Search Results (47)

Background/Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric consequence of trauma, and adolescents may be particularly vulnerable after large-scale disasters. Sleep disturbances and circadian preference may play a role in PTSD symptomatology. This study aimed to investigate the associations between PTSD, sleep quality, sleep problems, and chronotype in adolescents exposed to an earthquake. Methods: This cross-sectional study included 201 adolescents aged 12–18 years: 92 diagnosed with PTSD and 109 earthquake-exposed controls without a DSM-5 psychiatric disorder. Participants completed the Children’s Posttraumatic Stress Reaction Index (CPTS-RI), Pittsburgh Sleep Quality Index (PSQI), Children’s Sleep Habits Questionnaire (CSHQ), and Children’s Chronotype Questionnaire (CCTQ). Group differences, correlation analyses, and binary logistic regression analyses were performed. Results: Adolescents with PTSD had significantly higher CPTS-RI, PSQI, CSHQ, and CCTQ scores compared with controls (all p < 0.001), indicating poorer sleep quality, more sleep problems, and a greater tendency toward eveningness. PTSD severity was positively correlated with sleep problems, impaired sleep quality, and eveningness. In logistic regression analysis, poor sleep quality (p < 0.001) and clinically significant sleep problems (p = 0.011) were independently associated with PTSD, whereas chronotype was not. Conclusions: Sleep disturbances are more strongly associated with PTSD than chronotype in earthquake-exposed adolescents. Assessment and treatment of sleep problems may represent an important therapeutic target following large-scale trauma. Full article

As family structures and workforce compositions evolve, individuals increasingly navigate multiple roles across work and family domains. Despite growing research interest, a comprehensive synthesis examining the relationship between work–family conflict and health behaviors remains absent. This systematic review and meta-analysis addresses this significant gap by quantifying associations between work–family conflict and five important health behaviors: sleep disturbances, smoking behaviors, alcohol consumption, physical activity levels, and healthy diet. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases (PubMed, Embase, PsycINFO, Web of Science) were searched. Heterogeneity and publication bias were assessed using forest plots, I², Cochran’s Q-statistics, Funnel plots, and the Egger test, respectively. A total of 33 articles were included in this systematic review and meta-analysis. Work–family conflict had a small-to-medium positive association with sleep disturbances (r = 0.188; 95% CI [0.128, 0.247]); a negative association with healthy diet (r = −0.129; 95% CI [−0.219, −0.037]); and a modest and positive association with smoking behaviors (r = 0.082; 95% CI [0.033, 0.206]) and alcohol consumption (r = 0.074; 95% CI [0.039, 0.109]). The findings of this study suggest that individual, family, and organizational strategies reducing work–family conflict may facilitate the development and adoption of healthier behaviors, such as improving sleep and dietary practices. This study enhances understanding of work–family conflict’s relationship with health behaviors, bridging the management and occupational health psychology literature with the general and public health literature by systematically examining, for the first time, how work–family conflicts impair personal health behaviors. Full article

Background: South Africa faces the world’s highest HIV burden, disproportionately affecting women, alongside rising Type 2 Diabetes (T2D). Weight gain associated with preferred dolutegravir (DTG)-based antiretroviral therapy may worsen obesity and T2D risk. This process evaluation explored the implementation of a 12-month time-restricted eating (TRE) intervention for weight management in women with HIV and overweight/obesity in Khayelitsha, Cape Town. Methods: Using the RE-AIM framework, the study investigated the implementation journey. Data were collected from three groups: RCT participants, healthcare workers (n = 21), and fieldworkers (n = 3). Methods included structured informal interviews with TRE participants throughout the intervention and semi-structured in-depth interviews (IDIs) with a subset (n = 19) at 12 months. IDIs and focus group discussions were conducted with healthcare staff. Results: Implementation faced significant contextual challenges, including high food insecurity, economic constraints, and high crime levels. Cultural norms around food hospitality also posed barriers. Despite this, TRE was highly feasible and acceptable. Participants reported positive behavioural changes, establishing eating routines and consuming healthier foods. Perceived health benefits included improved appetite control, wellbeing, sleep, and weight management. Key facilitators were the intervention’s flexibility and, importantly, the non-judgmental, empathetic support from fieldworkers, which drove engagement and retention. Healthcare workers expressed willingness to integrate TRE into existing HIV counsellor-led services, and nearly all participants desired to continue TRE post-intervention. Conclusions: This process evaluation demonstrates that TRE is a contextually suitable and acceptable intervention from an implementation perspective. Its success in practice, however, depends on mitigating complex multi-level barriers through a flexible program design and high-quality, relationship-focused support integrated into existing healthcare infrastructure. Trial registration: PACTR202302484999720, 8 February 2023. Full article

