Background and Objective: Sleep is a critical biological necessity essential for maintaining both physical and mental health in humans. Given the prevalence of nocturnal enuresis (NE) in children, this study sought to explore its potential link to sleep-disordered breathing (SDB). Materials and Methods: This cross-sectional study involved children aged 5 to 10 years who visited Qazvin Children's Hospital, Iran, from 2016 to 2021. Data were gathered using the Iranian Children's Sleep Habits Questionnaire (CSHQ) completed by parents, alongside polysomnography (PSG) assessments conducted at the hospital. Children were catego-rized into two groups of with and without enuresis. The PSG data were analyzed to evaluate respiratory parameters in accordance with the American Academy of Sleep Medicine (AASM) guidelines. Results: Of 124 participants, 64 (51%) were boys, with an average (standard deviation) age of 82.2 (24.4) months. Ap-proximately 39.1% of the children experienced NE. Statistically significant correlations were found between NE and several factors: body mass index (BMI) (P = 0.025), total sleep time (P = 0.026), number of hypopneas (P < 0.001), hypopnea index (P = 0.012), total apnea and hypopnea events (P = 0.004), and the overall apnea-hypopnea index (AHI) (P = 0.005). However, no significant association was established between the oxygen desaturation index, arousal index (AI), and mean oxygen saturation (P > 0.05). Conclusion: The findings indicate an association between enuresis and obstructive sleep apnea (OSA), suggesting that treating OSA could ameliorate enuresis symptoms. Therefore, it is advisable to evaluate children with enuresis, particu-larly those who are obese, for OSA.
Background and Objective: Over 40% of individuals with obstructive sleep apnea (OSA) have reported experiencing insomnia. The combination of OSA and insomnia results in decreased sleep quality and adherence to continuous positive airway pressure (CPAP) therapy. This study aimed to assess insomnia among patients with OSA. Materials and Methods: This cross-sectional study involved 1771 participants. Patients with a high suspicion of OSA completed the Insomnia Severity Index (ISI) and the Beck Depression Inventory (BDI-II) questionnaires. All participants underwent overnight polysomnography (PSG). Results: In this study, 1242 (68%) of the 1771 participants were men, with a mean age of 47.18 ± 13.65 years. The average Respiratory Disturbance Index (RDI) was 41.53 ± 31.98, the mean ISI score was 12.11 ± 5.99, and the aver-age BDI score was 12.88 ± 11.22. A total of 639 (36%) participants reported moderate to severe insomnia (ISI score ≥ 15). Those with a normal RDI had mean ISI scores of 13.71 ± 6.32, while patients with mild, moderate, and severe OSA had mean ISI scores of 12.76 ± 5.96, 11.61 ± 5.92, and 11.91 ± 5.95, respectively (P = 0.001). The correlation between RDI and ISI score was 0.006 (P = 0.8). As the severity of insomnia increased, the BDI score also signifi-cantly increased (P < 0.0001). Conclusion: A notable correlation exists between insomnia and depression; individuals with more severe insomnia re-ported higher depressive symptoms. Given the link between insomnia and OSA, it is advisable to assess insomnia in patients diagnosed with OSA.
In this letter, the necessity of a control group in sleep studies is emphasized. Indeed, I believe that it is crucial to follow a correct methodological approach in sleep science studies. To make an evidence-based clinical decision, an appropriate control group is required to establish a valid asso-ciation between the risk factor/treatment and the outcome of an analytical sleep study. However, defining and recruiting healthy sleepers can be challenging for sleep researchers.
