Relevance of sleep for wellness:New trends in using artificial intelligence and machine learning

Sleep and well-being have been intricately linked,and sleep hygiene is paramount for developing mental well-being and resilience.Although widespread,sleep disorders require elaborate polysomnography laboratory and patient-stay with sleep in unfamiliar environments.Current technologies have allowed various devices to diagnose sleep disorders at home.However,these devices are in various validation stages,with many already receiving approvals from competent authorities.This has captured vast patient-related physiologic data for advanced analytics using artificial intelligence through machine and deep learning applications.This is expected to be integrated with patients’Electronic Health Records and provide individualized prescriptive therapy for sleep disorders in the future.

Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease(CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

Self-reported sleep quality and depression in post myocardial infarction patients attending cardiology outpatient clinics in Oman

Objective: This study aimed to examine the sleep quality and prevalence of depression in post myocardial infarction patients attending cardiology outpatient clinics of selected hospitals in Oman.Methods: A descriptive cross-sectional design was used to collect data from patients (n 180) who were at least 4 weeks post myocardial infarction diagnosis and receiving follow-up care in the outpatient clinic.The Arabic version of the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 were used to assess sleep quality and depressive symptoms,respectively.Results: The sample mean age was 62.0 ± 11.3 years.Poor sleep quality affected 61.1% of the participants.The significant predictors of poor sleep quality were gender (P ≤ 0.05),body mass index (P ≤ 0.05),and self-reported regular exercise (P ≤ 0.01).The most impacted domains of sleep quality were sleep latency,sleep duration,and sleep disturbances.The prevalence of major depression was low (5%) and the rate of re-infarction was 27.2%.The prevalence of minimal to mild major depression with a potential of transitioning into major depression overtime was very high.Self-reported regular exercise (P ≤ 0.01) was the only significant predictor of depressive symptoms.Conclusion: The sleep quality of post myocardial infarction patients was poor and the prevalence of depression was low.There was no significant relationship between sleep quality or depression with reinfarction.

Effects of Warm Needling at Zusanli(ST 36)on NO and IL-2 Levels in the Middle-Aged and Old People

42 middle-aged and old people at the age between 55-70 years were selected and given the warm needling at Zusanli (ST 36), and their IL-2 and NO contents of peripheral blood before and after acupuncture were determined. The results showed that IL-2 and NO contents increased significantly after the warm needling (P<0.01).

Treatment of Phlegm-and Heat-induced Insomnia by Acupuncture in 120 Cases

Clinical DataThe 120 cases in this series were outpatients suffering from insomnia due to interior-stirring by phlegm-heat, ranging in age from 28 to 67 years. They were randomly divided into a treatment group and a control group.

Analysis of the evidence of related factors,associated conditions and at-risk populations of the NANDA-I nursing diagnosis insomnia

Objectives:To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.Methods:An integrative review performed in Pubmed,Virtual Health Library and CINAHL.Forty-eight articles published in Portuguese,English or Spanish from 2011 to 2018 were included.An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.Results:There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions,except for grieving and frequent naps during the day.Smoking,caffeine intake,dysfunctional sleep beliefs,obesity and caregiver role strain are possible new related factors;chronic illness is a possible new associated condition and individuals going through changes in marital status,economically disadvantaged,female gender,increasing age and night shift worker are possible new at-risk populations.Conclusion:The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis.The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification,thereby supporting the clinical reasoning of nurses and students.

Experience in Differentiation and Treatment of Stubborn Insomnia

Stubborn insomnia is characterized by: a) a long course of illness, lasting over 3 months; b) ineffectiveness of the routine treatment; c) the patient can sleep no more than 2 hours at night; d) the patient has a low spirit, palpitation, poor memory, viscera function disorder, all seriously affecting the patient's life and work. The following is an account of the author's clinical experience in treating stubborn insomnia.

