Effects of strengthening prospective nursing practice on sleep quality,anxiety,and depression of awake patients in intensive care unit

BACKGROUND The intensive care unit(ICU)is a specialized hospital department.Awake patients in the ICU frequently encounter adverse psychological states,such as anxiety and fear,often accompanied by poor sleep quality.This situation has garnered significant attention within the medical community.AIM To investigate the impact of prospective nursing intervention strategies on the sleep quality and negative emotional state of conscious ICU patients.METHODS One hundred and twenty ICU awake patients admitted to our hospital were selected and randomly divided into control(n=60)and observation(n=60)groups.Patients in the control group were cared for using the conventional nursing model,while patients in the observation group were cared for using the prospective nursing model.Sleep improvement was assessed using the International Standardized Sleep Efficiency Formula and Pittsburgh Sleep Quality Index(PSQI).The PSQI,Generalized Anxiety Disorder 7-item(GAD-7)scale,Self-Depression Scale(SDS),and satisfaction before and after treatment were used to assess the negative emotional states of patients under the two care models.RESULTS Patient satisfaction in the observation group was significantly higher than in the control group.The GAD-7 and SDS scores in the observation group were significantly lower than those in the control group,and the total effective rate of sleep improvement in the observation group was significantly higher than in the control group.After treatment,the PSQI scores of the two groups significantly decreased(P<0.05).The decrease in the observation group was more significan than that in the control group,and the difference between the two groups was statistically significant.CONCLUSION Prospective nursing interventions can improve sleep quality and psychological levels and significantly affect conscious patients in the ICU,which is worthy of clinical application.

Regulation of sleep by astrocytes in the hypothalamic ventrolateral preoptic nucleus

Astrocytes are functionally dynamic cells that support neurons in multiple ways throughout an organism’s lifespan.The astrocytic regulation of neuronal activity has been increasingly recognized in recent years.Astrocytes are now recognized as playing a more complex role than mere bystanders in the central nervous system.However,their role in regulating the sleep neurocircuitry is not well understood.From this perspective,we highlight the role of astrocytes in sleep modulation,with a particular focus on regulatory mechanisms related to the ventrolateral preoptic nucleus(VLPO)of the hypothalamus.We briefly discuss recent literature reporting the role of VLPO astrocytes in regulating sleep-associated behaviors.

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.

Decoding the nexus:branched-chain amino acids and their connection with sleep,circadian rhythms,and cardiometabolic health

The sleep-wake cycle stands as an integrative process essential for sustaining optimal brain function and,either directly or indirectly,overall body health,encompassing metabolic and cardiovascular well-being.Given the heightened metabolic activity of the brain,there exists a considerable demand for nutrients in comparison to other organs.Among these,the branched-chain amino acids,comprising leucine,isoleucine,and valine,display distinctive significance,from their contribution to protein structure to their involvement in overall metabolism,especially in cerebral processes.Among the first amino acids that are released into circulation post-food intake,branched-chain amino acids assume a pivotal role in the regulation of protein synthesis,modulating insulin secretion and the amino acid sensing pathway of target of rapamycin.Branched-chain amino acids are key players in influencing the brain's uptake of monoamine precursors,competing for a shared transporter.Beyond their involvement in protein synthesis,these amino acids contribute to the metabolic cycles ofγ-aminobutyric acid and glutamate,as well as energy metabolism.Notably,they impact GABAergic neurons and the excitation/inhibition balance.The rhythmicity of branchedchain amino acids in plasma concentrations,observed over a 24-hour cycle and conserved in rodent models,is under circadian clock control.The mechanisms underlying those rhythms and the physiological consequences of their disruption are not fully understood.Disturbed sleep,obesity,diabetes,and cardiovascular diseases can elevate branched-chain amino acid concentrations or modify their oscillatory dynamics.The mechanisms driving these effects are currently the focal point of ongoing research efforts,since normalizing branched-chain amino acid levels has the ability to alleviate the severity of these pathologies.In this context,the Drosophila model,though underutilized,holds promise in shedding new light on these mechanisms.Initial findings indicate its potential to introduce novel concepts,particularly in elucidating the intricate connections between the circadian clock,sleep/wake,and metabolism.Consequently,the use and transport of branched-chain amino acids emerge as critical components and orchestrators in the web of interactions across multiple organs throughout the sleep/wake cycle.They could represent one of the so far elusive mechanisms connecting sleep patterns to metabolic and cardiovascular health,paving the way for potential therapeutic interventions.