Background and Objective: The coronavirus disease 2019 (COVID-19) pandemic has had an obvious impact on the mental health of healthcare workers, including nurses who have been at the forefront of managing patients with COVID-19. This study aimed to assess the mental health of nurses who worked at Afzalipour Hospital in Kerman City, Iran, after the pandemic of COVID-19. Materials and Methods: 400 nurses have been enrolled in a cross-section study. We used a questionnaire to collect demographic and occupational information and the General Health Questionnaire (GHQ) to assess mental health. Results: 84% of nurses had problems related to mental health, with anxiety being the most common symptom followed by sleep disorder and depression. Social problems were also prevalent among the nurses. There was no statistically sig-nificant difference in mental health between men and women or across different age groups, education levels, or work experience in the COVID-19 ward. However, there was a significant difference in the mental health of nurses with dif-ferent shift intervals and those working more than 15 shifts who had higher mental health scores. There was no statisti-cally significant difference in mental health of night shift nurses and day shift nurses. Conclusion: These findings highlight the need for interventions to promote mental health among nurses who have worked in the wards related to COVID-19.
Background and Objective: Patients with rheumatoid arthritis (RA) often suffer from chronic pain due to the nature of the disease, and in addition to the disease itself, this pain can be aggravated under the influence of psychological fac-tors. The study aimed to predict pain perception based on psychological distress and the mediating role of sleep quality in people with RA. Materials and Methods: This research was conducted by path analysis, including 202 patients with RA who were se-lected using the convenience sampling method. The study instruments included McGill Pain Questionnaire (MPQ), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety, and Stress Scale (DASS-21). Descriptive statistics reported frequency, mean, standard deviation (SD), and Pearson correlation. In analytical statistics, path analysis was used. Data were analyzed using SPSS and AMOS software. Results: Psychological distress (anxiety, stress, and depression) had a direct, statistically significant effect on sleep quality. Sleep quality had a direct effect on pain perception. On the other hand, anxiety, stress, and depression, with the mediating role on sleep quality, had a significant influence on pain perception by 0.11, 0.12, and 0.09, respectively. Descriptive statistics showed that a significant correlation existed among independent, mediation, and criteria variables. The proposed predictive model had a good fit. Conclusion: Along with medical treatments, we need to pay attention to the role of psychological factors such as psychological distress, depression, and sleep quality in patients with RA.
Background and Objective: Sleep is a biological necessity and essential for optimal health. Literature suggests college students are an at-risk population for sleep deprivation; hence, the present research was undertaken to assess the sleep habits of medical student population. Materials and Methods: The present cross-sectional study was carried out on a convenient sample of apparently healthy medical students at an institute in Northern India. Information pertaining to the usual sleep-wake habits of participants was collected through a structured questionnaire based on the Pittsburgh Sleep Quality Index (PSQI). Results: The study sample (n = 125) comprising 95 (76%) men and 30 (24%) women had mean age of 20.59 [standard deviation (SD) = 1.21] years. Findings about sleep habits were concerning as over two-thirds (68%) of the students were found to be sleep deprived. Almost half (46%) of the participants usually went to bed past midnight (average bedtime: 1:39 AM). Difficulty in falling asleep was reported by 46% of the sample. Half of the students perceived their sleep quality as poor or fair. Female students reported sleep deprivation more frequently (83% vs. 63%, respectively); female participants had about 3 times greater odds [odds ratio (OR): 2.92, 95% confidence interval (CI): 1.02-8.31] of being sleep deprived than male students. Conclusion: Sleep deprivation is quite prevalent among medical students with most of them staying up late at night. Difficulty in falling asleep and dissatisfaction with the sleep quality are also common. Female students seem to be more frequently sleep-restricted than male students.
Background and Objective: Improper sleeping habits can affect children's sleep structure and reduce the quantity and quality of sleep. In this study, we aimed to investigate the relationship between sleep habits and sleep structure in children. Materials and Methods: The population of this cross-sectional descriptive-analytical study included children aged 3-10 years who were referred to the sleep department of Children's Hospital in Qazvin City, Iran, during 2015-2021 and had undergone standard polysomnography (PSG). The Iranian version of the Children's Sleep Habits Questionnaire (CSHQ) was completed by parents. Sleep structure parameters of PSG were used. Statistical tests included mean, standard deviation (SD), and independent t-test. Results: Among 163 patients, 102 (62.6%) were boys. The average age of the children was 6.35±3.72 years. According to CSHQ, the average score of "resistance before sleep" was 2.08±0.38 and the highest score was related to "falling asleep in your bed" (2.50±0.81). The highest score of "sleep duration" was related to "sleeping the same amount each day" (2.54±0.75). The comparison of PSG findings showed that the mean score of bedtime resistance had a statistically significant relationship with increased stage N1 and decreased sleep efficiency (SE) (P = 0.01). Moreover, the mean score of "sleep duration" was associated with abnormal Arousal Index (AI) (P = 0.01). Conclusion: According to the results, children who were reported to be sleep-deprived had a higher percentage of light sleep and frequent night awakenings, and less SE in the PSG. Appropriate health strategies are needed to improve chil-dren's sleep habits.
