BackgroundQuality sleep is vital for well-being, especially for healthcare workers facing high risks of fatigue and burnout. Sleep deprivation impairs cognitive and motor functions, contributing to medical errors. Addressing sleep disorders among healthcare professionals is crucial for enhancing patient care. Tailored interventions are needed to support their well-being and improve healthcare outcomes.ObjectiveTo evaluate the effect of Sleep Quality and its Deprivation on Sudanese Healthcare Professionals amidst conflict in Sudan.MethodsA cross-sectional online survey of Sudanese doctors was conducted using convenience sampling. The questionnaire covered sleep quality, daytime sleepiness, and psychological well-being. Pilot testing ensured questionnaire clarity. Data collection utilized Google Forms distributed through social media and professional networks. A minimum sample size of 384 was calculated. Statistical analysis included descriptive statistics and various tests for significance. Data were securely stored and analyzed using SPSS and R software.ResultsAmong 649 participants, 404 (62.2%) were women, with a mean age of 30.34 years. Most were single (434, 66.9%). General practitioners constituted the largest professional group (267, 41.1%), followed by registrars/residents (142, 21.9%). Participants took an average of 43.70 minutes to fall asleep and slept an average of 5.90 hours per night. According to the PSQI, 300 (46.2%) reported mild sleep disturbance, 287 (44.2%) moderate, 42 (6.5%) severe, and only 20 (3.1%) normal sleep. The ESS revealed 285 (43.9%) with lower normal daytime sleepiness, 188 (29.0%) with higher normal, and various levels of excessive daytime sleepiness. Stress levels varied, with 398 (61.3%) reporting normal stress, while anxiety ranged from 248 (38.2%) normal to 148 (22.8%) extremely severe.ConclusionThis study emphasizes the importance of addressing sleep quality, mental health, and performance challenges among Sudanese healthcare professionals. It highlights the need for hospitals to implement measures enabling more time off, adequate sleep, and reduced on-call service days. Healthcare workers must recognize the significance of these factors for their well-being and patient care quality. The research outcomes can raise awareness about the necessity of regulating healthcare practitioners' working hours and ensuring adequate sleep.

BackgroundPost-arousal hypersynchrony (PAH) is a continuous delta wave occurring after arousal. We hypothesized that PAH would decrease with age because PAH is affected by sleep pressure, which decreases with age.MethodsWe evaluated polysomnography (PSG) during daytime napping to determine whether age affected the incidence of PAH. Twenty healthy participants (10 females, 45.0 ± 14.8 years [mean ± standard deviation], and age range, 22-67 years) were assessed using PSG during 90-min naps. PAH was present in two participants in their 20 s, one in their 40 s, and two in their 60 s. We first investigated whether the incidence of PAHs decreases with age using correlation analysis. Secondly, correlations between PAH and sleep index were analyzed to evaluate the factors influencing PAH occurrence. Thirdly, we evaluated whether sleep pressure decreases with age. %N3 and slow-wave activity (SWA) were used to measure sleep pressure.ResultsPAH occurrence was unchanged with age. PAH corrected with total sleep time (PAH/TST) increased with %N3, but not with SWA. PAH/arousal, which is PAH corrected by the number of arousals, was also increased with %N3 and SWA. These results indicate that PAH occurrence may be related to sleep pressure. Contrary to expectation, %N3 showed no change with age, but SWA decreased with age.ConclusionsPAH occurrence may be affected by sleep pressure. Contrary to our hypothesis, PAH was seen in older adults, and its occurrence was unchanged with age. This may be associated with the relatively high sleep pressure observed in older adults.

BackgroundSince evaluating sleep quality among students is of great importance and is one of the challenges facing the health field regarding this group, we were determined to conduct this study to evaluate the psychometric properties of the Sleep Quality Questionnaire (SQQ) among the medical students at the Guilan University of Medical Sciences.MethodsThis research was conducted as a cross-sectional study. In the procedure, a random group of medical students at Guilan University of Medical Sciences were provided with questionnaires and the study’s pre-prepared checklist and were asked to answer them accurately. The questionnaires used in this study include the Sleep Quality Questionnaire (SQQ), and the Pittsburgh Sleep Quality Index (PSQI). After collecting the entries, all the data were subjected to a statistical analysis using the SPSS software.ResultsIn this study, 249 medical students with an average age of 23.88 ± 2.46 were evaluated, of which 140 (56.2%) were female and the rest were male. According to the results, the average sleep quality for SQQ was 19.31 ± 8.06, and the Pittsburgh Sleep Quality Index (PSQI) was 7.95 ± 3.76. Based on the results obtained from the exploratory analysis, it was determined that no high overlap exists between the two evaluated factors in the sleep quality questionnaires, confirming their divergent validity. In evaluating the convergent validity, the correlation between the SQQ and PSQI questionnaires was reported as 0.642, which was significant (p < 0.001). Cronbach’s alpha for the SQQ questionnaire was equivalent to 0.882, which is verified since the minimum value is 0.70. Also, utilizing the test-retest method, the reliability was found to be 0.74, which is acceptable according to the minimum value of 0.70. SQQ scores had a direct and meaningful relationship with age (r = 0.185, p = 0.003). Based on the pairwise comparison, there was a significant difference in SQQ scores between the students in different stages and the duration of sleep.ConclusionThe current study’s findings indicate that the SQQ questionnaire possesses adequate validity and reliability, which could be utilized to evaluate sleep quality in domestic studies.

