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Zayeri ZD, Torabizadeh M, Kargar M, Kazemi H. The molecular fingerprint of neuroinflammation in COVID-19: A comprehensive discussion on molecular mechanisms of neuroinflammation due to SARS-COV2 antigens. Behav Brain Res 2024; 462:114868. [PMID: 38246395 DOI: 10.1016/j.bbr.2024.114868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Severe acute respiratory syndrome coronavirus 2 attacks the neural system directly and indirectly via various systems, such as the nasal cavity, olfactory system, and facial nerves. Considering the high energy requirement, lack of antioxidant defenses, and high amounts of metal ions in the brain, oxidative damage is very harmful to the brain. Various neuropathic pain conditions, neurological disorders, and neuropsychiatric complications were reported in Coronavirus disease 2019, prolonged Coronavirus disease 2019, and after Coronavirus disease 2019 immunization. This manuscript offers a distinctive outlook on the interconnectedness between neurology and neuropsychiatry through its meticulous analysis of complications. DISCUSSION After recovering from Coronavirus disease 2019, approximately half of the patients reported developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Long Coronavirus disease 2019 imaging reports illustrated the hypometabolism in various parts of the brain, such as olfactory bulbs, limbic/paralimbic domains, the brainstem, and the cerebellum. Ninety imaging and neuropathological studies of Coronavirus disease 2019 have shown evidence of white matter, brainstem, frontotemporal, and oculofrontal lesions. Emotional functions, such as pleasant, long/short-term memory, movement, cognition and cognition in decision-making are controlled by these regions. The neuroinflammation and the mechanisms of defense are well presented in the discussion. The role of microglia activation, Inducible NO synthase, Cyclooxygenases ½, Reactive oxygen species, neurotoxic toxins and pro-inflammatory cytokines, such as Interleukin-1 beta, Interleukin-6 and Tumor Necrosis Factor-alpha are highlighted in neuronal dysfunction and death. Nuclear factor kappa-light-chain-enhancer of activated B cells, Mitogen-activated protein kinase, Activator Protein 1, and Interferon regulatory factors are the main pathways involved in microglia activation in Coronavirus disease 2019 neuroinflammation. CONCLUSION The neurological aspect of Coronavirus disease 2019 should be highlighted. Neurological, psychological, and behavioral aspects of Coronavirus disease 2019, prolonged Coronavirus disease 2019, and Coronavirus disease 2019 vaccines can be the upcoming issues. We need a global awareness where this aspect of the disease should be more considered in health research.
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Affiliation(s)
- Zeinab Deris Zayeri
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mehdi Torabizadeh
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoud Kargar
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hashem Kazemi
- Department of Biology, Dezful Branch, Islamic Azad University, Dezful, Iran
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2
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Eschbach E, Wang J. Sleep and critical illness: a review. Front Med (Lausanne) 2023; 10:1199685. [PMID: 37828946 PMCID: PMC10566646 DOI: 10.3389/fmed.2023.1199685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Critical illness and stays in the Intensive Care Unit (ICU) have significant impact on sleep. Poor sleep is common in this setting, can persist beyond acute critical illness, and is associated with increased morbidity and mortality. In the past 5 years, intensive care clinical practice guidelines have directed more focus on sleep and circadian disruption, spurring new initiatives to study and improve sleep complications in the critically ill. The global SARS-COV-2 (COVID-19) pandemic and dramatic spikes in patients requiring ICU level care also brought augmented levels of sleep disruption, the understanding of which continues to evolve. This review aims to summarize existing literature on sleep and critical illness and briefly discuss future directions in the field.
