical thickness,cortical grey matter volume,and cortical surface area)in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep disturbances.Our findings indicate that the sleep disturbances patients had altered morphology in the cortical and hippocampal structures during the acute phase of infection and persistent changes in cortical regions at 3 months post-infection.These data improve our understanding of the pathophysiology of sleep disturbances caused by COVID-19.

Female Gender Was Associated With Increased Odds of Sleep Disturbance in Adult Chinese With Moderate-to-Severe Psoriasis:A Cross-Sectional Study

Objective:Up to 85.3%of patients with psoriasis experience sleep disturbance(SD).However,SD has not been characterized in Chinese patients with psoriasis,and the factors that affect SD among adult patients with psoriasis remain unclear.This study was performed to examine the risk of SD in patients with psoriasis compared with a control group of healthy individuals and to identify factors contributing to SD in patients with psoriasis.Methods:This was a cross-sectional,questionnaire-based,case-control study involving 142 adult participants with psoriasis and 142 healthy controls.The Pittsburgh Sleep Quality Index(PSQI)was administered to assess SD.Mild psoriasis was defined by Psoriasis Area and Severity Index and body surface area cut-offs of<10,and mild to severe psoriasis was determined by Psoriasis Area and Severity Index and body surface area cut-offs of≥10.Logistic regression was performed to investigate the associations.Results:The prevalence of SD(PSQI score of≥6)was 47.9%in adult patients with psoriasis.The mean PSQI score in patients with psoriasis was 6.1±3.7,which was higher than that in the control group(4.9±2.5,P<0.001).The risk of SD in the psoriasis group was 1.669 times higher(95%confidence interval,1.008-2.761;P=0.046)than that in the healthy group.Female sex(adjusted odds ratio,4.130;95%confidence interval,1.306-13.058;P=0.016)was significantly associated with an increased risk of SD in patients with moderate to severe psoriasis,whereas there were no significant factors affecting the risk of SD in patients with mild psoriasis.Conclusion:Patients with psoriasis were more likely than healthy controls to develop SD.In patients with moderate to severe psoriasis,but not in those with mild psoriasis,female sex was associated with a higher likelihood of SD.

Sleep disturbances in patients with cirrhosis:Pursuing just right

Liver cirrhosis represents the end-stage of chronic liver disease and is related to high morbidity and mortality.To date,there is no standard curative method for liver cirrhosis,but there is treatment for common complications.Therefore,improving the health-related quality of life(HRQoL)of patients with cirrhosis has become a potential therapeutic intervention by limiting its symptoms and complications.Sleep is a complex and rhythmic physiological process and is crucial to human health.Sleep disturbances are commonly encountered in patients with cirrhosis and adversely affect their HRQoL.Recently,sleep disturbances in patients with cirrhosis have received growing attention owing to their reciprocal effects.To better understand the effect of sleep disturbances on patients with cirrhosis,this review provides a comprehensive summary of the epidemiology and underlying mechanisms of sleep disturbances in cirrhosis.We also elaborate on the mutual relationships between sleep disturbances and other complications,such as muscle cramps,malnutrition,frailty,sarcopenia,HRQoL,and hepatic encephalopathy,in the context of cirrhosis.Finally,we discuss the potential management to improve poor sleep quality in patients with cirrhosis.

An Investigation of Lighting Levels and Sleep Quality

Sleep quality in young adults is compromised. Instead of the recommended 7 hours, young adults’ schedule interruptions disturb sleep to a typical six and a half hours, with common disturbances in falling asleep and staying asleep. Recent literature has identified an association between academic performance, negative mood state and low activity level in young adults with sleep disturbances. Young adulthood is a time for the installation of sleep health. Both individual and schedule impositions to the young adults’ sleep schedule are to be modified to obtain Sleep Health. Recent research has identified daytime light effects on sleep such as blue light from electronics as alerting and low level light for relaxation. The aim of this study was to identify sleep quality effects with varying light exposures. It was hypothesized that bright (>450 lux) light conditions would be considered focusing and low light (<220 lux) would be considered calming. We hypothesized that sleep quality would improve by 5% with the introduction of a calm light condition. Undergraduates from a small midwestern university were invited to participate in the study in exchange for a gift card. Six participants completed the study, two males, four females all between 21 - 24 years old. Both hypotheses were supported by qualitative analysis.

