The study reports about a case of a lung cancer patient with increasing difficulties in falling asleep and frequent periods of wakefulness. Severe dyspnea related to pneumonitis caused as a side effect of immunotherapy worsened the situation. Eventually, fear of falling asleep developed, including panic attacks and anxiety of choking, which was shown to lead to nights of complete wakefulness. The patient did not only sleep poorly; he did not sleep at all at night for several days, as evidenced by the notes he made during the night. Polygraphy showed no evidence of sleep-disordered breathing, but frequent periods of wakefulness and reduced basal saturation around 90% during sleep due to lung changes such as extensive functional failure of the left upper lobe with position-dependent shunts. The authors hypothesized that the symptoms described were causally related to a drop in oxygen saturation in the patient's blood. Therefore, they pursued the goal of finding a measurement technique that is as inexpensive as possible and that the patient can operate without outside assistance and great effort. So the patient started using a low-cost wearable device that allows simultaneous measurements of blood oxygen content, pulse rate and movement intensity. It consists of a finger ring with pulse oximetry sensor and a wristband with the control unit containing a vibration motor. The described device reliably warned of disturbances in oxygen concentration in the blood during the night with its vibration alarm. By use of that device during the whole night at home, the events of reduced oxygen saturation and the anxiety symptoms were reduced. Sleep disturbances with sudden awakenings did not occur when using the device. The patient benefited from the security gained in this way and slept much more peacefully, and he could spend nights without waking up again. In conclusion, wearable oximeters with vibration alarm can be recommended for patients’ home care in lung cancer patients.

Subjective cognitive decline (SCD) would correspond to a preclinical phase of Alzheimer's disease. The aim of this study was to find associations between lifestyle individual factors compatible scores with cognitive impairment (CI) in SCD people. Methods: This is a case-control study to detect SCD, CI and potential associated factors in 497 patients over 50 years in Community Pharmacies. Three screening tests detected possible CI and patients with at least one test compatible with CI were referred to Primary Care to be evaluated. Results: In self-complaint patients statistically significant with depressive feelings were found (86.8%) with benzodiazepines consumers (83.9%) and female patients (81.2%). Thirty percent of our sample obtained scores compatible with CI. Being older than 70 years old increased the odds of obtaining scores compatible with CI. High level education, reading and internet use were able to reduce the odds of positive scores compatible with CI (37%-91%, 7%-18% and 67%-86%), whereas, one extra hour television/day increased the risk in 8%-30%. Reading was able to nullify the effect of both internet and TV consumption. Conclusion: Not just the age but also modifiable lifestyle factors are acting in favour of a cognitive decline.

Fragile X syndrome (FXS) is caused by the full mutation in the FMR1 gene on the Xq27.3 chromosome region. It is the most common monogenic cause of Autism Spectrum Disorder (ASD) and inherited intellectual disability (ID). Besides ASD, ID and other issues, individuals with FXS may exhibit sleep problems and impairment of circadian rhythm (CR). The Drosophila melanogaster models of FXS, such as dFMR1B55, present excellent model for research in the FXS field. During this study, sleep pattern and CR in dFMR1B55 mutants were analyzed, using a new platform based on continuous high-resolution videography in integration with a highly-customized version of software. This methodology provides more sensitive results, which could be crucial for all further research in this model of fruit flies. The study revealed that dFMR1 B55 male mutants can be considered weak rhythmic flies rather than totally arrhythmic, and present a good alternative animal model of genetic disorder, which includes impairment of CR and sleep behavior. The combination of videography and software used in the current study should be recommended as a gold-standard methodology for such further research.

The movement toward prevention trials in people at-risk for Parkinson’s is rapidly becoming a reality. The authors of this article include a genetically at-risk advocate with the LRRK2 G2019S variant and two patients with rapid eye movement sleep behavior disorder (RBD), one of whom has now been diagnosed with Parkinson’s disease (PD). These authors participated as speakers, panelists, and moderators in the “Planning for Prevention of Parkinson’s: A Trial Design Forum” hosted by Massachusetts General Hospital in 2021 and 2022. Other authors include a young onset person with Parkinson’s (PwP) and retired family physician, an expert in patient engagement in Parkinson’s, and early career and veteran movement disorders clinician researchers. Several themes emerged from the at-risk participant voice concerning the importance of early intervention, the legitimacy of their input in decision-making, and the desire for transparent communication and feedback throughout the entire research study process. Challenges and opportunities in the current environment include lack of awareness among primary care physicians and general neurologists about PD risk, legal and psychological implications of risk disclosure, limited return of individual research study results, and undefined engagement and integration of individuals at-risk into the broader Parkinson’s community. Incorporating the perspectives of individuals at-risk as well as those living with PD at this early stage of prevention trial development is crucial to success.