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Affiliation(s)
- Erin Eschbach
- Division of Pulmonary, Critical Care, and Sleep, Mount Sinai Hospital, New York, NY, United States
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane R, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SM, Czeisler CA. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults. J Clin Sleep Med 2023; 19:1303-1311. [PMID: 37279079 PMCID: PMC10315594 DOI: 10.5664/jcsm.10588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? METHODS This was a cross-sectional survey of a diverse sample of 15,057 US adults. RESULTS COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized. CONCLUSIONS In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization. CITATION Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med. 2023;19(7):1303-1311.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Shaik L, Boike S, Ramar K, Subramanian S, Surani S. COVID-19 and Sleep Disturbances: A Literature Review of Clinical Evidence. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050818. [PMID: 37241050 DOI: 10.3390/medicina59050818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023]
Abstract
The need for adequate good quality sleep to optimally function is well known. Over years, various physical, psychological, biological, and social factors have been investigated to understand their impact on sleep. However, understanding the etiological processes that are involved in causing sleep disturbances (SD) as impacted by stressful phases such as pandemics has not been well studied. Many such etiological and management strategies have surfaced during the latest "coronavirus disease of 2019 (COVID-19) pandemic. The occurrence of these SD in the infected and uninfected individuals poses a need to investigate factors linked to such occurrence during this phase. Some of such factors include stressful practices such as social distancing, masking, vaccines, and medications availability, changes in routines, and lifestyles. As the status of infection improved, a collective term for all the prolonged effects of COVID-19 after the resolution of the primary infection called the post-COVID-19 syndrome (PCS) surfaced. Apart from impacting sleep during the infectious phase, the aftereffects of this virus left an even greater impact during the PCS. Various mechanisms have been hypothesized to be linked to such SD during the PCS, but the available data are inconclusive. Further, the varied patterns of incidence of these SDs differed by many factors, such as age, gender, and geographical location, making clinical management even more challenging. This review elucidates the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease on sleep health during the various phases of the COVID-19 pandemic. We also investigate different causal relationships, management strategies, and knowledge gaps related to SD during the COVID-19 pandemic.
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Affiliation(s)
- Likhita Shaik
- Department of Family Medicine, Hennepin Healthcare, Minneapolis, MN 55415, USA
| | - Sydney Boike
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | | | | | - Salim Surani
- Department of Pulmonary, Critical Care and Sleep Medicine, Texas A&M University, College Station, TX 77843, USA
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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Ahmadpour D, Kristoffersson A, Fredrikson M, Huang-Link Y, Eriksson A, Iacobaeus E, Landtblom AM, Haghighi S. Inventory study of an early pandemic COVID-19 cohort in South-Eastern Sweden, focusing on neurological manifestations. PLoS One 2023; 18:e0280376. [PMID: 36638113 PMCID: PMC9838851 DOI: 10.1371/journal.pone.0280376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Neurological manifestations in patients with COVID-19 have been reported previously as outcomes of the infection. The purpose of current study was to investigate the occurrence of neurological signs and symptoms in COVID-19 patients, in the county of Östergötland in southeastern Sweden. METHODS This is a retrospective, observational cohort study. Data were collected between March 2020 and June 2020. Information was extracted from medical records by a trained research assistant and physician and all data were validated by a senior neurologist. RESULTS Seventy-four percent of patients developed at least one neurological symptom during the acute phase of the infection. Headache (43%) was the most common neurological symptom, followed by anosmia and/or ageusia (33%), confusion (28%), hallucinations (17%), dizziness (16%), sleep disorders in terms of insomnia and OSAS (Obstructive Sleep Apnea) (9%), myopathy and neuropathy (8%) and numbness and tingling (5%). Patients treated in the ICU had a higher male presentation (73%). Several risk factors in terms of co-morbidities, were identified. Hypertension (54.5%), depression and anxiety (51%), sleep disorders in terms of insomnia and OSAS (30%), cardiovascular morbidity (28%), autoimmune diseases (25%), chronic lung diseases (24%) and diabetes mellitus type 2 (23%) founded as possible risk factors. CONCLUSION Neurological symptoms were found in the vast majority (74%) of the patients. Accordingly, attention to neurological, mental and sleep disturbances is warranted with involvement of neurological expertise, in order to avoid further complications and long-term neurological effect of COVID-19. Furthermore, risk factors for more severe COVID-19, in terms of possible co-morbidities that identified in this study should get appropriate attention to optimizing treatment strategies in COVID-19 patients.
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Affiliation(s)
- Doryaneh Ahmadpour
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Medical Specialists, Institute of Neurology, Motala Hospital, Motala, Sweden
| | - Anna Kristoffersson
- Department of Medical Specialists, Institute of Neurology, Motala Hospital, Motala, Sweden
| | | | - Yumin Huang-Link
- Department of Neurology, Linköping University Hospital, Linköping, Sweden
| | - Anne Eriksson
- Department of Medical Specialists, Institute of Medicine, Motala Hospital, Motala, Sweden
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Anne-Marie Landtblom
- Department of Neurology, Linköping University Hospital, Linköping, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sara Haghighi
- Department of Medical Specialists, Institute of Neurology, Motala Hospital, Motala, Sweden
- Department of Neurology, Linköping University Hospital, Linköping, Sweden
- * E-mail:
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Hayden MC, Schwarzl G, Limbach M, Mitrea S, Schuler M, Nowak D, Schultz K. Negative association between fatigue and signs of sleep apnoea in patients after COVID-19. ERJ Open Res 2022; 8:00289-2022. [PMID: 36575709 PMCID: PMC9510902 DOI: 10.1183/23120541.00289-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022] Open
Abstract
Compared to the general population, there are increased apnoea-hypopnoea indices in patients recovering from #COVID19, yet there is a negative correlation to symptoms of fatigue and no significant correlation to daytime sleepiness https://bit.ly/3pEl9C8.