Background and Objective: This study examines sleep quality in patients with coronavirus disease 2019 (COVID-19) after recovery, exploring demographic associations to inform post-discharge management and support. Materials and Methods: Conducted as a cross-sectional study, sleep quality was assessed in patients with COVID-19 2-4 weeks post-discharge in Iran. A two-part survey was administered via phone, capturing demographics and Pittsburgh Sleep Quality Index (PSQI) scores. Results: Among 147 patients (109 women and 38 men, mean age: 47.9 years), the average PSQI score was 12.48 ± 7.37, with a mean sleep duration of 6.26 ± 1.69 hours. Poor sleep was notably linked to female gender (P = 0.029), unemployment (P = 0.012), and mental health history (P = 0.021). Conclusion: Findings underscore the importance of monitoring sleep quality in COVID-19 recovery, with targeted support potentially reducing hospital readmissions.
Background and Objective: Insomnia is the most common sleep problem which is associated with cortical over- excitation. Transcranial direct-current stimulation (tDCS) potentially modifies insomnia-related cortical state. There- fore, we tested the hypothesis that insomnia severity can be modulated by tDCS. Materials and Methods: The current study was conducted with a pretest-posttest design and a control group. A total of 32 women with insomnia were randomly categorized into an intervention group (active stimulation) and a control group (sham stimulation). In the intervention group, tDCS was used with an intensity of 2mA for 20 to 30 minutes during 12 sessions (3 times a week). Anodal stimulation was performedon the left primary motor cortex (M1) and cathodal stimulation was performedon the right dorsal lateral prefrontal cortex (DLPFC). The control group received sham stim- ulation for 20 to 30 minutes during 12 sessions (3 times a week). All participants were evaluated before and after the intervention using the Insomnia Severity Index (ISI) and Positive Affect and Negative Affect Schedule (PANAS). Results: The results of univariate analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) showed a significant difference between the tDCS group and the sham group in terms of reduction in the severity of insomnia. We also observed that positive affect increased and negative affect decreased following insomnia treatment (P ≤ 0.005). Conclusion: The results of our study indicated that performing our designed tDCS protocol for treating insomnia can be effective in treating insomnia and improving positive and negative affect.
Background and Objective: Primary sleep disorders are common in patients with epilepsy. Seizures, epileptiform discharges, and antiepileptic drugs alter the sleep architecture of patients with juvenile myoclonic epilepsy (JME). We evaluated sleep architecture and its quality in these patients. Materials and Methods: Thirty patients with JME (11 men and 19 women with mean age of 21.10 ± 4.55 years) and 30 healthy controls underwent overnight polysomnography (PSG). Sleep quality and daytime sleepiness were assessed using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively. Results: Myoclonus and generalized tonic-clonic seizures (GTCS) were present in all patients with JME, while absence seizures were in 13.3%. Sleep deprivation was the most frequent precipitating factor for seizures (56.6%) followed by fatigue, sound, and photic stimulation. Patients with JME reported a statistically significant drop in sleep efficiency (P<0.001) with prolonged sleep onset latency (P<0.001). There was prolongation in the N1 stage of non-rapid eye movement (NREM) sleep (P=0.002), and reduction in the N2 stage of NREM (P<0.001) and rapid eye movement (REM) sleep (P<0.001). The median PSQI score was higher in patients with JME, suggesting poor sleep quality (P<0.001), and the daytime sleepiness was not different as indicated by the similar median ESS score (P=0.033). Conclusion: Our results suggest a significant alteration in the sleep architecture of patients with JME with reduced sleep efficiency and poor sleep quality. The possible role of the disease itself is suggested for these alterations as a simi- lar trend was also observed in drug naïve patients.
