Near-infrared brain functional characteristics of mild cognitive impairment with sleep disorders

BACKGROUND Mild cognitive impairment(MCI)has a high risk of progression to Alzheimer’s disease.The disease is often accompanied by sleep disorders,and whether sleep disorders have an effect on brain function in patients with MCI is unclear.AIM To explore the near-infrared brain function characteristics of MCI with sleep disorders.METHODS A total of 120 patients with MCI(MCI group)and 50 healthy subjects(control group)were selected.All subjects underwent the functional near-infrared spec-troscopy test.Collect baseline data,Mini-Mental State Examination,Montreal Cognitive Assessment scale,fatigue severity scale(FSS)score,sleep parameter,and oxyhemoglobin(Oxy-Hb)concentration and peak time of functional near-infrared spectroscopy test during the task period.The relationship between Oxy-RESULTS Compared with the control group,the FSS score of the MCI group was higher(t=11.310),and the scores of Pittsburgh sleep quality index,sleep time,sleep efficiency,nocturnal sleep disturbance,and daytime dysfunction were higher(Z=-10.518,-10.368,-9.035,-10.661,-10.088).Subjective sleep quality and total sleep time scores were lower(Z=-11.592,-9.924).The sleep efficiency of the MCI group was lower,and the awakening frequency,rem sleep latency period,total sleep time,and oxygen desaturation index were higher(t=5.969,5.829,2.887,3.003,5.937).The Oxy-Hb concentration at T0,T1,and T2 in the MCI group was lower(t=14.940,11.280,5.721),and the peak time was higher(t=18.800,13.350,9.827).In MCI patients,the concentration of Oxy-Hb during T0 was negatively correlated with the scores of Pittsburgh sleep quality index,sleep time,total sleep time,and sleep efficiency(r=-0.611,-0.388,-0.563,-0.356).It was positively correlated with sleep efficiency and total sleep time(r=0.754,0.650),and negatively correlated with oxygen desaturation index(r=-0.561)and FSS score(r=-0.526).All comparisons were P<0.05.CONCLUSION Patients with MCI and sleep disorders have lower near-infrared brain function than normal people,which is related to sleep quality.Clinically,a comprehensive assessment of the near-infrared brain function of patients should be carried out to guide targeted treatment and improve curative effect.

Non-alcoholic fatty liver disease and sleep disorders

Studies have shown that non-alcoholic fatty liver disease(NAFLD)may be associated with sleep disorders.In order to explore the explicit relationship between the two,we systematically reviewed the effects of sleep disorders,especially obstructive sleep apnea(OSA),on the incidence of NAFLD,and analyzed the possible mechanisms after adjusting for confounding factors.NAFLD is independently associated with sleep disorders.Different sleep disorders may be the cause of the onset and aggravation of NAFLD.An excessive or insufficient sleep duration,poor sleep quality,insomnia,sleep-wake disorders,and OSA may increase the incidence of NAFLD.Despite that some research suggests a unidirectional causal link between the two,specifically,the onset of NAFLD is identified as a result of changes in sleep characteristics,and the reverse relationship does not hold true.Nevertheless,there is still a lack of specific research elucidating the reasons behind the higher risk of developing sleep disorders in individuals with NAFLD.Further research is needed to establish a clear relationship between NAFLD and sleep disorders.This will lay the groundwork for earlier identification of potential patients,which is crucial for earlier monitoring,diagnosis,effective prevention,and treatment of NAFLD.