Effectiveness and safety of acupuncture in treatment of pregnancyrelated symptoms:a systematic review and Meta-analysis

OBJECTIVE:To systematically evaluate the efficacy and safety of acupuncture(AM)in the treatment of pregnancyrelated symptoms such as acute vomiting during pregnancy.METHODS:We comprehensively searched the available literature up to November 2021,including Pub Med,Embase,Cochrane Library,Chinese Biomedical Literature Database,and China National Knowledge Infrastructure Database,for randomized controlled trials(RCTs)on AM for the treatment of severe vomiting,insomnia,pharyngeal and pelvic pain,mood abnormalities,and dyspepsia during pregnancy.RESULTS:Sixteen RCTs with a cumulative sample size of 1178 cases were included.Of these,964 patients were included in the Meta-analysis.The Meta-analysis results showed that AM was more efficient than Western medicine in treating discomfort during pregnancy[odds ratio(OR)=1.19,95%confidence interval(CI)(1.11,1.28),P<0.01].AM was better than the control group in improving the visual analog scale scores[standard mean difference(SMD)=0.62,95%CI(0.53,0.71),P<0.01].AM was superior to the control group in improving Numerical Rating Scale(NRS)symptom scores[OR=7.31,95%CI(3.36,15.94),P<0.01].There was no significant difference in adverse effects between the AM and sham-AM groups and the analgesic drug group[OR=0.70,95%CI(0.39,1.28),P=0.25],but the treatment and control groups had mild adverse effects with a low incidence.CONCLUSIONS:AM is more effective than other treatments or pharmacotherapy alone in the treatment of pregnancy-related symptoms,and is relatively safe.However,the quality of the included trials was rather poor,and high-quality studies are required to confirm our findings.

Clinical Application of Fengchi Point

For Painful Heels - an Example for Treating Diseases of the Lower Body by Needling Points at the Upper Part of the BodyMrs. Mai, 40 years old, paid her first visit on the 4th August 1991, with the chief complaint of pain in the heels after getting up in the morning for 5 years. The pain was gradually aggravated and so severe that she could only walk on the tiptoes. On examination, her tongue proper was reddened with whitish fur, the pulse was thready, and with no abnormal findings of the sole and calcaneus revealed on X-ray films. The condition was due to deficiency of yin,and obstruction of blood stasis in the channels and collaterals. Prescription of acupoints: bilateral Fengchi (GB 20) and Taixi (KI 3).

Efficacy of needling Baihui(GV20),Neiguan(PC6),Shenmen(HT7) and Taichong(LR3) on cerebral cortical blood oxygen level in rats with insomnia

