Improved Pittsburgh Sleep Quality Index scores on first postoperative night achieved by propofol anesthesia in patients undergoing ambulatory gynecologic surgery

BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.

Sleep quality in middle-aged and elderly hemodialysis patients:Impact of a structured nursing intervention program

BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being.This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middleaged and elderly hemodialysis patients.AIM To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.METHODS This cross-sectional study was conducted in a tertiary hospital,the First Affiliated Hospital of Nanchang University,in 2023.This study included 105 middle-aged and elderly hemodialysis patients aged≥45 years who underwent maintenance hemodialysis for at least 3 mo,utilizing the Pittsburgh Sleep Quality Index(PSQI)to identify poor sleepers.Those identified underwent a 12-wk nursing intervention program focusing on education,relaxation techniques,and counseling.Post-intervention,sleep quality was reassessed using the PSQI.RESULTS The study found that 68.6%of hemodialysis patients were poor sleepers.Following the 12-wk nursing intervention program,there was a significant decrease in the mean global PSQI score from 8.9±3.2 to 5.1±2.7(P<0.001),indicating improved sleep quality.This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.CONCLUSION The structured nursing intervention program focusing on sleep hygiene education,relaxation techniques,and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients.The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population.These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.

Relationship between sleep quality and blood pressure level in nurses performing shift work

Objective:The aim of the study was to evaluate the quality of sleep in nurses performing shift work in therapeutic and surgical depar tments and to establish possible relationships between level of blood pressure(BP)and quality of sleep.Methods:A total of 20 nurses of the therapeutic depar tments and 20 nurses of the surgical depar tments were enrolled in the study.Sleep quality was assessed using the Pittsburgh Sleep Quality Index(PSQI).BP was measured according to the standard protocol using the Korotkoff method;a sphygmomanometer was used for this twice with an interval of 2 min between 10:00 a.m.and 10:30 a.m.The average value for the 2 indicators was calculated.The diagnosis of essential ar terial hyper tension(AH)was established according to the recommendations of the European Association of Cardiology and the European Association of Hypertension(2018).Results:The overall assessment of the sleep quality of the nurses involved in shift work indicates poor sleep quality;this was true in respondents of both the surgical and therapeutic profiles.However,it was observed that the quality of sleep was significantly lower in nurses of the therapeutic departments.Moreover,poor sleep quality was associated with AH,which was diagnosed in 65%of the nurses of the therapeutic departments and 45%of the nurses of the surgical departments,that is,in almost all of the subjects.Herewith,in the nurses of the therapeutic departments,the level of systolic BP exceeded that of the nurses of the surgical departments.Conclusions:Poor sleep quality is a significant risk factor for AH development and is relevant to nurses performing shift work.Additional clinical studies should be conducted to better understand the mechanisms underlying such adverse cardiometabolic outcomes associated with sleep disorders in the health-sector shift workers.

Relationship of depression and sleep quality,diseases and general characteristics

BACKGROUND Depression is the most common type of depressive disorder.The most common sleep disorder associated with depression is insomnia.Insomnia and depression are closely related.AIM To investigate the relationship of designed questionnaire items and depression,and analyze the related factors with depression.METHODS Questionnaire included Patient Health Questionnaire-9(PHQ-9)and Pittsburgh sleep quality index(PSQI),12 kinds of diseases,8 general characteristics,and 20 insomnia characteristics,totally 56 items were filled out by 411 patients enrolled.RESULTS All the 9 items of PHQ-9,6 components of PSQI(except sleep duration),education,living situation,exercise,years of insomnia,western medicine treatment,Chinese medicine treatment,psychotherapy,kinds of insomnia,treatment expected to treat insomnia,psychological counseling,habit of 1 h before bed,habit of lunch break,diagnosed depression,coronary heart disease,mental illness showed significant difference between without and with depression group.By univariate analysis and multivariate analysis.The odds ratio of education,exercise,kinds of insomnia,habit of 1 h before bed,diagnosed depression,coronary heart disease(P=0.01)showed significant difference.Their odds ratios were 0.71(0.55,0.93),2.09(1.32,3.31),0.76(0.63,0.91),0.89(0.81,0.98),0.32(0.17,0.60),0.43(0.23,0.79).CONCLUSION We demonstrated that education,exercise,kinds of insomnia,habit of 1 h before bed,diagnosed depression and coronary heart disease affect the depression.

