Actigraphy: A new diagnostic tool for hepatic encephaiopathy

AIM： To assess the actigraphy, an ambulatory and continuous monitoring of wrist motor activity fitted to study sleep/wake patterns in hepatic encephalopathy （HE）. METHODS： Twenty-five cirrhotic patients （17 M, 8 F, mean age 56± 11 years, 24/25 alcoholic, Child-Pugh A, B, C： 2, 6, 17） were included. The patients were classified into 3 groups： stage 0 group （n = 12）, stage 1-2 group （n = 6）, and stage 3-4 group （n = 7） of encephalopathy. Over three consecutive days, patients had clinical evaluation 3 times a day with psychometric test, venous ammoniemia, flash visually evoked potentials （VEP）, electroencephalogram and continuous actigraphic monitoring for 3 d, providing 5 parameters： mesor, amplitude, acrophase, mean duration of activity （MDAI） and inactivity （MDII） intervals. RESULTS： Serum ammonia and VEP did not differ among the 3 groups. Electroencephalography mean dominant frequency （MDF） correlated significantly with clinical stages of HE （r=0.65, P=0.003）. The best correlation with HE stage was provided by actigraphy especially with MDAI （r= 0.7, P〈10^-4） and mesor （r= 0.65, P〈 10^-4）. MDAI correlated significantly with MDF （r= 0.62, 0.004） and was significantly shorter in case of HE compared to patients without HE （stage 0： 5.33± 1.6 min; stage 1-2：3.28±1.4 min; stage 3-4：2.52±1.1 min; P〈0.05）. Using a threshold of MDAI of less than 4.9 min, sensitivity, specificity, positive predictive value, negative predictive value for HE diagnosis were 85%, 67%, 73% and 80%, respectively. CONCLUSION： Actigraphy may be an objective method to identify HE, especially for early HE detection. Motor activity at the wrist correlates well with clinical stages of HE. MDAI and mesor are the most relevant parameters.

Practice parameters for the use of actigraphy in the military operational context: the Walter Reed Army Institute of Research Operational Research Kit-Actigraphy(WORK-A)

Background: The Walter Reed Army Institute of Research(WRAIR) Operational Research Kit-Actigraphy(WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States Army Reserve Officers’ Training Corps(ROTC) cadets(n=286) during a month-long capstone pre-commissioning training exercise.Methods: The sleep of ROTC cadets(n=286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets(n=140).Results: Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep(P≤0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime(22:21±1:30 vs. 22:13±0:40, P=0.21) and waketime(04:30±2:17 vs. 04:31±0:47, P=0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed(TIB) for major sleep intervals(352±29) min and self-report nightly sleep duration [(337±57) min, P=0.006] than that between the WORK-A major TIB and Actiware TIB [(177±42) min, P≤0.001].Conclusions: Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.

Sleep Posture Affects Sleep Parameters Differently in Young and Senior Japanese as Assessed by Actigraphy

In an attempt to study the relationship between sleep postures and sleep parameters assessed by actigraphy, we applied the newly developed Activity Monitoring and Evaluation System (A-MES) and actigraphy at the same time to younger and senior Japanese volunteer groups. It was found that sleep postures and diurnal activity determines, to some extent, sleep parameters including activity mean score (AMS), activity index (ACTX), waking episodes (WEP) and sleep fragmentation index (SFX). It was also found that sleep properties are different in younger and senior Japanese. For example, increase in the proportion of time in the supine position resulted in enhancement and deterioration of the sleep in the younger and senior groups, respectively. Furthermore, there were correlations between supine posture and AMS, ACTX, SFX, total minutes scored as awake (TMSA) and WEP obtained by actigraphy in the younger group, but only AMS and ACTX in senior group. In addition, we also assessed sleep parameters by use of questionnaires, and found that objective sleep quality was rather poor but subjective sleep quality was better in the senior group. In the younger group, in contrast, objective sleep quality was better but subjective sleep quality was poor. On the other hand, there was no correlation between sleep parameters assessed by actigraphy and self-report at all. The present study with A-MES and actigraphy provides the first evidence that sleep posture affects sleep quality and is a convenient, inexpensive and home-based method for studying sleep.