Acupuncture combined with ear point taping and pressing for sleep disturbance in 30 children with mental retardation

Objective To observe the therapeutic effect of acupuncture combined with ear point taping and pressing on sleep disturbance of the children with mental retardation. Method Thirty children of mental retardation with sleep disturbance were treated with acupuncture combined with ear point taping and pressing therapy, Sìshénzhēn （四神针）, Nǎosānzhēn （脑三针）, Zhìsānzhēn （智三针）, Nièsānzhēn （颞三针）, Shǒuzhìzhēn （手智针） were selected as main acupoints, and adjunct points were used according to symptoms and syndrome differentiation. For ear point taping and pressing, ěrshénmén （耳神门 MA-TF1）, Pízhìxià （皮质下 MA–AT1）, Jiāogǎn （交感 MA-AH7）, Xīn （心, heart）, Shèn （肾 kidney）, Pí （脾 spleen） were selected. The treatment was given two therapeutic courses, thrice each week, 36 sessions constituted one course. Child Sleep Habit Questionnaire （CSHQ） scale was used for assessment of sleep state before and after the treatment. Results After the treatment, among the 30 cases, 11 cases were markedly effective, 16 cases were effective and 3 cases were failed, the total effective rate was 90.0%; after the treatment, the children had significant improvement in the total time of sleep, the time of going to bed for sleep, sleep habit, sleep behavior, awaking state at night, getting-up state in the morning, sleep state in the daytime and the total score （P0.01, P0.001）. Conclusion Acupuncture combined with ear point taping and pressing therapy has a positive therapeutic effect on sleep disturbance and increases sleep quality in varying degrees in children with mental retardation.

Increased Serum Cystatin C in Early Parkinson’s Disease with Objective Sleep Disturbances

Background：Sleep disturbance is one of the major non-motor symptoms which cause the disability of Parkinson’s disease （PD） patients. Cystatin C （CysC） is a more sensitive biomarker than serum creatinine or estimated glomerular filtration rate. Previous studies have reported altered CysC levels in neurodegenerative disorders and sleep disorders. This study aimed to explore the correlations of serum CysC levels and objective sleep disturbances in early PD.Methods：We recruited 106 early PD patients and 146 age- and sex-matched controls. All participants underwent clinical investigation and video-polysomnography. Sleep parameters and serum levels of CysC were measured. Then, we investigated the relationships between CysC and clinical variables and objective sleep disturbances in early PD patients.Results：The mean serum level of CysC was significantly higher in patients with early PD （1.03 ± 0.19 mg/L） compared to controls （0.96 ± 0.15 mg/L, P = 0.009）. There were significantly positive correlations between serum CysC levels and age （r = 0.334, P 〈 0.001）, gender （r = 0.264, P = 0.013）, and creatinine levels （r = 0.302, P = 0.018） in early PD patients. Increased serum CysC levels in early PD patients were significantly associated with higher apnea and hypopnea index （AHI） （r = 0.231, P = 0.017）, especially hypopnea index （r = 0.333, P 〈 0.001）. In early PD patients, elevated serum CysC levels were positively correlated with oxygen desaturation index （r = 0.223, P = 0.021）, percentage of time spent at oxygen saturation （SaO2） 〈90% （r = 0.644, P 〈 0.001）, arousal with respiratory event during sleep （r = 0.247, P = 0.013）. On the contrary, the elevated serum CysC levels were negatively correlated with mean and minimal SaO2 （r = ？0.323, ？0.315, both P = 0.001） in PD patients.Conclusions：The level of serum CysC was higher in early PD patients. PD patients with elevated serum CysC levels had more respiratory events and more severe oxygen desaturation. Therefore, the serum CysC levels may predict the severities of sleep-disordered breathing problems in early PD patients.