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Affiliation(s)
- Markus C. Hayden
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany,These authors contributed equally
| | - Gabriele Schwarzl
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany,These authors contributed equally,Gabriele Schwarzl ()
| | - Matthias Limbach
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
| | - Sorin Mitrea
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
| | - Michael Schuler
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum, Germany
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
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Sunada N, Nakano Y, Otsuka Y, Tokumasu K, Honda H, Sakurada Y, Matsuda Y, Hasegawa T, Omura D, Ochi K, Hagiya H, Ueda K, Kataoka H, Otsuka F. Characteristics of Sleep Disturbance in Patients with Long COVID: A Retrospective Observational Study in Japan. J Clin Med 2022; 11:jcm11247332. [PMID: 36555948 PMCID: PMC9783729 DOI: 10.3390/jcm11247332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine the clinical and endocrinological features of sleep disturbance in patients with long COVID. METHODS This study was a single-center retrospective observational study for patients who visited the COVID-19 aftercare outpatient clinic (CAC) established in Okayama University Hospital in Japan during the period from 15 February 2021 to 29 July 2022. The long COVID patients were divided into two groups based on the presence or absence of sleep disturbance, and the clinical and laboratory characteristics of the patients were analyzed. RESULTS Out of 363 patients with long COVID, after excluding 6 patients, 60 patients (16.5%) (55% males, median age of 38 years) complaining of sleep disturbance were compared with 303 patients (83.5%) (43% males, median age of 40 years) without sleep-related symptoms. Although there were no significant differences in clinical backgrounds and severities of COVID-19 between the two groups by the multivariate analysis, the percentage of long COVID patients with sleep disturbance was significantly increased among patients infected in the Omicron-dominant phase. In addition, the prevalence rate of sleep disturbance in patients when infected in the Omicron phase (24.8%) was two-times higher than that in patients infected in the Delta phase (12.8%). Of note, the percentages of patients with sleep disturbance who also complained of general fatigue, headache, concentration loss, anxiety, low-grade fever, and brain fog symptoms were higher than the percentages of patients without sleep disturbance who had the same complaints. Among the types of sleep disturbance, the percentage of patients who complained of loss of sleep induction (75%) was much higher than the percentage of patients with early-awakening sleep disturbance (6.7%), and many of the patients with mid-awakening types of insomnia had brain fog symptoms. Endocrine examinations revealed that long COVID patients with sleep disturbance had significantly higher levels of plasma adrenocorticotropin and lower levels of serum growth hormone, suggesting the presence of hypothalamic-pituitary stress. CONCLUSION The prevalence of sleep disturbance has been increasing in long COVID patients infected in the Omicron phase with a certain clinical and endocrine trend.
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Affiliation(s)
- Naruhiko Sunada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Honda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yasue Sakurada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yui Matsuda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toru Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Daisuke Omura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kanako Ochi
- Center for Education in Medicine and Health Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hitomi Kataoka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Correspondence: ; Tel.: +81-86-235-7342
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Afzali A, Sahraei H, Hatef B, Meftahi GH, Shayad S, Pirzad Jahromi G. The Relationship between the Severity of the COVID-19 Disease, Temperament and Psychological Factors. IRANIAN JOURNAL OF PSYCHIATRY 2022; 17:462-468. [PMID: 36817813 PMCID: PMC9922356 DOI: 10.18502/ijps.v17i4.10696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/16/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
Objective: The coronavirus (COVID-19) pandemic negatively affects public mental health around the world. Individuals' reactions to COVID-19 vary depending on their temperament, individual differences, and personality traits. Therefore, the current study is conducted to assess the association of demographical features, Persian temperament, and psychological characteristics with the severity of COVID-19. Method: An online survey was sent to COVID-19 patients to collect their demographic information, COVID-19 symptoms, and clinical data. The Depression, Anxiety and Stress Scale (DAAS-21) questionnaire, Beck Depression Inventory (BDI-II), Spiel Berger State-Trait Anxiety Inventory (STAI) , Pittsburgh Sleep Quality Inventory (PSQI), and Persian general and brain temperament Questionnaire were also completed by 258 participants (127 men and 131 women) 45 days after recovery from COVID-19. Non-parametric analysis was used for statistical analysis. Results: Results showed the significant relationship of demographic factors such as weight, age and gender with the severity of the COVID-19 (P < 0.05). Mean scores of brain temperament (warm/cold) in the severe group were significantly lower than the moderate and mild groups (P < 0.05). There was a significant increase in the dry/wet temperament of the brain in the severe and moderate groups compared to the mild group (P < 0.05). The results of DASS-21 showed a significantly higher anxiety in patients with severe COVID-19 compared with moderate and mild groups (P < 0.05). The severe group was found to be significantly different compared to moderate group in the results of BDI-II (P < 0.05). The result of STAI (state and trait) showed a significant difference between the severe group and the mild and moderate groups. The score of PSQI between the moderate and mild groups was significant (P < 0.05). Conclusion: These results indicate the relationship between demographic factors such as weight, age and gender, brain temperament, as well as some psychological factors such as sleep quality and anxiety with the severity of the COVID-19 disease.