Sleep-related eating disorder (SRED) is a non-REM parasomnia with potentially significant negative effects on general health (dangerous activities during night eating episodes, obesity, or metabolic syndrome, for example). Although the history of SRED encompasses more than six decades, public awareness and even the awareness of the mental health specialists of this disorder is very limited, a phenomenon that hinders the development of research in this field. Therefore, an updated review, based on a narrative methodology, explored the available evidence for SRED found in four electronic databases (PubMed, Cochrane Collaboration, Google Scholar, and Clarivate/Web of Science). A number of 94 primary and secondary reports were retrieved, investigating aspects regarding the risk factors, epidemiology, clinical data and differential diagnosis, epidemiology, structured evaluation, and treatment of SRED. Based on the results of these reports, Z-drugs, but also certain benzodiazepines, antidepressants, antipsychotics, and psychostimulants may trigger the onset of SRED. Psychiatric and neurologic disorders have also been associated with SRED, either as risk factors or comorbid conditions. Cerebral glucose metabolism dysfunctions, neurotransmitter dysfunctions, and genetic factors have been invoked as pathogenetic contributors. Structured assessment of SRED is possible, but there is a dearth of instruments dedicated to this purpose. Data on the prevalence and treatment of SRED exist, but good-quality epidemiological studies and clinical trials are still missing. In conclusion, future research is expected to address the shortcomings of SRED exploration by creating the conditions for better quality and larger group clinical research. The need for such investigation is granted by the importance of this pathology and its negative functional consequences.

Sleep-disordered breathing affects the growth and development, mental aspect, and learning ability of affected children. Postoperative scarring causes anteroposterior and vertical develop-mental disorders of the maxilla. Obstructive apnea is likely to occur due to the influence on the maxillofacial and airway morphology. In this study, we investigated the sleep-respiratory dynamics of school-aged children with unilateral cleft lip and palate by performing a simple over-night sleep study, maxillofacial morphology and airway analysis using lateral cranial radiographs, and model analysis. Children with unilateral cleft lip and palate showed a significantly higher respiratory event index (REI) than normal children; the maxilla was located in the posterior position in terms of maxillofacial morphology, and airway morphology showed narrow values for all distance measurement items. Moreover, the width and length of the dental arch and the width of the alveolar base arch were significantly smaller. Furthermore, there was a negative correlation between REI and SNA, ANB, REI, and alveolar base arch width. Children with unilateral cleft lip and palate are more likely than normal children to develop sleep-disordered breathing due to in-creased airway resistance caused by undergrowth of the maxilla and narrowing of the upper airway and oral volume.

Recently, the Internet of Things (IoT) has attracted wide attention from many fields, especially healthcare, because of its large capacities of information perception and collection. In this paper, we present an IoT-based home telehealth system for providing smart healthcare management for individuals, especially older people. Each client node of the system is mainly composed of an electronic water meter that records the user's daily water usage and an unobtrusive sleep sensor that monitors the user's physiological parameters during sleep such as heart rate (HR), respiratory rate (RR), body movement (BM), and states on the bed or outside the bed. The sleep sensor senses the biosignals and states by a sensor matrix composed of 12 piezoelectric sensors. The collected data can be transmitted to a remote centralized cloud service by a wireless home gateway for analyzing the living pattern and rhythm of users. Furthermore, the periodic feedback of results can be provided to users themselves as well as their family and health advisers. In the present study, data collections from a total of 18 older subjects were made for one year to evaluate the effectiveness of the proposed system. By analyzing living pattern and rhythm, preliminary results indicate the effectiveness of the telehealth system and suggest the potential of the system regarding improvement of quality of life (QoL) of older people and promotion of their health.

Despite concerns about the negative effects of social distancing and prolonged school closures on children’s lifestyle and physical activity (PA) during the COVID-19 pandemic, robust evidence is lacking on the impact of the COVID-19 pandemic on children’s wellbeing and daily life. This study aimed to examine changes in the PA levels, sleep patterns and screen time of school-aged children during the different phases of COVID-19 outbreak in Hong Kong using a repeated cross-sectional design. School students (Grades 1 to 12) were asked to report their daily electronic device usage and to fill in a sleep dairy recording their daily sleep and wake-up time. They were equipped with a PA monitor, Actigraph wGT3X-BT, to obtain objective data on their PA levels and sleep patterns. Students were recruited before the pandemic (Sep 2019 – Jan 2020; n=577), during school closures (Mar 2020 – Apr 2020; n=146), and after schools partially reopened (Oct 2020 – Jul 2021; n=227). Our results indicated lower PA levels, longer sleep duration, and longer screen time among participants recruited during school closures than those recruited before the COVID-19 outbreak. Primary school students were found to sleep on average for an extra hour during school closures. Our findings illustrate the impact of social distancing policies during the COVID-19 pandemic on the sleep pattern, screen time, and PA level in school-aged children in Hong Kong. Professionals should reinforce the importance of maintaining a physically active lifestyle, good sleep hygiene, and healthy use of electronic devices to parents and school-aged children during the COVID-19 Pandemic.

The fear of missing out (FoMO) is characterized in the literature as a fear that others are having rewarding experiences while one is missing out, and a constant need to keep connected with one’s social network. Driven by Social Determination Theory (SDT) FoMO has been linked with Problematic Social Networking Sites use (PSNSU), negative affectivity (NA), self-esteem (SE) and sleep disturbances. The present study reports findings from 512 individuals (79.1% women, mean age 30.5 years, SD= 8.61). Structural equation modelling (SEM) suggests that the duration of SNSs use and the numbers of SNSs platforms actively used partially mediated the relationship between FoMO and PSNSU. In turns, PSNSU partially mediated the relationship between FoMO and NA. Furthermore, the present study has extended the literature by incorporating the Vulnerability Model in the FoMO concept, identifying that SE partially mediated the relationship between FoMO and NA, while NA fully mediated the relationship between FoMO and sleeping disturbances. Accordingly, the present has extended previous research findings in showing exercise as a potential protective factor to prevent against FoMO. Practical and theoretical implications are discussed.