Parental behaviors and sleep/wake patterns of infants and toddlers in Hong Kong, China

Background:To describe the sleep patterns of children below 36 months in Hong Kong,and evaluate the associations between parental behaviors and childhood sleep/wake patterns.Methods:Parents of 1049 infants and toddlers completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.Results:Total sleep duration (P<0.001),frequency (P<0.001) and duration (P<0.001) of nocturnal awakenings decreased with age,whereas the longest sleep duration (P<0.001) and nocturnal sleep duration (P<0.001) increased with age.Children who room-or bed-shared with parents had later bedtimes (P<0.001),but similar sleep duration compared with those who had a separate sleep location.Falling asleep independently was associated with longer nocturnal sleep duration (P<0.001) and less sleep awakenings (P<0.001).Full-time employment of parents was associated with shorter total sleep duration of children (P<0.001).Although breastfeeding was associated with more nocturnal awakenings (P<0.001),no association was detected between breastfeeding and shorter sleep duration in children.Conclusions:As infants and toddlers develop,their sleep consolidates.Falling asleep independently was associated with longer nocturnal sleep duration and fewer sleep awakenings,whereas sleep location was not.This is an important finding,especially for families with limited living space where parent/ child room-or bed-sharing cannot be avoided.

Increased Orexin Expression Promotes Sleep/Wake Disturbances in the SOD1-G93A Mouse Model of Amyotrophic Lateral Sclerosis

Background：Sleep/wake disturbances in patients with amyotrophic lateral sclerosis （ALS） are well-documented,however,no animal or mechanistic studies on these disturbances exist.Orexin is a crucial neurotransmitter in promoting wakefulness in sleep/wake regulation,and may play an important role in sleep disturbances in ALS.In this study,we used SOD1-G93A transgenic mice as an ALS mouse model to investigate the sleep/wake disturbances and their possible mechanisms in ALS.Methods：Electroencephalogram/electromyogram recordings were performed in SOD1-G93A transgenic mice and their littermate control mice at the ages of 90 and 120 days,and the samples obtained from these groups were subjected to quantitative reverse transcriptase-polymerase chain reaction,western blotting,and enzyme-linked immunosorbent assay.Results：For the first time in SOD1-G93A transgenic mice,we observed significantly increased wakefulness,reduced sleep time,and up-regulated orexins （prepro-orexin,orexin A and B） at both 90 and 120 days.Correlation analysis confirmed moderate to high correlations between sleep/wake time （total sleep time,wakefulness time,rapid eye movement [REM] sleep time,non-REM sleep time,and deep sleep time） and increase in orexins （prepro-orexin,orexin A and B）.Conclusion：Sleep/wake disturbances occur before disease onset in this ALS mouse model.Increased orexins may promote wakefulness and result in these disturbances before and after disease onset,thus making them potential therapeutic targets for amelioration of sleep disturbances in ALS.Further studies are required to elucidate the underlying mechanisms in the future.

Genetically engineered systems revealed the roles of basal ganglia in sleep-wake regulation

The basal ganglia(BG) act as a cohesive functional unit that regulates motor function,habit formation,and reward/addictive behaviors. However,it is still not well understood how the BG maintains wakefulness and suppresses sleep to achieve al these fundamental functions until genetical y engineered systems developed these years. Significant research efforts have recently been directed at developing genetic-molecular tools to achieve reversible and cell-type specific in vivo silencing or activation of neurons in behaving animals. Optogenetic tools can be used both to specifically activate or inhibit neurons of interest and identify functional synaptic connectivity between specific neuronal populations,both in vivo and in brain slices. Another recently developed system by Roth and colleagues permits the selective and ″remote″ manipulation(activation and silencing) of neuronal activity via all 3 major GPCR signaling pathways(G_i,G_s and G_q). These so-called ″ designer receptors exclusively activated by designer drugs″(DREADD) involve mutant GPCRs that do not respond to their endogenous ligands but are responsive to otherwise inert biological compounds. Recently,we demonstrated the essential roles and the neural pathways of the neurons expressing adenosine A_(2A) receptors or dopamine D_1 receptors in the BG for sleep-wake regulation using the genetically engineered systems including optogenetics and DREADD. We proposed a plausible model in which the caudate-putamen and the nucleus accumbens integrates behavioral processes with sleep/wakefulness through adenosine and dopamine receptors.