Relationship between depression,smartphone addiction,and sleep among Chinese engineering students during the COVID-19 pandemic

BACKGROUND Existing research has demonstrated that depression is positively related to smartphone addiction, but the role of sleep has not been discussed thoroughly, especially among engineering undergraduates affected by the coronavirus disease 2019 pandemic.AIM To evaluate sleep as a mediator of the association between smartphone addiction and depression among engineering undergraduates.METHODS Using a multistage stratified random sampling method, a cross-sectional survey was conducted among 692 engineering undergraduates from a top engineering university in China, and data were collected by self-reported electronic questionnaires. The data included demographic characteristics, such as age, gender, the Smartphone Addiction Scale-Short Version(SAS-SV), the 9-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index. Pearson correlation and multiple linear regression analyses were used to examine the association between smartphone addiction and depression, while structural equation models were established to evaluate the possible mediating role of sleep.RESULTS Based on the cutoffs of the SAS-SV, the rate of smartphone addiction was 63.58 percent, with 56.21 percent for women and 65.68 percent for men, among 692 engineering students. The prevalence of depression among students was 14.16 percent, with 17.65 percent for women, and 13.18 percent for men. Smartphone addiction was positively correlated with depression, and sleep played a significant mediating effect between the two, accounting for 42.22 percent of the total effect. In addition, sleep latency, sleep disturbances, and daytime dysfunction significantly mediated the relationship between depression and smartphone addiction. The mediating effect of sleep latency was 0.014 [P < 0.01;95% confidence interval(CI): 0.006-0.027], the mediating effect of sleep disturbances was 0.022(P < 0.01;95%CI: 0.011-0.040), and the mediating effect of daytime dysfunction was 0.040(P < 0.01;95%CI: 0.024-0.059). The influence of sleep latency, sleep disturbances, and daytime dysfunction accounted for 18.42%, 28.95%, and 52.63% of the total mediating effect, respectively.CONCLUSION The results of the study suggest that reducing excessive smartphone use and improving sleep quality can help alleviate depression.

Can subjective sleep quality, evaluated at the age of 73, have an influence on successful aging? The PROOF study

Objective: Sleep complaints are recurrent in Geriatrics and are often attributed to physiological aging. The aim of this work is to describe subjective sleep quality and its impact on successful aging. Methods: Subjective sleep quality was evaluated by using the Pittsburgh subjective sleep quality questionnaire. Two visual analogical scales (graduate from 0 to 10) were used to quantify perceived state of health and life satisfaction. Objective respiratory sleep parameters were also collected. Results: 370 data were analysed (46.2% of males). The average age was 73.2 +/- 1. The level of perceived state of health was 6.9 +/- 2, and life satisfaction level was 7.7 +/-2. Subjective sleep quality was significantly related to perceived health status (p = 0.034) and life satisfaction (p = 0.005). There was no significant association between sleep quality and objective respiratory sleep parameters. Conclusion: The assessment of sleep quality plays an important role in the management of elderly persons and can help them to age more successfully.

Sleep Quality in Non Dialysis Chronic Kidney Disease: Associated Factors and Influence on Prognosis

Deficient sleep quality (SQ) has been linked with a higher hospitalization rate and mortality in dialysis patients, however the prevalence of sleep disorders and their influence on prognosis in non-dialysis chronic kidney disease (CKD) has been poorly investigated. The aim of this study was to assess factors related with SQ in CKD patients (stages I-IV) followed in a nephrology outpatient clinic as well as the long-term impact of SQ on patient’s outcome. Between January and May 2008, Pittsburgh Sleep Quality Index (PSQI) was self-administered by 122 patients (68 males and 54 females) with a mean age of 65 years. Patients were classified as “good” (global PSQI < 6) and “poor” sleepers (global PSQI ≥ 6). We identified 66 (54%) poor sleepers (PS), characterized by an older age (66 ± 14.2 vs 57 ± 17.0, p < 0.01), female predominance (59% vs 26%, p < 0.01) and worse renal function (49 ± 19.1 vs 57 ± 23.2 ml/min, p < 0.05). There was a significant correlation between phosphate and PSQI score (r = 0.234, p = 0.01), however no correlation with calcium or PTH. Vitamin D was also lower in PS (17 ± 7.2 vs 23 ± 15.1 ng/ml, p < 0.05). Until June 2015, hospitalization rate was higher among PS (64% vs 44%, p < 0.05). In this period, there was also a trend towards higher mortality for PS (18% vs 16%). In summary, over 50% of CKD patients have poor SQ, which was associated with older age, female gender, worse renal function, lower vitamin D and higher phosphate levels. Deficient sleep was associated with a greater probability of hospitalization and might be a prognostic marker in CKD.