BackgroundSleep apnea headache is a major symptom accompanying obstructive sleep apnea (OSA), but relatively little evidence has been reported on the magnitude of its negative effects on patients or the evaluation of therapeutic effects. We quantitatively assessed sleep apnea headache using the Epworth sleepiness scale (ESS) and headache impact test (HIT)-6.MethodsThe first part of this study enrolled 86 patients (72 male; mean [± standard deviation] age 53.2 ± 13.8 years) who had been diagnosed with OSA by polysomnography in our sleep center and investigated the prevalence and characteristics of sleep apnea headache. The second part enrolled 21 patients (12 male; mean age, 47.5 ± 13.0 years) diagnosed with sleep apnea headache by polysomnography and/or peripheral arterial tonometry and evaluated the effects of OSA therapy on headache. Medical records including ESS, HIT-6, and polysomnographic data were retrospectively analyzed.ResultsThe prevalence of sleep apnea headache among OSA patients was 22.1%, and was higher in female (50.0%) than in male (16.7%). The proportion of N3 and HIT-6 score showed a significant negative correlation (Pearson’s R = -0.51, p < 0.05). In female, median apnea–hypopnea index (AHI) was significantly lower in patients with headache (26.1 /h [interquartile range 21.4–29.6 /h]) than in patients without (54.2 /h [41.3–73.9 /h], p < 0.05, Wilcoxon rank-sum test). HIT-6 and ESS scores improved from 56.4 ± 9.7 to 45.9 ± 8.4 and from 9.0 ± 4.4 to 5.3 ± 4.2 in patients with oral appliance (OA), and from 54.3 ± 10.7 to 44.6 ± 6.1 and from 10.0 ± 4.0 to 4.9 ± 2.9 with continuous positive airway pressure (CPAP). In patients with good CPAP adherence, these scores improved from 58.1 ± 10.8 to 44.0 ± 6.0 and from 9.6 ± 3.8 to 3.6 ± 1.7.ConclusionAmong patients with OSA, prevalence of sleep apnea headache was higher in female than in male. In female, headache was associated with relatively mild OSA. OA showed substantial effects on headache in mild to moderate OSA patients. CPAP adherence was important for improving the headache. HIT-6 score appears useful for the diagnosis and management of sleep apnea headache.

Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory technique approved by the US Food and Drug Administration for use in treatment-resistant major depressive disorder. It works by generating localized magnetic fields that create depolarizing electrical currents in neurons a few centimeters below the scalp. This localized effect is believed to stimulate neural plasticity, activate compensatory processes, and influence cortical excitability. Additionally, rTMS has been used in a variety of clinical trials for neurological and psychiatric conditions such as anxiety, post-traumatic stress disorder and epilepsy. Beneficial effects in sleep parameters have been documented in these trials, as well as in major depressive disorder, and have led to an interest in using rTMS in the field of sleep medicine for specific disorders such as insomnia, hypersomnia, and restless legs syndrome. It is unknown whether rTMS has intrinsically beneficial properties when applied to primary sleep disorders, or if it only acts on sleep through mood disorders. This narrative review sought to examine available literature regarding the application of rTMS for sleep disorder to identify knowledge gaps and inform future study design. The literature in this area remains scarce, with few randomized clinical trials on rTMS and insomnia. Available studies have found mixed results, with some studies reporting subjective sleep improvement while objective improvement is less consistent. Due to the heterogeneity of results and the variations in rTMS protocols, no definitive conclusions have been reached, signaling the need for further research.

BackgroundThe recent pandemic has made it more challenging to assess patients with suspected obstructive sleep apnea (OSA) with in laboratory polysomnography (PSG) due to concerns of patient and staff safety. The purpose of this study was to assess how Level II sleep studies (LII, full PSG in the home) might be utilized in diagnostic algorithms of suspected OSA using a theoretical decision model.MethodsWe examined four diagnostic algorithms for suspected OSA: an initial PSG approach, an initial LII approach, an initial Level III approach (LIII, limited channel home sleep study) followed by PSG if needed, and an initial LIII approach followed by LII if needed. Costs per patient assessed was calculated as a function of pretest OSA probability and a variety of other variables (e.g. costs of tests, failure rate of LIII/LII, sensitivity/specificity of LIII). The situation in British Columbia was used as a case study.ResultsThe variation in cost per test was calculated for each algorithm as a function of the above variables. For British Columbia, initial LII was the least costly across a broad range of pretest OSA probabilities (< 0.80) while initial LIII followed by LII as needed was least costly at very high pretest probability (> 0.8). In patients with a pretest OSA probability of 0.5, costs per patient for initial PSG, initial LII, initial LIII followed by PSG, and initial LIII followed by LII were: $588, $417, $607, and $481 respectively.ConclusionsUsing a theoretical decision model, we developed a preliminary cost framework to assess the potential role of LII studies in OSA assessment. Across a broad range of patient pretest probabilities, initial LII studies may provide substantial cost advantages. LII studies might be especially useful during pandemics as they combine the extensive physiologic information characteristic of PSG with the ability to avoid in-laboratory stays. More empiric studies need to be done to test these different algorithms.

