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Fulltext Sleep-disordered breathing in patients with Parkinson's disease [Retracted article]

Noradina AT, Karim NA, Hamidon BB, Norlinah I, Raymond AA

Singapore Med J, 2010 Jan;51(1):60-4.
PMID: 20200778

Retraction notice: Following investigations of duplicate publication in Parkinsonism and Related Disorders 2009; 15: 670–674, we have determined that there is indeed a substantial overlap between the two articles. As such, we fully retract this paper from the published record of the Singapore Medical Journal.
Professor Teo Eng Kiong, Editor, Singapore Medical Journal
http://smj.sma.org.sg/5201/5201rec1.pdf

There are limited studies reporting the frequency of sleep-disordered breathing (SDB) in Parkinson's disease (PD), and the figures quoted are variable, ranging from 2.5 to 66 percent. This study aimed to determine the prevalence and types of SBD in PD patients attending the Universiti Kebangsaan Malaysia Medical Centre neurology clinic, and the correlation between the subjective sleep symptoms using the Parkinson's disease sleep scale (PDSS) and the objective measurements using polysomnography (PSG).
METHODS: This was a cross-sectional study involving 46 PD patients over a period of six months. The patients' demographic data, Hoehn and Yahr staging and PDSS scores were collected. The patients were then subjected to overnight PSG using the Somnomedic system.
RESULTS: There were 27 male and 19 female patients with a mean age of 64.0+/-9.7 years. 29 were Chinese, 15 Malay and 2 Indian. The mean duration of illness was 5.8+/-4.3 years. The mean PDSS score was 120.3+/-13.5. SDB was found in 54.6 percent of the patients (apnoeahypopnoea index [AHI] 5 and above), with 27.3 percent having moderate and severe SDB (AHI 15 and above). The median AHI was 6.7 (range 0-40.4). The prevalence of SDB in PD patients based on the AHI cutoffs were 27.3 percent for mild, 18.2 percent for moderate and 9.1 percent for severe. There were statistically significant positive correlations between the AHI and the neck circumference and between the AHI and the waist-hip ratio. There was no significant correlation between the AHI and PDSS, or the AHI and disease severity.
CONCLUSION: There was a high prevalence of SBD in our PD patients, which was comparable to other studies. Obstructive sleep apnoea was the dominant type of SBD. There was no correlation between the subjective sleep symptoms using the PDSS and the objective measurements using PSG.

Study site: Neurology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Sleep Apnea, Obstructive/complications*; Sleep Apnea, Obstructive/epidemiology*; Sleep Apnea, Central/complications*; Sleep Apnea, Central/epidemiology*
Effect of current breastfeeding on sleep patterns in infants from Asia-Pacific region

Ramamurthy MB, Sekartini R, Ruangdaraganon N, Huynh DH, Sadeh A, Mindell JA

J Paediatr Child Health, 2012 Aug;48(8):669-74.
PMID: 22616943 DOI: 10.1111/j.1440-1754.2012.02453.x

AIM:
The aim of this study was to assess the relationship between breastfeeding and sleep patterns in infants from Asia-Pacific region.

METHODS:
Parents of 10 321 infants (0-11 months) from Australia, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand and Vietnam completed an expanded version of the Brief Infant Sleep Questionnaire.

RESULTS:
Overall, 4714 (45.72%) were currently being breastfed; 61.3% of those between 0 and 5 months and 36.6% of those between 6 and 11 months. Currently breastfed infants, when compared with not currently breastfed infants, had a significant increase in the number and duration of night-time wakings and less consolidated sleep. Interestingly, currently breastfed infants less than 6 months also showed longer duration of daytime sleep and obtained more sleep overall. Of note, of those who were currently breastfed, those infants who were nursed back to sleep during night, woke up more often at night (2.41 vs. 1.67 times) and had shorter continuous night-time sleep period (5.58 vs. 6.88 h; P < 0.001). There was no significant difference between breastfeeding and non-breastfeeding infants in the number of night wakings, when the nursing to sleep variable was controlled for in the analysis of variance.