Screening of Effective Traditional Chinese Medicine Monomer Compounds for the Treatment of Nonorganic Sleep Disorders Based on Network Pharmacology

[Objectives] To find effective monomer compounds of traditional Chinese medicine targeting nonorganic sleep disorders.[Methods] The reverse thinking of "target-compound" was adopted to search for effective traditional Chinese medicine monomer compounds that intervene in the core targets of nonorganic sleep disorders, and molecular docking technology was used to verify the traditional Chinese medicine monomer compounds that meet the expected goals.[Results] Based on the storm related targets of nonorganic sleep disorders, five monomer compounds of traditional Chinese medicine were screened, namely paeoniflorin, chlorogenic acid, quercetin, baicalin, and ginsenoside Rg1. These monomer compounds of traditional Chinese medicine act on multiple targets such as CASP8, IKBKB, IL1B, IL6, CXCL8, etc. , thereby playing a role in calming the mind and improving sleep.[Conclusions] These monomer compounds of traditional Chinese medicine had potential pharmacological effects on nonorganic sleep disorders and high value in subsequent experiments and clinical applications.

Sleep Disorders among Professional Oil Tanker Drivers in Ouagadougou Burkina Faso

Introduction: Sleep disorders among professional drivers are a major road safety problem. They cause fatigue and drowsiness at the wheel, which can lead to road traffic accidents and even accidents at work. The aim of this study was to assess sleep disorders among professional drivers of oil tankers in Ouagadougou, Burkina Faso. Methods: This was a descriptive and analytical cross-sectional study carried out from 11 April 2020 to 11 September 2020 in the national hydrocarbon company’s fuel depot. All the drivers present at the time were included and accomplished a questionnaire incorporating the commonly scales using to assess sleep disorders, sleep quality and sleep apnoea. Data analysis using R 3.6.1 software enabled to perform univariate and multivariate analyses to identify associated factors. Adjusted odd ratios were used to measure the strength of association. The significance level chosen was p ≤ 0.05. Results: All the 339 respondents were male. A proportion of 33.6% suffered from insomnia, including 12.7% with moderate to severe insomnia, and 18.58% were at risk of sleep apnoea. On the Epworth scale, 26.6% of drivers showed sleep debt and 4.1% excessive daytime sleepiness. The risk factors associated with insomnia were the use of psychostimulants. A history of diabetes and insomnia were risk factors associated with sleep apnoea syndrome. Conclusion: The prevalence of sleep disturbance and insomnia among the respondents were 52.2% and 33.6% respectively. Use of psychostimulants was the identified risk factor. The prevalence of SAS was 4.72%, with diabetes and insomnia as associated factors.

Lack of a causal relationship between tea intake and sleep disorders: a two-sample Mendelian randomization study

Background:The relationship between tea intake(TI)and sleep disorders(SDs)has been a topic of interest for some time,but there remains a lack of data showing a causal relationship.We aimed to use a two-sample Mendelian randomization study to determine whether there is a causal link between TI and SDs.Methods:We collected data regarding TI,with a focus on green tea intake(GTI),herbal tea intake(HTI),and rooibos tea intake(RTI);and data regarding SDs and insomnia from genome-wide association studies.We analyzed these data using an inverse variance-weighted two-sample Mendelian randomization study,by means of the TwoSampleMR package in R4.2.3 software.Results:We found no genetic causal relationships of TI,GTI,HTI,or RTI with insomnia.The odds ratios(ORs)for these relationships were as follows:TI:OR=0.61,95%confidence interval(CI):0.29–1.28;GTI:OR=1.04,95%CI:0.95–1.14;HTI:OR=0.98,95%CI:0.82–1.17;and RTI:OR=1.04,95%CI:0.99–1.09.In addition,there were no genetic causal relationships of TI,GTI,HTI,or RTI with SDs.The OR values for these relationships were as follows:TI:OR=0.6,95%CI:0.34–1.06;GTI:OR=1,95%CI:0.93–1.07;HTI:OR=0.89,95%CI:0.66–1.2;and RTI:OR=1.02,95%CI:0.98–1.06.Conclusion:We found no causal relationships of TI with SDs or insomnia,irrespective of the type of tea consumed.However,additional Mendelian randomization studies are required to further explore the relationships of the timing and quantity of tea consumption with SDs and insomnia.