Effect of Guizhi Gancao Longgu Muli Tang on sleep disturbances in menopausal women

OBJECTIVE: To evaluate the effect of Guizhi Gancao Longgu Muli Tang(GGLMT), a decoction prepared with herbal medicine of Traditional Chinese Medicine, on sleep disturbances in women with menopause.METHODS: Totally 162 participants were recruited for the treatment of sleep difficulty from February,2012 to December, 2014. Decoction of 200 mL was taken by every participant twice daily in half an hour after lunch and dinner during two weeks.Sleep quality was assessed by Pittsburg sleep quali-ty index(PSQI) and menopausal symptoms and quality of life were evaluated by the menopause rating scale(MRS) and the Chinese version of World Health Organization quality of life-BREF at the final fellow-up in the fourth weekend after beginning.RESULTS: The average scores of PSQI had reduced from(13.82 ± 4.97) to(8.14 ± 3.19), 95% CI(- 4.87,- 3.05) after 2-week GGLMT treatment in the fourth week. GGLMT improved symptoms in patients with more severe conditions(MRS ≥ 16).Three adverse drug reaction, mouth ulcer, constipation, and folliculitis, might be related with GGLMT and disappeared after withdrawals of the treatment.CONCLUSION: For menopausal women suffering from chronic sleep disturbances, our findings suggest that two weeks treatment of GGLMT was safe and effective.

Postoperative sleep disorders and their potential impacts on surgical outcomes

Postoperative sleep disturbance is a common occurrence with significant adverse effects on patients including delayed recovery,impairment of cognitive function,pain sensitivity and cardiovascular events.The development of postoperative sleep disturbance is multifactorial and involves the surgical inflammatory response,the severity of surgical trauma,pain,anxiety,the use of anesthetics and environmental factors such as nocturnal noise and light levels.Many of these factors can be managed perioperatively to minimize the deleterious impact on sleep.Pharmacological and non-pharmacological treatment strategies for postoperative sleep disturbance include dexmedetomidine,zolpidem,melatonin,enhanced recovery after surgery(ERAS) protocol and controlling of environmental noise and light levels.It is likely that a combination of pharmacological and non-pharmacological therapies will have the greatest impact;however,further research is required before their use can be routinely recommended.

Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude

AIM:To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients.METHODS:Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed.Validated questionnaires:the Pittsburg Sleep Quality Index(PSQI)and Epworth Sleepiness Scale(ESS)were administered prospectively.Subjects with nonglaucomatous optic neuropathy or concomitant retinal pathology were excluded.Glaucoma severity was based on HVF 24-2 perimetry.Binocular single vision was represented based on the better eye.Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared.RESULTS:A total of 79 primary open angle glaucoma(POAG),27 primary angle-closure glaucoma(PACG)patients,and 89 controls were recruited.PACG patients had higher median PSQI scores(P=0.004)and poorer sleep quality(P<0.001).Compared to controls,PACG patients were 3.34 times more likely to have poor sleep quality(P=0.008),which remained significant after adjustment for demographics(P=0.016)and predictive variables(P=0.013).PACG patients have poorer sleep quality when visual acuity(VA)was 6/15 or worse(P=0.009).Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance.CONCLUSION:PACG patients have poorer sleep quality but not daytime sleepiness.This is important in South-East Asian population with heavy disease burden.Evaluations on sleep disturbances can be considered to provide more ho istic care.