Background: Obstructive sleep apnea (OSA) affects quality of life and increases cardiovascular risk. Nocturnal oxygen therapy (NOT) offers a potential alternative for patients intolerant to CPAP. The objective of this study was to compare NOT and continuous positive airway pressure (CPAP) by evaluating five-year survival in patients with obstructive sleep apnea. Methods: A retrospective cohort study was conducted using propensity score matching (PSM) methodology. A PSM analysis was conducted to reduce selection bias due to differences in baseline characteristics between patients using CPAP and those receiving oxygen therapy. Balance between treated and untreated groups was assessed using standardized mean differences. A PSM was estimated using a logistic regression model, matching patients adherent to CPAP therapy to those treated with NOT. Results: A total of 497 patients with a confirmed diagnosis of OSA were included in the analysis. The mean age was 62.1 years (SD13.6), and 54.3% (270/497) were male. Overall, 42.1% (209/497) of the patients were over 65 years old. Of the total, 303 patients received CPAP therapy and 194 received NOT. After PSM, a matched cohort of 370 patients (185 per group) was obtained. The CPAP-treated group showed a significantly lower residual Apnea–Hypopnea Index compared to the oxygen therapy group (3.9, IQR: 1.8–6.5 vs. 15, IQR:7.5–29.1; p < 0.001), indicating better physiological control of respiratory events. Treatment with CPAP was associated with a significantly lower risk of mortality compared with NOT across analytical approaches, including weighted logistic regression (OR = 0.11; 95% CI 0.02–0.48; p = 0.004) and PSM with bootstrap estimation (ATT = −0.12; 95% CI −0.22 to −0.01; p = 0.030). Conclusions: In this cohort, higher five-year survival was observed among patients with OSA treated with CPAP compared with those receiving supplemental oxygen. These findings indicate a favorable association between CPAP use and long-term outcomes, supporting its role as the preferred first-line therapy in patients with OSA. Full article

Obstructive sleep apnea syndrome (OSAS) is a common disorder with established cardiovascular and metabolic risks. Positive airway pressure (PAP) therapy remains the standard of care; however, its long-term effectiveness is often limited by poor compliance and adherence. This study sought to explore clinical and device-related factors influencing PAP use, with emphasis on pressure variability in Auto-PAP users and comorbidities such as COPD. We performed a retrospective analysis of 359 patients with OSAS who were treated with CPAP, Auto-PAP, or BiPAP devices at the Marius Nasta Institute of Pneumology between January 2022 and July 2024. Compliance was measured as the proportion of days the device was used, whereas adherence was estimated through average nightly hours of use. Patient data were stratified by demographic, clinical, and device-related characteristics. Statistical testing included Chi-square, Wilcoxon rank-sum, and correlation analyses. Demographics did not significantly differ between compliant and non-compliant groups. Notably, Auto-PAP users with greater pressure variability (>10 cm H₂O) had significantly lower compliance (p = 0.001). Nasal mask preference was also associated with poorer compliance (p = 0.030). Multivariate models further revealed that atrial fibrillation reduced the likelihood of good adherence (OR = 0.319, 95% CI 0.137–0.746). These results highlight the importance of monitoring pressure variability, device type, and comorbidities to personalize PAP therapy and improve long-term outcomes. Full article

