Search Results (180)

This narrative review examines the complex relationship between sleep changes during the menopausal transition and cardiometabolic risks. The most common complaint about sleep is increased awakenings during sleep. Other complaints include having trouble falling asleep, waking up too early, insufficient and non-restorative sleep, and overall poor quality. Sleep determined using objective methods also indicates that greater awakenings after sleep onset are associated with the period of menopausal transition. Polysomnography recordings suggest physiological hyperarousal during sleep. Changes in other sleep metrics, such as sleep latency and sleep duration, are less consistent, and some studies suggest they may not worsen during the menopausal transition. These sleep issues are influenced by multiple factors, such as hormonal fluctuations, vasomotor symptoms, and psychosocial factors, and evidence suggests that hypothalamic kisspeptin/neurokinin B/dynorphin (KNDy) neurons are key underlying mechanisms for these associations. The menopausal transition is also associated with increases in cardiometabolic risk factors, such as body fat, altered lipid profiles, blood pressure, and vascular health. Emerging evidence suggests that poor sleep health during this period is associated with increased cardiometabolic risks and adverse cardiovascular outcomes. Thus, addressing sleep disturbances is crucial for comprehensive healthcare during the menopausal transition to safeguard long-term cardiometabolic health. Future research is needed to investigate interventions that can improve sleep and their impact on cardiometabolic health in this population experiencing increases in cardiometabolic risk. Full article

Background/Objectives: Cardiac Syndrome X (CSX) is associated with significant physical and psychiatric morbidity despite no obvious effect on long-term mortality. Obstructive sleep apnea (OSA) is a prevalent condition in close association with numerous cardiovascular diseases. The precise relation between CSX and OSA remains unclear. The aim of this study is to explore the relation between OSA and CSX, as well as the impact of continuous positive airway pressure (CPAP) therapy on myocardial ischemia. Methods: This single-center prospective cohort study examined patients who were selected consecutively from the Cardiology Outpatient Clinic with angina or angina-equivalent complaints and with ischemia on myocardial perfusion scintigraphy (MPS), and who were subsequently diagnosed with CSX via coronary angiography. Patients with previous myocardial infarction and previous percutaneous coronary intervention or coronary artery by-pass grafting surgery were excluded, since these conditions could not be regarded as CSX. The presence of OSA was explored by polysomnography (PSG). CPAP therapy was applied for three months to those diagnosed with OSA. Following a three-month course of treatment, a myocardial perfusion scintigraphy (MPS) was conducted, to assess myocardial ischemia. The IBM^® SPSS Statistics Version 26 software was employed for the purpose of statistical analysis. Results: Among the 27 consecutive patients (mean age 58.1 ± 9.6 years and 22 female) with CSX 24 patients were found to have OSA according to PSG examination. CPAP therapy was applied to 17 patients (mean age 56.4 ± 8.6 years, 14 female) who accepted to participate in the treatment phase of the study. Following a three-month course of treatment, myocardial ischemia was reduced in 13 of the 17 patients. There were statistically significant correlations between the reduction in myocardial ischemia and patient’s diagnosis of hypertension (p = 0.006), higher serum HDL cholesterol levels (p = 0.009), and adherence to CPAP therapy (p = 0.047). Conclusions: The prevalence of OSA is significantly higher among the patients with CSX compared to the general adult population. In patients with CSX and OSA, improvement in myocardial ischemia was observed in MPS following CPAP therapy. Full article

Background and Objectives: Sleep complaints are particularly relevant in the development of children, affecting cognitive development, neuropsychological functioning, and learning abilities. The aims of this study were as follows: (i) to determine the incidence of sleep disorders in low-risk infants and toddlers with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH), using the Italian version of the Sleep Disturbance Scale for Children (SDSC); and (ii) to compare the data with those of a healthy control group. Materials and Methods: This is a cross-sectional case–control study involving a total of 167 infants and toddlers (aged 6–36 months) with HIE treated with TH and 160 typically developing infants assessed using the SDSC filled out by the mother. A neurocognitive assessment was also performed. Exclusion criteria were mild perinatal asphyxia, major brain lesions, congenital malformations, severe postnatal infectious diseases, metabolic complications, cerebral palsy, neurodevelopmental impairment, and epilepsy. Results: In the study group, an abnormal total SDSC score was found in 1.8% of infants; 10% of infants had an abnormal score on at least one of the SDSC factors. No specific differences in the SDSC total and the factor scores were observed between the study and control group, with the exception of difficulties in maintaining sleep and sleep hyperhidrosis, with higher scores in HIE infants. Conclusions: Low-risk infants and toddlers with HIE showed a low incidence of sleep disorders, similar to those observed in control group, with some exceptions. As these incidences may increase significantly with age, further clinical assessments will be needed to confirm these data at older ages. Full article