SOOJI CHIM (Koryo hand acupuncture) for perimenopausal insomnia:Evidence from actigraphy and serum hormone testing

Objective:This study is conducted to determine the effects of SOOJI CHIM(Koryo hand acupuncture,KHA)therapy on sleep structures and perimenopause symptoms among insomniacs.Methods:Totally 49 participants who met the inclusion criteria were enrolled in a two-arm randomized,placebo controlled,patients-blind trial,with 24 cases allocated to a real-KHA group and 25 cases allocated to a sham-KHA group.Patients in each group received corresponding treatment every other day,three times a week for total eight weeks.Both actigraphy and testing of serum hormones level reflected by biological markers such as follicle-stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were performed at pre-and post-treatment.Additionally,the scores of Pittsburgh sleep quality index(PSQI)was used for assessing the subjective sleep experience of insomniacs.Meanwhile,adverse effects were monitored and recorded.Results:After eight-week treatment,the global scores of PSQI declined significantly(P<0.05)in the realKHA group but not in the sham-KHA group(P>0.05).According to the outcomes of actigraphy,a striking increase was observed in both sleep efficiency(SE)and total sleep time(TST)in the real-KHA group(both P<0.05)but not in the sham-KHA group(P>0.05).However,no significant changes of sleep awakenings(SA)in both groups was found after treatment(both P>0.05).Meanwhile,FSH and LH in the real-KHA group decreased markedly after intervention(both P<0.05)while those indicators only slightly changed in the sham-KHA group(P>0.05).The fluctuation of E2 levels were not significant in both groups(both P>0.05).No serious adverse event was reported in either real-or sham-KHA group.Conclusion:KHA may be a potential alternative therapy for improving perimenopausal insomnia via down regulating the levels of FSH and LH.

Therapeutic effect of melatonin on pediatric functional dyspepsia: A pilot study

AIM: To study the effectiveness of melatonin vs placebo in children with functional dyspepsia(FD).METHODS: The study was conducted as a double blind, randomized, placebo controlled crossover trial. Subjects were aged 8-17 years and diagnosed with FD based on Rome Ⅲ criteria. All subjects had failed to respond to 4 wk of acid suppression. Subjects receive a continuous two weeks of placebo and a continuous two weeks of melatonin in an order blinded to the participant and the study team. A Global Clinical Score was obtained to assess changes in abdominal pain. Pain was self-reported to be worse(grade 1), no change(grade 2), moderate improvement(grade 3), good(grade 4; minimal pain and not interfering with daily activities), or excellent(grade 5; no pain), respectively. A positive clinical response was defined as a grade 3 or greater response. Subjects wore an actigraph to assess sleep during a one week baseline period and during each treatment period. Subjects' sleep latency and total sleep time were recorded throughout the duration of the study. RESULTS: Fourteen subjects were enrolled and 12 completed the study. One withdrew prior to starting both melatonin and placebo and the other before starting melatonin. A positive clinical response(grade 3-5) was achieved in 42% of subjects on melatonin vs 50% of subjects on placebo(NS). Effect size was calculated and revealed a Cohen's D of 0.343 which demonstrates a medium effect favoring placebo. A grade 4 or grade 5 response was seen in 4 patients on melatonin and 5 patients on placebo. Baseline sleep parameters were in the healthy range with the longest sleep latency being just over 20 min(mean 7.46 ± 8.53 min) and the shortest sleep duration just over 7 h(mean 10.09 ± 2.72 h). The mean latency did not differ between periods of treatment with melatonin as compared to placebo(4.48 ± 6.45 min vs 3.58 ± 4.24 min; NS). The mean sleep duration did not differ between periods of treatment with melatonin as compared to placebo(9.90 ± 3.53 h vs 9.41 ± 2.70 h; NS).CONCLUSION: Melatonin does not appear to have efficacy in relieving pain in unselected pediatric FD. Future studies should consider FD subtypes, pathophysiologic mechanisms, and baseline sleep disturbances.

