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.

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.

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.

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.

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.

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.