Sleep deficiency impacts the quality of life and may have serious health consequences in the long run. Questionnaire-based subjective assessment of sleep deficiency has many limitations. On the other hand, objective assessment of sleep deficiency is challenging. In this study, we propose a polysomnography-based mathematical model for computing baseline sleep deficiency severity score and then investigated the estimation of sleep deficiency severity using features available only from wearable sensor data including heart rate variability and single-channel electroen-cephalography for a dataset of 500 subjects. We used Monte-Carlo Feature Selection (MCFS) and inter-dependency discovery for selecting the best features and removing multi-collinearity. For developing the Regression model we investigated both the frequentist and the Bayesian ap-proaches. An Artificial Neural Network achieved the best performance of RMSE = 5.47 and an R-squared value of 0.67 for sleep deficiency severity estimation. The developed method is com-parable to conventional methods of Functional Outcome of Sleep Questionnaire and Epworth Sleepiness Scale for assessing the impact of sleep apnea on sleep deficiency. Moreover, the results pave the way for reliable and interpretable sleep deficiency severity estimation using a wearable device in Smart Health.

Pediatric obstructive sleep apnea (OSA) has significant negative effects on health and behavior in childhood including depression, failure to thrive, neurocognitive impairment, and behavioral issues. It is strongly associated with an increased risk for chronic adult disease such as obesity and diabetes, accelerated atherosclerosis, and endothelial dysfunction. Accumulating evidence suggests that adult-onset non-communicable diseases may originate from early life through a process by which an insult applied at a critical developmental window causes long-term effects on the structure or function of an organism. Recently, much attention has been paid to the role of epigenetic mechanisms in the pathogenesis of adult disease susceptibility. Epigenetic mechanisms that influence adaptive variability include histone modifications, non-coding RNAs, and DNA methylation. This review will highlight what is currently known about the phenotypic associations of epigenetic modifications in pediatric OSA and will emphasize the importance of epigenetic changes as both modulators of chronic disease and potential therapeutic targets.

It has been widely described that chronic intake of fructose causes metabolic alterations which can be associated with brain function impairment. In this study, we evaluated the effects of fructose intake on the sleep-wake cycle, locomotion and neurochemical parameters in Wistar rats. The experimental group was fed with 10% fructose in drinking water for five weeks. After treatment, metabolic indicators were quantified in blood. Electroencephalographic recordings were used to evaluate the sleep architecture and the spectral power of frequency bands. Likewise, the locomotor activity and the concentrations of orexin A and monoamines were estimated. Our results show that fructose diet significantly increased the blood levels of glucose, cholesterol, and triglycerides. Fructose modified the sleep-wake cycle of rats increasing the waking duration and conversely decreasing the non-rapid eye movement sleep. Furthermore, these effects were accompanied by increases of the spectral power at different frequency bands. Chronic consumption of fructose caused a slight increase in the locomotor activity as well as an increase of orexin-A and dopamine levels in the hypothalamus and brainstem. Specifically, immunoreactivity for orexin-A was increased in the ventral tegmental area after the intake of fructose. Our study suggests that fructose induces metabolic changes and stimulates the activity of orexinergic and dopaminergic neurons which may be responsible for alterations of the sleep-wake cycle.

Obstructive sleep apnea (OSA) is a common sleep disorder that is associated with a wide variety of health conditions, including cardiovascular, cerebrovascular, metabolic, neoplastic, and neurocognitive manifestations. OSA as a chronic condition is mainly characterized by repeated upper airway obstructions during sleep that cause episodes of intermittent hypoxia (IH), resulting in tissue hypoxia-reoxygenation cycles. Decreased arterial oxygen pressure (PaO₂) and hemoglobin saturation (SatO₂) stimulate reflex responses to overcome the obstruction. The prevalence of OSA is significant worldwide, and an underrated problem when focusing on women during pregnancy. The physiological changes associated with pregnancy, especially during its latest stages, are related with a higher prevalence of OSA events in pregnant mothers, and associated with an increased risk of hypertension, pre-eclampsia and diabetes, among other deleterious consequences. Furthermore, OSA during pregnancy can interfere with normal fetal development and is associated with growth retardation, preterm birth, or low term weight. Carotid body overstimulation and hypoxia-reoxygenation episodes contribute to cardiovascular disease and oxidative stress, which can harm both mother and fetus and have long-lasting effects that can reach into adulthood. Because IH is the hallmark of OSA, this review examines the literature available about the impact of gestational intermittent hypoxia (GIH) on the respiratory system at maternal, fetal, and offspring levels. Offering the latest scientific data about OSA during pregnancy, we may help to tackle this condition with lifestyle changes and therapeutic approaches, that could influence the mothers, but also impact adult health problems, mostly unknown, inherited from these hypoxic episodes in the uterus.