Sleep quality improved following a single session of moderate-intensity aerobic exercise in older women:Results from a pilot study

Background： Poor sleep quality is associated with adverse effects on health outcomes. It is not clear whether exercise can improve sleep quality and whether intensity of exercise affects any of the effects. Methods： Fifteen healthy, non-obese （body mass index = 24.4 ± 2.1 kg/m^2, mean 4- SD）, sedentary （〈20 min of exercise on no more than 3 times/week） older women （66.1 ± 3.9 years） volunteered for the study. Peak oxygen consumption （VO2peak） was evaluated using a graded exercise test on a treadmill with a metabolic cart. Following a 7-day baseline period, each participant completed two exercise sessions （separated by 1 week） with equal caloric expenditure, but at different intensities （60% and 45% VO2peak, sequence randomized） between 9：00 and 11：00 am. A wrist ActiGraph monitor was used to assess sleep at baseline and two nights following each exercise session. Results： The average duration of the exercise was 54 and 72 rain, respectively at 60% （moderate-intensity） and 45% VO2peak （light-intensity）. Wake time after sleep onset was significantly shorter （p = 0.016）, the number of awakenings was less （p = 0.046）, and total activity counts were lower （p = 0.05） after the moderate-intensity exercise compared to baseline no-exercise condition. Conclusion： Our data showed that a single moderate-intensity aerobic exercise session improved sleep quality in older women.

Sleep conditions and quality of life among patients with ischemic heart disease after elective percutaneous coronary intervention

In Japan, percutaneous coronary intervention (PCI) is a major therapeutic intervention for ischemic heart disease (IHD). Previous studies suggested that an association of the risk of IHD caused by sleep duration was related to factors closely associated with daily activities. However, in Japan, there is no study about this relationship objectively measured using the actigraphy in patients with IHD. Moreover, there is little reported data about sleep condition and early outcomes of patient’s Health-Related Quality of Life (QOL) after PCI. This study determines the correlations between sleep conditions and QOL (measured by SF36 version 2) of 25 patients with IHD who underwent elective PCI. Data were collected seven days after PCI using night-sleep condition. Using Spearman’s rank test, the results revealed positive correlation between vitality score and longest sleep duration (ρ = 0.43, p = 0.031): social functioning (SF) score and duration of night-time sleep (ρ = 0.42, p = 0.037);total sleep duration (ρ = 0.45, p = 0.026), and longest sleep duration (ρ = 0.44, p = 0.024);mental health score and longest sleep duration (ρ = 0.54, p = 0.006). However, negative correlation was found between physical functioning score and arousal during sleep (ρ = -0.44, p = 0.027). Sleep condition was significantly correlated with QOL. In particular, SF score was positively related to night-time sleep. This seems to indicate that SF score might be related to night-time sleep condition. Moreover, the longest sleep durations were correlated with the mental component summary. The results of the study suggest that not only the length of whole sleep durations leads to better QOL, but also the increase the amount of uninterrupted sleep.

