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 morb...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.展开更多
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 pat...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.展开更多
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...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.展开更多
目的:为克服观察性研究中的混杂因素和反向因果关系的影响,通过两样本孟德尔随机化法探讨失眠与2型糖尿病之间的关联关系。方法:在欧洲裔人群最新的全基因组关联研究(genome-wide association study,GWAS)中选择与失眠密切相关的遗传位...目的:为克服观察性研究中的混杂因素和反向因果关系的影响,通过两样本孟德尔随机化法探讨失眠与2型糖尿病之间的关联关系。方法:在欧洲裔人群最新的全基因组关联研究(genome-wide association study,GWAS)中选择与失眠密切相关的遗传位点作为工具变量。剔除与吸烟、体育活动、饮酒、教育程度、肥胖或2型糖尿病显著相关的位点后,使用逆方差加权评估失眠对2型糖尿病的效应,并采用加权中位数法和MR-Egger回归分析来检验结果的稳健性。通过计算F统计量来检验工具变量的适用性,F统计量大于10认为存在弱工具变量偏倚可能性较小。采用MR-Egger回归进行多效性检验。此外,采用留一法(leave-one-out)进行敏感性分析,以进一步验证结果的稳定性和可靠性。结果:在全基因组水平上选择了248个与失眠独立相关的单核苷酸多态性(single nucleotide polymorphisms,SNPs)作为候选工具变量集合,基于千人基因组计划对候选工具变量集合进行修剪并剔除潜在的多效SNPs后,共纳入与失眠相关的167个SNPs作为最终的工具变量。本研究中F统计量为39.74,符合孟德尔随机化的相关性假设。逆方差加权法发现失眠与2型糖尿病的发生风险较高,在失眠的人群中发生2型糖尿病的风险是无失眠人群的1.14倍(95%CI:1.09~1.21,P<0.001)。加权中位数法和MR-Egger回归结果支持失眠对2型糖尿病存在正向关联。多效性检验表明结果受多效性影响的可能性较小,敏感性分析支持研究结果的可靠性与稳定性。结论:失眠是2型糖尿病的危险因素,失眠与2型糖尿病发病存在正向关联,本研究为糖尿病高危人群保持健康的生活方式提供了进一步的理论依据。展开更多
目的评价不同治疗方案对睡眠障碍的疗效及不良反应,为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorde(r睡眠障碍)、insomnia(失眠)、restless legss yndrome or RLS(不宁腿综合征)、obstructive sleep apnea or OSA(阻塞...目的评价不同治疗方案对睡眠障碍的疗效及不良反应,为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorde(r睡眠障碍)、insomnia(失眠)、restless legss yndrome or RLS(不宁腿综合征)、obstructive sleep apnea or OSA(阻塞性睡眠呼吸暂停)、narcolepsy(发作性睡病)、REM behaviour disorder or RBD(快速眼动睡眠期行为障碍)、treatment or therapy(治疗)等英文词汇作为检索词,分别检索2006-2013年Cochrane图书馆、美国国家图书馆医学在线(MEDLINE)、Science Direct等数据库,获得临床指南、系统评价、随机对照临床试验、回顾性病例分析研究、病例观察研究及综述等文献,采用Jadad量表进行质量评价。结果经筛选共计纳入与睡眠障碍治疗有关的临床指南6篇、系统评价12篇、随机对照临床试验5篇、回顾性病例分析2篇、病例观察1篇、综述14篇;其中33篇为高质量文献、7篇为低质量文献。经对各项临床试验治疗原则及不同治疗方法疗效和安全性评价显示:(1)失眠为最常见的睡眠障碍,以药物治疗和改善认知行为为主要治疗方法,两种治疗方法各有优缺点,联合治疗为最佳方案。(2)原发性不宁腿综合征的一线治疗药物为多巴胺受体激动药和抗惊厥药,继发性患者主要为病因治疗。(3)阻塞性睡眠呼吸暂停综合征治疗包括经鼻持续气道正压通气、口腔矫正器、手术治疗,其中经鼻持续气道正压通气为一线治疗方法。(4)发作性睡病的药物治疗包括莫达非尼、羟丁酸钠及抗抑郁药,应根据临床分型选择不同药物。(5)快速眼动睡眠期行为障碍的治疗包括一般治疗如避免诱因、保证睡眠环境安全等,药物治疗主要有苯二氮类及褪黑素。结论借助循证医学评价方法可为不同类型睡眠障碍的治疗提供最佳临床证据。展开更多
基金Supported by a NIH grant to Dr.Cukor(MD006875)(in part)
文摘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.