Abstract Introduction: In the last thirty years, brain neuromodulation techniques have been used as an alternative to pharmacological treatment of neurological disorders. Parkinson's disease (PD) is a neurodegenerative disorder leading to bradykinesia, rest tremor, postural changes, and non-motor symptoms such as depression, anxiety, sleep disorders, pain, and cognitive decline that compromises executive functions (EFs), responsible for the orderly execution of behaviors and tasks of daily life and intentional and directed actions. To this date, a few studies with transcranial direct current stimulation (tDCS) have shown beneficial effects in PD patients concerning specific motor and non-motor symptoms, targeting the motor cortex and/or prefrontal regions. Objective: The main objective of this study was to evaluate the effects of left prefrontal tDCS across a broad spectrum of motor and non-motor symptoms of PD using established validated scales. Method: Single-blind randomized clinical trial with 18 volunteers with PD, aged between 45 and 80 years (66.1 ± 9.65), who met inclusion and exclusion criteria. Participants were submitted to assessments of motor and non-motor functions employing psychometric scales and tests to evaluate EFs and were randomly divided into two groups: control (sham stimulation) and experimental (active stimulation). All participants were involved in three separate tDCS sessions. The anode was positioned over the left dorsolateral prefrontal cortex and the cathode over the right supraorbital region, with a direct current intensity of 2mA, lasting 20 minutes. At the end of the three sessions, all participants were reassessed. Results: Significant effects of tDCS on non-motor functions were observed for cognition (verbal fluency of actions, clock copy test, appointment by visual confrontation, and verbal memory with immediate free recall) and subjective assessment of sleep quality (overall restlessness and discomfort in the arms and legs at night, leg and arm cramps at night and distressing dreams). There was also an improvement in the rate of errors and successes for congruent and incongruent stimuli of the Stroop Test. The beneficial effects on motor function were decreased rigidity, improved gait, and greater agility in the finger-tapping test. Conclusion: Three tDCS sessions showed positive results for participants with PD, producing significant improvements in various motor and non-motor functions, including sleep quality, cognition, and EFs. Additionally, the present results indicate that tDCS neuromodulation of the left dorsolateral prefrontal cortex region is feasible, safe, and provides significant objective benefits for PD patients.

Obstructive sleep apnea (OSA) is a common sleep disorder, and continuous positive airways pressure (CPAP) is the most effective treatment. Poor adherence is one of the major challenges in CPAP therapy. The recent boom of wearable optical sensors measuring oxygen saturation makes the at-home multiple-night CPAP titrations possible, which may essentially improve the adherence of CPAP therapy by optimizing its pressure in a real-life setting economically. We tested whether the oxygen desaturations (OD) measured in the arm muscle (arm_OD) by gold-standard frequency-domain multi-distance near-infrared spectroscopy (FDMD-NIRS) changes with titrated CPAP pressures in OSA patients together with polysomnography. We found that the arm_OD (2.08 ± 1.23%, mean ± standard deviation) was significantly smaller (P-value <0.0001) than the fingertip OD (finger_OD) (4.46 ± 2.37%) measured by polysomnography pulse oximeter. Linear mixed-effects models suggested that CPAP pressure was a significant predictor for finger_OD but not for arm_OD. Since FDMD-NIRS measures a mixture of arterial and venous OD, whereas fingertip pulse oximeter measures arterial OD, our results of no association between arm_OD and finger_OD indicate that the arm_OD mainly represented venous desaturation. Arm_OD measured by near-infrared optical sensors may be not a suitable indicator of the effectiveness of CPAP titration.

Syncope and presyncope occurring during work can affect safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress and metabolic disorders in promoting syncope, presyncope and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47±11 years), employed in different companies, underwent clinical evaluation and blood tests and completed questionnaires to assess sleep quality, occupational distress and mental disorders. The occurrence of syncope, presyncope and unexplained falls during their working life was assessed by an ad hoc interview. The prevalence of syncope, presyncope and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted Odds Ratio aOR: 1.62, Confidence Intervals at 95%: 1.05-2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16-2.77) and poor mental health (aOR: 2.43 CI 95%: 1.52-3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25-2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08-4.18) and poor mental health (aOR: 2.61 CI 95%: 1.78-3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors and increasing worker resilience might reduce syncope and presyncope events in the working population.

Leucokinins (LKs) constitute a family of neuropeptides identified in numerous insects and many other invertebrates. The LKs act on G-protein coupled receptors that display only distant relations to other known receptors. In adult Drosophila, 26 neurons/neurosecretory cells of three main types express LK. The four brain interneurons are of two types, and these are implicated in several important functions in the fly’s behavior and physiology, including feeding, sleep-metabolism interactions, state-dependent memory formation, as well as modulation of gustatory sensitivity and nociception. The 22 neurosecretory cells (ABLKs) of the abdominal neuromeres coexpress LK and a diuretic hormone (DH44), and together these regulate water and ion homeostasis and associated stress, as well as food intake. In Drosophila larvae, LK neurons modulate locomotion, escape responses, and aspects of ecdysis behavior. A set of lateral neurosecretory cells, ALKs, in the brain express LK in larvae, but inconsistently so in adults. These ALKs coexpress three other neuropeptides and regulate water and ion homeostasis, feeding and drinking, but the specific role of LK is not yet known. This review summarizes Drosophila data on embryonic lineages of LK neurons, functional roles of individual LK neuron types, interactions with other peptidergic systems, and orchestrating functions of LK.