Photoacoustic treatment mitigates cognitive dysfunction in a model of sleep-wake rhythm disturbance

Sleep-wake rhythm disturbances,which are characterized by abnormal sleep timing or duration,are associated with cognitive dysfunction.Photoacoustic treatments including light and sound stimulation have been found to be effective in modulating sleep patterns and improving cognitive behavior in abnormal sleep-wake pattern experiments.In this study,we examined whether light and sound interventions could reduce sleep-wake pattern disturbances and memory deficits in a sleep rhythm disturbance model.We established a model of sleep rhythm disturbance in C57 BL/6 J mice via a sleep deprivation method involving manual cage tapping,cage jostling,and nest disturbance.We used a Mini Mitter radio transmitter device to monitor motor activity in the mice and fear conditioning tests to assess cognitive function.Our results indicated that an intervention in which the mice were exposed to blue light(40-Hz flickering frequency)for 1 hour during their subjective daytime significantly improved the 24-hour-acrophase shift and reduced the degree of memory deficit induced by sleep deprivation.However,interventions in which the mice were exposed to a 40-Hz blue light at offset time or subjective night time points,as well as 2 Hz-blue light at 3 intervention time points(subjective day time,subjective night time,and offset time points),had no positive effects on circadian rhythm shift or memory deficits.Additionally,a 2000-Hz sound intervention during subjective day time attenuated the24-hour-acrophase shift and memory decline,while 440-Hz and 4000-Hz sounds had no effect on circadian rhythms.Overall,these results demonstrate that photoacoustic treatment effectively corrected abnormal sleep-wake patterns and cognitive dysfunction associated with sleep-deprivation-induced disturbances in sleep-wake rhythm.All animal experiments were approved by the Experimental Animal Ethics Committee of Drum Tower Hospital Affiliated to the Medical College of Nanjing University,China(approval No.20171102)on November20,2017.

Dynamic detection of wake-sleep transition with reaction time-magnitude

BACKGROUND： According to observable behaviors, sleep and wakefulness are two fundamentally different behavioral states. Although electroencephalogram （EEG） is traditionally used to define sleep stage, it is difficult to detect or to quantify microarousals or disruptions during sleep. In addition initial sleep cannot be defined. It is thought that the wake-sleep transition cannot be defined by EEG patterns. OBJECTIVE： To observe the behavioral response magnitude during wake-sleep transition by EEG monitoring and to define the wake-sleep transition. DESIGN, TIME AND SETTING： A behavioral and neural network study was performed at the Key Lab of Human Being Development and Mental Health of Central China Normal University, and Lab of Brain and Cognitive Science of South Central University for Nationalities, China in July 2007. PARTICIPANTS： A total of 30 healthy volunteers, of equal gender and aged （19.7 ± 1.1 ） years, were recruited from the Central China Normal University, China for this study. None of the subjects had undergone EEG recording prior to this study or received any medication for sleep disturbances. METHODS： A novel adaptive approach was applied to detect wake-sleep transition, which avoided stimulus-induced waking. To test the difference between wake state and wake-sleep transition, the amount of self-information and mutual-information were effective parameters to analyze wake-sleep transition. MAIN OUTCOME MEASURES： The following parameters were measured： morphological changes in reaction time-magnitude, as well as correlation between phase changes and sleep, and wake and wake-sleep transition. RESULTS： There were three typical phases in morphological changes of reaction time-magnitude. With regard to the behavioral definition and criterion for sleep, the phase morphological characteristics displayed good correlation with behavioral states, such as sleep, wakefulness, and sleep onset. Entropy as an indicator of brain cognitive processes was introduced to test for differences between the wakefulness and sleep onset phase. Results indicated a cognitive declined transitional period different between sleep and wake. After staggered cognitive changes during the wake-sleep transition, the brain underwent marked alterations and transitioned into sleep quickly with no bi-directional EEG changes. CONCLUSION： Wake-sleep transition exists as an independent stage.