OBJECTIVE:To evaluate the effect of needling Baihui(GV20),Neiguan(PC6),Shenmen(HT7) and Taichong(LR3) on cerebral cortical blood oxygen level in rats with insomnia identified as liver-Qi stagnation pattern in terms of Traditional Chinese Medicine.METHODS:Sixty Wistar rats were randomly divided into blank group(n = 10),the rest of the rats were clamped tail as stimulation combined with injected intraperitoneally p-chlorophenylalanine(PCPA) to establish sleep deprivation model.After the successful replication of the model,they were randomly divided into model group,grabbing group,Western Medicine group,acupuncture group and sham acupuncture group,with 10 rats in each group.The model group was given normal saline;The grasping group was grasped in the same way as the two treatment groups;Western medicine group was given estazolam solution;The acupuncture group was treated with the acupuncture method of "soothing the liver Qi and regulating mind" needling Baihui(GV20),Neiguan(PC6),Shenmen(HT7) and Taichong(LR3);The sham acupuncture group were needled with four nonacupoint sites.After 7 d of treatment of rats in each group,sodium pentobarbital sleep experiment was used to evaluate the sleep latency(SL) and sleep time(ST).The percentage of rats entering the open arm(OE%) and the percentage of time entering the open arm(OT%) in each group were monitored by elevated cross maze,and the vertical score,horizontal crossing times,central grid score and modification times were monitored by open field test,functional near infrared spectroscopy(f NIRs) was used to monitor the changes of oxygenated hemoglobin(Oxy-Hb),deoxyhemoglobin(Deoxy-Hb) and total hemoglobin(Total-Hb) in the cerebral cortex of rats in each group under light stimulation and dark stimulation,the statistically significant channel combinations were selected from 8 light sources and 12 detectors(S-D).According to the position of the light source detector covering the cerebral cortex,Preliminarily determine the key brain areas of insomnia(the preliminary experiment found that 6S-8D and 7S-9D were the key channels of insomnia under light stimulation,and the corresponding brain areas were prefrontal lobe and occipital lobe respectively;7S-7D channel under dark stimulation,and the corresponding brain area was occipital lobe);The hemodynamic map of cerebral cortex was constructed through the absolute value of whole brain blood oxygen level.Further identify key brain regions for insomnia.RESULTS:Compared with the blank group,ST,OE%,OT%,the vertical score,horizontal crossing times,central grid score,the concentration of Deoxy-Hb in prefrontal and occipital lobes were decreased significantly(P < 0.01),and the concentrations of SL,modification times,Oxy-Hb and Total-Hb were increased significantly(P < 0.01);There was no difference in the above indexes between the model group and the grabbing group(P > 0.05);After treatment,ST,OE%,OT%,the vertical score,horizontal crossing times,central grid score and DeoxyHb concentration in acupuncture group and Western medicine group increased significantly,while SL,modification times,Oxy-Hb and Total-Hb concentrations were decreased significantly(P < 0.01,P < 0.05),Compared with the Western Medicine group,the values of OE% and OT% were more significantly higher in the acupuncture group(P < 0.05),while the rest of the indexes were not significantly different between the two groups(P > 0.05);Compared with the acupuncture group,ST,OE%,OT%,the vertical score,horizontal crossing times,central grid score and the concentration of deoxy Hb in the sham acupuncture group decreased significantly(P < 0.01),and the concentrations of SL,modification times,Oxy-Hb and Total-Hb increased significantly(P < 0.01).CONCLUSIONS:The needling method for soothing the liver Qi and regulating mind could improve the abnormal behavior of insomnia rats with liver Qi stagnation,and its effect on the improvement of abnormal mood caused by insomnia with liver Qi stagnation is better than that of Western Medicine,and the mechanism of action may be related to the regulation of blood oxygen metabolism in the prefrontal and occipital lobes of the cerebral cortex by acupuncture.

Efficacy of electroacupuncture stimulating Shenmen(HT7),Baihui(GV20),Sanyinjiao(SP6)on spatial learning and memory deficits in rats with insomnia induced by para-chlorophenylalanine:a single acupoint vs combined acupoints

