Summary Obstructive sleep apnea (OSA) causes sleep fragmentation and excessive daytime sleepiness (EDS). OSA has been hypothesised to impair the circadian sleep–wake rhythm, and this dysregulation may in turn exacerbate OSA‐related diurnal symptoms. Hence, this study aimed to assess the sleep–wake rhythm through actigraphy, and its relationship with EDS in patients with untreated OSA. Patients with moderate–severe OSA (apnea–hypopnea index ≥15/h) and healthy controls (HC) underwent a 7‐day actigraphic recording to evaluate the sleep–wake rhythm. Participants underwent a sleep medicine visit and completed the self‐report questionnaires assessing EDS (Epworth sleepiness scale, ESS), sleep quality (Pittsburgh sleep quality index, PSQI), and chronotype (morningness‐eveningness questionnaire, MEQ). This study included 48 OSA patients (72.9% males; mean age 56.48 ± 9.53 years), and 22 HC (45.5% males; mean age 53.73 ± 18.20 years). After controlling for MEQ scores, actigraphic recording showed that the OSA patients present a lower sleep time ( p = 0.011) and sleep efficiency ( p = 0.013), as well as a higher sleep latency ( p = 0.047), and sleep fragmentation ( p = 0.029) than the HC. Regarding the sleep‐wake rhythm actigraphic parameters, the OSA patients showed a lower average activity during the most active 10‐hour period ( p = 0.036) and a lower day/night activity ratio ( p = 0.007) than the HC. Patients with OSA also reported higher ESS ( p = 0.005) and PSQI scores ( p < 0.001), and a chronotype less of morning type ( p = 0.027) than the HC. In conclusion, this study documented a reduced diurnal motor activity and lower day/night activity ratio in OSA patients than in controls. These findings suggest a dysregulation of the circadian sleep–wake rhythm in OSA, possibly related to both EDS and reduced daytime motor activity.
Background: Sleep disorders may cause dysregulation in cerebral glucose metabolism and synaptic functions, as well as alterations in cerebrospinal fluid (CSF) biomarker levels. Objective: This study aimed at measuring sleep, CSF Alzheimer’s disease (AD) biomarkers, and cerebral glucose consumption in patients with obstructive sleep apnea syndrome (OSAS) and patients with periodic limb movement disorder (PLMD), compared to controls. Methods: OSAS and PLMD patients underwent 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET), polysomnographic monitoring, and lumbar puncture to quantify CSF levels of amyloid-β42 (Aβ42), total tau, and phosphorylated tau. All patients were compared to controls, who were not affected by sleep or neurodegenerative disorders. Results: Twenty OSAS patients, 12 PLMD patients, and 15 controls were included. Sleep quality and sleep structure were altered in both OSAS and PLMD patients when compared to controls. OSAS and PLMD patients showed lower CSF Aβ42 levels than controls. OSAS patients showed a significant increase in glucose uptake in a wide cluster of temporal-frontal areas and cerebellum, as well as a reduced glucose consumption in temporal-parietal regions compared to controls. PLMD patients showed increased brain glucose consumption in the left parahippocampal gyrus and left caudate than controls. Conclusion: Sleep dysregulation and nocturnal hypoxia present in OSAS patients, more than sleep fragmentation in PLMD patients, were associated with the alteration in CSF and 18F-FDG PET AD biomarkers, namely reduction of CSF Aβ42 levels and cerebral glucose metabolism dysregulation mainly in temporal areas, thus highlighting the possible role of sleep disorders in driving neurodegenerative processes typical of AD pathology.
Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women.155 pregnant women participated in this longitudinal study.Expectant mothers completed a questionnaire and then 2-years after the child's birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined.Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers' intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years.Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.
ABSTRACT Objectives: Anorectal malformations (ARMs) are rare congenital colorectal anomalies, which may have a negative impact on health‐related quality of life (HRQoL) due to long‐lasting consequences, like fecal incontinence. The aim of the present study was to test whether a pervasive mode of appraising and viewing life experiences from a positive stance (ie, positivity) mediates the effect of fecal continence on HRQoL. Methods: Participants were enrolled from the Italian Association for Anorectal Malformations. Adult patients with ARMs who completed measures of fecal continence (Hirschsprung Disease/Anorectal Malformation Quality of Life Questionnaire), positivity (Life Satisfaction Scale, Rosenberg Self‐esteem Scale, and Life Orientation Test), and mental/physical HRQoL (SF‐36) were included. Data were analyzed using the PROCESS macro for SPSS statistical software (Model 4). Results: The study included 66 adult patients with ARMs. Mediated regression analyses showed a significant total effect in which patients with higher fecal continence perceived higher physical (β = 0.210, SE = 0.038, 95% CI [0.133, 0.286]) and mental HRQoL (β = 0.226, SE = 0.056, 95% CI [0.115, 0.338]) than patients with lower fecal continence. The indirect effects were also significant, indicating that positivity mediated the impact of fecal continence on physical (β = 0.026, SE = 0.017, 95% CI [0.002, 0.068]), and mental HRQoL (β = 0.146, SE = 0.058, 95% CI [0.047, 0.275]). Conclusions: The findings extend previous literature on ARM patients and additional evidence that an optimistic view of oneself, one's life, and one's future contribute to explain the effects of functional impairments on quality of life.
Chronic insomnia disorder (CID) significantly impacts well-being and daily functioning. Daridorexant, a double orexin receptor blocker, has shown efficacy in randomized clinical trials and has been recently approved for the treatment of CID in adult patients. This retrospective observational study aimed to describe real-world data on daridorexant effectiveness and safety in adult patients with CID.
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