Survey of the Sleep Quality of Medical Staff in a Grade A Tertiary Hospital during the Novel Coronavirus Pneumonia Outbreak

This study aimed to investigate the sleep quality of medical staff in China who are combatting novel coronavirus pneumonia(COVID-19).To perform this,a survey of 127 medical staff from three separate wards(the general ward,isolation ward,and fever clinic)of a Grade A tertiary hospital in China was conducted.The survey questionnaire measured general characteristics and included the Pittsburgh Sleep Quality Index(PSQI).We consequently found that global PSQI scores differed significantly between the different wards(χ2=44.561,P<0.001).Whilst the medical staff in the general ward did not report any sleep disturbances,those in the isolation ward and the fever clinic both exhibited various degrees of sleep disturbance(global PSQI score>7).Medical staff in the isolation ward had the worst sleep quality(mean rank=91.74),followed by those in the fever clinic(mean rank=70.52)and the general ward(mean rank=39.10),respectively.The primary sleep disturbances reported by the medical staff from the isolation ward included difficulty falling asleep(24 cases,71.42%),waking early or at night(28 cases,80%),and nightmares(18 cases,51.42%).In addition,31.42%(11 cases)of the medical staff from the isolation ward had less than six hours of sleep a night,and 65.71%(23 cases)felt that their sleep quality was poor;meanwhile,for the staff from the fever clinic these ratios were 16.67%(seven cases)and 33.33%(14 cases),respectively.In contrast,among medical staff in the general ward,98%(49 cases)reported sleeping for more than six hours a night,and 96%felt that their sleep quality was good.In conclusion,of the medical staff providing treatment for COVID-19,those in isolation wards and fever clinics are more likely to experience sleep disturbances.

Effect of Mindfulness-based Cognitive Training on Sleep Quality and Mindfulness Cognitive Level of College Students

Objective:To study the effect of mindfulness-based cognitive training on sleep quality and mindfulness cognitive level of college students who score below the critical value of sleep disorders.Methods:The subjects were freshmen of a university in Shanghai who had scored below the critical value of sleep disorders.They were divided into the control group and experimental group by a random number table method,with 35 students in each group.No intervention was provided in the control group,and the mindfulness-based cognitive training(1 hour per day,5 days per week for 8 consecutive weeks)was performed in the intervention group.Eight weeks later,the Pittsburgh Sleep Quality Index(PSQI)and Five Facet Mindfulness Questionnaire(FFMQ)scores were compared between the two groups before and after the intervention for changes in the sleep quality and mindfulness cognitive level.Results:The sleep quality and daytime dysfunction were significantly improved,the sleep latency was shortened,the sleep duration was prolonged(P<0.05),and the mindfulness level of the subjects was significantly improved(P<0.05)in the intervention group compared with the control group.Conclusion:Mindfulness-based cognitive training can significantly improve the sleep quality of college students who scored below the critical value of sleep disorders.Furthermore,its psychological mechanism may be associated with the improvement of the mindfulness level of college students.