CONCLUSION:
Breastfeeding is associated with reduced sleep consolidation in infants. This relationship, however, may be moderated by parenting practices of nursing to sleep and back to sleep during the night. Thus, parents of infants with night waking problems should be encouraged to limit the association between nursing and falling to sleep, to improve sleep while maintaining breastfeeding.

Matched MeSH terms: Sleep/physiology*
Effect of amplitude criteria on operating characteristic of detection for OSAH events with oxygen saturation

Lee YK, Bister M, Salleh YM, Blanchfield P

Annu Int Conf IEEE Eng Med Biol Soc, 2007;2007:4645-8.
PMID: 18003041

Effect of amplitude criteria on the operating characteristics of algorithms for detecting OSAH events based on the analysis of oxygen saturation alone is investigated. The objective is to establish that there exists an oxygen desaturation level that leverages these algorithms to be more sensitive or more specific, irrespective of the differences in detection mechanism and database, a first ever attempt. Linear classification of algorithms from previous studies discovered that a drop in oxygen saturation of 3% or less makes the detection algorithms more sensitive while a drop of 4% or more makes it more specific. Results from two algorithms developed here also supported this. This finding explains the contradiction cited in the performance of algorithms from the different authors, which casts doubts on their detection ability. It could lead to the establishment of standard oxygen desaturation levels for screening and diagnosis of moderate/severe OSA, thus providing a more credible comparison basis for automated detection algorithms or even clinical tests.

Matched MeSH terms: Sleep Apnea, Obstructive/physiopathology*
Fulltext The AC/AG Diplotype for the 118A>G and IVS2 + 691G>C Polymorphisms of OPRM1 Gene is Associated with Sleep Quality Among Opioid-Dependent Patients on Methadone Maintenance Therapy

Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, et al.

Pain Ther, 2016 Jun;5(1):43-54.
PMID: 26792136 DOI: 10.1007/s40122-016-0044-3

INTRODUCTION: Methadone is a full agonist of the opioid receptor mu 1 which is encoded by the OPRM1 gene. Sleep disorders were frequently reported by opioid-dependent patients during methadone maintenance therapy (MMT). It is possible, therefore, that genetic polymorphisms in OPRM1 influence sleep quality among patients on MMT. This study investigated the association of OPRM1 polymorphisms with sleep quality among opioid-dependent patients on MMT.
METHODS: The sleep quality of 165 male opioid-dependent patients receiving MMT was evaluated using the Pittsburgh Sleep Quality Index (PSQI). DNA was extracted from whole blood and subjected to polymerase chain reaction (PCR) genotyping.
RESULTS: Patients with IVS2 + 691 CC genotype had higher PSQI scores [mean (SD) = 5.73 (2.89)] compared to those without the IVS2 + 691 CC genotype (IVS2 + 691 GG/GC genotype) [4.92 (2.31)], but the difference did not reach statistical significance (p = 0.081). Patients with combined 118 AA genotype and IVS2 + 691 GC genotype (AC/AG diplotype) had significantly lower PSQI scores [mean (SD) = 4.25 (2.27)] compared to those without the diplotype [5.68 (2.77)] (p = 0.018).
CONCLUSION: Our study indicates that the AC/AG diplotype for the 118A>G and IVS2 + 691G>C polymorphisms of OPRM1 gene is associated with better sleep quality among males with opioid dependence on MMT.
KEYWORDS: AC/AG diplotype; Male patients; Methadone; Methadone maintenance therapy; OPRM1; Opioid dependence; Opioid receptor; Opioid receptor, mu 1 gene; Pittsburgh Sleep Quality Index; Sleep quality

Matched MeSH terms: Sleep*
Fulltext Road traffic accidents in patients with obstructive sleep apnoea

Liam CK, How LG, Tan CT

Med J Malaysia, 1996 Mar;51(1):143-5.
PMID: 10967996

Three patients involved in road traffic accidents were suspected to have obstructive sleep apnoea (OSA). Two of them fell asleep while riding motorcycles and one patient fell asleep behind the wheel of a truck causing it to overturn. The diagnosis of OSA in each case was suspected based on a history of loud snoring, restless sleep, and excessive daytime somnolence and was confirmed by sleep studies.