SLEEP-MAD模式护理策略在结直肠癌病人术后护理中的应用

目的:探讨SLEEP-MAD模式护理策略在结直肠癌病人术后护理中的应用价值。方法:2022年5月—2023年5月选取医院收治的86例结直肠癌病人为研究对象,按照随机数字表法将病人分为观察组、对照组各43例,对照组行常规护理,观察组实施SLEEP-MAD模式护理策略,干预前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、视觉模拟疼痛评分表(VAS)、匹兹堡睡眠质量指数量表(PSQI)、癌因性疲乏评分及欧洲癌症研究与治疗组织生命质量量表(EORTC QLQ-C30)评价病人的不良情绪、疼痛感、癌因性疲乏、睡眠质量及生活质量。结果:干预后观察组病人HAMA、HAMD、VAS、PSQI及癌因性疲乏评分低于对照组(P<0.05);干预后观察组病人EORTC QLQ-C30评分高于对照组(P<0.05)。结论:SLEEP-MAD模式护理策略可有效减轻结直肠癌病人焦虑及抑郁情绪,减轻病人术后疼痛感及癌因性疲乏,改善病人睡眠质量及生活质量。

In the dorsal raphe neucleus,the role of Ca^(2+),PKC and CaMKⅡ in sleep-wake regulation

OBJECTIVE Dorsal raphe nucleus(DRN) is the largest single collection of neurons containing5-HT in the entire brain and particularly attractive in a wide variety of complex physiological and behavioral processes,such as sleep-wake regulation. Calmodulin dependent kinaseⅡ(CaMKⅡ) and protein kinase C(PKC)are important signal-transducing molecules activated by Ca^(2+). Since the Ca^(2+)modulation in DRN plays an important role in sleep-wake regulation,it should be presumed that the intracellular CaMKⅡ/PKC signaling in DRN may be involved in the regulation of sleep-wake. METHODS The polysomnogram consisting of EEG and EMG was recorded for analyzing sleep architecture. Immunohistochemisrty and Western-blotting methods were used in this study to investigate the roles of Ca^(2+),CaMKⅡ and PKC in sleep-wake regulation in rat DRN. RESULTS Ca^(2+)in the DRN exert arousal effects by reducing the NREMs,SWS and REMs via up-regulating serotonergic functions and activating CaMK Ⅱ-PKC.However,inhibition of PKC leads to significant promotion of total sleep time especial y the NREM sleep,but there were no changes in sleep parameters after the inhibition of CaMKⅡ by its inhibitor KN-93 in DRN.CONCLUSION The molecular,pharmacological,and behavioral findings of this study demonstrate a novel wake promoting and sleep-suppressing role for the Ca^(2+)/CaMK Ⅱ/PKC signaling pathway in DRN. Abnormalities in CaMK Ⅱ are found in patients with several neurological disorders that are associated with disturbed sleep,such as schizophrenia,depression,and Alzheimer′s disease. Several psychotropic drugs modulate CaMK Ⅱ activity. In addition,PKC is a cellular target of most current mood stabilizing and anti-manic agents and involved in bipolar disorder. The data of the present study raise the question whether PKC or CaMKⅡ modulations may also be effective on the sleep disorders or the mood disorders associated with sleep disorders.

The influence of heterogeneity on the analysis of sleep-wake architecture in the single-prolonged stress rats

Objective: To observe the influence of heterogeneity on sleep-wake architecture in single-prolonged stress(SPS) animal model. Methods: SPS rats were subdivided into low responders(LR) and high responders(HR) based on their freezing responses to a novel environment. Sleeping time(ST), awakening numbers(AN), brief awakening numbers(b AN) and frequency distribution of sleep bouts were used as observing indicators, single factor variance analysis combined with Dunnett t test were used to compare the differences between control, exposure, LR and HR groups. Results: We found sleeping time was increased only in HR group. Moreover, awakening numbers and brief awakening number increased in exposure group and HR group during the light phase, but not in LR group. The number of sleep bouts for the ranges of 40-80 s increased obviously in HR group, but not in exposure and LR group. In addition, there were significant correlation between sleep-related parameters and freezing in HR group, but not in LR group. Conclusion: Heterogeneity existed in SPS model in view of different sleep-wake architectures of SPS rats. Rats in HR group exactly mimicked the freezing response and sleep disorders of PTSD. So HR rats were more appropriate to be used as PTSD-like models, especially when studying sleep disorder in PTSD.