Background and Objective: Sleep medicine is a multidisciplinary specialty that focuses on diagnosing and treating sleep disorders. Sleep medicine fellowship programs in Iran commenced in 2012 at Tehran University of Medical Sciences, Tehran, Iran. This study aimed to investigate the human resources and employment status of sleep medicine fellowship graduates in Iran. Materials and Methods: This study was a descriptive cross-sectional study conducted in Iran in 2022 using conven- ience sampling and included 41 sleep medicine fellows in Iran. Data collection tools included a demographic question- naire and a researcher-made survey. Data were analyzed using the SPSS software. Results: Out of 57 sleep medicine fellows, 41 individuals with an average age of 44.95 ± 7.57 years participated in the study. Only 12% of the fellows were satisfied with their income, and all participants expressed dissatisfaction with their insurance coverage. 92% considered the existence of a national guideline for sleep medicine to be crucial, while 66.7% felt the curriculum of medical sleep medicine had some deficiencies. Conclusion: Lack of a suitable national guideline for treating and preventing sleep disorders, lack of insurance coverage for tests and respiratory assist devices, and high costs of establishing and equipping specialized sleep clinics are major challenges recognized by sleep medicine fellows. Additionally, due to the low priority given to these diseases by authorities and the inappropriate distribution of sleep medicine specialists in the country, access to appropriate treatment for sleep disorders is only feasible in giant cities.
Background and Objective: During the coronavirus disease 2019 (COVID-19) pandemic, one of the vulnerable groups was pregnant women. This study aimed to determine sleep quality in pregnant women in the third trimester of pregnancy referred to Ibn Sina Health Center in Tabriz, Iran. Materials and Methods: We performed a cross-sectional study among third-trimester pregnant women in May 2021. To study sleeping habits, we used the Pittsburgh Sleep Quality Questionnaire (PSQI), which had acceptable reliability and validity in Persian to evaluate sleep quality. Participants filled out the questionnaires with the help of healthcare providers in the health center. Results: A total of 176 pregnant women participated in this study. The mean and standard deviation (SD) of partici- pants’ age was 25.9 ± 1.2 years. This study showed that the mean of sleep quality in the third trimester was 9.97 ± 1.81 and the majority of pregnant women (87.79%) had poor sleep quality. Conclusion: The findings of the current study demonstrated that most pregnant women during COVID-19 had poor sleep quality. Finding ways to improve their sleep quality is important
Background and Objective: After going through the alpha wave before waking, a person usually enters the conscious phase physiologically by opening the eyes and communicating with the environment. We conducted the present study to investigate the brain rhythm wave pattern before waking up among the children admitted to the sleep clinic at Ghods Children's Hospital, Qazvin, Iran. Materials and Methods: In this cross-sectional study, we investigated 42 children without physical or acute respiratory diseases for brain rhythm wave patterns, 15 seconds before waking up. Data were analyzed manually from the poly- somnography (PSG) recorded during sleep. Then, we divided the children into two groups based on the results of the apnea-hypopnea index (AHI), i.e., mild to moderate and severe AHI. The frequency of brain waves before waking up on epochs 30s, 10s, and 1s were checked between the two groups statistically. Results: Alpha waves appeared before waking up as the principal brain waves. The frequency of alpha waves went through a decreasing rate until they reached 10 Hz, and then the child woke up. We observed three repetitions of 10 Hz frequencies before waking up for both groups of low-moderate and high AHI. Conclusion: Awakening happens with a specific trigger of alpha waves in the occipital lobe in the N2 phase at a 10 Hz frequency.