Matched MeSH terms: Sleep Apnea Syndromes/physiopathology*
A review of fluid-structure interaction simulation for patients with sleep related breathing disorders with obstructive sleep

Faizal WM, Ghazali NNN, Badruddin IA, Zainon MZ, Yazid AA, Ali MAB, et al.

Comput Methods Programs Biomed, 2019 Oct;180:105036.
PMID: 31430594 DOI: 10.1016/j.cmpb.2019.105036

Obstructive sleep apnea is one of the most common breathing disorders. Undiagnosed sleep apnea is a hidden health crisis to the patient and it could raise the risk of heart diseases, high blood pressure, depression and diabetes. The throat muscle (i.e., tongue and soft palate) relax narrows the airway and causes the blockage of the airway in breathing. To understand this phenomenon computational fluid dynamics method has emerged as a handy tool to conduct the modeling and analysis of airflow characteristics. The comprehensive fluid-structure interaction method provides the realistic visualization of the airflow and interaction with the throat muscle. Thus, this paper reviews the scientific work related to the fluid-structure interaction (FSI) for the evaluation of obstructive sleep apnea, using computational techniques. In total 102 articles were analyzed, each article was evaluated based on the elements related with fluid-structure interaction of sleep apnea via computational techniques. In this review, the significance of FSI for the evaluation of obstructive sleep apnea has been critically examined. Then the flow properties, boundary conditions and validation of the model are given due consideration to present a broad perspective of CFD being applied to study sleep apnea. Finally, the challenges of FSI simulation methods are also highlighted in this article.

Matched MeSH terms: Sleep Apnea, Obstructive/physiopathology*
Deep convolutional neural network for classification of sleep stages from single-channel EEG signals

Mousavi Z, Yousefi Rezaii T, Sheykhivand S, Farzamnia A, Razavi SN

J Neurosci Methods, 2019 08 01;324:108312.
PMID: 31201824 DOI: 10.1016/j.jneumeth.2019.108312

Using a smart method for automatic diagnosis in medical applications, such as sleep stage classification is considered as one of the important challenges of the last few years which can replace the time-consuming process of visual inspection done by specialists. One of the problems regarding the automatic diagnosis of sleep patterns is extraction and selection of discriminative features generally demanding high computational burden. This paper provides a new single-channel approach to automatic classification of sleep stages from EEG signal. The main idea is to directly apply the raw EEG signal to deep convolutional neural network, without involving feature extraction/selection, which is a challenging process in the previous literature. The proposed network architecture includes 9 convolutional layers followed by 2 fully connected layers. In order to make the samples of different classes balanced, we used a preprocessing method called data augmentation. The simulation results of the proposed method for classification of 2 to 6 classes of sleep stages show the accuracy of 98.10%, 96.86%, 93.11%, 92.95%, 93.55% and Cohen's Kappa coefficient of 0.98%, 0.94%, 0.90%, 0.86% and 0.89%, respectively. Furthermore, comparing the obtained results with the state-of-the-art methods reveals the performance improvement of the proposed sleep stage classification in terms of accuracy and Cohen's Kappa coefficient.

Matched MeSH terms: Sleep Stages/physiology*
Fulltext Selected recommendations from international guidelines on obstructive sleep apnoea

Nurul Yaqeen Mohd Esa

Journal of Clinical and Health Sciences, 2017;2:19-25.