Objectives: To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. Methods: In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Well-controlled chronic background pain during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). Results: In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (Linear p-value = 0.1) and dyspnoea (Linear p-value =0.05). The ESAS and PSQI questionnaires confirmed these positive results (p<0.0001 and p=0.002, respectively). Conclusions: This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance

There is increasing evidence and recognition that Lyme borreliosis, and other associated tick-borne diseases (LB/TBD) cause mental symptoms. Data was drawn from databases, search engines and clinical experience to review current information on LB/TBD. LB/TBD infections cause immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity and may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a comprehensive psychiatric clinical exam relevant to patient’s complaints and findings with a thorough history, mental status exam, review of systems, neurological exam, physical exam, a knowledgeable interpretation of laboratory findings, pattern recognition and clinical judgment facilitate diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression. Awareness of the association between LB/TBD and neuropsychiatric impairments and studies of their prevalence in neuropsychiatric conditions can improve understanding of the causes of mental illness and violence and result in more effective prevention, diagnosis and treatment.

Introduction: Obstructive sleep apnea (OSA) is the most common sleep-breathing disorder. OSA is associated with cardiovascular diseases such as coronary artery disease (CAD) and arrhythmias with an increased risk of sudden cardiac death. Some changes in ECG markers are seen as an indicator of arrhythmogenicity, especially ventricular arrhythmias. The goal of this study was to investigate if OSA patients with CAD have QT dispersion and T peak to T end (TpTe) changes as a surrogate of arrhythmogenicity. Methods: We studied 75 patients with CAD who underwent polysomnographic studies. Patients were categorized into mild, moderate, and severe OSA according to the Apnea hypopnea index (AHI). Baseline ECG and echocardiography for assessing LV function and valvular heart disease were done for all of them. Results: Results showed that in patients with moderate and severe sleep apnea QT dispersion was higher in a group with more involvement of coronary artery disease, reduced ejection fraction, and a history of old MI. However, we didn’t find any significant statistical relationship between OSA and TpTe marker. Conclusion: Our results showed a positive relation between ECG arrhythmic indices such as QT dispersion and OSA severity in patients with CAD.

COVID-19 has harmful impact on health. It is especially important for endurance athletes (EAs). Sleep and psychology influence sport performance. Aims of this study were: (1) investigation of the consequences of mild COVID-19 on sleep and psychology and (2) assessment of the conse-quences of the infection on cardiopulmonary exercise test (CPET) results. 49 EAs (males= 43; 87.76%, females= 6; 12.24%, age= 39.9±7.8 years, height= 178.4±6.8 cm, weight= 76.3±10.4 kg; BMI= 24.0±2.6 kg·m−2) underwent maximal cycling or running CPET pre- and post- COVID-19 and completed a survey. Exercise performance was deteriorated after COVID-19 (maximal oxy-gen uptake; VO2max= 47.81±7.81 vs 44.97±7.00 ml·kg·min−1 respectively pre- and post- infection; p<0.001). Waking up at night affected heart rate (HR) at the respiratory compensation point (RCP) (p=0.028). Sleep time influenced pulmonary ventilation (p=0.013), breathing frequency (p=0.010), and blood lactate concentration (Lac) (p=0.013) at RCP. Maximal power/speed (p=0.046) and HR (p=0.070) linked with the quality of sleep. Stress management and relaxation techniques linked with VO2max (p=0.046), maximal power/speed (p=0.033), and maximal Lac (p=0.045). Cardiorespiratory fitness was deteriorated after mild COVID-19 and was correlated with sleep and mental health. Medical Professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

The practice of quantified-self sleep tracking is increasingly common nowadays among healthy individuals as well as patients with sleep problems. However, existing sleep-tracking technologies only support simple data collection and visualization, and are incapable of providing actionable recommendations that are tailored to users' physical, behavioral and environmental context. Here we coined the term context-aware sleep health recommender system (CASHRS) as an emerging multidisciplinary research field that bridges ubiquitous sleep computing and context-aware recommender systems. In this paper, we presented a narrative review to analyze the type of contextual information, the recommendation algorithms, the context filtering techniques, the behavior change techniques, the system evaluation, and the challenges in peer-reviewed publications that meet the characteristics of CASHRS. Analysis results identified current research trends, the knowledge gap, and future research opportunities in CASHRS.

Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings such as macula layer thickness, peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS using optical coherence tomography (OCT) and monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: first, before treatment; secondly, after six months of treatment. In mild-moderate patients, where retinal swelling has been demonstrated, retinal thicknesses decreased [fovea (p=0.026), as well as inner ring macula (p=0.007), outer ring macula (p=0.015), and macular volume (p=0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p&lt;0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.

Bedbug (Cimex spp.) are a nuisance public-health pest that is on the rise globally, particularly in crowded cities such as Hong Kong. To investigate the health impacts of bedbug infestations among bedbug victims, online surveys were distributed in Hong Kong between June 2019 to July 2020. Data on sociodemographics, self-rated health, average hours of sleep per day, and details of bedbug infestation were collected. Bivariate and multivariable analysis were performed using logistic regression. The survey identified 422 bedbug victims; among them, 223 (52.9%) experienced ≥5 bites in the past month, most bites occurred on the arms (n=202, 47.8%) and legs (n=215, 51%), and the most common reaction to bites were itchiness (n=322, 76.3%), redness, and swelling of the skin (n=246, 58.1%), and difficulties sleeping or restlessness (n=125, 29.6%). Bites usually occurred during sleep (n=230, 54.5%). For impact on daily life in the past month, most bedbug victims reported moderate to severe impact on mental and emotional health (n=223, 52.8%) and sleeping quality (n=239, 56.6%). Lower self-rated health (aOR&lt;1) was independently associated with impact to physical appearance (p=0.008), spending money on medication or doctor consultation (p=0.04), number of bites in the past month (p=0.023), and irregular time of bites (p=0.003). Lower average hours of sleep per day (aOR&lt;1) was independently associated with impact on mental and emotional health (p=0.016). This study brings attention to the neglected issue of bedbug infestation by considering bedbugs as an infectious agent instead of a vector and providing empirical evidence describing its health impacts.