Objective and subjective measures for sleep disorders

Subjective and objective measures of sleep structure or quality could help to characterize the chronic sleep disturbances, with relation to patients＇ risk factor profiles and co-morbidities. Studies have shown that discrepancies can occur between subjective data regarding sleep disturbances and the impact of insomnia and objective assays, and surrogate markers of sleep and sleep disturbances. Both objective and subjective measures should be incorporated into clinic studies. It seems likely that sleep quality is represented by a combination of more than one subjective sleep parameter. Objective and subjective assessments of sleep quality may relate to different parameters. Future studies incorporated both subjective and objective measures could help to address the sleep disorders.

Exercise-with-melatonin therapy improves sleep disorder and motor dysfunction in a rat model of ischemic stroke

Exercise-with-melatonin therapy has complementary and synergistic effects on spinal cord injury and Alzheimer's disease,but its effect on stroke is still poorly understood.In this study,we established a rat model of ischemic stroke by occluding the middle cerebral artery for 60 minutes.We treated the rats with exercise and melatonin therapy for 7 consecutive days.Results showed that exercise-with-melatonin therapy significantly prolonged sleep duration in the model rats,increased delta power values,and regularized delta power rhythm.Additionally,exercise-with-melatonin therapy improved coordination,endurance,and grip strength,as well as learning and memory abilities.At the same time,it led to higher hippocampal CA1 neuron activity and postsynaptic density thickness and lower expression of glutamate receptor 2 than did exercise or melatonin therapy alone.These findings suggest that exercise-withmelatonin therapy can alleviate sleep disorder and motor dysfunction by increasing glutamate receptor 2 protein expression and regulating hippocampal CA1 synaptic plasticity.

Sleep,immunity and inflammation in gastrointestinal disorders

Sleep disorders have become a global issue,and discovering their causes and consequences are the focus of many research endeavors.An estimated 70 million Americans suffer from some form of sleep disorder.Certain sleep disorders have been shown to cause neurocognitive impairment such as decreased cognitive ability,slower response times and performance detriments.Recent research suggests that individuals with sleep abnormalities are also at greater risk of serious adverse health,economic consequences,and most importantly increased all-cause mortality.Several research studies support the associations among sleep,immune function and inflammation.Here,we review the current research linking sleep,immune function,and gastrointestinal diseases and discuss the interdependent relationship between sleep and these gastrointestinal disorders.Different physiologic processes including immune system and inflammatory cytokines help regulate the sleep.The inflammatory cytokines such as tumor necrosis factor,interleukin-1(IL-1),and IL-6 have been shown to be a significant contributor of sleep disturbances.On the other hand,sleep disturbances such as sleep deprivation have been shown to up regulate these inflammatory cytokines.Alterations in these cytokine levels have been demonstrated in certain gastrointestinal diseases such as inflammatory bowel disease,gastro-esophageal reflux,liver disorders and colorectal cancer.In turn,abnormal sleep brought on by these diseases is shown to contribute to the severity of these same gastrointestinal diseases.Knowledge of these relationships will allow gastroenterologists a great opportunity to enhance the care of their patients.

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.

Sleep disorders in Alzheimer’s disease:the predictive roles and potential mechanisms

Sleep disorders are common in patients with Alzheimer’s disease,and can even occur in patients with amnestic mild cognitive impairment,which appears before Alzheimer’s disease.Sleep disorders further impair cognitive function and accelerate the accumulation of amyloid-βand tau in patients with Alzheimer’s disease.At present,sleep disorders are considered as a risk factor for,and may be a predictor of,Alzheimer’s disease development.Given that sleep disorders are encountered in other types of dementia and psychiatric conditions,sleep-related biomarkers to predict Alzheimer’s disease need to have high specificity and sensitivity.Here,we summarize the major Alzheimer’s disease-specific sleep changes,including abnormal non-rapid eye movement sleep,sleep fragmentation,and sleep-disordered breathing,and describe their ability to predict the onset of Alzheimer’s disease at its earliest stages.Understanding the mechanisms underlying these sleep changes is also crucial if we are to clarify the role of sleep in Alzheimer’s disease.This paper therefore explores some potential mechanisms that may contribute to sleep disorders,including dysregulation of the orexinergic,glutamatergic,andγ-aminobutyric acid systems and the circadian rhythm,together with amyloid-βaccumulation.This review could provide a theoretical basis for the development of drugs to treat Alzheimer’s disease based on sleep disorders in future work.