Background and Objective: Nightmare frequency is typically measured using interval and ordinal, but rarely Likert- type, scales. The current study aimed to examine the validity and reliability of a Likert-type measure of retrospective nightmare frequency. Materials and Methods: Participants included a convenience sample of undergraduate students. They completed a recent- ly developed Likert-type nightmare frequency item, an established Nightmare Frequency Scale, an estimate of nightmare frequency over the past week, and measures of hypothetically related variables including neuroticism, psychological dis- tress, and trauma symptoms. Convergent and discriminant validity was evaluated through relationships between the Likert- type nightmare frequency item with other nightmare measures and hypothetically related variables. Reliability was esti- mated using a correction for attenuation approach designed to provide a conservative estimate of single-item reliability. Results: The sample included 233 (119 female, 51.1%; 114 male, 48.9%) university students (mean age: 19.05 ± 1.91). The average convergent validity coefficient between the Likert-type nightmare frequency item and other nightmare measures (r = 0.647) was significantly different (z = 5.45, P < 0.001) from its average correlation coefficient with hypo- thetically related measures (r = 0.256). The single-item reliability coefficient was 0.722. Conclusion: The reliability and convergent and discriminant validity of the Likert-type nightmare frequency item were supported.
Background and Objective: Some studies have investigated the quality of sleep among patients with irritable bowel syndrome (IBS); however, they are not comprehensive. The current study was conducted to predict quality of sleep among patients with IBS based on mindfulness, the mediating role of self-regulation, and rumination. Materials and Methods: This was a cross-sectional study in form of structural equation modeling (SEM). The samples included 231 patients with IBS, and the measures were Mindfulness, Self-regulation, Rumination, and Pittsburgh Sleep Quality Index (PSQI) scales. In addition, the SPSS and R software were used to analyze data. Results: Mindfulness, along with the mediating role of self-regulation and rumination could predict sleep quality among patients with IBS (P < 0.01), and the fit indices indicated the model fit. Conclusion: Mindfulness, rumination, and self-regulation had an important role in sleep problems among patients with IBS.
Background and Objective: Periodic limb movements of sleep (PLMS) and obstructive sleep apnea (OSA) are two common sleep disorders that frequently co-occur in one subject. In this study, we evaluated the polysomnographic (PSG) features of patients with OSA with and without PLMS. Materials and Methods: Patients with OSA diagnosed by PSG who referred to our sleep clinic over 2 years were studied for PLMS during a standard diagnostic sleep study. PSG features including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleep quality were evaluated and compared between patients with OSA with and without PLMS. Results: We evaluated 122 patients with OSA, of whom 17 had comorbid PLMS. Mean sleep quality was significantly lower in patients with PLMS compared to those without PLMS (P < 0.05). There was no significant difference in terms of mean age, gender, arousal index (AI), ODI, and apnea/hypopnea between the two groups. Conclusion: Patients with OSA with PLMS comorbidity have remarkably lower sleep quality and this finding is independent of the severity of arousals or respiratory events. Proper evaluation, diagnosis, and treatment of PLMS comorbidity in patients with OSA might improve treatment response.
Background and Objective: Determining sleep quality in hemodialysis patients and kidney transplant recipients can provide valuable clinical information for planning treatment and care in this group of patients. Thus, we compared sleep quality between hemodialysis patients and kidney transplant recipients. Materials and Methods: In this cross-sectional study, 60 transplant patients and 60 hemodialysis patients were selected using convenience sampling method. The Pittsburgh Sleep Quality Index (PSQI) with 89% validity and 86% reliability was used to assess patients' sleep quality. Results: The mean PSQI score was higher in the hemodialysis group (7.78) than the kidney transplantation group (6.15). This indicates that the sleep quality in hemodialysis patients is worse than in patients after kidney transplantation (P = 0.028). The frequency of poor sleep quality in hemodialysis patients was higher than in kidney transplant patients [50(83.3%) vs. 37(61.7%)]. Conclusion: The results of this study indicate that kidney transplant recipients have better sleep quality than hemodialysis patients.