It is unclear which noise exposure time window and noise characteristics during nighttime are most detrimental for sleep quality in real life settings. We have conducted a field study with 105 volunteers wearing a wrist actimeter to record their sleep during seven days, together with concurrent outdoor noise measurements at their bedroom window. Actimetry recorded sleep latency increased by 5.6 minutes (95% confidence interval: 1.6 to 9.6 minutes) per 10 dB(A) increase in noise exposure during the first hour after bedtime. Actimetry assessed sleep efficiency was significantly reduced by 2-3 percent per 10 dB(A) increase in measured outdoor noise (Leq, 1h) for the last three hours of sleep. For subjectively reported sleepiness, noise exposure during the last hour prior to wake up was most crucial with an increase in the sleepiness score of 0.31 units (95% CI: 0.08 to 0.54) per 10 dB(A) Leq,1h. Associations for estimated indoor noise were not more pronounced than for outdoor noise. Considering noise events in addition to equivalent sound pressure levels (Leq) only marginally improved the statistical models. Our study provides evidence that matching the nighttime noise exposure time window to the individual’s diurnal sleep-wake pattern results in a better estimate of detrimental nighttime noise effects on sleep. We found that noise exposure at the beginning and the end of the sleep is most crucial for sleep quality.

Metabolic Syndrome (MetS) is a serious condition that significantly increases the risk of cardiovascular diseases and the severity of type 2 diabetes, also impacting on the development and evolution of other chronic diseases. Predicting metabolic syndrome is a complex task due to the multifactorial nature of this condition, which involves a combination of various risk factors such as abdominal obesity, insulin resistance, dyslipidemia, and hypertension. The complex interplay of these factors makes it challenging to predict the syndrome. Both genetic predisposition and environmental factors also contribute to the development of metabolic syndrome. Metabolic syndrome affects diverse populations with different ethnicities, lifestyles, and socioeconomic backgrounds. Prediction models, in addition, need to account for population heterogeneity and consider variations in risk factors across different groups. The present study analyzed data from participants in a cohort from Mexico City to identify key risk factors in men and women, addressing the presence of unbalanced data. In order to tackle the issues posed by data imbalance data, SMOTE and ADASYN were applied to assess significant differences in the selection of risk factors for MetS prediction. Random Forest and RPART models using ADASYN and SMOTE demonstrated better performance, achieving a balanced accuracy of approximately 87%. In women, they highlighted sleep quality, anxiety factors, tobacco consumption, and nutritional components. In the case of men, stronger associations were identified with the social development index and factors related to gout in parents.

The main objective of this this cross-sectional study was to analyze the influence of lifestyle fac-tors (diet, physical activity, sleep), which can affect the concentrations of fecal short-chain fatty acids (SCFAs) and SCFAs potential role in modulating cardiometabolic disease risk by interact-ing with biochemical and body composition parameters. The study comprised 77 healthy, non-obese individuals, aged 30-45 years who were assessed in the light of SCFAs concentration in stool, diet, physical activity level and sleep duration. Moreover, body composition measurement and patients’ biochemical parameters were included in the analysis. We have indicated a signifi-cant negative correlation between several SCFAs [especially acetic acid (AA), isobutyric acid (IBA), butyric acid (BA), isovaleric acid (IVA) and valeric acid (VA)] with BMI, VAT/SAT ratio (visceral to subcutaneous fat ratio) and percentage of fat mass in a group of females enrolled in the study as well as with waist circumference (WC) in case of both sexes included in the study. Moreover, the results of our study acknowledged the importance of a diet in shaping SCFAs pro-file - we noticed the significant negative associations between energy and fat intake and some SCFAs in males [IBA, IVA, VA, isocaproic acid (ICA)]. In terms of fiber intake, we noticed elevat-ed concentrations of vast majority of SCFAs and amount of SCFAs in total in case of both sexes included in the study. These strong correlations reflect the fact that diet shapes the composition of the gut microbiota and SCFAs (main microbial metabolites) are synthesized from dietary fiber. Furthermore, we noticed that in a group of women, the concentration of AA, propionic acid (PA) and ICA as well as the total concentration of SCFAs showed a significant positive association with their sleep duration. We concluded that SCFAs can have a potential role in modulating car-diometabolic disease risk by interacting with adiposity parameters and diet. In addition, this potential direct link between diet and SCFAs may at least partly contribute to sleep improvement.