Analysis of sleep characteristics and clinical outcomes of 139 adult patients with infective endocarditis after surgery

BACKGROUND Little is known about the postoperative sleep quality of infective endocarditis patients during hospitalization and after discharge.AIM To investigate the sleep characteristics of infective endocarditis patients and to identify potential risk factors for disturbed sleep quality after surgery.METHODS The Pittsburgh Sleep Quality Index(PSQI)and the Epworth Sleepiness Scale were used to assess patient sleep quality.Logistic regression was used to explore the potential risk factors.RESULTS The study population(n=139)had an average age of 43.40±14.56 years,and 67.6%were men(n=94).Disturbed sleep quality was observed in 86 patients(61.9%)during hospitalization and remained in 46 patients(33.1%)at 6 mo after surgery.However,both PSQI and Epworth Sleepiness Scale scores showed significant improvements at 6 mo(P<0.001 and P=0.001,respectively).Multivariable logistic regression analysis showed that the potential risk factors were age(odds ratio=1.125,95%confidence interval:1.068-1.186)and PSQI assessed during hospitalization(odds ratio=1.759,95%confidence interval:1.436-2.155).The same analysis in patients with PSQI≥8 during hospitalization suggested that not using sleep medication(odds ratio=15.893,95%confidence interval:2.385-105.889)may be another risk factor.CONCLUSION The incidence of disturbed sleep after infective endocarditis surgery is high.However,the situation improves significantly over time.Age and early postoperative high PSQI score are risk factors for disturbed sleep quality at 6 mo after surgery.

Sleep Disturbance among Type II Diabetic Patients and Influence of Glycemic Control

Background: Experimental and observational studies have indicated that poor sleep quantity and quality are associated with an increased risk of chronic diseases including insulin resistance. Additionally, sleep disorders have been reported to aggravate diabetes due to decreased glucose metabolism and elevated cortisol levels as well as it can increase the risk for the development of diabetes. Objectives: To assess the sleep quality and its determinants and impact on glycemic control of type II diabetic patients. Methods: A cross sectional study was adopted among a representative sample of patients diagnosed with type II Diabetes seen in Prince Mansour Military Hospital Diabetic Center in Taif throughout the study period (March-July 2021). A self-administered questionnaire was utilized in the present study including 5 main parts: demographic data of the patients, medical and social history, the Pittsburgh Sleep Quality Index (PSQI) to assess the subjective sleep quality, weight and height measurements and the most recent glycated hemoglobin (HbA1c) level. Results: The study included 270 type II diabetic patients out of a targeted 282 with a response rate of 95.7%. Most of them aged either between 51 and 60 years (34.8%) or over 60 years (42%). Females represent 63% of them. Majority of patients (87.8%) had HbA1c ≥ 7%, indicating uncontrolled blood glucose levels. Overall, poor sleep quality, based on PSQI was observed among 41.1% of type II diabetic patients. Results of multivariate logistic regression analysis revealed that compared to patients whose income was lower than 5000 SR/month, those with income of 50,001 - 1000 and >15,000 SR/month were at lower significant risk for having poor sleep (Adjusted odds ratio “AOR” = 0.44, 95% confidence interval “CI” = 0.22 - 0.86, p = 0.016 and AOR = 0.21, 95% CI = 0.06 - 0.77, p = 0.019;respectively). Opposed to diabetic patients with a duration of less than one year of DM, those with a duration exceeding 10 years were at almost 6-folds higher risk for poor sleep quality (AOR = 6.39, 95% CI = 1.12 - 36.43, p = 0.037). Patients with a history of social stressors were at a higher significant risk for poor sleep quality compared to those without such a history (AOR = 4.99, 95% CI = 1.71 - 14.67, p = 0.003). Conclusion: A considerable proportion of type II diabetic patients attending the diabetic center, Prince Manasour Military hospital in Taif, Kingdom of Saudi Arabia expressed poor sleep quality. However, there was no association between glycemic control level and poor sleep quality.

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

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

Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus

Background Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus. Methods From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin （HbAlc）, and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index （PSQI） questionnaire to evaluate their sleep status. ＂Good sleep quality＂ was defined as PQSI 〈5, ＂average sleep quality＂ was defined as PQSI 6-8, and ＂poor sleep quality＂ was defined as PQSI 〉8. Poor glycemic control was defined as HbAlc 〉7%. Sleep quantity was categorized as 〈6, 6-8, and 〉8 hours/ night. Short sleep time was defined as sleep duration 〈6 hours/night. Results In the poor glycemic control group, the rate of patients who had insufficient sleep was much higher than that in the other group （X2=11.16, P=0.037）. The rate of poor sleep quality in poor glycemic control group was much greater than that in the average control group （X2=9.79, P=-0.007）. After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score＇s OR was 1.048 （95% CI 1.007-1.092, P=0.023） for HbAlc level. The sleep duration＇s OR was 0.464 （95% CI 0.236-0.912, P=0.026） for HbAlc level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance （P 〈0.01）. Conclusions Inadequate sleep, in both quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night＇s sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.