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Affiliation(s)
| | | | | | | | | | - Gila Pirzad Jahromi
- Corresponding Author: Address: Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran, Postal Code: 193956558. Tel: 98-21 87554490, Fax: 98-21 87554490,
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10
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Werner S, Doerfel C, Biedermann R, Lorenz M, Rasche M, Proquitté H, Newman L, Vilser D. The CSHQ-DE Questionnaire Uncovers Relevant Sleep Disorders in Children and Adolescents with Long COVID. CHILDREN 2022; 9:children9091419. [PMID: 36138727 PMCID: PMC9497557 DOI: 10.3390/children9091419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022]
Abstract
Acute SARS-CoV-2 infections in children and adolescents are usually mild. However, they can suffer from ongoing symptoms, generally referred to as long COVID. Sleep disorders are one of the most frequent complaints in long COVID although precise data are missing. We assessed the sleep behavior of children and adolescents who presented at our outpatient clinic between January 2021 and May 2022 with the Children’s Sleep Habits Questionnaire (CSHQ-DE). We compared the sleep behavior at three different time points: pre-COVID-19; post-COVID-19 at the initial presentation; and post-COVID-19 at re-presentation. Data from 45 patients were analyzed. Of those, 64% were female and the median age was 10 years (range: 0–18 years). Asymptomatic or mild COVID-19 disease was experienced in 89% of patients; 11% experienced moderate disease. The initial presentation occurred at a median of 20.4 weeks (6 weeks–14 months) after the infection. The CSHQ-DE score increased significantly from pre-COVID-19 (45.82 ± 8.7 points) to post-COVID-19 (49.40 ± 8.3 points; p ≤ 0.01). The score then normalized at re-presentation (46.98 ± 7.8; p = 0.1). The greatest changes were seen in the CSHQ-DE subscale score “daytime sleepiness”. Our data showed that children and adolescents with long COVID often suffer from sleep disturbances. For most children and adolescents, these sleep disorders decreased over time without any further medical intervention aside from a basic sleep consultation.
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Affiliation(s)
- Sarah Werner
- Neonatal and Pediatric Intensive Care Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Claus Doerfel
- Neonatal and Pediatric Intensive Care Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Richard Biedermann
- Neonatal and Pediatric Intensive Care Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Michael Lorenz
- Respiratory, Allergy and Cystic Fibrosis Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Marius Rasche
- Respiratory, Allergy and Cystic Fibrosis Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Hans Proquitté
- Neonatal and Pediatric Intensive Care Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Lars Newman
- Cardiology Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Daniel Vilser
- Cardiology Section, Department of Child and Adolescent Medicine, University Hospital Jena, 07747 Jena, Germany
- Correspondence:
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2022; 128:248-330. [PMID: 36096911 DOI: 10.1016/j.prosdent.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.