Environmental studies, metabolic research, and state of the art neurobiology point towards the reduced amount of natural day and sunlight exposure of the developing child’s organism as the consequence of increasingly long hours spent indoors online as the single unifying source of a whole set of health risks identified worldwide, as is made clear in this review of the current literature. Over exposure to digital environments, from abuse to addiction, now concerns even the youngest (ages 0 to 2), and triggers, as argued on the basis of clear examples herein, a chain of interdependent negative and potentially long-term metabolic changes. This leads to a deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain, currently associated with online activity abuse and/or internet addiction, and akin to that found in severe substance abuse syndromes. A general functional working model is proposed under the light of evidence brought to the forefront in this review.

Transcranial direct current stimulation (tDCS) is acknowledged for its non-invasive modulation of neuronal activity in psychiatric disorders. However, its application in insomnia research yields varied outcomes depending on different tDCS types and patient conditions. Our primary objective is to elucidate its efficiency and uncover the underlying mechanisms in insomnia treatment. We hypothesized that anodal prefrontal cortex stimulation activates glutaminergic projections from the infralimbic cortex (IL) to ventrolateral preoptic area (VLPO) to promote sleep. After administering 0.06 mA of electrical currents for 8 minutes, our results indicate significant non-rapid eye movement (NREM) enhancement in naïve mice within the initial 3 hours post-stimulation, persisting up to 16-24 hours. In the insomnia group, tDCS enhanced NREM sleep bout numbers during acute stress response and improved NREM and REM sleep duration in subsequent acute insomnia. Sleep quality, assessed through NREM delta powers, remains unaffected. Interference of the IL-VLPO pathway, utilizing designer receptors exclusively activated by designer drugs (DREADDs) with the cre-DIO system, partially blocked tDCS's sleep improvement in stress-induced insomnia. This study elucidated that the activation of the IL-VLPO pathway mediates tDCS's effect on stress-induced insomnia. These findings support the understanding of tDCS effects on sleep disturbances, providing valuable insights for future research and clinical applications in sleep therapy.

Background: The link between nocturia and aging male symptoms (AMS) has not been scientifically established. This study aimed to measure the degree of severity of AMS that impact on the health-related quality-of-life (HRQoL) in adult males living with nocturia, and to determine the predictive values of nocturnal factors on AMS. Methods: It is an extended analysis of new data collected by using the Hong Kong Traditional AMS (HK-AMS) scale and Cantonese version of the Pittsburgh Sleep Quality Index (PSQI) in a recently published cross-sectional population-based survey. Results: Of the 781 respondents that have completed the set of questionnaires, 68% and 61% of men living with nocturia reported clinically significant (at moderate-to-severe levels) somato-vegetative and sexual AMS, whereas the prevalence and severity were increased with advancing nighttime voiding frequency. The nocturia-specific QoL (NQoL) score and nocturnal frequency were found to be significant predictive factors for composite, somato-vegetative and sexual AMS, in addition to age, global OSQI score, and certain metabolic diseases. Conclusions: Current findings suggested the inclusion of nocturia when measuring the male-specific HRQoL related to aging.

Obstructive Sleep Apnea (OSA) is nowadays one of the respiratory pathologies with a higher in-cidence globally in developed countries. This situation led to an increase in the demand for medical appointments and diagnostic studies related to that condition, especially those based on poly-somnographies and cardiorespiratory polygraphies. These studies are limited in resources, causing long waiting lists with the subsequent impact on the patients’ health. Furthermore, it is necessary to mention that OSA’s symptomatology is not very specific, and it is typically present in the general population (excessive sleepiness, snore, etc.). In this regard, this paper proposes a novel intelligent clinical decision support system for the diagnosis of OSA which could be used to help medical teams, both in primary care settings and in units specialized in respiratory pathologies. The aim of the proposed system is to help discriminate the patients suspected of suffering from the pathology from those who are not. To this end, two types of information sets of heterogeneous nature are consid-ered. The first one encompasses objective data, related to the patient's health profile with infor-mation usually available in electronic health records. The second type comprises subjective data, referred to the symptomatology reported by the patient in a previous interview. To process the first group of information, a Machine Learning classification algorithm is used, Bagged Trees in this case. For processing the second information set, related with the symptomatology of the patient, a col-lection of expert systems based on fuzzy inferential systems arranged in cascade are employed. As a result, the system is able to determine two risk indicators related to the patient's risk of suffering from OSA: the Statistical Risk and the Symbolic Risk respectively. Subsequently, by interpreting both risk indicators mentioned it will be possible to determine the severity of the patients’ health, proposing a preliminary evaluation on their condition. For the initial tests of the system, a software artifact has been built using a dataset with 4,978 selected patients, suspected of suffering from OSA, from the Álvaro Cunqueiro Hospital in Vigo. The results obtained are promising, demonstrating the potential usefulness of this type of tools in medical diagnosis. Once the system has been validated with new data from clinical environments, it is considered as possible to obtain a relevant improvement in the quality of the healthcare services, and a reduction in the associated costs.