OBJECTIVE:To investiage the effect of electroacupuncture(EA)at a single acupoint of Shenmen(HT7),Baihui(GV20),Sanyinjiao(SP6)and at combined acupoints of Shenmen(HT7)and Baihui(GV20)and Sanyinjiao(SP6)on the PKA/CREB and BDNF/TrkB signaling,as well as neuroapoptosis and neurogenesis in hippocampus and elucidate the underlying mechanism of single and combined acupoints on ameliorating spatial learning and memory deficits in a rat model of primary insomnia.METHODS:Primary insomnia was modeled by intraperitoneal injection of para-chlorophenylalanine(PCPA)once daily for 2 d.EA was applied at Shenmen(HT7),Baihui(GV20),Sanyinjiao(SP6),or Shenmen(HT7)+Baihui(GV20)+Sanyinjiao(SP6)(combined)for 30 min daily for 4 d.Spatial learning and memory function was evaluated by the Morris water maze(MWM)test.Protein expressions of hippocampal cAMP-dependent protein kinase(PKA)-Cβ,phosphorylated cAMP-responsive element-binding protein(p-CREB),brainderived neurotrophic factor(BDNF),and tyrosine kinase receptor B(TrkB)were evaluated by Western blotting.Neuronal apoptosis in the hippocampus was detected with the transferase-mediated dUTP-X nick end labeling assay.Endogenous neurogenesis was examined with bromodeoxyuridine staining.The MWM test and hippocampal p-CREB,BDNF,and TrkB protein levels in the combined acupoints group were evaluated after the administration of a PKA-selective inhibitor(H89).RESULTS:Spatial learning and memory were significantly impaired in rats with insomnia.The spatial learning deficits were ameliorated in the Shenmen(HT7),Baihui(GV20),Sanyinjiao(SP6),and combined groups;this improvement was significantly greater in the combined group than the single acupoint groups.The spatial memory impairment was improved in the combined,Baihui(GV20),and Shenmen(HT7)groups,but not the Sanyinjiao(SP6)group.The expressions of PKA-Cβ,p-CREB,BDNF,and TrkB were decreased in rats with insomnia.All these proteins were significantly upregulated in the combined group.PKA/p-CREB protein levels were elevated in the Baihui(GV20)and Shenmen(HT7)groups,whereas BDNF/TrkB expression was upregulated in the Sanyinjiao(SP6)group.The staining results showed significant attenuation of hippocampal cell apoptosis and increased numbers of proliferating cells in the combined group,whereas the single acupoint groups only showed decreased numbers of apoptotic cells.In the combined group,the PKA inhibitor reversed the improvement of spatial memory and upregulation of pCREB expression caused by EA,but did not affect its activation of BDNF/TrkB signaling.CONCLUSIONS:EA at the single acupoints Baihui(GV20),Shenmen(HT7),or Sanyinjiao(SP6)had an ameliorating effect on the spatial learning and memory deficits induced by insomnia.EA at combined acupoints exerted a synergistic effect on the improvements in spatial learning and memory impairment in rats with insomnia by upregulating the hippocampal PKA/CREB and BDNF/TrkB signaling,facilitating neurogenesis,and inhibiting neuronal apoptosis.These findings indicate that EA at combined acupoints[(Baihui(GV20),Shenmen(HT7),and Sanyinjiao(SP6)]achieves a more pronounced regulation of hippocampal neuroplasticity than EA at single acupoints,which may partly explain the underlying mechanisms by which EA at combined acupoints exerts a better ameliorative effect on the cognitive dysfunction caused by insomnia.

Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia,anxiety and depression:a systematic review and Meta-analysis

OBJECTIVE:To evaluate the efficacy and safety of acupuncture and moxibustion therapy(AMT) for cancerrelated psychological symptoms(CRPS) of insomnia,depression and anxiety.METHODS:Seven databases were searched for randomized controlled trials(RCT) comparing AMT to routine care or conventional drug for alleviating CRPS of insomnia,depression,and anxiety before April 2020.Two independent reviewers performed the data extraction and assessed the risk of bias.RESULTS:A total of 30 RCTs involving 2483 cancer patients were enrolled.The pooled analysis indicated that the treatment group was significantly better than the control group in improving the depression effective rate [RR = 1.29,95% CI(1.12,1.49),P = 0.0004],the quality of life(QOL) [MD = 1.11,95% CI(0.80,1.42),P < 0.000 01],and reducing Self-rating Anxiety Scale(SAS) [MD =﹣7.75,95% CI(﹣10.44,﹣5.05),P < 0.000 01].But there was no statistically significant difference between two groups in improving the insomnia effective rate [RR = 1.18,95% CI(0.93,1.51),P = 0.18].The subgroup analysis showed the effectiveness of different intervention on CRPS.Compared with routine care,AMT helps relieve CRPS better evaluated by Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Scale(HAMD),and Self-rating Depression Scale(SDS),and depression effective rate.Compared with conventional drug,AMT performs better evaluated by SDS,depression effective rate and QOL.Moreover,the conventional drug showed higher treatment efficacy on improving insomnia effective rate compared with AMT.Compared to conventional drug,AMT plus conventional drug resulted in a significant reduction on CRPS such as PSQI,HAMD,SDS,and SAS,and also had a meaningful improvement on insomnia effective rate,depression effective rate and QOL.Fewer published reports were found on the adverse events of AMT than the conventional drug.CONCLUSION:The results suggested that AMT might be effective in improving CPRI;however,a definite conclusion could not be drawn because the quality of trials are low.Further large-scale and high-quality RCTs to verify the efficacy and safety of AMT on CRPS are still warranted.