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Schilling C, Meyer-Lindenberg A, Schweiger JI. [Cognitive disorders and sleep disturbances in long COVID]. DER NERVENARZT 2022; 93:779-787. [PMID: 35576015 PMCID: PMC9109661 DOI: 10.1007/s00115-022-01297-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
Hintergrund In den letzten 2 Jahren der COVID-19(„coronavirus disease 2019“)-Pandemie ist das Wissen um Langzeitfolgen der Erkrankung, das sog. „Long-COVID“, rapide gewachsen. Es bleiben jedoch noch viele Fragen offen, v. a. was die Ursachen überdauernder Beschwerden und ihre Prognose betrifft. Kognitive Störungen und Schlafstörungen gehören zu den häufig beklagten Beschwerden. Beide gehen mit starkem Leidensdruck und deutlicher Alltagsbeeinträchtigung einher. Ziel der Arbeit Wie ist die Datenlage zum Auftreten kognitiver Störungen und Schlafstörungen bei Long-COVID? Welches sind Einflussfaktoren und was ist bekannt zum Verlauf und zu möglichen zugrunde liegenden Mechanismen? Welche Therapieoptionen gibt es? Material und Methode In einem narrativen Review werden die wichtigsten Befunde zu kognitiven Störungen und Schlafstörungen bei Long-COVID dargestellt. Es wird ein Überblick gegeben über die Kohortenstudien mit Daten zu Prävalenz und Einflussfaktoren beider Symptomkomplexe. Es werden derzeitige Kenntnisse und Hypothesen zu pathophysiologischen Mechanismen dargestellt und ein Ausblick auf Behandlungsansätze gegeben. Ergebnisse Etwa ein Fünftel der Betroffenen berichtet mehr als 3 Monate nach einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion über kognitive Einschränkungen, etwa ein Drittel über Schlafstörungen, wobei es neben insomnischen auch zu hypersomnische Beschwerden kommt. Kognitive Störungen und Schlafstörungen treten bei Betroffenen aller Schweregrade auf. Es gibt Hinweise auf eine Besserung kognitiver Defizite im Verlauf, allerdings sind weitere Längsschnittstudien notwendig. Diskussion Neben der Prognose sind die zugrunde liegenden Krankheitsmechanismen noch unzureichend verstanden. Zudem besteht großer Forschungsbedarf zur Wirksamkeit und zu spezifischen Wirkfaktoren therapeutischer Interventionen.
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Affiliation(s)
- Claudia Schilling
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Andreas Meyer-Lindenberg
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Janina Isabel Schweiger
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
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Mashaqi S, Kallamadi R, Matta A, Quan SF, Patel SI, Combs D, Estep L, Lee-Iannotti J, Smith C, Parthasarathy S, Gozal D. Obstructive Sleep Apnea as a Risk Factor for COVID-19 Severity-The Gut Microbiome as a Common Player Mediating Systemic Inflammation via Gut Barrier Dysfunction. Cells 2022; 11:1569. [PMID: 35563874 PMCID: PMC9101605 DOI: 10.3390/cells11091569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
The novel corona virus that is now known as (SARS-CoV-2) has killed more than six million people worldwide. The disease presentation varies from mild respiratory symptoms to acute respiratory distress syndrome and ultimately death. Several risk factors have been shown to worsen the severity of COVID-19 outcomes (such as age, hypertension, diabetes mellitus, and obesity). Since many of these risk factors are known to be influenced by obstructive sleep apnea, this raises the possibility that OSA might be an independent risk factor for COVID-19 severity. A shift in the gut microbiota has been proposed to contribute to outcomes in both COVID-19 and OSA. To further evaluate the potential triangular interrelationships between these three elements, we conducted a thorough literature review attempting to elucidate these interactions. From this review, it is concluded that OSA may be a risk factor for worse COVID-19 clinical outcomes, and the shifts in gut microbiota associated with both COVID-19 and OSA may mediate processes leading to bacterial translocation via a defective gut barrier which can then foster systemic inflammation. Thus, targeting biomarkers of intestinal tight junction dysfunction in conjunction with restoring gut dysbiosis may provide novel avenues for both risk detection and adjuvant therapy.
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Affiliation(s)
- Saif Mashaqi
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA; (S.F.Q.); (S.I.P.); (D.C.); (L.E.); (S.P.)
| | - Rekha Kallamadi
- Department of Internal Medicine, The University of North Dakota School of Medicine, Grand Forks, ND 58203, USA; (R.K.); (A.M.)
| | - Abhishek Matta
- Department of Internal Medicine, The University of North Dakota School of Medicine, Grand Forks, ND 58203, USA; (R.K.); (A.M.)
| | - Stuart F. Quan
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA; (S.F.Q.); (S.I.P.); (D.C.); (L.E.); (S.P.)
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Salma I. Patel
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA; (S.F.Q.); (S.I.P.); (D.C.); (L.E.); (S.P.)
| | - Daniel Combs
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA; (S.F.Q.); (S.I.P.); (D.C.); (L.E.); (S.P.)
| | - Lauren Estep
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA; (S.F.Q.); (S.I.P.); (D.C.); (L.E.); (S.P.)
| | - Joyce Lee-Iannotti
- Department of Sleep Medicine, The University of Arizona College of Medicine, Phoenix, AZ 85006, USA;
| | - Charles Smith
- The Intermountain Healthcare, Merrill Gappmayer Family Medicine Center, Provo, UT 84604, USA;
| | - Sairam Parthasarathy
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA; (S.F.Q.); (S.I.P.); (D.C.); (L.E.); (S.P.)