Significant change of sensitivity index d' in sensory processing of human brain during wake-sleep transition

The sensor area in the brain remains active during the wake-sleep transition. However, the behavioral mechanisms of sensor sensitivity involved in the transition from a state of wakefulness to a sleep state remain poorly understood. To detect sensitivity index （d） changes during the wake-sleep transition, the present study recorded response times of wakefulness versus wake-sleep transition in 14 healthy undergraduate volunteers. During wake-sleep transition testing, morphological changes in the time courses of behavior response revealed 2 typical phases （stages A and B）. In stage A, subject behavior responses exhibited temporal fluctuations, and all subjects displayed a high accuracy rate. In stage B, subjects did not exhibit behavioral responses. The sensitivity index d＇ during the wake-sleep transition （stage A） was significantly weaker than during wakefulness. Results demonstrated that at the behavioral level, sensation capacity for transfer information from the external world into the internal system significantly decreased during the transition to sleep.

Hypothalamic GABAergic neurocircuitry in the regulation of energy homeostasis and sleep/wake control

Gamma-aminobutyric acid(GABAergic)neuron,as one of important cell types in synaptic transmission,has been widely involved in central nervous system(CNS)regulation of organismal physiologies including cognition,emotion,arousal and reward.However,upon their distribution in various brain regions,effects of GABAergic neurons in the brain are very diverse.In current report,we will present an overview of the role of GABAergic mediated inhibitory neurocircuitry in the hypothalamus,underlying mechanism of feeding and sleep homeostasis as well as the characteristics of latest transcriptome profile in order to call attention to the GABAergic system as potentially a promising pharmaceutical intervention or a deep brain stimulation target in eating and sleep disorders.

GABAergic synaptic transmission and plasticity oscillate across sleep and wake

Sleep is a widely expressed behavior across the animal kingdom. In addition to the numerous health benefits that are associated with sleep, it is believed that sleep plays a pivotal role in mental processes such as learning and memory. Indeed, it has been demonstrated that learning and memory benefit from sleep, whereas sleep loss causes cognitive impairment(Rasch and Born, 2013). Changing the strength of synapses.

Is yawning a tool for wakefulness or for sleep?

Numerous theories as to why we yawn have been advanced, but yawning appears to be a complex phenomenon that is difficult to study. The physiology of yawning with its sharp chest inhalation, along with its contagious nature, can be explained by an arousal theory, that is, yawning promotes vigilance and alertness within a group that overrides a drive to sleep. Other theories of yawning, such as brain thermoregulation, are not necessarily excluded by the arousal theory but may be the results of yawning rather than its cause.

Association of accelerometer-measured sleep duration and different intensities of physical activity with incident type 2 diabetes in a population-based cohort study

Purpose:The aim of the current study was to investigate the association of accelerometer-measured sleep duration and different intensities of physical activity(PA)with the risk of incident type 2 diabetes in a population-based prospective cohort study.Methods:Altogether,88,000 participants(mean age=62.2±7.9 years,mean±SD)were included from the UK Biobank.Sleep duration(short:<6 h/day;normal:6-8 h/day;long:>8 h/day)and PA of different intensities were measured using a wrist-won accelerometer over a 7-day period between 2013 and 2015.PA was classified according to the median or World Health Organization-recommendation:total volume of PA(high,low),moderate-to-vigorous PA(MVPA)(recommended,not recommended),and light-intensity PA(high,low).Incidence of type 2diabetes was ascertained using hospital records or death registries.Results:During a median follow-up of 7.0 years,1615 incident type 2 diabetes cases were documented.Compared with normal sleep duration,short(hazard ratio(HR)=1.21,95%confidence interval(95%CI):1.03-1.41)but not long sleep duration(HR=1.01,95%CI:0.89-1.15)was associated with excessive type 2 diabetes risk.This increased risk among short sleepers seems to be protected against by PA.Compared with normal sleepers with high or recommended PA,short sleepers with low volume of PA(HR=1.81,95%CI:1.46-2.25),not recommended(below the World Health Organization-recommended level of)MVPA(HR=1.92,95%CI:1.55-2.36),or low light-intensity PA(HR=1.49,95%CI:1.13-1.90)had a higher risk of type 2 diabetes,while short sleepers with a high volume of PA(HR=1.14,95%CI:0.88-1.49),recommended MVPA(HR=1.02,95%CI:0.71-1.48),or high light-intensity PA(HR=1.14,95%CI:0.92-1.41)did not.Conclusion:Accelerometer-measured short but not long sleep duration was associated with a higher risk of incident type 2 diabetes.A higher level of PA,regardless of intensity,potentially ameliorates this excessive risk.