Epidemiology of Sleep Disorders among Chronic Hemodialysis Patients in Senegal: A Multicentric Study

Introduction: Sleep disorders (SD) are common dialysis patients and can impact their quality of life. In previous studies, black ethnicity was associated with higher incidence of SD but a few data are available in African patients. This study aimed to describe prevalence and risk factors of SD among Senegalese dialysis patients. Methods: We performed a cross-sectional study between February 15th and April 30th 2012 including 127 patients (75 males and 52 females) aged 46.8 ± 16.9 (16 - 85 years) and dialysed since >6 months in three dialysis centres. For each patient, we assessed insomnia according to international definition, obstructive sleep apnea syndrome (OSAS) with the Berlin questionnaire, restless leg syndrome (RLS) using abridged version of Cambridge-Hopkins RLS questionnaire, and excessive daytime sleepiness (EDS) with Epworth sleepiness scale. Logistic multivariate regression was used to identify factors associated with different SD. Results: Overall prevalence of SD was 88% comprising: insomnia (64.3%), OSAS (49.1%), RLS (24.1%) and EDS (20.5%). Forty-two patients presented at least two disorders. No difference was noticed in prevalence of SD between genders (p = 0.14). Level of blood pressure were not different across patients with and without SD. Insomnia correlated with anemia, inflammation and EDS. OSAS was associated with age ≥50 years, EDS and neck circumference ≥25 cm. RLS correlated with anemia and EDS. Other parameters such as gender, dialysis vintage, KT/V, obesity, diabetes status and hypoalbuminemia were not associated with the different SD. The majority of patients had not been diagnosed before the survey and none of them was under treatment. Conclusions: Our findings are compatible with high prevalence of sleep disorders reported in other populations. Insomnia and OSAS are the most frequent SD but some patients combined many disorders. Nephrologists should be more aware of these SD in order to detect them early and provide efficient treatment.

Effects of mindfulness-based intervention programs on sleep among people with common mental disorders:A systematic review and meta-analysis

BACKGROUND Sleep problems are particularly prevalent in people with depression or anxiety disorder.Although mindfulness has been suggested as an important component in alleviating insomnia,no comprehensive review and meta-analysis has been conducted to evaluate the effects of different mindfulness-based intervention(MBI)programs on sleep among people with depression or anxiety disorder.AIM To compare the effects of different MBI programs on sleep among people with depression or anxiety disorder.METHODS Related publications in Embase,Medline,PubMed and PsycINFO databases were systematically searched from January 2010 to June 2020 for randomised controlled trials.Data were synthesized using a random-effects or a fixed-effects model to analyse the effects of various MBI programs on sleep problems among people with depression or anxiety disorder.The fixed-effects model was used when heterogeneity was negligible,and the random-effects model was used when heterogeneity was significant to calculate the standardised mean differences(SMDs)and 95%confidence intervals(CIs).RESULTS We identified 397 articles,of which 10 randomised controlled trials,involving a total of 541 participants,were included in the meta-analysis.Studies of internet mindfulness meditation intervention(IMMI),mindfulness meditation(MM),mindfulness-based cognitive therapy(MBCT),mindfulness-based stress reduction(MBSR)and mindfulness-based touch therapy(MBTT)met the inclusion criteria.The greatest effect sizes are reported in favour of MBTT,with SMDs of-1.138(95%CI:-1.937 to-0.340;P=0.005),followed by-1.003(95%CI:-1.645 to-0.360;P=0.002)for MBCT.SMDs of-0.618(95%CI:-0.980 to-0.257;P=0.001)and-0.551(95%CI:-0.842 to-0.260;P<0.0001)were reported for IMMI and MBSR in the pooling trials,respectively.Significant effects on sleep problem improvement are shown in all reviewed MBI programs,except MM,for which the effect size was shown to be nonsignificant.CONCLUSION All MBI programs(MBTT,MBCT,IMMI and MBSR),except MM,are effective options to improve sleep problems among people with depression or anxiety disorder.