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO 65201, USA;
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14
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Sampol J, Sáez M, Martí S, Pallero M, Barrecheguren M, Ferrer J, Sampol G. Impact of home CPAP treated obstructive sleep apnea on COVID-19 outcomes in hospitalized patients. J Clin Sleep Med 2022; 18:1857-1864. [PMID: 35404224 PMCID: PMC9243267 DOI: 10.5664/jcsm.10016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To investigate the association between moderate or severe obstructive sleep apnea (OSA) treated with home continuous positive airway pressure (CPAP) and severe coronavirus disease 2019 (COVID-19). METHODS Retrospective study of patients admitted for COVID-19. Patients with OSA treated with home CPAP were identified and for each of them we selected 5 patients admitted consecutively in the following hours. The main outcome of the study was the development of severe COVID-19, defined as: a) death, or b) a composite outcome of death or the presence of severe hypoxemic respiratory failure at or during admission. The association between CPAP-treated OSA and these outcomes was estimated by logistic regression analysis after applying inverse probability of treatment weighting using a propensity score-weighting approach. RESULTS Of the 2059 patients admitted, 81 (3.9%) were receiving treatment with home CPAP. Among the 486 patients included in the study, 19% died and 39% presented the composite outcome. The logistic regression analysis did not show an association of CPAP treatment either with death (OR [95% CI]: 0.684 [0.332-1.409], p:0.303) or with the composite outcome (OR [95% CI]: 0.779 [0.418-1.452], p:0.432). Death was associated with age (OR [95% CI]: 1.116 [1.08-1.152], p<0.001) and number of comorbidities (OR [95% CI]: 1.318 [1.065-1.631], p:0.012), and the composite outcome was associated with male sex (OR [95% CI]: 2.067[1.19-3.589], p:0.01) and number of comorbidities (OR [95% CI]:1.241 [1.039-1.484], p:0.018). CONCLUSIONS In hospitalized COVID-19 patients, prior OSA treated with home CPAP is not independently associated with worse outcomes.
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Affiliation(s)
- Júlia Sampol
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sáez
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Martí
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Pallero
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Miriam Barrecheguren
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jaume Ferrer
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel Sampol
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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15
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Hu M, Han X, Ren J, Wang Y, Yang H. Significant association of obstructive sleep apnoea with increased risk for fatal COVID-19: A quantitative meta-analysis based on adjusted effect estimates. Sleep Med Rev 2022; 63:101624. [PMID: 35378481 PMCID: PMC8920966 DOI: 10.1016/j.smrv.2022.101624] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 12/12/2022]
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16
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Abstract
This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, and touches upon pandemic-related considerations for obstructive sleep apnea and continuous positive airway pressure treatment. Treatment strategies and management approaches are also briefly discussed.
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Affiliation(s)
- Sushanth Bhat
- Hackensack Meridian-Health JFK University Medical Center, 65 James Street, Edison, NJ, 08818, USA.
| | - Sudhansu Chokroverty
- Sleep Medicine Research, and Co-Chair Emeritus of Neurology, Hackensack Meridian-Health JFK University Medical Center, 65 James Street, Edison, NJ, 08818, USA.