Optimal recovery supports health and enhances performance in soccer players, yet the empirical evidence on various recovery strategies in soccer is complex to interpret. This review aimed to summarize the literature on post-exercise recovery modalities in male and female soccer players of all ages and competition levels. Following PRISMA guidelines, PubMed, SPORTDiscuss, and Web of Science were systematically searched until 17 October 2023. Randomized controlled trials or within-subjects crossover design studies that examined the effects of post-exercise recovery interventions on physical, psychological, or performance outcomes in soccer players were included. A single reviewer extracted data and assessed study quality using the Physiotherapy Evidence Database (PEDro) scale. Overall, 41 studies were included in the final review. The recovery strategies represented in these studies were organized into the following categories: active recovery, blood flow restriction, cold water immersion, contrast water therapy, compression garments, active cool-down, cryotherapy, cold garments, sleep and daytime nap, pneumatic cooling, foam rolling, mindfulness interventions, nutritional intervention, and static stretching. The findings demonstrated that cold-water immersion consistently improved jump performance and perceptions of fatigue, soreness, and overall well-being. Other recovery strategies, such as active recovery, compression therapy, sleep interventions, and nutrition supplementation, also positively impacted recovery, albeit with varying levels of effectiveness and evidence. However, the studies exhibited heterogeneity in methods, outcome measures, and recovery intervention protocols, posing challenges for generalizability. This review summarizes recovery strategies for soccer players, emphasizing the need for practitioners, coaches, and athletes to individualize interventions based on athletes’ needs, preferences, and competition level. Full article

Background/Objectives: Sleep is pivotal for recovery, immunity, and energy restoration; however, sleep problems exist in elite athletes. Nutrition and supplementation strategies can play both a positive and negative role in sleep quality and quantity. Elite athletes experience unique psychological and physiological demands above non-elite athletes and may require different nutrition strategies to promote sleep. Nutrient interventions and their effect on sleep in elite athletes is an emerging area, with further research warranted. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews and Joanna Brigg’s Institute Reviewer’s Manual for Scoping Reviews were utilised to assess the available evidence on nutrition strategies used to promote sleep in elite athlete cohorts, and we tried to identify the interventions that could be best researched in the future. NUtrition QUality Evaluation Strengthening Tools (NUQUEST) was used to enhance rigour and assess risk of bias in studies. The Paper to Podium (P2P) Matrix was used to offer practitioners practical recommendations. Results: 12 studies met the inclusion criteria for nutrition interventions or exposures to promote sleep in elite athletes. The median participant group size was 19 and study designs were considered together to ascertain potential sleep promoting strategies. Kiwifruit, Tart Cherry Juice and high dairy intake, limited to females, have demonstrated the highest potential to promote sleep in elite athletes, despite limited sample sizes. A-lactalbumin, carbohydrate pre-bed, casein, tryptophan, probiotic and meeting energy demands showed varying results on sleep quality in elite athletes. Conclusions: Kiwifruit, Tart Cherry Juice and dairy consumption offer potential nutritional interventions to promote sleep in elite athletic populations, while protein-based interventions may have a ceiling effect on sleep quality when elite athletes are already consuming >2.5 g·kg⁻¹ body mass (BM) or are already meeting their sleep duration needs. Full article

Background: Flexible bronchoscopy (FB) is a widely used diagnostic and therapeutic procedure in patients with pulmonary disease, many of whom are at risk of gas exchange impairment. FB may exacerbate hypoxaemia due to increased airway resistance, alveolar derecruitment, and haemodynamic fluctuations. Objectives: To assess the effectiveness of non-invasive respiratory support strategies in preventing oxygen desaturation and respiratory complications during FB. Methods: A systematic review and meta-analysis were conducted using PubMed and Cochrane databases, covering studies from 2000 to 2024. Inclusion criteria focused on adult patients undergoing FB with any form of non-invasive oxygen support. Twelve high-quality studies were selected, including randomised trials and prospective cohorts. Results: High-flow therapy (HFT) was more effective than conventional oxygen therapy (COT) in maintaining oxygenation and reducing procedure interruptions, especially in patients with moderate hypoxaemia or risk factors such as obesity and obstructive sleep apnoea. Continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) offered superior oxygenation and ventilatory support in patients with more severe respiratory or cardiac compromise. Conclusions: Non-invasive respiratory support should be individualised based on patient risk and procedural complexity. HFT benefits mild-to-moderate cases, while CPAP or NIV is preferable in more severe conditions. Further multicentre randomised trials are needed to establish formal guidelines. Full article