Acupuncture Treatment of Insomnia——A Report of 28 Cases

Insomnia, also called hyposomnia, refers to the disorder characterized by failure to obtain a normal sleep. For mild cases, the patients are slow to go into sleep, or in an oneirism or with very short sleep. For severe cases, the patients can only have a sleep of 2 to 3 hours or even no sleep during the night, which inserts a serious impact on the normal life of the patients. Using Shenmen (HT 7) and Benshen (GB 13) as the main points, the author has treated 28 cases of insomnia with quick and satisfactory therapeutic effect. A report follows.

Clinical Application of the Du Channel

The authors have, in recent years, obtained quite good therapeutic results in their acupuncture treatment of mental diseases, heat syndromes and cerebrovascular diseases through treating mainly the Du Channel with the methods of resuscitating and regulating the mind, and clearing and activating the channels and collaterals. The illustrative cases are reported below.

46 CASES OF INSOMNIA TREATED BY SEMICONDUCTOR LASER IRRADIATION ON AURICULAR POINTS

Insomnia is a commonly encounteredsymptom in clinical practice. The author hastreated it by using semiconductor laserirradiation on auricular points with satisfactorytherapeutic results. A report is presented asfollows.General DataIn this series, there were 46 cases

Clinical Observation on Acupuncture Treatment of Insomnia in 35 Cases

Since 1998, the author of this article has treated 35 cases of insomnia with body acupuncture plus the plum-blossom needle tapping, and obtained satisfactory results as reported in the following.

Distribution of elements extracted from symptom patterns and characteristics of polysomnograph of common symptom patterns of insomnia with Traditional Chinese Medicine

OBJECTIVE: To analyze the distribution and combined regulation of elements of symptom patterns in the diagnosis of insomnia with Traditional Chinese Medicine(TCM).METHODS: The samples were collected from the patients, diagnosed with insomnia, of Henan Province Hospital of TCM between June 2011 and September 2013. The symptom patterns in insomnia were extracted. Next, symptom differentiation,characteristics of polysomnography(PSG), distribution and combined regulation of these symptom patterns were conducted by tests.RESULTS: In total, 286 eligible patients were recruited. The main locations of the disease symptom elements were the brain and heart, and the main characteristics of the disease symptom elements were phlegm-heat, Yin-deficiency and Qi-stagnation. The elements from two or three symptom patterns were commonly manifested in patients with insomnia, especially from three symptom patterns. We also found that all TCM symptom patterns had an effect on polysomnographic indicators in PSG tests.CONCLUSION: The elements of symptom patterns in insomnia were identified as mainly fire-heat and phlegm-heat. The most common patterns of excess were pathogenic fire derived from stagnation of liver-Qi, and mental disturbance due to phlegm-heat,while the most common patterns of deficiency in both the heart and the spleen. There are many differences in PSG indicators of different syndrome patterns of insomnia.

Curative effect of acupuncture and moxibustion on insomnia: a randomized clinical trial

OBJECTIVE: To observe the effect of acupuncture and moxibustion on insomnia and explore its mechanism. METHODS: One hundred and twenty patients were randomly divided into an experiment group and a control group. Sixty patients in the experiment group were treated once a day with acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Shenmai (BL 62), and Zhaohai (KI 6) and with moxibustion at Baihui (GV 20) and Sishencong (EX-HN 1). Sixty patients in the control group were acupunctured once a day at Shenmen (HT 7), Neiguan (PC 6), and Sanyinjiao (SP 6).The Pittsburgh Sleep Quality Index (PSQI) was used to compare sleep improvement between the two groups. RESULTS: The total effective rate was 87.7% in the experiment group and 76.3% in the control group. The PSQI scores and the total score were lower after treatment than before treatment in bothgroups. However, the reduction in the experiment group was greater than that in the control group in sleeping quality, time to fall asleep, sleeping disorder, and daytime function (P<0.05). CONCLUSION: Acupuncture and moxibustion at Baihui (GV 20), Sishencong (EX-HN 1), Shenmai (BL 62), and Zhaohai (KI 6) significantly improved insomnia symptoms in the experiment group compared with the control group.