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Cardoso E, Herrmann MJ, Grize L, Hostettler KE, Bassetti S, Siegemund M, Khanna N, Sava M, Sommer G, Tamm M, Stolz D. Is sleep-disordered breathing a risk factor for COVID-19 or vice versa? ERJ Open Res 2022; 8:00034-2022. [PMID: 35475113 PMCID: PMC8883039 DOI: 10.1183/23120541.00034-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Sleep is a physiologically invigorating, mostly nocturnal state, that plays an important role in the empowerment of the immune system [1]. Obstructive sleep apnoea (OSA) is the most frequent form of sleep disordered breathing (SDB) [2], which may represent a relevant risk factor for the clinical course and prognosis of coronavirus disease 2019 (COVID-19) [3, 4]. Common characteristics and comorbidities of OSA and COVID-19 (male gender, age >60 years, metabolic syndrome, cardiovascular and chronic pulmonary disease) were recently described as prognostic factors in COVID-19 [5]. However, the prevalence of SDB after COVID-19 remains insufficiently explored. Sleep disordered breathing may be a risk factor or a sequela of COVID-19.https://bit.ly/37v5Gyz
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18
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Goncalves M, Henriques A, Costa A, Correia D, Severo M, Lucas R, Barros H, Santos AC, Ribeiro AI, Rocha A, Lopes C, Correia D, Ramos E, Gonçalves G, Barros H, Araújo J, Talih M, Tavares M, Severo M, Lunet N, Meireles P, Duarte R, Lucas R, Camacho R, Fraga S, Correia S, Silva S, Leão T. Insomnia and nightmare profiles during the COVID-19 pandemic in Portugal: characterization and associated factors. Sleep Med 2022; 90:44-52. [PMID: 35093683 PMCID: PMC8744402 DOI: 10.1016/j.sleep.2021.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/22/2022]
Abstract
Objective/background To describe and characterize insomnia symptoms and nightmare profiles in Portugal during the first six weeks of a national lockdown due to COVID-19. Patients/methods An open cohort study was conducted to collect information of the general population during the first wave of SARS-CoV-2/COVID-19 pandemic in Portugal. We analyzed data from 5011 participants (≥16 years) who answered a weekly questionnaire about their well-being. Two questions about the frequency of insomnia and nightmares about COVID-19 were consecutively applied during six weeks (March–May 2020). Latent class analysis was conducted and different insomnia and nightmare profiles were identified. Associations between individual characteristics and both profiles were estimated using odds ratios (ORs) and 95% confidence intervals (CI). Results Five insomnia (No insomnia, Stable-mild, Decreasing-moderate, Stable-severe, Increasing-severe) and three nightmares profiles (Stable-mild, Stable-moderate, Stable-severe) were identified. Being female, younger, perceiving their income as insufficient and feelings of fear towards COVID-19 were associated with higher odds of insomnia (Women: OR = 6.98 95%CI: 4.18–11.64; ≥60 years: OR = 0.30 95%CI: 0.18–0.53; Insufficient income: adjusted OR (aOR) = 8.413 95%CI: 3.93–16.84; Often presenting fear of being infected with SARS-CoV-2 infection: aOR = 9.13 95%CI: 6.36–13.11), and nightmares (Women: OR = 2.60 95%CI: 1.74–3.86; ≥60 years: OR = 0.45 95%CI: 0.28–0.74; Insufficient income: aOR = 2.60 95%CI: 1.20–5.20; Often/almost always presenting fear of being infected with SARS-CoV-2 infection: aOR = 6.62 95%CI: 5.01–8.74). Having a diagnosis of SARS-CoV-2 virus infection was associated with worse patterns of nightmares about the pandemic. Conclusions Social and psychological individual factors are important characteristics to consider in the development of therapeutic strategies to support people with sleep problems during the COVID-19 pandemic.
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19
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Huynh G, Nguyen HV, Vo LY, Le NT, Nguyen HTN. Assessment of Insomnia and Associated Factors Among Patients Who Have Recovered from COVID-19 in Vietnam. Patient Prefer Adherence 2022; 16:1637-1647. [PMID: 35837086 PMCID: PMC9275485 DOI: 10.2147/ppa.s371563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has been affecting the lives of millions of people globally. Patients recovering from COVID-19 are facing, not only the symptom of long COVID, but also psychological problems, such as sleep disturbance. This study aims to assess the proportion of COVID-19 recovered adult patients that suffer from insomnia and associated factors in Vietnam. METHODS A cross-sectional study was performed between January and March 2022 among patients who have recovered from a COVID-19 infection. Data were collected based on a self-administered questionnaire that included sociodemographic and standardized questionnaires from the Hospital Anxiety and Depression Scale (HADS), the Perceived stress scale (PSS) and the dependent variable using Insomnia Severity Index (ISI). Multivariable logistic regression was conducted to explore factors associated with the patients' insomnia disorder. RESULTS A total of 325 participants were included in this analysis, 34.5% of participants had insomnia. According to multivariable logistic regression, participants who were equal to and over 50 years of age, feeling alienated from others, and were not supported by families or relatives, reported significantly higher levels of insomnia disorders over those aged under 50 years, having closer ties with family and had received support from family or relatives. Besides, respondents who recorded mental health problems that included anxiety, depression and stress were more likely to get insomnia disorders than those without mental health symptoms (OR 2.7, 95% CI 1.1-6.6) (OR 4.5, 95% CI 2.3-8.9) (OR 2.3, 95% CI 1.1-5.3), respectively, all p < 0.05. CONCLUSION There was a remarkable rate of COVID-19 recovered patients experiencing insomnia disorders. Older age, alienated relationships and not being supported by families or relatives, as well as had mental health problems, are factors that affected the patients' insomnia, which showed that these sleep issues need to be screened and managed among adults who have recovered from COVID-19.