Correlation between blepharospasm and psychological diseases:the anxiety,depression and sleep disorder study

AIM:To investigate the relationship between benign essential blepharospasm(BEB)symptoms and depression/anxiety/sleep disorder in a prospective manner and to determine whether treatment the BEB with botulinum toxin type A(BoNT/A)can impact psychological symptoms.METHODS:This prospective interventional case series recruited 61 adults with evidence of BEB.Patients were administered the Jankovic Rating Scale(JRS),the Blepharospasm Disability Index(BSDI),Personal Health Questionnaire Depression Scale(PHQ-8),Generalized Anxiety Disorder 7-item scale(GAD-7)and the Athens insomnia scale(AIS)to evaluate the severity of BEB symptoms,depression,anxiety and sleep disorder before and 1wk,1,3mo after the BoNTA treatment.Statistical analysis was performed to assess the relationships between changes in the survey scores.RESULTS:The mean score for JRS,BSDI,PHQ-8,and GAD-7 improved significantly(P<0.0001),respectively,compared to the initial visit at follow-up.At baseline,worse BSDI scores were correlated with worse GAD-7 and PHQ-8,but not with worse AIS.At 1mo follow-up visit,there was no correlation between change in BSDI and PHQ-8/AIS,the change in GAD-7 showed a mild association with change in BSDI.The change in BSDI was correlated with the change in both PHQ-8 and GAD-7 in the subgroup of patients without a prior diagnosis of depression or anxiety.Patient satisfaction with BoNT/A treatment reached the highest at 1mo of follow-up(83.6%,51/61).CONCLUSION:BEB may lead to psychological diseases.BoNT/A can significantly improve motor and non-motor symptoms of BEB,which emphasize the effectiveness of BoNT/A and therefore pave the way for its use in the field of psychiatry.However,further research is needed to confirm these findings and understand the underlying mechanisms.

Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders

To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts.METHODSIn this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts.RESULTSAmong the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016).CONCLUSIONPhysicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.

Effects of serum inflammatory factors,health index and disease activity scores on ankylosing spondylitis patients with sleep disorder

BACKGROUND Patients with ankylosing spondylitis(AS)frequently suffer from comorbid sleep disorders,exacerbating the burden of the disease and affecting their quality of life.AIM To investigate the clinical significance of serum inflammatory factors,health index and disease activity scores in patients with AS complicated by sleep disorders.METHODS A total of 106 AS patients with comorbid sleep disorders were included in the study.The patients were grouped into the desirable and undesirable prognosis groups in accordance with their clinical outcomes.The serum levels of inflammatory factors,including C-reactive protein,erythrocyte sedimentation rate,interleukin(IL)-6,tumour necrosis factor-αand IL-1β,were measured.Disease activity scores,such as the Bath AS functional index,Bath AS disease activity index,Bath AS metrology index and AS disease activity score,were assessed.The health index was obtained through the Short Form-36 questionnaire.RESULTS The study found significant associations amongst serum inflammatory factors,health index and disease activity scores in AS patients with comorbid sleep disorders.Positive correlations were found between serum inflammatory factors and disease activity scores,indicating the influence of heightened systemic inflammation on disease severity and functional impairment.Conversely,negative correlations were found between disease activity scores and health index parameters,highlighting the effect of disease activity on various aspects of healthrelated quality of life.Logistic regression analysis further confirmed the predictive value of these factors on patient outcomes,underscoring their potential utility in risk assessment and prognostication.CONCLUSION The findings demonstrate the intricate interplay amongst disease activity,systemic inflammation and patientreported health outcomes in AS patients complicated by sleep disorders.The results emphasise the need for comprehensive care strategies that address the diverse needs and challenges faced by these patients and underscore the potential relevance of serum inflammatory factors,health index and disease activity scores as prognostic markers in this patient population.