Introduction: Obstructive sleep apnea syndrome (OSAS) is caused by anatomical and non-anatomical factors which lead to upper airway (UA) obstruction during sleep. Intrinsic UA collapse is the most frequent determinant of OSA. In the era of personalized medicine, adopting a tailored diagnostic approach is essential to rule out secondary causes of UA collapse, particularly those stemming from extrinsic anatomical factors. Although being rarely considered in the differential diagnosis, space-occupying lesions of deep cervical spaces such as the parapharyngeal space (PPS) may be responsible for airway obstruction and lead to OSAS. Objective: This study aimed to present an atypical case of OSAS caused by extrinsic PPS compression, outlining the relevance of modern personalized medicine in the diagnostic and therapeutic protocols, and to enhance understanding through a comprehensive literature review. Methods: A 60-year-old female presented with sleep-disordered complaints and was diagnosed with severe OSAS after polysomnography. At physical examination, a swelling of the right posterior oropharyngeal mucosa was noticed. Imaging confirmed the suspicion of a PPS tumor, and transcervical resection was planned. Case presentation was adherent to the CARE checklist. A comprehensive literature review was conducted using the most reliable scientific databases. Results: Surgery was uneventful, and the patient made a full recovery. The histopathology report was consistent with the diagnosis of pleomorphic adenoma. Postoperative outcomes showed marked improvement in polysomnographic parameters and symptom burden. Conclusions: Parapharyngeal space tumors are a rare, often overlooked cause of OSA. This case highlights the role of a personalized head and neck assessment in OSA patients, particularly in identifying structural causes and offering definitive surgical management when indicated. Full article

Background/Objectives: Fibromyalgia syndrome (FMS) is a chronic pain condition in which executive function (EF) alterations have been reported, though strikingly, relationships between simple executive functions (EFs) (updating, inhibition, and mental flexibility) and high-order ones, such as planning and problem-solving, have not been addressed yet in this population. This research aimed to firstly explore how low-level EFs play a role in planning and problem-solving performances. Methods: Thirty FMS patients and thirty healthy participants completed a series of neuropsychological tests evaluating low- and high-order EFs. Clinical and emotional symptoms were assessed with self-report questionnaires, while pain and fatigue levels were measured with numerical scales. Importantly, specific drug restrictions were accounted for. Results: Patients scored lower in most neurocognitive tests, with statistical significance noted only for visuospatial working memory (WM) and two planning and problem-solving tests. Pain, fatigue, and sleep disturbances showed important effects on most of the cognitive outcomes. Multiple regression analyses reflected that planning and problem-solving were successfully and partially predicted by updating, inhibition, and mental flexibility (though differences emerged between tasks). Conclusions: Our study confirms the presence of cognitive impairments in FMS, especially in high-order EFs, supporting patients’ complaints. Clinical symptoms play a role in FMS dyscognition but do not explain it completely. For the first time, as far as the authors know, simple EF influences on planning and problem-solving tests have been described for FMS patients. These results might help in unraveling the dysexecutive profile in FMS to design more adjusted treatment options. Full article

This narrative review examines the effects of caffeine on brain health in older adults, with particular attention to its potential for dependence—an often-overlooked issue in geriatric care. Caffeine acts on central adenosine, dopamine, and glutamate systems, producing both stimulating and rewarding effects that can foster tolerance and habitual use. Age-related pharmacokinetic and pharmacodynamic changes prolong caffeine’s half-life and increase physiological sensitivity in the elderly. While moderate consumption may enhance alertness, attention, and possibly offer neuroprotective effects—especially in Parkinson’s disease and Lewy body dementia—excessive or prolonged use may lead to anxiety, sleep disturbances, and cognitive or motor impairment. Chronic exposure induces neuroadaptive changes, such as adenosine receptor down-regulation, resulting in tolerance and withdrawal symptoms, including headache, irritability, and fatigue. These symptoms, often mistaken for typical aging complaints, may reflect a substance use disorder yet remain under-recognized due to caffeine’s cultural acceptance. The review explores caffeine’s mixed role in neurological disorders, being beneficial in some and potentially harmful in others, such as restless legs syndrome and frontotemporal dementia. Given the variability in individual responses and the underestimated risk of dependence, personalized caffeine intake guidelines are warranted. Future research should focus on the long-term cognitive effects and the clinical significance of caffeine use disorder in older populations. Full article

