A Narrative Review of the Association between Post-Traumatic Stress Disorder and Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) and post-traumatic stress disorder (PTSD) are often co-morbid with implications for disease severity and treatment outcomes. OSA prevalence is higher in PTSD sufferers than in the general population, with a likely bidirectional effect of the two illnesses. There is substantial evidence to support the role that disturbed sleep may play in the pathophysiology of PTSD. Sleep disturbance associated with OSA may interfere with normal rapid eye movement (REM) functioning and thus worsen nightmares and sleep-related movements. Conversely, hyperarousal and hypervigilance symptoms of PTSD may lower the arousal threshold and thus increase the frequency of sleep fragmentation related to obstructive events. Treating OSA not only improves OSA symptoms, but also nightmares and daytime symptoms of PTSD. Evidence suggests that positive airway pressure (PAP) therapy reduces PTSD symptoms in a dose-dependent fashion, but also presents challenges to tolerance in the PTSD population. Alternative OSA treatments may be better tolerated and effective for improving both OSA and PTSD. Further research avenues will be introduced as we seek a better understanding of this complex relationship.

Profile of nursing diagnoses in indigenous older adults in the community: a cross-sectional study

ABSTRACT Objective: to describe the profile of nursing diagnoses evidenced in indigenous elderly in the community. Methods: this is a cross-sectional study, carried out with 51 indigenous elderly people of Potiguara ethnicity, through a nursing consultation. The clinical data, obtained from the consultation, were analyzed following Risner’s diagnostic reasoning process and the NANDA-I Taxonomy (2018-2020). For greater accuracy, the diagnoses obtained underwent peer review by a specialist. Results: 37 diagnoses were identified, such as Impaired dentition (98.0%), Risk for impaired skin integrity (66.7%), Chronic pain (64.7%), Risk for deficient fluid volume (54.9%), Impaired swallowing (45.1%), Impaired walking (45.1%), Disturbed sleep pattern (43.1%), Stress urinary incontinence (41.2%), Risk for falls (35.3%), and Sexual dysfunction (33.3%). Conclusion: the diagnoses identified were predominantly from Safety/protection domain and result from factors that negatively influence indigenous elderly’s functional capacity.

Sleep markers in psychiatry: do insomnia and disturbed sleep play as markers of disrupted neuroplasticity in mood disorders? A proposed model

Introduction: Since insomnia and disturbed sleep may affect neuroplasticity, we aimed at reviewing their potential role as markers of disrupted neuroplasticity involved in mood disorders. Method: We performed a systematic review, according to PRIMA, on PubMed, PsycINFO and Embase electronic databases for literature regarding mood disorders, insomnia, sleep loss/deprivation in relation to different pathways involved in the impairment of neuroplasticity in mood disorders such as 1] alterations in neurodevelopment 2] activation of the stress system 3] neuroinflammation 4] neurodegeneration/neuroprogression, 4] deficit in neuroprotection. Results: Sixty-five articles were analyzed and a narrative/ theoretical review was conducted. Studies showed that insomnia, sleep loss and sleep deprivation might impair brain plasticity of those areas involved in mood regulation throughout different pathways. Insomnia and disrupted sleep may act as neurobiological stressors that by over-activating the stress and inflammatory systems may affect neural plasticity causing neuronal damage. In addition, disturbed sleep may favor a deficit in neuroprotection hence contributing to impaired neuroplasticity. Conclusions: Insomnia and disturbed sleep may play a role as markers of alteration in brain plasticity in mood disorders. Assessing and targeting insomnia in the clinical practice may potentially play a neuroprotective role, contributing to “repairing” alterations in neuroplasticity or to the functional recovery of those areas involved in mood and emotion regulation.

Validation of Somno-Art Software, a novel approach of sleep staging, compared with polysomnography in disturbed sleep profiles

Integrated analysis of heart rate (electrocardiogram [ECG]) and body movements (actimetry) during sleep in healthy subjects has previously been shown to generate similar evaluation of sleep architecture and continuity with Somno-Art Software compared to polysomnography (PSG), the gold standard. However, the performance of this new approach of sleep staging has not yet been evaluated on patients with disturbed sleep. Sleep staging from 458 sleep recordings from multiple studies comprising healthy and patient population (obstructive sleep apnea [OSA], insomnia, major depressive disorder [MDD]) was obtained from PSG visual scoring using the American Academy of Sleep Medicine (AASM) rules and from Somno-Art Software analysis on synchronized ECG and actimetry. Inter-rater reliability, evaluated with 95% absolute agreement intra-class correlation coefficient, was rated as "excellent" (ICCAAAvg95% ≥0.75) or "good" (ICCAAAvg95% ≥0.60) for all sleep parameters assessed, except NREM and N3 sleep in healthy participants (ICCAAAvg95% =0.43, ICCAAAvg95% =0.56) and N3 sleep in OSA patients (ICCAAAvg95% =0.59) rated as "fair" inter-rater reliability. Overall sensitivity, specificity, accuracy and Cohen's kappa coefficient of agreement (κ)on the entire sample were respectively of 93.3%, 69.5%, 87.8% and 0.65 for wake/sleep classification and accuracy and κ were of 68.5% and 0.55 for W/N1+N2/N3/REM classification. These performances were similar in healthy and patient population. The present results suggest that Somno-Art can be a valid sleep-staging tool in both healthy subjects and patients with OSA, insomnia or MDD. It could complement existing non-attended techniques measuring sleep-related breathing pattern or be a useful alternative to laboratory-based PSG when this latter is not available.