Obstructive Sleep Apnea Syndrome Phenotyping by Cluster Analysis: Typical Sleepy, Obese Middle-aged Men with Desaturating Events are A Minority of Patients in A Multi-ethnic Cohort of 33% Women

Objective Several clinical obstructive sleep apnea syndrome(OSAS)phenotypes associated with heterogeneous cardiovascular risk profiles have been recently identified.The purpose of this study was to identify clusters amongst these profiles that allow for the differentiation of patients.Methods This retrospective study included all moderate-to-severe OSAS patients referred to the sleep unit over a 5-year period.Demographic,symptom,comorbidity,polysomnographic,and continuous positive airway pressure(CPAP)adherence data were collected.Statistical analyses were performed to identify clusters of patients.Results A total of 567 patients were included(67%men,54±13 years,body mass index:32±7 kg/m2,65%Caucasian,32%European African).Five clusters were identified:less severe OSAS(n=172);healthier severe OSAS(n=160);poorly sleeping OSAS patients with cardiometabolic comorbidities(n=87);younger obese men with sleepiness at the wheel(n=94);sleepy obese men with very severe desaturating OSAS and cardiometabolic comorbidities(n=54).Patients in clusters 3 and 5 were older than those in clusters 2 and 4(P=0.034).Patients in clusters 4 and 5 were significantly more obese than those in the other clusters(P=0.04).No significant differences were detected in terms of symptoms and comorbidities.Polysomnographic profiles were very discriminating between clusters.CPAP adherence was similar in all clusters but,among adherent patients,daily usage was more important in cluster 1(less severe patients)than in cluster 5.Conclusion This study highlights that the typical sleepy obese middle-aged men with desaturating events represent only a minority of patients in our multi-ethnic moderate-to-severe OSAS cohort of 33%females.

Associations between walking parameters and subsequent sleep difficulty in older adults: A 2-year follow-up study

Purpose: This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults.Methods: A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later.The 5-item Athens Insomnia Scale(AIS-5) was used to measure sleep difficulty. Frequency, duration, and speed of outdoor walking were self-reported. Walking speed was assigned a metabolic equivalent value(MET) from 2.5 to 4.5. Total walking volume in MET-h/week was calculated as frequency × duration × speed. Negative binomial regressions were performed to examine the associations between volume and components of walking with subsequent sleep difficulty with covariates of age, sex, education, marital status, living arrangement, smoking, alcohol consumption, mental health, Charlson Index, exercise(excluding walking), and sleep difficulty at baseline.Results: Participants with low walking volume had a higher level of sleep difficulty 2 years later compared with those with high walking volume(incident rate ratios = 1.61, p = 0.004). When speed, frequency, and duration of walking were simultaneously entered into 1 model, only walking speed was significantly associated with subsequent sleep difficulty(after the model was adjusted for covariates and baseline sleep difficulty).Sensitivity analyses showed that walking duration emerged as a significant predictor among 3 walking parameters, with 2-year changes of sleep scores as dependent variable.Conclusion: Total amount of walking(especially faster walking and lasting for more than 20 min) is associated with less subsequent sleep difficulty after 2 years among older adults.

Prevalence and predictors of smartphone addiction and insomnia among nurses working in the outpatient department after the second wave of the coronavirus disease 2019 pandemic

Objectives:The present study aims to assess the prevalence and predictors of smartphone addiction and insomnia among nurses working in the outpatient department(OPD)after the second wave of the coronavirus disease 2019(COVID-19)pandemic.Materials and Methods:A descriptive,cross-sectional study was carried out among 117 OPD nurses between October and December 2021 using a purposive sampling technique.Two self-reported standardized scales,the Smartphone Addiction Scale-ShortVersion and Insomnia Severity Index were used.Kolmogorov–Smirnov test,Mann–Whitney U,and Kruskal–Wallis Htest were used.Pearson’s correlation and Scatter plot were used to determine the relationship between the study variables.A stepwise multiple linear regression analysis was also performed.Results:The majority of participants had slight smartphone addiction(78.6%)and suffered from sub-threshold to severe forms of insomnia(73.5%).A significant mild positive correlation was found between smartphone addiction and insomnia(r=0.195,P<0.05).Stepwise multivariate logistic regression analysis predicted factors such as female gender and exposure to smartphones for more than 5 years influencing smartphone addiction.A strong influence of exposure to the smartphone for more than 5 years was found on insomnia severity.Conclusion:Smartphone addiction and insomnia were identified problems among nurses working in the OPD after the second wave of the COVID-19 pandemic,requiring an urgent need to identify and manage various factors responsible for smartphone addiction and insomnia such as female gender and years of exposure to smartphones.