Clinical Observation on the Treatment of Insomnia in Germany with Deficiency of Heart and Spleen by the Ear Bean Therapy

Objective: To observe the effect of insomnia patients with deficiency of heart and spleen in Germany by the therapy of ear points pressing with bean. Methods: A total of 80 cases of insomnia with deficiency of heart and spleen in Germany were divided into the observation group and the control group, with 40 cases in each group. The patients in the control group were treated with oral modified Guipi Decoction(归脾汤), while the patients in the observation group were treated with oral traditional Chinese medicine(TCM) and the therapy of ear points pressing with bean. The efficacy, sleep quality, the TCM syndromes score and the incidence of adverse reactions were compared between the two groups. Results: The effective rate in the observation group was higher than that in the control group, and there was statistical difference between the two group(P<0.05). After treatment, the Pittsburgh sleep quality index scale(PSQI) score, insomnia severity index(ISI) score and the TCM syndromes score in the two groups were decreased sharply(P<0.01), and those scores in the observation group were lower than that in the control group(P<0.05). There was no adverse reaction between the two groups. Conclusion: The therapy of ear points pressing with bean is effective on insomnia in Germany, which is worth further study and promotion.

Efficacy of gabapentin for low back pain at a tertiary hospital: A prospective observational study

Objective:To assess the efficacy of gabapentin in the treatment of low back pain patients.Methods:This prospective observational study was conducted over 6 months to assess the efficacy of gabapentin in patients suffering from low back pain.Past medical history,pain severity by Visual Analogue scale(VAS)and sleep quality by Pittsburgh Sleep Quality Index(PQSI)were collected.VAS scores and PQSI scores before and after gabapentin treatment were compared,and gabapentin satisfaction post treatment were recorded.Results:This study included 100 low back pain patients with 65 males and 35 females,and the mean age was(39.0±10.5)years.The commonest presentation was non-radiating low back pain(40%).The mean VAS score and the mean PQSI score in the study before treatment were 7.70±1.91 and 10.95±5.02,respectively.After treatment with gabapentin,the mean VAS score and the mean PQSI score decreased to 2.75±1.79 and 4.90±2.20,respectively,and the differences before and after the treatment were significantly different(both P=0.001).Overall,62%of the patients were extremely satisfied with gabapentin because they reported no adverse drug reaction.Besides,31%of the patients were satisfied and 7%were strongly dissatisfied with the therapy.Conclusion:Gabapentin can improve sleep quality and reduce lower back pain as measured by the VAS and PQSI.The efficacy of this drug is relatively good,but further improvement is required.

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

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

Clinical observation of auricular needle-embedding therapy for primary insomnia

Objective:To observe the clinical efficacy of auricular needle-embedding therapy for treating primary insomnia.Methods:A total of 63 patients were randomly divided into a conventional acupuncture group and an auricular needleembedding group.The conventional acupuncture group received acupuncture at meridian points,while the auricular needle-embedding group received acupuncture at auricular points.Treatments were given once a day for 6 consecutive days,followed by a 1-day break,as a course of treatment.Both groups were treated for 2 courses.Before treatment,and after 1 course and 2 courses of treatment,the Pittsburgh sleep quality index(PSQI)score was assessed,and the efficacy was evaluated.Results:The cured and markedly effective rate and total effective rate of the auricular needle-embedding group were higher than those of the conventional acupuncture group,but there was no significant difference between the two groups(P>0.05).After 1 course of treatment,the PSQI global score and the scores of subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,and daytime dysfunction of both groups decreased compared with those before treatment(P<0.01);there was no statistical significance in comparing the PSQI global score and individual component scores between the two groups(P>0.05).After 2 courses of treatment,the PSQI global score and the scores of sleep latency and habitual sleep efficiency of the auricular needle-embedding group decreased compared with those after 1 course of treatment(P<0.01 or P<0.05),while only the score of sleep latency of the conventional acupuncture group decreased compared with that after 1 course of treatment(P<0.05);the PSQI global score and the scores of subjective sleep quality and sleep latency of the auricular needle-embedding group were lower than those of the conventional acupuncture group(P<0.05).Conclusion:Both therapies can improve insomnia.Compared to conventional acupuncture,auricular needleembedding therapy demonstrates a therapeutic advantage in improving sleep latency and sleep quality,making it worthy of clinical promotion.