How do people with knee osteoarthritis perceive and manage flares? A qualitative study

BackgroundAcute flares in people with osteoarthritis (OA) are poorly understood. There is uncertainty around the nature of flares, their impact, and how these are managed.AimExplore understandings and experiences of flares in people with knee OA, describe self-management and help-seeking strategiesDesign & settingQualitative interview study of people with knee OA in England, United Kingdom.MethodSemi-structured interviews with 15 people with knee OA. Thematic analysis using constant comparison methods.ResultsWe identified four main themes: experiencing pain, consequences of acute pain, predicting and avoiding acute pain, and response to acute pain. People with OA described minor episodes which were frequent, fleeting, occurred during everyday activity, had minimal impact, and were generally predictable. This contrasted with severe episodes which were infrequent, had greater impact, and were less likely to be predictable. The latter generally led to feelings of low confidence, vulnerability and of being a burden. The term ‘flare’ was often used to describe the severe events but this was applied inconsistently and some would describe a flare as any increase in pain.Participants used numerous self-management strategies but tended to seek help when these had been exhausted, their symptoms led to emotional distress, disturbed sleep, or pain experience worse than usual. Previous experiences shaped whether people sought help and who they sought help from.ConclusionSevere episodes of pain are likely to be synonymous with flares. Developing a common language about flares will allow a shared understanding of these events, early identification and appropriate management.

Mobile phone addiction among children aged 5-12 years, a hospital-based study in South Kerala

Background: The uncontrolled, inappropriate or excessive use of the mobile phone can give rise to social, behavioural and affective problems. Mobile phone addiction has emerged as a challenging public health issue. The aim of the study was to find out the proportion and associated factors of mobile phone addiction among children aged 5-12 years.Methods: A cross-sectional study was conducted among 222 children in the age group of 5-12 years. Data collection was done using a semi-structured questionnaire and outcome variable measured using the diagnostic criteria developed by Lin et al. Chi-square test and binary logistic regression was done to find out the association between exposure and outcome variables.Results: 42.3% of children aged 5-12 years had mobile phone addiction. Factors like higher socio-economic status of the family, educated father, children with normal weight for age, presence of visual problems, headache, poor concentration and disturbed sleep were found to have statistically significant association with the mobile phone addiction. The predictor variables found on regression were higher socio-economic status, children with normal weight for age, disturbed sleep and poor concentration.Conclusions: This study found nearly half of the children belonging to 5-12 years was addicted to mobile phones which is higher than expected and is a serious matter for the growing children. The risk factors found in the study are modifiable to an extent and hence regional and national level strategies has to be implemented in accordance with the available studies to tackle this public health problem.

Disturbed Sleep in PTSD: Thinking Beyond Nightmares

Sleep disturbances frequently co-occur with posttraumatic stress disorder (PTSD). Insomnia and nightmares are viewed as core symptoms of PTSD. Yet, relations between disturbed sleep and PTSD are far more complex: PTSD is linked to a broad range of sleep disorders and disturbed sleep markedly affects PTSD-outcome. This article provides a concise overview of the literature on prevalent comorbid sleep disorders, their reciprocal relation with PTSD and possible underlying neurophysiological mechanisms. Furthermore, diagnostic procedures, standard interventions—particularly first choice non-pharmacological therapies—and practical problems that often arise in the assessment and treatment of sleep disturbances in PTSD are described. Finally, we will present some perspectives on future multidisciplinary clinical and experimental research to develop new, more effective sleep therapies to improve both sleep and PTSD.

Pain thresholds and suprathreshold pain after sleep restriction in migraine – A blinded crossover study

Objective There is an unexplained association between disturbed sleep and migraine. In this blinded crossover study, we investigate if experimental sleep restriction has a different effect on pain thresholds and suprathreshold pain in interictal migraineurs and controls. Methods Forearm heat pain thresholds and tolerance thresholds, and trapezius pressure pain thresholds and suprathreshold pain were measured in 39 interictal migraineurs and 31 healthy controls after two consecutive nights of partial sleep restriction and after habitual sleep. Results The effect of sleep restriction was not significantly different between interictal migraineurs and controls in the primary analyses. Pressure pain thresholds tended to be lower (i.e., increased pain sensitivity) after sleep restriction in interictal migraineurs compared to controls with a 48-hour preictal-interictal cut-off (p = 0.061). We found decreased pain thresholds after sleep restriction in two of seven migraine subgroup comparisons: heat pain thresholds decreased in migraineurs with lower pain intensity during attacks (p = 0.005) and pressure pain thresholds decreased in migraineurs with higher severity of photophobia during attacks (p = 0.031). Heat pain thresholds tended to decrease after sleep restriction in sleep-related migraine (p = 0.060). Sleep restriction did not affect suprathreshold pain measurements in either group. Conclusion This study could not provide strong evidence for an increased effect of sleep restriction on pain sensitivity in migraineurs compared to healthy controls. There might be a slightly increased effect of sleep restriction in migraineurs, detectable using large samples or more pronounced in certain migraine subgroups.