Efficacy of Huadananshen mistura on insomnia: a randomized, double-blind, placebo-controlled, and multi-center clinical trial

OBJECTIVE: To evaluate the effect of Huadananshen mistura in clinical treatment of Chinese patients with insomnia. METHODS: In this randomized, double-blind, placebo-controlled, multi-center study, 244 patients with insomnia were randomly assigned to a placebo group, a low-dose (10 mL/day), or a high-dose (20 mL/day) mistura group. Efficacy was assessed by using the sleep dysfunction rating scale (SDRS) and Clinical Global Impression-Improvement (CGI-I) scores. Safety and tolerability assessments included emergent adverse events, laboratory tests, and electrocardiograms. RESULTS: Total SDRS scores decreased in all three groups, and there were significant differences between the placebo group and the lowand high-dose mistura groups (P=0.000). CGI-I ratings in the lowand high-dose mistura groups were sig-nificantly better than that of the placebo group (P= 0.000). Incidences of rebound insomnia were similar in all three groups (placebo group: 6.94% , low-dose mistura group: 12.99% , and high-dose mistura group: 10.96% ; P=0.475). The efficacy of Huadananshen mistura in the lowor high-dose group was significantly better than that of the placebo group (P=0.000), but with no significant difference found between the lowand high-dose mistura groups (P=0.887). The rates of adverse events were similar in the three groups (placebo 2.44% , low-dose mistura 0%, and high-dose mistura 5%; P=0.088). CONCLUSION: Huadananshen mistura is an effective and generally well-tolerated hypnotic medicine for the treatment of Chinese patients with insomnia.

Efficacy of Zhenjingdingzhi decoction in treating insomnia with Qi-deficiency of heart and gallbladder:a randomized,double-blind,controlled trial

OBJECTIVE: To evaluate the clinical efficacy of Zhenjingdingzhi decoction in treating insomnia with Qi-deficiency of heart and gallbladder.METHODS: We conducted a double-blind,randomized,controlled trial involving 100 patients with insomnia of Qi-deficiency of heart and gallbladder.Patients were randomly divided into the treatment group(n = 50) and the control group(n = 50) according to a random number table. The treatment group was given Zhenjingdingzhi decoction,while the control group was treated with Suanzaoren decoction. the pharmacological treatment lasted for 8weeks. The clinical efficacy was assessed by using Spiegel scale,Pittsburgh sleep quality index(PSQI)and Traditional Chinese Medicine(TCM) syndrome scores.RESULTS: Comparing Spiegel scores between the two groups at 4 and 8 weeks,the differences in curative effect between the two groups were both significant(both P < 0.05). The total effective rate was46% in the treatment group and 27.7% in the control group at 4 weeks,and 80% and 53.2% at 8weeks,respectively; After 8 weeks,PSQI scores showed that the total effective rates differed significantly between the two groups(P < 0.01): 84% in the treatment group and 59.6% in the control group; In improving sleep quality and sleep duration,the curative effect of the treatment group was better than that of the control group(P < 0.05).TCM syndrome,especially insomnia and palpitation,was improved better in the treatment group after 8 weeks as compared to that in the control group(P < 0.05). The total effective rate of the two groups was 84% and 66%,respectively.CONCLUSION: Zhenjingdingzhi decoction is effective and safe for the treatment of insomnia with Qi-deficiency of heart and gallbladder,especially for improving sleep quality and sleep duration.