The First Chinese Case of Creutzfeldt-Jakob Disease with Mutation of E200K in PRNP

Objective To investigate epidemiological, clinical and genetic features of the first Chinese case of Creutzfeldt-Jakob disease （CJD） with mutation of E2OOK in PRNP. Methods The general epidemiological and clinical data were collected; CSF 14-3-3 protein was analyzed by Western blot; The PRNP was amplified by PCR and analyzed. Results A missense mutation in codon 200 （E200K） of the PRNP was identified in this patient; CSF 14-3-3 protein was positive; sleep disturbance was the initial sign and the other symptoms gradually appeared, including memory loss, dizziness and ataxia. Conclusion The CJD patient who was first reported in China has a missense mutation in codon 200 （E200K） of the PRNP, and the codon 129 is a methionine homozygous genotype.

Double-blind randomized controlled study of the efficacy, safety and tolerability of eszopiclone vs placebo for the treatment of patients with post-traumatic stress disorder and insomnia

BACKGROUND Sleep disturbance is a core feature of post-traumatic stress disorder(PTSD).Given the relationship between sleep disturbance and PTSD,there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD.Eszopiclone(ESZ)is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.AIM To evaluate the efficacy of ESZ vs placebo(PBO)for patients with PTSD and insomnia.METHODS The study was a 12-wk,double blind,randomized controlled trial with 3 mg of ESZ(n=13)or PBO(n=12).RESULTS Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV(CAPS):ESZ(t11=-3.12,P=0.005)and PBO(t11=-3.5,P=0.002)and by self-report with the Short PTSD Rating Interview(ESZ t11=-3.38,P=0.003 and PBO t11=-4.48,P=0.0005).There were no significant differences between treatments on the CAPS(t22=-0.13,P=0.70)or the Short PTSD Rating Interview(t22=-0.58,P=0.56).Similarly,both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum(PSQI)and on total sleep time(TST)and sleep latency assessed by actigraphy with no significant differences between groups(PSQI t22=-0.24,P=0.81;total sleep time t10=0.13,P=0.90 and sleep latency t10=0.68,P=0.50).There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS,r(8)=0.79,P=0.01 for ESZ treated subjects,but not for those treated with PBO r(9)=0.16,P=0.69.Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia(30%,mild),sedation(20%,mild)and headache(20%,moderate to severe).CONCLUSION Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.

Perioperative psychological issues and nursing care among patients undergoing minimally invasive surgeries

Minimally invasive surgeries,including laparoscopic,endoscopic,and robotic surgeries,have gained great popularity and have gradually replaced conventional open surgeries.Commonly,patients may have perioperative psychological issues such as anxiety,depression,sleep disturbance,and delirium.A comprehensive literature review was conducted to identify how these psychological issues occur in minimally invasive surgeries and how nurses can take better care of patients to alleviate these issues.Only papers focusing on psychological issues during the perioperative period were included in the re-view,and preexisting issues before the setting of surgical treatment plan were not discussed.Compared to conventional surgeries,the incidence of postoperative anxiety,preoperative depression,and sleep disturbance is lower in minimally invasive surgeries,the incidence of postoperative depression may be higher with limited evidence,and the incidence of preoperative anxiety and delirium is inconclusive.Systematic perioperative nursing programs not only alleviate psychological issues,but also reduce postsurgical complications and accelerate recovery.However,special nursing programs to handle delirium are lacking.