Background: Only few studies have studied the link between risk perception and sleep in the context of the COVID-19 pandemic. This study investigates the effect of two distinct risk appraisals—risk perception and perception of collective coordinated defense (PCCD) on Chinese adults’ sleep quality during the COVID-19 pandemic, and tested COVID-19-related fear and rumination as potential mediators of the relationships. Methods: Data were collected using a self-report online questionnaire from a sample of 224 Chinese adults during the fourth wave of the COVID-19 pandemic in Hong Kong. Results: COVID-19 risk perception and PCCD were related to poor sleep quality. Mediation analysis showed that both fear and rumination mediated the relationship between risk perception and sleep quality, whereas only fear mediated the relationship between PCCD and sleep quality. The model showed an excellent fit to the data and accounted for 44% of the variance in sleep quality in Chinese adults. Conclusions: This study demonstrates the distinct perceptual processes—risk appraisals in particular—contributed to poor sleep quality in Chinese adults during the COVID-19 public emergencies. These findings would be helpful for policy makers to address the sleep problems induced by psychological consequences of the pandemic.

Adverse childhood experiences are known to program children for disrupted biological cycles, premature aging, microbiome dysbiosis, immune-inflammatory misregulation, and chronic disease multimorbidity. To date, the microbiome has not been a major focus of deprogramming efforts despite its emerging role in every aspect of ACE-related dysbiosis and dysfunction. This article examines: 1) the utility of incorporating microorganism-based, anti-aging approaches to combat ACE-programmed chronic diseases (also known as noncommunicable diseases and conditions, NCDs) and 2) microbiome regulation of core systems biology cycles that affect NCD comorbid risk. In this review microbiota influence over three key cyclic rhythms (circadian cycles, the sleep cycle, and the lifespan/longevity cycle) as well as tissue inflammation and oxidative stress are discussed as an opportunity to deprogram ACE-driven chronic disorders. Microbiota, particularly those in the gut, have been shown to affect host-microbe interactions regulating the circadian clock, sleep quality, as well as immune function/senescence and regulation of tissue inflammation. The microimmunosome is one of several systems biology targets of gut microbiota regulation. Furthermore, correcting misregulated inflammation and increased oxidative stress is key to protecting telomere length and lifespan/longevity and extending what has become known as the healthspan. This review article concludes that to reverse the tragedy of ACE-programmed NCDs and premature aging, managing the human holobiont microbiome should become a routine part of healthcare and preventative medicine across the life course.

Experimental evidence suggests that chronic intermittent hypoxia (CIH), a major hallmark of obstructive sleep apnea (OSA), boosts carotid body (CB) responsiveness, thereby causing in-creased sympathetic activity, arterial and pulmonary hypertension, and cardiovascular disease. An enhanced circulatory chemoreflex, oxidative stress, and NO signaling appear to play im-portant roles in these responses to CIH in rodents. Since the guinea pig has a hypofunctional CB (i.e., it is a natural CB knockout), in this study we used it as a model to investigate the CB de-pendence of the effects of CIH on pulmonary vascular responses, including those mediated by NO, by comparing them with those previously described in the rat. We have analyzed pulmonary artery pressure (PAP), the hypoxic pulmonary vasoconstriction (HPV) response, endothelial function both in vivo and in vitro, and vascular remodeling (intima-media thickness, collagen fiber content, and vessel lumen area). We demonstrate that 30 days of exposure of guinea pigs to CIH (FiO2, 5% for 40 s, 30 cycles/h) induces pulmonary artery remodeling but does not alter en-dothelial function or the contractile response to phenylephrine in these arteries. In contrast, CIH exposure increased the systemic arterial pressure, and enhanced the contractile response to phenylephrine while decreasing endothelium-dependent vasorelaxation to carbachol in the aorta, without causing its remodeling. We conclude that since all of these effects are independent of CB sensitization, there must be other oxygen sensors, beyond the CB, with the capacity to alter the autonomic control of the heart and vascular function and structure in CIH.

Abstract: Background: We previously found that forest bathing significantly reduced the scores for negative emotions and in-creased the score for vigor in the profile of mood states (POMS) test in both males and females and increased the sero-tonin level in males, indicating the potential for beneficial effect on depressive status. In the present study, we investi-gated the effects of forest bathing on the levels of serotonin, oxytocin and insulin-like growth factor I (IGF-1) in blood, Self-Rating Depression Scale (SDS) scores, POMS, subjective fatigue symptoms and subjective sleep quality in female subjects with depression/depressive tendencies. Methods: Thirty-one female subjects aged 40.1±2.4 years with depression/depressive tendencies were recruited after obtaining informed consent. These subjects took day trips to a forest park, the birthplace of forest bathing in Japan named Akasawa Shizen Kyuyourin in Nagano Prefecture, and to a city area of Nagano Prefecture as a control in June 2023. On both trips, they walked 2.2-2.5 km for two hours each in the morning and afternoon on Saturday and Sunday, respectively. Blood was sampled in the afternoon before and after each trip. Concentrations of serotonin, oxytocin, IGF-1 and lactic acid in blood were measured. The SDS scores, POMS test, and questionnaires for subjective fatigue symptoms and subjective sleep quality were conducted before and after the trips. Ambient temperature and humidity were monitoring during the trips. The Nippon Medical School Central Ethics Committee approved this study. Results: Forest bathing significantly decreased SDS scores and the effect lasted for one week after forest bathing. Forest bath-ing also significantly increased the level of serotonin in serum in subjects who were not taking antidepressants, significantly increased the levels of oxytocin and IGF-1 in blood, significantly increased the scores for vigor-activity and friendliness and de-creased the scores for anger-hostility, confusion-bewilderment, fatigue-inertia, tension-anxiety, depression-dejection and total mood disturbance compared with city walking (all p