Daily Activities and Sleep Durations of Patients with Ischemic Heart Disease Who Were Discharged to Their Homes after Elective Percutaneous Coronary Intervention

The purpose of this study was to examine the relationship between daily activities and sleep durations for patients following elective percutaneous coronary intervention (ePCI) and diagnosed with ischemic heart disease (IHD) after discharge to their homes. The actigraph data were used to collect data from twenty five patients. The duration of night-time sleep (minutes from the start to end of night-time) and actual night-time sleep duration (total sleep duration excluding wake-up durations of night-time) on the seventh day after discharge were divided into three groups;less than 360, 360 to 480, and more than 480 minutes (short, optimal and long respectively). Subsequently, among the three groups of patients, the data were analyzed by Kruskal Wallis H-test with multiple comparison procedures using the Scheffé-test in order to compare differences in daytime activity items at seven days after discharge from the hospital. Total daytime nap duration (p p p p < 0.05). However, the duration of night-time sleep and daytime activity did not significantly differ. If actual night-time sleep duration is improved from 360 to 480 minutes, daytime nap could potentially be decreased. Determining objective sleep conditions for patients and treating sleep disorders may improve overall patient health, facilitating appropriate sleep and wake rhythms.

The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus

The aim of this study was to determine the relationship between sleep condition and autonomic nervous function of women in their 70s with type 2 diabetes mellitus by analyzing the activity counts (AC) on actigraphs and heart rate variability (HRV). Ten healthy women in their 30s to 40s as control and four women patients with type 2 diabetes in their 70s wore the electrocardiograph and an actigraph for 24 hours while keeping a diary of activities, including their sleep and food intake. The Pittsburgh Sleep Quality Index was used to assess subjective sleep conditions. The subjective sleeping results were significantly correlated with those measured by the AC and HRV. However, AC and HRV correlation pattern showed different activity in the patients with type 2 diabetes mellitus. The quality of sleep of those with chronic diabetes was not good even if their HbA1c was well controlled. Furthermore, their automatic nervous function was different from the control group. The sleeping hours of patients with type 2 diabetes were shorter or longer than those of healthy women. Ultimately, this study maintains that it is important to examine automatic nervous functions using objective examination index during the early stage of diabetes mellitus.

Feasibility and acceptability of wrist actigraph in assessing sleep quality and sleep quantity: A home-based pilot study in healthy volunteers

Purpose: This study aimed to determine the feasibility and acceptability of actigraphy to monitor sleep quality and quantity in healthy self-rated good sleeper adults at home-based settings. Method: Sixteen healthy volunteers (age > 18) were invited to participate. Each participant was provided with a wrist actigraph device to be worn for 24-hour/day for seven consecutive days to monitor their sleep-wake patterns. Actigraphy data were downloaded using-proprietary software to generate an individual-sleep report. Participants also completed a set of self-reported Health Related Quality of Life (HRQOL) using WHO (five) Well Being Index (WBI) questionnaires. Results: Actigraphy was well accepted by all participants. Only 43.8% of the participants achieved normal total sleep time (TST) and 62.5% had a mean sleep efficiency value below the normal range. Despite a reduced quality of sleep among the participants, the self-reported HRQOL scores produced by the WHO-5 WBI showed a “fair” to “good” among the participants. Conclusions: To maintain healthy well-being, it is vital to have efficient and quality sleep. Insufficient and poor sleep may contribute to various health problems and hazardous outcomes. People often believe they have normal and efficient sleep, not realising they may be developing poor sleep habits. This study found that actigraphy can be easily utilized to monitor sleep-wake patterns at home-based settings. We proposed that actigraphy could be adapted for use in the primary care settings (e.g. community pharmacy) to improve the sleep health management in the community.

Deconstructing athletes’sleep:A systematic review of the influence of age,sex,athletic expertise,sport type,and season on sleep characteristics