BackgroundHigh intakes of fruit and vegetable has been shown to protect against diseases and all-cause mortality however, the associations between sleep and fruit and vegetable consumption are not well characterized. This study aims to explore both cross-sectional and prospective associations between sleep duration and fruit and vegetable intakes in UK women. This is the first study to demonstrate the prospective association between sleep duration and fruit and vegetable consumption.MethodsCross–sectional and prospective data were obtained from the UK Women’s Cohort Study. Sleep duration was assessed by self-report of average hours slept on weekdays and weekends and diet was assessed by a 4-day food diary at baseline and follow-up (~ 4 years later). Sleep duration was categorized as short (≤6 h/d), recommended (7–9 h/d) and long (≥9 h/d). Regression analyses adjusting for age, socio-economic status, smoking, ethnicity and total energy intake were used and restricted cubic spline models were developed to explore potential non-linear associations between sleep duration and fruit and vegetable intakes.ResultsIn adjusted cross-sectional analyses, short sleepers had on average 17 g/d (95% CI -30 to-4, p = 0.01) and long sleepers had 25 g/d (95% CI -39 to − 12, p < 0.001) less total fruits and vegetables compared to Recommended Sleepers (RS). In adjusted prospective analyses, short sleepers had on average 85 g/d (95% CI -144 to − 26, p = 0.005) less total fruits and vegetables in comparison to RS. Restricted cubic spline models showed that the cross-sectional (p < 0.001) and prospective (p = 0.001) associations between sleep duration and fruit and vegetable intakes were non-linear with women sleeping 7–9 h/d having the highest intakes.ConclusionsFruit and vegetable consumption differed between sleep duration categories with UK women sleeping the recommended 7–9 h/day having the highest intake of fruits and vegetables in cross-sectional and prospective analyses. These findings suggest that sleeping the recommended duration is associated with higher consumption of fruits and vegetables. Sleep is an overlooked lifestyle factor in relation to fruit and vegetable consumption and more notice is vital. Further studies are required to clarify the underlying mechanisms for these associations.

Circadian clocks regulate the daily timing of many of our physiological, metabolic and biochemical functions. The immune system also displays circadian oscillations in immune cell count, synthesis and cytokine release, clock gene expression in cells and organs of the immune system as well as clock-controlled genes that regulate immune function. Circadian disruption leads to dysregulation of immune responses and inflammation which can further disrupt circadian rhythms. The response of organisms to immune challenges, such as allergic reactions also vary depending on time of the day, which can lead to detrimental responses particularly during the rest and early active periods. This review evaluates what is currently known in terms of circadian biology of immune response and the cross-talk between circadian and immune system. We discuss the circadian pattern of three respiratory-related inflammatory diseases, chronic obstructive pulmonary disease, allergic rhinitis and asthma. Increasing our knowledge on circadian patterns of immune responses and developing chronotherapeutic studies in inflammatory diseases with strong circadian patterns will lead to preventive measures as well as improved therapies focussing on the circadian rhythms of symptoms and the daily variation of the patients’ responses to medication.

BackgroundThe present study aimed to analyze the association among depression, sleep quality, and quality of life using the Japanese version of the Structured Clinical Interview for DSM-IV Axis I Disorders Non-Patient Edition (SCID-I/NP), and to compare these findings with those obtained using self-reported scales, in an urban male working population in Japan.MethodsThe present study included 324 middle-aged participants (43.8 ± 8.37 years) (participation rate: 69.5%). The Japanese version of the SCID-I/NP was administered by a single physician. Self-reported scales, including the Zung Self-Rating Depression Scale (SDS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Assessment (PSQI), and 36-item Short-Form Health Survey (SF-36) were used to assess depression, sleepiness, sleep quality, and quality of life, respectively. Participants were then divided into a major depressive disorder (MDD) and control group based on the results of structured interviews, following which self-reported scale scores were compared between the two groups.ResultsA total of 24 participants met criteria for MDD based on responses during structured interviews (current: 4; past: 20). Patients with MDD did not report feeling sleepier than those without psychiatric disorders (controls) (ESS: P = 0.184), although they experienced slightly poorer sleep quality (PSQI: P = 0.052). In addition, participants of the MDD group exhibited lower SF-36 subscale scores for general health (P = 0.002), vitality (P < 0.001), social functioning (P < 0.001), role emotional (P = 0.004), and mental health (P < 0.001) domains, and higher SDS scores (P = 0.038) compared to controls. The area under the receiver (AUC) operating characteristic curve for the detection of MDD was 0.631 and 0.706 for the SDS and mental health subscales, respectively.ConclusionsOur findings indicate that patients with MDD exhibit slightly poorer sleep quality and significantly poorer quality of life compared to controls, and that the SF-36 may be used as an alternative to the SDS to screen for depression in an urban male working population in Japan.