Background. Type 2 diabetes mellitus (T2D) and moderate-to-severe obstructive sleep apnea (OSA) commonly coexist and exacerbate poor glycemic control, systemic inflammation, and diminished quality of life (QoL). Although continuous positive airway pressure (CPAP) therapy has demonstrated metabolic and anti-inflammatory benefits, its real-world impact in Bulgarian outpatient settings—where CPAP costs are borne entirely by patients—has not been characterized. Objectives. To evaluate the effects of six months of CPAP therapy on glycemic control (hemoglobin A₁c [HbA₁c]), systemic inflammation (high-sensitivity C-reactive protein [hsCRP]), body mass index (BMI), lipid profile (low-density lipoprotein [LDL]), QoL (Short Form 36 Physical Component Summary [SF-36 PCS] and Mental Component Summary [SF-36 MCS]), and survival among Bulgarian outpatients with T2D and moderate-to-severe OSA. Methods. In this prospective, multicenter cohort study conducted from January 2022 to July 2023, 142 adults with established T2D and OSA (apnea–hypopnea index [AHI] ≥ 15) were enrolled at three outpatient centers in Bulgaria. Fifty-five patients elected to purchase and use home-based CPAP (intervention group), while 87 declined CPAP—either because of cost or personal preference—and continued standard medical care without CPAP (control group). All participants underwent thorough outpatient evaluations at baseline (month 0) and at six months, including measurement of HbA₁c, hsCRP, BMI, fasting lipid profile (LDL), and patient-reported QoL, via the SF-36 Health Survey. Survival was tracked throughout follow-up. Results. After six months, the CPAP group experienced a significant reduction in HbA₁c from a median of 8.2% (IQR 7.5–9.5%) to 7.7% (6.7–8.7%), p < 0.001, whereas the control group’s HbA₁c decreased modestly from a median of 8.6% (IQR 7.9–9.4%) to 8.3% (7.6–9.1%); p < 0.001), with a significant between-group difference at follow-up (p = 0.005). High-sensitivity CRP in the CPAP arm fell from a median of 2.34 mg/L (IQR 1.81–3.41) to 1.45 mg/L (IQR 1.25–2.20), p < 0.001, while remaining unchanged in controls (p = 0.847). BMI in the CPAP group declined significantly from 28.6 kg/m², IQR 26.6–30.6 to 28 kg/m², IQR 25.6–29.2 (p < 0.001), compared to no significant change in controls (median 28.9 kg/m²), p = 0.599. LDL decreased in the CPAP group from a median of 3.60 mmol/L (IQR 3.03–3.89) to 3.22 mmol/L (IQR 2.68–3.48), p < 0.001, with no significant reduction in controls (p = 0.843). Within the CPAP arm, both SF-36 PCS and SF-36 MCS scores improved significantly from baseline (p < 0.001 for each), although between-group differences at six months did not reach statistical significance (PCS: 48 ± 10 vs. 46 ± 9, p = 0.098; MCS: 46, IQR 40–54 vs. 46, IQR 39–53, p = 0.291). All-cause mortality during follow-up included 2 events in the CPAP group and 11 events in the control group (log-rank p = 0.071). Conclusions. In Bulgarian outpatients with T2D and moderate-to-severe OSA, six months of CPAP therapy significantly improved glycemic control, reduced systemic inflammation, lowered BMI and LDL, and enhanced QoL, with a non-significant trend toward reduced mortality. These findings underscore the importance of integrating CPAP into multidisciplinary management despite financial barriers. Full article