Purpose:This systematic review aimed to describe objective sleep parameters for athletes under different conditions and address potential sleep issues in this specific population.Methods:PubMed and Scopus were searched from inception to April 2019.Included studies measured sleep only via objective evaluation tools such as polysomnography or actigraphy.The modified version of the Newcastle-Ottawa Scale was used for the quality assessment of the studies.Results:Eighty-one studies were included,of which 56 were classified as medium quality,5 studies as low quality,and 20 studies as high quality.A total of 1830 athletes were monitored over 18,958 nights.Average values for sleep-related parameters were calculated for all athletes according to sex,age,athletic expertise level,training season,and type of sport.Athletes slept on average 7.2±1.1 h/night(mean±SD),with 86.3%±6.8%sleep efficiency(SE).In all datasets,the athletes’mean total sleep time was<8 h.SE was low for young athletes(80.3%±8.8%).Reduced SE was attributed to high wake after sleep onset rather than sleep onset latency.During heavy training periods,sleep duration and SE were on average 36 min and 0.8%less compared to pre-season and 42 min and 3.0%less compared to in-season training periods,respectively.Conclusion:Athletes’sleep duration was found to be short with low SE,in comparison to the general consensus for non-athlete healthy adults.Notable sleep issues were revealed in young athletes.Sleep quality and architecture tend to change across different training periods.

Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder

The purpose of this case study was to examine the changes before and after improvements of the subjective sleep status of Mr A, a 40-year-old man diagnosed with pre-diabetes and a sleep disorder. Data were collected using a Holter monitor for 24 hours a day for 3 days to assess autonomic nervous activity by recording bed-time and waking time activity (activity counts: ACs). Mr. A kept a diary of activities and completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The study revealed that subjective sleeping hours correlated almost precisely with those measured by the actigraph and as described in the diary. Both the parasympathetic and sympathetic nervous system activities were imbalanced. However, no correlation was observed between the ACs and autonomic nervous activity. Subjective sleep state according to the PSQI score improved remarkably by dietary and exercise therapy from 13 to 3 points, after six months, with corresponding high level sleep satisfaction level. Significant correlations were observed between ACs and high-frequency spectral power of R-R intervals, and between ACs and the low-frequency/high frequency ratio of spectral power of R-R intervals. Although Mr. A’s sleep satisfaction level has improved, the autonomic nervous system activity remained different from that of healthy people.

Dimensional Characteristics of Children and Adolescents with Mood Disorders and Autism Spectrum Disorders

Objective: We sought to identify clinical discriminators between predominantly mood disordered and predominantly autism spectrum disordered research subjects that may reflect phenotypic state and treatment response characteristics. Method: Participants were 26 boys and 4 girls aged 2 to 18 years (Mean Age = 7.70). Subjects with DSM-IV diagnoses of Major depression (N = 2), Bipolar Disorder (N = 4) and Mood Disorder not otherwise specified (NOS) (N = 11) represented the mood disorder group (MD) (N = 17, Mean Age = 8.2) and those with diagnoses of Autistic Disorder (N = 1), Asperger’s Disorder (7) or Pervasive Developmental Disorder (NOS) (N = 3) comprised the autism spectrum disorder (ASD) group (N = 9, Mean Age = 6.8). Primary outcome measurements were continuous actigraphic measurements collected over one to three week periods. Secondary outcomes included personality and observational measurements. Personality characteristics reflected significant cross-group impairments related to self-control and self-discipline and differed relative to intellectual measures. Observational measurements reflected greater general impairments among the ASD group. Results: Predominantly mood disordered children demonstrated greater impairments related to sleep (P = 0.000) and sleep onset latency (P = 0.000) and were more active than ASD children during evening periods (P = 0.000). ASD children had lower verbal functioning and greater deviations from the norm on measures of cognitive development (P = 0.003) and psychosis (P = 0.047). Conclusions: Sleep disturbances, evening activity levels and phase delayed sleep appear to differentiate predominant mood and autism spectrum disordered children suggesting future areas for further exploration of neurological and phenotypic treatment response characteristics.