Obstructive sleep apnoea (OSA) is increasingly seen as a major health threat globally.
However, it is still underdiagnosed mainly among Asian population partly due to lack of
understanding on the pathophysiology, and limited access to the diagnostic and management
aspect of the disease. Recurring complete and/or partial collapses of the upper airways define
OSA. Based on the number of apnoeas and/or hypopnoeas per hour of sleep, OSA is
categorized as mild, moderate and severe. Both the American Association of Sleep Medicine
(AASM) and American College of Physicians (ACP) has published guidelines regarding the
management of OSA in adults. Three recommendations have been suggested by the
guidelines which can be used to tailor the management of OSA. The aim of this article is to
select relevant recommendations from these guidelines in epidemiology, pathophysiology,
diagnostic procedures and treatment for proper management of OSA, while considering
specific patient populations, such as hypertensive, diabetic, obese and Asian patients.

Matched MeSH terms: Sleep; Sleep Apnea, Obstructive
Fulltext Devastating insomnia experience following general anaesthesia for mastoidectomy surgery

Misron, L.H., Misron, K., Misron, S.N.F.

International Medical Journal Malaysia, 2018;17(2):139-142.
MyJurnal

Sleep disorder including insomnia is one of the complications of general anaesthesia. It is not uncommon and it is temporary but majority remains unnoticed and untreated. The effect of insomnia ranges from mild to severe, influencing both physical and mental health. Surgeon and anaesthetist need to identify this complication so that an appropriate treatment can be delivered. In complicated case, psychiatrist involvement is crucial. The treatment is symptomatic and temporary. We reported a case of distressful sleep disorder as a sequelae of general anaesthesia for mastoidectomy surgery. Subsequently after symptomatic treatment, he recovered completely and regained his normal sleep pattern.

Matched MeSH terms: Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders
Associations between primary aldosteronism and diabetes, poor bone health, and sleep apnea-what do we know so far?

Loh HH, Sukor N

J Hum Hypertens, 2020 01;34(1):5-15.
PMID: 31822780 DOI: 10.1038/s41371-019-0294-8

Primary aldosteronism (PA), the most common cause of secondary hypertension, is a well-recognized condition that can lead to cardiovascular and renal complications. PA is frequently left undiagnosed and untreated, leading to aldosterone-specific morbidity and mortality. In this review we highlight the evidence linking PA with other conditions such as (i) diabetes mellitus, (ii) obstructive sleep apnea, and (iii) bone health, along with clinical implications and proposed underlying mechanisms.

Matched MeSH terms: Sleep Apnea, Obstructive/metabolism
Fulltext Sleep quality and psychosocial correlates among elderly attendees of an urban primary care centre in Malaysia

Razali R, Wahab S, Mohd Daud TI, Ariffin J, Abdul Aziz AF, Wan Puteh SE

Neurology Asia, 2016;21(3):265-273.
MyJurnal

Sleep quality can vary in relation to one’s general well-being and in the elderly, it is often affected by the presence of medical or psychological conditions. This study aims to determine the frequency of different components of sleep quality in the elderly, and their relationships with psychosocial and medical attributes. A cross-sectional study was conducted on 123 attendees aged 60 years and above at Pusat Perubatan Primer Universiti Kebangsaan Malaysia. Sleep quality and psychological distress were assessed using the validated Malay versions of Pittsburgh sleep quality index (PSQI) and Hamilton anxiety depression scale (HADS) respectively. Information on medical comorbidities and medications were obtained from the participants, their doctors and medical notes. Almost half of the patients experienced poor sleep quality (47.2%) which was significantly associated with older mean age (69.5 ±4.55). There was no statistical significance between sleep quality and other sociodemographic characteristics (gender, ethnicity and living arrangement). Most patients described their sleep quality as subjectively generally “fairly good” (69.1%) despite PSQI scores indicating poor sleep quality. A majority of the patients (59.3%) were on follow-up for 3 or more medical illnesses, with heart disease as the only medical comorbidity significantly associated with poor sleep quality. Most of them also complained of only “mild difficulty” with their sleep. Among the 7 sleep components of PSQI, “sleep disturbance” was the most frequent experience. Most experienced mild sleep disturbance (87.8%) and usage of hypnotic agents was low (6.5%). Only 23.6% of patients had significant psychological distress (HADS scores ≥ 8), with positive correlation with sleep quality.
Study site: Pusat Perubatan Primer, Universiti Kebangsaan Malaysia (PPPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Sleep*
Fulltext Effects of night shift work towards health and safety of production workers. [Kesan bekerja shif malam terhadap kesihatan dan keselamatan di kalangan pekerja pengeluaran]

Deros, B.M., Khamis, N.K., Ismail, A.R., Ludin, A.