Obstructive sleep apnea (OSA) is a prevalent and heterogeneous sleep disorder associated with significant health and societal burdens. While continuous positive airway pressure (CPAP) remains the gold standard treatment, its limitations in adherence and patient tolerance have highlighted the need for alternative therapies. Positional therapy (PT), which targets apneas that occur predominantly in the supine position, has emerged as a promising option for individuals with positional OSA (POSA). This narrative review synthesizes the current literature on PT, examining its clinical indications, typologies, comparative efficacy with CPAP, oral appliances, and hypoglossal nerve stimulation, as well as data on adherence and barriers to long-term use. Traditional methods such as the tennis ball technique have largely been replaced by modern vibrotactile devices, which demonstrate improved comfort, adherence, and comparable short-term outcomes in selected POSA subjects. While PT remains inferior to CPAP in reducing overall AHI and oxygen desaturation, it performs favorably in terms of mean disease alleviation (MDA) and sleep continuity. Importantly, treatment effectiveness is influenced by both anatomical and non-anatomical traits, underscoring the need for accurate phenotyping and individualized care. PT should be considered within a broader patient-centered model that incorporates preferences, lifestyle, and motivational factors. Further research is needed to validate long-term efficacy, optimize selection criteria, and integrate PT into personalized OSA management strategies. Full article

Background/Objectives: Obstructive sleep apnea is a prevalent, yet often underdiagnosed, condition characterized by recurrent upper airway obstruction during sleep, leading to significant perioperative risks in surgical patients. This systematic review aims to evaluate the incidence and impact of objectively diagnosed obstructive sleep apnea on postoperative outcomes across various surgical specialties—including bariatric, orthopedic, cardiac, and otorhinolaryngologic surgeries—and to assess the effectiveness of preoperative screening and perioperative management strategies. Methods: A comprehensive literature search of PubMed was conducted for studies published between January 2013 and December 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies involved adult surgical patients with OSA confirmed by polysomnography or respiratory polygraphy. Studies were assessed for methodological quality using the Oxford Centre for Evidence-Based Medicine Levels of Evidence framework. Results: The findings consistently indicated that obstructive sleep apnea significantly increases the risk of postoperative complications, such as respiratory depression, atrial fibrillation, acute kidney injury, delirium, and prolonged hospital stay. Continuous positive airway pressure therapy demonstrated a protective effect in bariatric and cardiac surgeries, though its effectiveness in orthopedic and otorhinolaryngologic contexts was inconsistent, largely due to adherence variability and limited implementation. Preoperative screening tools such as the STOP-BANG questionnaire were widely used, but their utility depended on integration with confirmatory diagnostics. Conclusions: Obstructive sleep apnea represents a significant, modifiable risk factor in surgical populations. Preoperative identification and risk-adapted perioperative management, including CPAP therapy and multimodal analgesia, may substantially reduce postoperative morbidity. However, further randomized trials and cost-effectiveness studies are needed to optimize care pathways and ensure consistent implementation across surgical disciplines. Full article

Introduction: The introduction of the transdiagnostic approach in psychiatry shifts the focus from discrete diagnoses to shared symptoms across various disorders. The Transdiagnostic Global Impression—Psychopathology (TGI-P) scale is a newly developed tool designed to assess psychiatric symptoms across diagnostic boundaries. It evaluates ten core symptom domains—positive, negative, cognitive, manic, depressive, addiction, anxiety, sleep, hostility, and self-harm—regardless of specific diagnoses. Objective: This study aims to evaluate the efficacy of cariprazine across these ten transdiagnostic symptom domains. Methods: A systematic literature review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed on EMBASE and clinicaltrials.gov. Efficacy measures such as the Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Hamilton Anxiety Rating Scale (HAM-A), and Columbia-Suicide Severity Rating Scale (C-SSRS) were used to assess cariprazine’s effect on the ten transdiagnostic symptoms. Multilevel random-effects meta-analyses were conducted to evaluate the efficacy of cariprazine versus placebo in alleviating depressive and anxiety symptoms across clinical trials. Results: A total of 30 studies were included in the review. Cariprazine showed therapeutic benefits on positive, negative, manic, and depressive symptoms in specifically designed trials. Preliminary positive effects were seen on anxiety, hostility, and cognitive symptoms across disorders. However, specific trials have not been conducted for anxiety disorders or cognitive impairment. Meta-analyses demonstrated that cariprazine significantly reduces both depressive and anxiety symptoms compared to placebo. Cariprazine significantly improved sleep-related symptoms in both mania and depression trials. Suicidality was evaluated in non-suicidal populations, and no increase was observed. Addiction symptoms were part of the exclusion criteria in the RCTs, so they could not be assessed. Previous reports of cariprazine’s anti-craving and anti-abuse effects come from real-world evidence rather than RCT data. Conclusions: Cariprazine appears to be promising in addressing a broad range of symptom domains across psychiatric conditions. Full article