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.

Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic

Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction

OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.

Sleep Disorders in Older Adults and Elderly Following the Catastrophic Stressful Life Events

In this paper we will discuss on sleep disorders in older adults and aged people following the catastrophes and stressful life events, and then note very shortly some treatments. Sleep disorders, accompanied with headache, have been known throughout the history of humanity and traditional medicine. In our time, diverse psychosocial and environmental factors such as wars also some psycho-socio-political events, acts of terrorism and others have shocked the world with numerous material, human, damages and victims. Many of these catastrophic acts and stressful life events, with their pathological effects, can bring consequently anxiety and depression. Sleep disorders and insomnia resulting from anxiety and depression, are very common, underdiagnosed, and become a significant source of major pain complaints in older adults and geriatric population. Some modifications in sleep patterns, during normal ageing process, as well as in retired people, may not be considered a part of pathological process of ageing; however, some factors like psychosomatical problems, death of spouse or loss of a child or other dear member family etc. can be related to pathological processes, and produce disturbances in circadian rhythm and consequently lead to sleep disorder. Based on his teaching experiences and clinical observations at Mental Health Centres, as well as theoretical studies （particularly during these three last decades） the author presents the results of his clinical researches. Our studies and lectures in University Hospitals： （Ste Anne, Lariboisière and La Salpêtrière） have enriched this research. The experiences and researches have shown that anxiety and depression exert pathological effects, not only on the cognitive system as noted elsewhere and harmful influences on the cardiovascular system, but have also pathological effects on the pineal gland and its “melatonin” hormone secretion which is considered as stimulator system （pace-maker-like） to regulate the rhythm of wake-sleep. Major depression, anxiety and trauma, resulting of catastrophic stressful life event, such as wars, acts of terrorism or others, when accumulating and occurring together, can perturb not only the circadian rhythm system, but in some extreme situations （such as inability to cope with stress or suffering, facing economic crisis and failure etc.） in some cases as noted elsewhere, they can also engender behaviour and personality disorders and finally lead to suicide. Concerning current treatments, the efficacy of melatonin to improve the quality of sleep is well established however the author would propose if possible, to maximize the dosage.

Clinical Characteristics of Sleep Disorders in Patients with Parkinson's Disease

In order to investigate the sleep quality and influencing factors in patients with Parkinson＇s disease（PD）, 201 PD patients were enrolled and underwent extensive clinical evaluations. Subjective sleep evaluation was assessed using the Pittsburgh Sleep Quality Index（PSQI）, and the Epworth Sleepiness Scale（ESS）. It was found that poor sleep quality（77.11%） and excessive daytime sleepiness（32.34%） were commonly seen in PD patients and positively correlated with disease severity. Then 70 out of the 201 PD patients and 70 age- and sex-matched controls underwent a polysomnographic recording. The parameters were compared between PD group and control group and the influencing factors of sleep in PD patients were analyzed. The results showed that sleep efficiency（SE） was significantly decreased（P〈0.01）, and sleep latency（SL） and the arousal index（AI） were increased（P〈0.05） in the PD group as compared with those in the control group. SE and total sleep time（TST） were positively correlated with the Hoehn and Yahr（H＆Y） stage. There was significant difference in the extent of hypopnea and hypoxemia between the PD group and the control group（P〈0.05）. Our results indicate that PD patients have an overall poor sleep quality and a high prevalence of sleep disorder, which may be correlated with the disease severity. Respiratory function and oxygen supply are also affected to a certain degree in PD patients.