文摘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.
文摘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.
文摘目的:为克服观察性研究中的混杂因素和反向因果关系的影响,通过两样本孟德尔随机化法探讨失眠与2型糖尿病之间的关联关系。方法:在欧洲裔人群最新的全基因组关联研究(genome-wide association study,GWAS)中选择与失眠密切相关的遗传位点作为工具变量。剔除与吸烟、体育活动、饮酒、教育程度、肥胖或2型糖尿病显著相关的位点后,使用逆方差加权评估失眠对2型糖尿病的效应,并采用加权中位数法和MR-Egger回归分析来检验结果的稳健性。通过计算F统计量来检验工具变量的适用性,F统计量大于10认为存在弱工具变量偏倚可能性较小。采用MR-Egger回归进行多效性检验。此外,采用留一法(leave-one-out)进行敏感性分析,以进一步验证结果的稳定性和可靠性。结果:在全基因组水平上选择了248个与失眠独立相关的单核苷酸多态性(single nucleotide polymorphisms,SNPs)作为候选工具变量集合,基于千人基因组计划对候选工具变量集合进行修剪并剔除潜在的多效SNPs后,共纳入与失眠相关的167个SNPs作为最终的工具变量。本研究中F统计量为39.74,符合孟德尔随机化的相关性假设。逆方差加权法发现失眠与2型糖尿病的发生风险较高,在失眠的人群中发生2型糖尿病的风险是无失眠人群的1.14倍(95%CI:1.09~1.21,P<0.001)。加权中位数法和MR-Egger回归结果支持失眠对2型糖尿病存在正向关联。多效性检验表明结果受多效性影响的可能性较小,敏感性分析支持研究结果的可靠性与稳定性。结论:失眠是2型糖尿病的危险因素,失眠与2型糖尿病发病存在正向关联,本研究为糖尿病高危人群保持健康的生活方式提供了进一步的理论依据。
文摘目的评价不同治疗方案对睡眠障碍的疗效及不良反应,为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorde(r睡眠障碍)、insomnia(失眠)、restless legss yndrome or RLS(不宁腿综合征)、obstructive sleep apnea or OSA(阻塞性睡眠呼吸暂停)、narcolepsy(发作性睡病)、REM behaviour disorder or RBD(快速眼动睡眠期行为障碍)、treatment or therapy(治疗)等英文词汇作为检索词,分别检索2006-2013年Cochrane图书馆、美国国家图书馆医学在线(MEDLINE)、Science Direct等数据库,获得临床指南、系统评价、随机对照临床试验、回顾性病例分析研究、病例观察研究及综述等文献,采用Jadad量表进行质量评价。结果经筛选共计纳入与睡眠障碍治疗有关的临床指南6篇、系统评价12篇、随机对照临床试验5篇、回顾性病例分析2篇、病例观察1篇、综述14篇;其中33篇为高质量文献、7篇为低质量文献。经对各项临床试验治疗原则及不同治疗方法疗效和安全性评价显示:(1)失眠为最常见的睡眠障碍,以药物治疗和改善认知行为为主要治疗方法,两种治疗方法各有优缺点,联合治疗为最佳方案。(2)原发性不宁腿综合征的一线治疗药物为多巴胺受体激动药和抗惊厥药,继发性患者主要为病因治疗。(3)阻塞性睡眠呼吸暂停综合征治疗包括经鼻持续气道正压通气、口腔矫正器、手术治疗,其中经鼻持续气道正压通气为一线治疗方法。(4)发作性睡病的药物治疗包括莫达非尼、羟丁酸钠及抗抑郁药,应根据临床分型选择不同药物。(5)快速眼动睡眠期行为障碍的治疗包括一般治疗如避免诱因、保证睡眠环境安全等,药物治疗主要有苯二氮类及褪黑素。结论借助循证医学评价方法可为不同类型睡眠障碍的治疗提供最佳临床证据。