Background: In light of increasing breast cancer survival rates, it is essential to address cancer-related cognitive impairment (CRCI), a common yet often underestimated symptom. Methods: A randomised controlled trial is proposed involving 50 newly diagnosed participants, divided into a control group (CG) and an intervention group (IG). Both groups will receive an educational leaflet, while the IG will also take part in an individualised cognitive training programme based on everyday cognition (80 sessions distributed across four periods, compiled in a training dossier). Cognitive, emotional, and functional variables will be assessed before and after the intervention: cognitive function (MoCA test), everyday cognition (PECC), anxiety (Hamilton), functionality (LB), sleep quality (PSQI), quality of life (ECOG), and subjective memory complaints (FACT-COG). Expected results: Findings may guide future interventions and tailored protocols to alleviate CRCI in breast cancer patients undergoing active treatment. Ethics and dissemination: This study was approved by the Ethics Committee of the University of Salamanca (PI 2023 12 1478-TD). Full article

Background and Objectives: Early detection of cognitive decline (CD) is crucial for managing dementia risk factors and preventing disease progression. This study pursues two main objectives: (1) to review existing cognitive screening practices implemented in community pharmacy settings and (2) to characterize the cognitive profile of individuals eligible for screening in this context. Materials and Methods: This study was conducted in two phases. First, a scoping review of cognitive screening tools used in community pharmacies was carried out following PRISMA-ScR guidelines. Second, a cross-sectional study was performed to design and implement a CD screening protocol, assessing cognitive function. Data collection included demographic and clinical variables commonly associated with dementia risk. Decision tree analysis was applied to identify key variables contributing to the cognitive profile of patients eligible for screening. Results: The scoping review revealed that screening approaches differed by country and population, with limited pharmacy involvement suggesting implementation barriers. Cognitive screening was conducted in 18 pharmacies in Valencia, Spain (1.45%), involving 286 regular users reporting Subjective Memory Complaints (SMC). The average age of participants was 71 years, and 74.8% were women. According to the unbiased Gini impurity index, the most relevant predictors of CD—based on the corrected mean decrease in corrected impurity (MDcI), a bias-adjusted measure of variable importance—were age (MDcI: 2.60), internet and social media use (MDcI: 2.43), sleep patterns (MDcI: 1.83), and educational attainment (MDcI: 0.96). Simple decision trees can reduce the need for full screening by 53.6% while maintaining an average sensitivity of 0.707. These factors are essential for defining the profile of individuals who would benefit most from CD screening services. Conclusions: Community pharmacy-based detection of CD shows potential, though its implementation remains limited by issues of consistency and feasibility. Enhancing early dementia detection in primary care settings may be achieved by prioritizing individuals with limited internet and social media use, irregular sleep patterns, and lower education levels. Targeting these groups could significantly improve the effectiveness of CD screening programs. Full article

Ergothioneine is a diet-derived antioxidant with emerging evidence of neuroprotective benefits, but no dose-ranging study has evaluated its effects in healthy older adults. In this 16-week randomized, double-blind, placebo-controlled trial, 147 adults aged 55–79 with subjective memory complaints received ergothioneine (10 mg or 25 mg/day ErgoActive^®) or placebo. The primary outcome was the change in composite memory (CNS Vital Signs). Secondary outcomes included other cognitive domains, subjective memory and sleep quality, and blood biomarkers. At baseline, participants showed slightly above-average cognitive function (neurocognitive index median = 105), with plasma ergothioneine levels of median = 1154 nM (interquartile range = 889.9). Plasma ergothioneine increased by ~3- and ~6-fold for 10 mg, and ~6- and ~16-fold for 25 mg, at weeks 4 and 16, respectively (p < 0.001). 25 mg ergothioneine showed a within-group improvement in composite memory at week 4 (p < 0.05), although this was not sustained. Reaction time improved in both groups, dependent on time. Other domains showed null or limited effects. Subjective prospective memory and sleep initiation improved dose-dependently, with significant effects at 25 mg (p < 0.05). Liver function improved and a within-group increase in telomere length was noted. In conclusion, ergothioneine supplementation was safe and well tolerated, with evidence suggesting some benefits in this cohort of healthy older adults. Longer trials in individuals with lower baseline ergothioneine or cognitive function are warranted. Full article