Brain Activity in Sleep Compared to Wakefulness: A Meta-Analysis

Objective: Neuroimaging studies using a variety of techniques have been conducted in sleep to explore the changes in brain activity during the different sleep stages. The current study employed a quantitative meta-analytic technique in an attempt to integrate the findings from such studies. Methods: Using an updated version of the Activation Likelihood Estimation (ALE) method, individual meta-analyses were carried out on: 1) studies contrasting REM sleep and wakefulness, and 2) studies contrasting NREM sleep and wakefulness. Results: Based on the results of the current meta-analyses, a number of cortical and subcortical brain regions appear to be involved in sleep and sleep processes, with both decreases and increases noted across NREM and REM sleep. Specifically, areas of decreased activity comprised thalamic structures (pulvinar, dorsomedial thalamus) and frontal regions (inferior, superior, and middle frontal gyrus). Furthermore, increased and decreased activity was noted in the anterior cingulate during sleep. Conclusions: Despite limited overlap across these sleep stages among regions identified, consistent decreases were revealed in NREM sleep (thalamus) and REM sleep (frontal cortex) when compared to wakefulness. Such findings suggest that these regions may ultimately play a key role in the loss of consciousness characteristic of sleep. Further research is needed to determine if and how such activity may be related to dreaming.

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.

Clinical efficacy and mechanism study of mid-frequency anti-snoring device in treating moderate obstructive sleep apnea-hypopnea syndrome

BACKGROUND Obstructive sleep apnea-hypopnea syndrome(OSAHS)is primarily caused by airway obstruction due to narrowing and blockage in the nasal and nasopha-ryngeal,oropharyngeal,soft palate,and tongue base areas.The mid-frequency anti-snoring device is a new technology based on sublingual nerve stimulation.Its principle is to improve the degree of oropharyngeal airway stenosis in OSAHS patients under mid-frequency wave stimulation.Nevertheless,there is a lack of clinical application and imaging evidence.METHODS We selected 50 patients diagnosed with moderate OSAHS in our hospital between July 2022 and August 2023.They underwent a 4-wk treatment regimen involving the mid-frequency anti-snoring device during nighttime sleep.Following the treatment,we monitored and assessed the sleep apnea quality of life index and Epworth Sleepiness Scale scores.Additionally,we performed computed tomo-graphy scans of the oropharynx in the awake state,during snoring,and while using the mid-frequency anti-snoring device.Cross-sectional area measurements in different states were taken at the narrowest airway point in the soft palate posterior and retrolingual areas.RESULTS Compared to pretreatment measurements,patients exhibited a significant reduction in the apnea-hypopnea index,the percentage of time with oxygen saturation below 90%,snoring frequency,and the duration of the most prolonged apnea event.The lowest oxygen saturation showed a notable increase,and both sleep apnea quality of life index and Epworth Sleepiness Scale scores improved.Oropharyngeal computed tomography scans revealed that in OSAHS patients cross-sectional areas of the oropharyngeal airway in the soft palate posterior area and retrolingual area decreased during snoring compared to the awake state.Conversely,during mid-frequency anti-snoring device treatment,these areas increased compared to snoring.CONCLUSION The mid-frequency anti-snoring device demonstrates the potential to enhance various sleep parameters in patients with moderate OSAHS,thereby improving their quality of life and reducing daytime sleepiness.These therapeutic effects are attributed to the device’s ability to ameliorate the narrowing of the oropharynx in OSAHS patients.