Malaysian Journal of Community Health, 2009;15(1):64-75.
MyJurnal

Introduction : Shift work is practised in manufacturing industry to increase production capacity up to three times compared to the normal daily eight hours working system and able to optimize the utilization of machine and equipment. However, shift work has negatif effects on human social interaction, health and safety.
Methodology : The study was conducted to evaluate production workers’ perception on the effects of working at night shift. The respondents of the study were production workers in Company X in Kuala Lumpur. The Data was collected using self administered questionnaires. The study objectives was to study the work schedule design, to find out their perceptions on the effects of night shift and to study on personal factors, employees’ level of acceptance on the work schedule design and personal factors that cause safety and health disruption.
Result : A total of 200 production workers participated in the study. The result of the study shows 61% of production workers took sick leave and 43.5% were absent between 1 and 2 times a month. In terms of health and safety disruption, 77% of respondents agreed that they faced lack of focus with family and friends, 75.5% of them did not have enough sleep and 76.5% felt sleepy during working time. Regarding the work schedule and workstation design, 81.5% said they felt uncomfortable because they were required to stand during working and 77% felt that the resting period provided by the factory was too short and inadequate. More than 70% of the respondents proposed the rest period should be extended from the current 40 minutes to one hour. More than 80% of respondents agreed they would feel comfortable if standing at work is changed to sitting work system.
Conclusion : To minimize the unwanted effect of night shift among the production.

Matched MeSH terms: Sleep; Sleep Stages
Fulltext Selected recommendations from international guidelines on obstructive sleep apnoea

Nurul Yaqeen Mohd Esa

Journal of Clinical and Health Sciences, 2017;2(2):19-25.
MyJurnal

Obstructive sleep apnoea (OSA) is increasingly seen as a major health threat globally.
However, it is still underdiagnosed mainly among Asian population partly due to lack of
understanding on the pathophysiology, and limited access to the diagnostic and management
aspect of the disease. Recurring complete and/or partial collapses of the upper airways define
OSA. Based on the number of apnoeas and/or hypopnoeas per hour of sleep, OSA is
categorized as mild, moderate and severe. Both the American Association of Sleep Medicine
(AASM) and American College of Physicians (ACP) has published guidelines regarding the
management of OSA in adults. Three recommendations have been suggested by the
guidelines which can be used to tailor the management of OSA. The aim of this article is to
select relevant recommendations from these guidelines in epidemiology, pathophysiology,
diagnostic procedures and treatment for proper management of OSA, while considering
specific patient populations, such as hypertensive, diabetic, obese and Asian patients.

Matched MeSH terms: Sleep; Sleep Apnea, Obstructive
Fulltext Self-reported sleep quality using the Malay version of the Pittsburgh Sleep Quality Index (PSQI-M) in Malaysian adults

Farah NM, Saw Yee T, Mohd Rasdi HF

Int J Environ Res Public Health, 2019 Nov 27;16(23):4750.
PMID: 31783607 DOI: 10.3390/ijerph16234750