Background: Comprehensive geriatric assessments (CGAs) are necessary to address the needs of people with human immunodeficiency virus infection (PWH) aged ≥ 50 years and ensure that they receive high-quality care. We aimed to identify the most effective tests from an extensive CGA to develop a short CGA. Methods: This observational, cross-sectional, and analytical study was conducted in three phases: (1) describing PWH aged ≥ 50 and matched controls; (2) jointly analyzing data to identify the most effective tests from the original CGA and develop a short version; and (3) applying the short CGA separately to both groups. Results: The most effective tests—the Lawton scale, SPPB, Barber questionnaire, Pittsburgh Sleep Quality Index, and Cognitive Complaints questionnaire—were used to create a short CGA. It identified abnormalities in 77% of PWH flagged by the full CGA, though 65% with the normal short CGA results had at least one abnormal result in the full version. Most false negatives were due to the excluded Hearing-Dependent Activities scale. Conclusions: These findings represent an initial step toward developing a short CGA for an easy and rapid identification of PWH aged ≥ 50, beyond a frailty assessment, who may benefit from early clinical management. Full article

Background/Objectives: Research on oral dysfunctions as contributing factors to obstructive sleep apnea (OSA) is needed to prevent and treat OSA. This study aimed to explore the association of OSA with oral dysfunction and examine its impact on nutrient intake, physical activity, and handgrip strength. Methods: This cross-sectional study analyzed data from the Eighth cycle Korea National Health and Nutrition Examination Survey (KNHANES, 2019–2021). The OSA group included diagnosed individuals and those over 40 years with symptoms such as snoring, fatigue, or witnessed breathing pauses during sleep. The non-OSA group included individuals not meeting these criteria. Using 1:1 propensity score matching to control for confounders (sex, age, lifestyle factors), 7636 participants were included. Oral dysfunction was assessed based on chewing problems, complaints of chewing discomfort, and speech difficulties. Nutrient intake, physical activity, and handgrip strength were analyzed using the Rao–Scott χ² test, complex sample t-test, and complex sample logistic regression. Results: The OSA group demonstrated significantly more oral dysfunction elements than the non-OSA group (p < 0.001). Higher energy intake was observed in the OSA group, with no significant differences in macronutrient intake. Physical activity levels were similar between groups; however, OSA participants without oral problems had higher handgrip strength (p < 0.05). Regression analysis showed increased OSA risk correlated with greater oral dysfunction and lower protein intake. Conclusions: This study revealed a strong association between oral dysfunction and OSA risk. Focusing on the assessment and early intervention of oral dysfunctions that influence OSA risk factors may aid in the early detection and prevention of OSA. Full article

Background and Objectives: Although psychiatric disorders in early childhood are increasingly recognized, comprehensive clinical data from large samples in this age group remain limited. This study presents one of the largest and longest-term evaluations in Türkiye of children aged 0–72 months referred to child psychiatry. It aims to identify the most common presenting complaints, diagnostic patterns, and key predictors of psychotropic medication initiation in a previously understudied age group. Materials and Methods: This retrospective analysis included 3312 children aged 0–72 months who presented to the outpatient child psychiatry clinic of Trakya University Medical Faculty Hospital in Edirne, Türkiye. Clinical records were reviewed to extract data on presenting complaints, psychiatric diagnoses, psychotropic medication initiation, and demographic details, including age and sex. Results: The most common presenting complaints were “delayed speech development”, “irritability/frustration”, “hyperactivity”, “requests for medical reports”, and “stuttering.” These complaints were more prevalent among children who received psychiatric diagnoses. Psychiatric diagnoses were more common in boys. Boys also presented at older ages and had longer follow-up durations. Psychotropic medications were initiated in 26.9% of the cases. The most frequently reported side effects were loss of appetite and drowsiness. Logistic regression analysis revealed that specific complaints were significantly predictive of initiating medication. These included “inability to speak”, “irritability/frustration”, “hyperactivity”, “lack of eye contact”, “aggression”, “school refusal”, “sleep problems”, and “fears.” Conclusions: This study revealed that some early childhood complaints, such as “inability to speak”, “restlessness”, “hyperactivity”, and “not making eye contact”, are strong predictors of both psychiatric diagnosis and initiation of psychotropic medication. The findings highlight the usefulness of structured assessment protocols in early childhood psychiatric services. The implementation of systematic screening for risk symptoms may facilitate early diagnosis and support more appropriate and timely treatment approaches, especially in resource-limited regions. Full article