Clinical observation of acupuncture plus acupoint sticking therapy for insomnia and its influence on subjective and objective sleep indicators

Objective To observe the effects of acupoint sticking therapy of different dosages and durations on the subjective and objective sleep indicators in insomnia patients.Methods Ninety-six patients with insomnia due to liver-Qi stagnation and spleen deficiency were divided into a high-dosage 7 d group(25 cases),a high-dosage 14 d group(22 cases),a low-dosage 7 d group(21 cases),and a low-dosage 14 d group(28 cases)using the random numbers generated in a stratified and stage-by-stage manner in combination with the visiting sequence.The four groups all received the same acupuncture treatment,but acupoint sticking therapy varied in dosage and duration.Before and after treatment,the actigraphic readings(total time in bed,total sleep time,sleep efficiency,number of wake bouts,length of wakes after asleep,and sleep latency),Pittsburgh sleep quality index(PSQI)score,and symptoms score of traditional Chinese medicine(TCM)were observed.A correlation analysis was conducted among the subjective and objective indicators.Results The PSQI score was positively correlated with the total time in bed and total sleep time(P<0.05).After treatment,the sleep latency,PSQI scores,and TCM symptoms scores changed significantly in the four groups(P<0.05).The total sleep time and sleep efficiency gained improvements after treatment in the high-dosage 14 d and low-dosage 14 d groups(P<0.05).The high-dosage acupoint sticking groups had longer total sleep time compared with the low-dosage groups of the same treatment duration(P<0.05).After treatment,the length of wakes after asleep,PSQI scores,and TCM symptoms scores were better in the 14 d groups than in the 7 d groups of the same acupoint sticking dosage(P<0.05).Conclusion Given the same acupuncture treatment,acupoint sticking therapy of different treatment durations produces different effects on the length of wakes after asleep,PSQI score,and TCM symptoms score in insomnia patients,and the 14-day acupoint sticking treatment is superior to the 7-day treatment.

Tuina for primary insomnia： a meta-analysis

Objective： To systematically evaluate the therapeutic efficacy of tuina therapy for primary insomnia. Methods： Nine Chinese and English databases were searched from the inception to May 2017 to identify randomized controlled trials （RCTs） studying tuina therapy for insomnia. The enrolled articles were all RCTs with tuina as the monotherapy or major therapy in the experiment group, with clear diagnostic criteria for primary insomnia well recognized worldwide or in China, and Pittsburgh sleep quality index （PSQI） as one of the outcome measures. Two researchers evaluated the risk of bias and quality of the enrolled studies by following Cochrane Handbook version 5.1.0. The meta-analysis was performed by RevMan version 5.3. Results： Eleven studies were included with a total of I 076 participants. The Western medication adopted in the control groups were benzodiazepine receptor agonists. The studies were all assessed as high risk of bias for blinding since blinding method was unable to be performed due to the specificity of tuina therapy; no study reported the support of fund or potential interest conflict, so they were all rated unclear for selective reporting. The meta-analysis showed that compared with other traditional Chinese medicine therapies, tuina worked more effectively in reducing the PSQI score （MD=-4.11〈O, 95% confidence interval （CI） -6.01 to -2.22, P〈0.O001）; compared with oral administration of Western medication, tuina showed more significant efficacy in reducing the PSQI score （MD=-3.42〈0, 95%CI -5.19 to -1.66, P〈0.O001）. Subgroup analysis showed that head tuina alone showed no significant difference compared with oral administration of Western medication regarding the change of PSQI score （MD=-4.19〈O, 95%CI -8.87 to 0.50, P〉0.05）; a combination of head and back tuina could more effectively reduce the PSOJ score compared with oral administration of Western medication （MD=-2.08〈O, 95%CI -3.09 to -1.06, P〈0.O001）. Conclusion： Tuina can produce more significant efficacy in treating primary insomnia compared with other traditional Chinese medicine therapies and oral administration of Western medication, especially the combination of head and back tuina.