(1) Background: The Pittsburgh Sleep Quality Index (PSQI) is a useful tool for the assessment of subjective sleep quality in non-clinical and clinical settings. This study aimed to determine sleep quality in a general Malaysian adult population using a validated Malay version of the Pittsburgh sleep quality index (PSQI-M); (2) Methods: The original PSQI was translated into Malay following forward and backward translation guidelines. The final Malay version was administered to a sample of healthy working adults (n = 106; mean age: 35.3 ± 7.6 years) without history of sleep disorders. Reliability and agreement were assessed using Cronbach's alpha, intra-class correlations coefficient (ICC), standard error of measurement (SEM), and Bland-Altman plot. Convergent validity of PSQI-M was examined with the Malay version of Epworth sleepiness scale (ESS-M) using Pearson's correlation coefficient; (3) Results: Overall mean PSQI global score was 5.25 ± 1.85. About 45% of the sample had PSQI global score >5, indicating poor sleep quality. Total sleep duration per night was 5.95 ± 1.05 h, below the recommended amount. Sleep quality seems to be affected by age but not gender. Internal consistency as measured by Cronbach's alpha in the whole sample was 0.74, with test-retest reliability (ICC) of 0.58 and SEM of 1.34. The PSQI test-retest scores indicated that most of the respondents (90%) lay within the 95% limits of agreement. The PSQI-M also showed significant correlation with ESS-M scores (r = 0.37, p < 0.01); (4) Conclusion: The PSQI-M showed acceptable reliability and is valid to be used in a general Malaysian adult population. Findings also indicate that a majority of the adults in our sample were experiencing inadequate sleep, thus further research is needed to identify the factors associated with poor sleep quality.
Study site and participants: adults working in a university satellite campus in Kuala Lumpur, Malaysia

Matched MeSH terms: Sleep; Sleep Wake Disorders
The association of weight loss from anti-obesity medications or bariatric surgery and apnea-hypopnea index in obstructive sleep apnea

Locke BW, Gomez-Lumbreras A, Tan CJ, Nonthasawadsri T, Veettil SK, Patikorn C, et al.

Obes Rev, 2024 Apr;25(4):e13697.
PMID: 38342767 DOI: 10.1111/obr.13697

INTRODUCTION: Weight loss is recommended for individuals with obstructive sleep apnea (OSA) and overweight or obesity, but there is limited evidence to guide the selection of weight management strategies for patients who do not lose sufficient weight with diet and lifestyle changes. We evaluated the relationship between weight loss caused by pharmacologic or surgical interventions and subsequent improvement in OSA by the apnea-hypopnea index (AHI).
METHODS: PubMed, Cochrane CENTRAL, and EMBASE were searched for randomized trials comparing pharmacologic or surgical obesity interventions to usual care, placebo, or no treatment in adults with OSA. The association between percentage weight loss and AHI change between randomization and last follow-up was evaluated using meta-regression.
PROSPERO: CRD42022378853.
RESULTS: Ten eligible trials (n = 854 patients) were included. Four (n = 211) assessed bariatric surgery, and 6 (n = 643) assessed pharmacologic interventions over a median follow-up of 13 months (interquartile range 6-26 months). The linear best estimate of the change in AHI is 0.45 events per hour (95% Confidence Interval 0.18 to 0.73 events per hour) for every 1% body weight lost.
CONCLUSIONS: Weight loss caused by medication or surgery caused a proportionate improvement of the AHI. Providers could consider extrapolating from this relationship when advising patients of the expected effects of other pharmacologic or surgical interventions without direct evidence in OSA.

Matched MeSH terms: Sleep Apnea, Obstructive*
Fulltext Cross-sectional interrelationships between chronotype, obstructive sleep apnea and blood pressure in a middle-aged community cohort

Sansom K, Reynolds A, Dhaliwal SS, Walsh J, Maddison K, Singh B, et al.

J Sleep Res, 2023 Jun;32(3):e13778.
PMID: 36330799 DOI: 10.1111/jsr.13778

Chronotype is linked to adverse health measures and may have important associations with obstructive sleep apnea and blood pressure, but data are limited. This study aimed to determine the separate and combined associations of chronotype with obstructive sleep apnea and blood pressure in a middle-aged community population. Adults (n = 811) from the Raine Study (female = 59.2%; age mean [range] = 56.6 [42.1-76.6] years) were assessed for chronotype (Morningness-Eveningness Questionnaire), blood pressure and hypertension (doctor diagnosed or systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg), and obstructive sleep apnea at different in-laboratory apnea-hypopnea index thresholds (5, 10, 15 events per hr). Linear and logistic regression models examined relationships between chronotype and the presence and severity of obstructive sleep apnea, blood pressure, hypertension, and blood pressure stratified by obstructive sleep apnea severity at above-mentioned apnea-hypopnea index thresholds. Covariates included age, sex, body mass index, alcohol consumption, smoking, physical activity, sleep duration, anti-hypertensive medication, insomnia, and depressive symptoms. Most participants were categorised as morning (40%) or intermediate (43%), with 17% meeting criteria for evening chronotypes. Participants with apnea-hypopnea index ≥ 15 events per hr and morning chronotype had higher systolic (9.9 mmHg, p sleep apnea.