Alternating sleeping arrangements as a coping strategy for snorers and their bed partners—A prospective study

Background: Despite overwhelming evidence for gender differences in sleep quality as well as gender-specific changes of sleep parameters with respect to habitual sleeping arrangements, studies on snorers and their bed partners have ignored the influence of individual quality of sleep as a potential co-factor. Objective: The objective of this study was to record subjective and objective sleep parameters and to analyze the effects of alternating of sleeping arrangements in snorers and their bed partners. Methods: Habitual snorers and their bed partners were recruited via newspaper articles not stating the exact purpose of the study. Both filled out a 90-day sleep diary. During this time, we recorded subjective and objective sleep parameters in the snorers and their bed partners via wrist actigraphy and sleep diaries for 14 days. For statistical analysis, we used two-sided t-tests and Spearman’s Rho. Results: The dataset included 45 snorers (11 females) and 45 bed partners (34 females) with a mean age of 47 ± 13 and 43 ± 12 years. Screening for sleep apnea yielded snoring without OSAS, mild-, moderate- and severe OSAS in 27 (60%), eight (18%), three (7%) and six (15%) snorers. PSQI total scores were significantly lower in snorers than in bed partners (4 ± 2 vs. 6 ± 4, p = 0.002). We could not find a significant correlation between subjective and objective sleep latency and efficiency. Couples who changed their sleeping arrangement were significantly younger than those who habitually slept alone or together (p = 0.01). Subjective sleep parameters of snorers or bed partners were not related to the number of consecutive nights spent either together or apart. Conclusions: Our study confirmed the weak correlation of subjective and objective sleep parameters in pairs with snoring problems. Couples changing their sleeping arrangement were the youngest among the whole group, but their separation of sleeping arrangements did not improve subjective sleep parameters.

Overview of smartphone applications for sleep analysis

Objective:To review and assess the current selection of sleep analysis smartphone applications (apps) available for download. Methods:The iOS and Google Play mobile app store were searched for sleep analysis apps tar-geted for consumer use. Alarm clock, sleep-aid, snoring and sleep-talking recorder, fitness tracker apps, and apps geared towards health professionals were excluded. App information and features were obtained from in-store descriptions, and the app developer website. Results:A total of 51 unique sleep apps in both iOS and Google Play stores were included. The apps were rated 3.8/5 in both stores, and had an average price of$1.12 in the iOS store and$0.58 in the Google Play store.>65%of sleep apps report on sleep structure, including dura-tion, time awake, and time in light/deep sleep, while reporting of REM was limited. The avail-ability of extra features was variable, ranging from 4%to 73%of apps. Conclusions:There are a variety of sleep analysis apps with a range of functionality. The apps with the most reviews from the each store are featured. Many apps provide data on sleep structure;however the algorithms are not validated by scientific literature or studies. Since patients may inquire about their sleep habits from these apps, it is necessary for physicians to be aware of the most common apps and the features offered and their limitations in order to properly counsel patients. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Ambulatory clinical parameters and sleep respiratory events in a group of obese children unselected for respiratory problems

Background:Obstructive sleep apnea in children is frequently due to tonsil and adenoid hypertrophy.This study aimed to investigate the relationship between ambulatory clinical parameters and sleep respiratory events in obese children.Methods:We carried out a prospective respiratory sleep study between 2013 and 2015.Nails obstruction,tonsils enlargement and palate position were subjectively measured.Italian attention deficit hyperactivity disorder (ADHD) rating scale for parents was also performed.The polygraph study was performed using a portable ambulatory device.Results:Forty-four obese children were consecutively recruited into this study.Mild sleep respiratory disturbance was showed in 31.8 % of patients;18.2% previously had an adeno (tonsillectomy).In 50% of these obese children,both apnea-hypopnea index and oxygen desaturation index showed polygraph abnormal results.ADHD rating scale for parents scores were positive in 9.1% of patients.Conclusions:We found a high rate of mild sleep respiratory disturbance and ADHD-like symptoms referred by parents.The respiratory disturbance was not totally cured by surgery.Finally,otorhinolaryngology variables were not able to explain mild sleep respiratory disturbance.