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence of symptoms 3 months after acute SARS-CoV-2 infection. The long-term prevalence and clinical progression of PCS has not been established. Our aim was to investigate the symptoms in PCS patients, explore the degree of physical activity, according to the fatigue severity score, and analyze its association with basic cardio-pulmonary exercise testing (CPET) parameters. Methods: A total of 192 subjects with history of SARSCoV-2 infection were included. They filled in the Chronic Fatigue Syndrome Questionnaire (CFSQ) and were divided into symptomatic and asymptomatic groups. Forty-seven had persistent post-COVID complaints—reduced physical capacity, fatigue, dyspnea, sleep disturbances, muscle pain. CPET was performed and the pathophysiological parameters in the different fatigue severity groups were compared. Results: Subjects with persistent long-term PCS were divided into two groups—mild (20) and moderate–severe (27), depending on the CFSQ score; forty-eight PCS subjects without complaints served as a control group. The average period between the acute illness and the study was 1028 ± 214 days. Subjects with moderate–severe PCS had more symptoms during CPET (73.6% vs. 24.8% vs. 17.4%), as compared to mild/asymptomatic. The rate of perceived effort was subjective and did not correspond to the workload, heart, or breathing rate in the symptomatic group. These subjects were unable to reach the anaerobic threshold, compared to mild/asymptomatic subjects (51.8% vs. 25%, vs. 12.5%). Patients with moderate–severe PCS showed lower peak VO₂ (24.13 ± 6.1 mL/min/kg vs. 26.73 ± 5.9 mL/min/kg, vs. 27.01 ± 6.3 mL/min/kg), as compared to mild/asymptomatic subjects. Conclusions: Long-term PCS is still present in up to 24% of the general population, more than thirty months after the acute episode. It is characterized by increased perception of symptom burden and diminished aerobic metabolism. A third of the long-term PCS exhibit lower cardio-respiratory fitness, independently from the severity of the symptoms. Full article

Considering the frequent co-occurrence of major depressive disorder and excessive daytime sleepiness in apneic individuals, this study aimed to explore the relationship between excessive daytime sleepiness and the risk of developing major depressive disorder in this specific subpopulation. Demographic and polysomnographic data were retrospectively extracted from the clinical database of 1849 apneic individuals at the Sleep Unit. Excessive daytime sleepiness was considered present when the Epworth Sleepiness Scale score was >10 and major depressive episodes were diagnosed according to DSM criteria. Logistic regression analyses were performed to assess the risk of major depressive disorder associated with excessive daytime sleepiness in apneic individuals. The prevalence of major depressive disorder was 26.3% in apneic individuals. After controlling for major confounding variables, multivariate logistic regression analyses revealed that apneic individuals with complaints of excessive daytime sleepiness had a higher likelihood of developing major depressive disorder compared to those without complaint of excessive daytime sleepiness. This study highlights the strong association between excessive daytime sleepiness and major depressive disorder in apneic individuals, underlining the importance of systematically assessing and adequately treating excessive daytime sleepiness to better manage depressive symptoms and improve overall treatment outcomes in this specific subpopulation. Full article

Background and Objectives: Sleep disorders are highly prevalent in society and require focused attention within healthcare systems. While patient history, reported complaints, and subjective sleep questionnaires can provide initial insights into potential sleep issues, polysomnography (PSG) remains the gold standard for diagnosing various sleep disorders. However, long waiting times for PSG appointments in many healthcare facilities pose challenges for timely diagnosis and treatment. This study aimed to evaluate the diagnostic value of subjective measures, including patient-reported parameters, in comparison to the objective findings of PSG. Materials and Methods: In this study, we retrospectively analysed the data from 562 patients who underwent clinical evaluation and PSG testing at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2018 and 2024. We report the diagnostic accuracy of different sleep questionnaires to detect various sleep disorders in our population. Results: We report the corresponding sensitivity and specificity values: the Epworth Sleepiness Scale (ESS)—73.2% and 44.1% for detecting severe obstructive sleep apnoea and 87.1% and 76.8% for detecting hypersomnia; the Insomnia Severity Index (ISI)—77.2% and 63.3% for detecting insomnia; the Berlin Questionnaire (BQ)—67.8% and 68.8% for detecting obstructive sleep apnoea; the Ullanlina Narcolepsy Scale (UNS)—84.4% and 58.9% for detecting hypersomnia; the Innsbruck REM Sleep Behaviour Disorder Inventory (RBD-I)—93.3% and 52.5% for detecting RBD; the REM Sleep Behaviour Disorder Single-Question Screen (RBD1Q)—73.3% and 81.0% for detecting RBD; and the Paris Arousal Disorder Severity Scale (PADSS)—57.5% and 90.5% for detecting parasomnia. Conclusions: When comparing our findings with the previous literature, we found that the screening tools generally demonstrated a slightly poorer performance in our population. However, our results suggest that certain individual questions from the comprehensive questionnaires may provide comparable diagnostic values, while reducing the patient burden. We propose a targeted screening approach that integrates fundamental clinical parameters, key screening questions, and selected validated questionnaires, enabling primary care and outpatient clinicians to more efficiently identify patients who may require referral for specialised sleep evaluation and treatment. Full article