Matched MeSH terms: Sleep/physiology
Prevalence and Trajectories of Post-COVID-19 Neurological Manifestations: A Systematic Review and Meta-Analysis

Giussani G, Westenberg E, Garcia-Azorin D, Bianchi E, Yusof Khan AHK, Allegri RF, et al.

Neuroepidemiology, 2024;58(2):120-133.
PMID: 38272015 DOI: 10.1159/000536352

INTRODUCTION: The aim of this systematic review and meta-analysis was to evaluate the prevalence of thirteen neurological manifestations in people affected by COVID-19 during the acute phase and at 3, 6, 9 and 12-month follow-up time points.
METHODS: The study protocol was registered with PROSPERO (CRD42022325505). MEDLINE (PubMed), Embase, and the Cochrane Library were used as information sources. Eligible studies included original articles of cohort studies, case-control studies, cross-sectional studies, and case series with ≥5 subjects that reported the prevalence and type of neurological manifestations, with a minimum follow-up of 3 months after the acute phase of COVID-19 disease. Two independent reviewers screened studies from January 1, 2020, to June 16, 2022. The following manifestations were assessed: neuromuscular disorders, encephalopathy/altered mental status/delirium, movement disorders, dysautonomia, cerebrovascular disorders, cognitive impairment/dementia, sleep disorders, seizures, syncope/transient loss of consciousness, fatigue, gait disturbances, anosmia/hyposmia, and headache. The pooled prevalence and their 95% confidence intervals were calculated at the six pre-specified times.
RESULTS: 126 of 6,565 screened studies fulfilled the eligibility criteria, accounting for 1,542,300 subjects with COVID-19 disease. Of these, four studies only reported data on neurological conditions other than the 13 selected. The neurological disorders with the highest pooled prevalence estimates (per 100 subjects) during the acute phase of COVID-19 were anosmia/hyposmia, fatigue, headache, encephalopathy, cognitive impairment, and cerebrovascular disease. At 3-month follow-up, the pooled prevalence of fatigue, cognitive impairment, and sleep disorders was still 20% and higher. At six- and 9-month follow-up, there was a tendency for fatigue, cognitive impairment, sleep disorders, anosmia/hyposmia, and headache to further increase in prevalence. At 12-month follow-up, prevalence estimates decreased but remained high for some disorders, such as fatigue and anosmia/hyposmia. Other neurological disorders had a more fluctuating occurrence.
DISCUSSION: Neurological manifestations were prevalent during the acute phase of COVID-19 and over the 1-year follow-up period, with the highest overall prevalence estimates for fatigue, cognitive impairment, sleep disorders, anosmia/hyposmia, and headache. There was a downward trend over time, suggesting that neurological manifestations in the early post-COVID-19 phase may be long-lasting but not permanent. However, especially for the 12-month follow-up time point, more robust data are needed to confirm this trend.