While morningness (a preference for rising earlier in the day) is associated with positive affect and life satisfaction, eveningness is correlated with negative emotionality, poor sleep, less self-control, and more procrastination. The current study investigated inter-relationships between morningness–eveningness; bedtime, academic, and exercise procrastination; mind wandering; sleep quality; self-control; and depressive symptoms. An online survey including questionnaire measures of these variables was completed by 306 university students (aged 18–51 years; mean = 20.36, SD = 4.001; 34 male). Morningness correlated with more self-control and better sleep quality—eveningness correlated with more bedtime, academic, and exercise procrastination; depressive symptoms; and mind wandering. All forms of procrastination negatively correlated with self-control and sleep quality, and positively correlated with depressive symptoms and mind wandering, although more strongly with spontaneous than deliberate mind wandering. Mediation effects were found—bedtime procrastination (BP) between eveningness and spontaneous mind wandering (MW); spontaneous MW between BP and sleep quality; sleep quality between BP and depressive symptoms; self-control between depressive symptoms and academic procrastination. A path model of these inter-relationships was developed. This study adds to a growing body of research indicating that interventions to reduce bedtime procrastination may bring about improvements in wellbeing and academic achievement. Full article

Objectives: This systematic review aimed to evaluate general dentists and dental specialists’ knowledge regarding obstructive sleep apnea (OSA) diagnosis, referral, risk factors, and treatment. Methods: A systematic search of databases, including Web of Science, PubMed, and ProQuest, was conducted for studies published up to 25 September 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included cross-sectional studies that assessed the knowledge of general dentists or dental specialists. A quality assessment was performed using the Newcastle–Ottawa Quality Assessment Scale. Results: The seven included studies demonstrated varied knowledge levels among respondents regarding polysomnography as the gold standard for diagnosing OSA, with percentages ranging from 40.18% to 90%. While recognition of craniofacial structure as a risk factor for OSA was consistently high, knowledge about body weight as a risk factor varied. Additionally, the understanding of continuous positive airway pressure as the standard treatment showed discrepancies across the studies. Conclusions: Given that some of the included articles displayed a moderate to high risk of bias, the results highlight the varying levels of OSA knowledge among dentists and specialists across the studies. This indicates a potential need for targeted educational programs to improve their understanding and management of OSA. Full article

This feasibility study investigates the relationship between functional food consumption and mental well-being, focusing on natural foods traditionally linked to mental health benefits. This research also examines consumer preferences to identify key characteristics that novel functional foods designed to enhance mental well-being should possess. Additionally, this study lays the groundwork for a clinical trial exploring the effects of a novel functional food on mental health and well-being. Data were collected through an online bilingual survey (Greek/English) from 362 participants across Greece and Cyprus, using an adapted Functional Food Frequency Questionnaire (FFFQ) featuring 30 foods with documented effects on cognitive function and mood regulation. The survey included validated scales measuring mental well-being, health-related quality of life (HRQoL), sleep quality, and food choice motives, along with demographic and anthropometric data. Analysis revealed significant associations between functional food consumption and mental health outcomes, particularly in HRQoL, sleep quality, and body mass index (BMI). Most functional foods consumed were natural and aligned with the Mediterranean dietary pattern, such as fruits, vegetables, nuts, herbal infusions, and honey, all demonstrating positive effects on mental and physical health. Consumer preferences showed a strong inclination toward functional foods that balance sensory appeal with health benefits, including milk-based and plant-based beverages, protein bars, and granola bars. Ingredients like St. John’s wort and Greek mountain tea were identified as potentially beneficial for mental well-being, consistent with their established efficacy in psychological health. A significant majority of participants (66.9%) expressed interest in participating in clinical trials, highlighting the need for further research into the efficacy of functional food components. This study provides a foundation for future clinical trials examining the impact of novel functional food formulations on mental and physical health, addressing the growing consumer demand for products that enhance psychological resilience and well-being. Full article