Acupuncture treatment of a male patient suffering from long-term schizophrenia and sleep disorders

OBJECTIVE: To investigate the effectiveness of acupuncture in the treatment of chronic schizophrenia and co-morbid sleep disorders.METHODS: A 42-year-old German male outpatient,suffering from long-term schizophrenia and sleep disorders, entered the study. Acupuncture was used as a non-pharmacological intervention. In addition to his ongoing Western Medicine(pharmacological) treatment, the patient received 12 weekly(non-standardized) acupuncture treatments in the clinic. The Traditional Chinese Medicine(TCM) diagnosis, the psychological assessment and the actiwatch data were compared before and after the acupuncture treatment.RESULTS: The TCM diagnosis revealed a Liver Fire pattern before the acupuncture treatment, which was still present, although to a lesser degree, after the treatment. The psychological assessment revealed no change in the positive symptoms, but a small decrease in the negative symptoms and the general psychopathology of the patient. This was further illustrated by the small decrease in the number of depressive symptoms. The subjective sleep disorders improved markedly after acupuncture treatment, but the daytime sleepiness did not. The actiwatch results showed that after acupuncture treatment, the patient was moving less during sleep, but no significant results were found for the other sleep parameters.CONCLUSION: Acupuncture was found to be an effective non-pharmacological add-on method for treating subjective sleep disorders, and, to a lesser degree, objective sleep disorders and the negative symptoms of chronic schizophrenia. Future larger clinical trials with follow-up measurements are needed in order to replicate the present preliminary beneficial acupuncture findings and in order to determine whether the observed effects can be sustained.

Correlation study of sleep efficiency with C-reactive protein and IL-6 in patients with infective endocarditis

Background Sleep disorders have been found in patients with infective endocarditis(IE)and are reported to have a strong correlation with inflammation. In this study,we measured the serum levels of inflammatory factors and evaluated the correlations of postoperative sleep efficiency with C-reactive protein and interleukin-6(IL-6)in IE patients. Methods A total of 117 post-operative patients with IE were enrolled in the study. All patients were tested using a wearable actigraphy device for their sleep efficiency. All patients were examined for C-reactive protein,and 72 patients were tested for IL-6. Results A correlation analysis was performed between C-reactive protein and IL-6. The average sleep efficiency of most of the IE patients was 80.81±8.52%,and the average result of the C-reactive protein test was 29.98±26.3 mg/L. The correlation coefficient between sleep efficiency and C-reactive protein was-0.3011. The average result of the IL-6 test was 24.52±23.85 pg/mL,and the correlation coefficient between sleep efficiency and IL-6 was-0.3543. Conclusions Postoperative sleep efficiency is negatively correlated with serum levels of C-reactiveprotein and IL-6 in patients with IE.[S Chin J Cardiol2019;20(2):103-107]

Sleep and stress in the acute phase of concussion in youth

This study sought to address the complex interplay between both biological and psychological perceptions of stress and sleep in the acute stages following a mild traumatic brain injury.A secondary goal was to identify potential targets for intervention.Eleven acutely injured youth(mean age 12 years)were studied at home with overnight actigraphy,salivary cortisol and melatonin assays,and subjective ratings of stress and fatigue(injured group).Nine matched control youth also were assessed(control group).Results suggested longer sleep latencies(time to fall asleep)and higher levels of fatigue in the injured group exist(p=0.025 and p=0.004,respectively).In the injured group,stress and sleep onset were significantly related with most subjects meeting criteria for Acute Stress Disorder.Melatonin levels were lower at bedtime in the injured group.Saliva samples were collected via passive drool at three time points:~1 h before bed(“bedtime”or T1),immediately upon waking(time 2:T2),and 30 min post-waking(time 3:T3).Overnight increases in cortisol(T1 to T2)were greater for the injured group;however,post-sleep changes in cortisol(T2 to T3)were reversed with control concentrations increasing.These findings are unique in using actigraphy and salivary hormone levels in an acutely injured youth while in their homes.The differences in sleep latency and the presence of injury-related stress point to potential treatment targets in acute concussion.