Matched MeSH terms: Sleep Wake Disorders*
Fulltext Effects of Internet Cognitive Behavioral Therapy for Insomnia and Internet Sleep Hygiene Education on Sleep Quality and Executive Function Among Medical Students in Malaysia: Protocol for a Randomized Controlled Trial

Mariappan V, Mukhtar F

JMIR Res Protoc, 2024 Dec 11;13:e59288.
PMID: 39661437 DOI: 10.2196/59288

BACKGROUND: Medical students are frequently affected by poor sleep quality. Since poor sleep quality has negative physiological and psychological consequences such as on executive function, there is an opportunity to improve sleep quality and executive functions using non-pharmacological intervention such as cognitive behavioural therapy.
OBJECTIVE: The aim of this study therefore is to determine if improving sleep quality could improve executive functions in medical students with poor sleep quality by comparing cognitive behavioural therapy for insomnia (CBT-I) with sleep hygiene education (SHE) in a randomized controlled trial (RCT).
METHODS: A parallel group, RCT with a target sample of 120 medical students recruited from government-based medical universities in Malaysia. Eligible participants will be randomized to internet group CBT-I or internet group SHE in a 1:1 ratio. Assessments will be performed at baseline, post-intervention, 1 month, 3-months, and 6-months. The primary outcome is between-group differences in sleep quality and executive function post-baseline. The secondary outcomes include pre-sleep worry, attitude about sleep, sleep hygiene and sleep parameters.
RESULTS: This study received approval from the Research Ethics Committee in Universiti Putra Malaysia (JKEUPM-2023-1446) and Universiti Kebangsaan Malaysia (JEP-2024-669). The clinical trial was also registered in Australian New Zealand Clinical Trial Registry (ACTRN1264000243516). As of June 2024, the recruitment process is ongoing and a total of 48 and 49 students have been enrolled from the universities into the CBT-I and ISHE groups, respectively. All the participants provided signed and informed consent to participate in the study. Data collection has been completed for the baseline (pre-treatment assessment), and follow-up assessments for T1 and T2 for all the participants in both groups, while T3 and T4 assessments will be completed by July 2025. Data analysis will be performed by August 2025 and the research will be completed by December 2025.
CONCLUSIONS: This study is the first attempt to design a CBT intervention to ameliorate poor sleep quality and its related negative effects among medical students. This research is also the first large-scale exploring the relationship between health status and CBT-mediated sleep improvement among medical students.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12624000243516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=387030.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/59288.

Matched MeSH terms: Sleep Hygiene*
Sleep disturbances in Malaysian patients with Parkinson's disease using polysomnography and PDSS

Norlinah MI, Afidah KN, Noradina AT, Shamsul AS, Hamidon BB, Sahathevan R, et al.

Parkinsonism Relat Disord, 2009 Nov;15(9):670-4.
PMID: 19362875 DOI: 10.1016/j.parkreldis.2009.02.012

Sleep disturbances such as sleep fragmentation, sleep disordered breathing (SDB), periodic limb movements (PLM), excessive daytime somnolence (EDS) and insomnia are prevalent in Parkinson's disease (PD). However, studies in the Asian population are limited.

Matched MeSH terms: Sleep Wake Disorders/diagnosis*; Sleep Wake Disorders/etiology; Sleep Wake Disorders/epidemiology*
The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and meta-analysis

Lee SWH, Ng KY, Chin WK

Sleep Med Rev, 2017 02;31:91-101.
PMID: 26944909 DOI: 10.1016/j.smrv.2016.02.001

Recent epidemiological studies have suggested that there is an association between glycemic control and sleep disturbances in patients with type 2 diabetes, but the extent is unclear. A systematic literature search was performed in nine electronic databases from inception until August 2015 without any language restriction. The search identified 20 studies (eight studies reporting duration of sleep and 15 studies evaluating sleep quality), and 15 were included in the meta-analysis. Short and long sleep durations were associated with an increased hemoglobin A1c (HbA1c) (weighted mean difference (WMD): 0.23% [0.10-0.36], short sleep; WMD: 0.13% [0.02-0.25], long sleep) compared to normal sleep, suggesting a U-shaped dose-response relationship. Similarly, poor sleep quality was associated with an increased HbA1c (WMD: 0.35% [0.12-0.58]). Results of this study suggest that amount of sleep as well as quality of sleep is important in the metabolic function of type 2 diabetes patients. Further studies are needed to identify for the potential causal role between sleep and altered glucose metabolism.

Matched MeSH terms: Sleep/physiology; Sleep Wake Disorders/complications*

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