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Affiliation(s)
- Giao Huynh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hau Viet Nguyen
- Emergency Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Correspondence: Hau Viet Nguyen, Emergency Department, University Medical Center Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam, Tel +84918764092, Email
| | - Lan Y Vo
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngoc Thi Le
- Faculty of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Han Thi Ngoc Nguyen
- Infection Control Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Han Thi Ngoc Nguyen, Infection Control Department, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam, Tel +84397975519, Email
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Kotova O, Tsareva E, Medvedev V, Belyaev A, Gushanskaya E, Frolova V, Kotelnikova I. Clinical aspects of the use of imidazopyridine derivatives in the treatment of sleep disorders associated with post-COVID syndrome. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:39-44. [DOI: 10.17116/jnevro202212212139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Rögnvaldsson KG, Eyþórsson ES, Emilsson ÖI, Eysteinsdóttir B, Pálsson R, Gottfreðsson M, Guðmundsson G, Steingrímsson V. Obstructive sleep apnea is an independent risk factor for severe COVID-19: a population-based study. Sleep 2021; 45:6430441. [PMID: 34791469 PMCID: PMC8690036 DOI: 10.1093/sleep/zsab272] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has been proposed as a risk factor for severe COVID-19. Confounding is an important consideration as OSA is associated with several known risk factors for severe COVID-19. Our aim was to assess the association of OSA with hospitalization due to COVID-19 using a population-based cohort with detailed information on OSA and comorbidities. METHODS Included were all community-dwelling Icelandic citizens 18 years of age and older diagnosed with SARS-CoV-2 infection in 2020. Data on demographics, comorbidities, and outcomes of COVID-19 was obtained from centralized national registries. Diagnosis of OSA was retrieved from the centralized Sleep Department Registry at Landspitali-The National University Hospital. Severe COVID-19 was defined as the composite outcome of hospitalization and death. The associations between OSA and the outcome were expressed as odds ratios (OR) with 95% confidence intervals (95% CI), calculated using logistic regression models and inverse probability weighting. RESULTS A total of 4,756 individuals diagnosed with SARS-CoV-2 infection in Iceland were included in the study (1.3% of the Icelandic population), of whom 185 had a diagnosis of OSA. In total, 238 were hospitalized or died, 38 of whom had OSA. Adjusted for age, sex, and BMI, OSA was associated with poor outcome (OR 2.2, 95% CI 1.4 -3.5). This association was slightly attenuated (OR 2.0, 95% CI 2.0, 1.2-3.2) when adjusted for demographic characteristics and various comorbidities. CONCLUSIONS OSA was associated with twofold increase in risk of severe COVID-19, and the association was not explained by obesity or other comorbidities.
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Affiliation(s)
| | - Elías Sæbjörn Eyþórsson
- Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Össur Ingi Emilsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Division of Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Björg Eysteinsdóttir
- Division of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Runólfur Pálsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Magnús Gottfreðsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Division of Infectious Diseases, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gunnar Guðmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Division of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Vilhjálmur Steingrímsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
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22
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Samushiya MA, Mironova NV, Poluektov MG. Sleep disorders in patients with COVID-19. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sleep disorders often accompany COVID-19 and are a part of post-COVID syndrome. Some of the sleep disorders that occur in patients hospitalized for COVID-19 can be attributed to acute forms of insomnia. This type of sleep disorders is due to special conditions associated with hospitalization, and is short-term. Other sleep disorders appear as a part of anxiety-depressive symptoms diagnosed in patients with COVID-19. These symptoms can be classified as nosogenies psychogenic disorders that are associated with diagnosis of coronavirus infection; somatogenies psychopathological conditions resulting from pathological effects on the central nervous system of somatic and neurological complications of COVID-19; iatrogenies mental disorders that occur due to the intake of medication. Currently, information on the impact of sleep quality on the severity of COVID-19 and the effectiveness of treatment for post-COVID syndrome is accumulating. This review provides up-to-date information on sleep disorders in patients with COVID-19 and the principles of their therapy.
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Abstract
PURPOSE OF REVIEW To evaluate the impact of the COVID-19 pandemic on the care of people with sleep disorders, to explore relationships between OSA and COVID-19, and to describe current knowledge of the effect of the pandemic on sleep globally. RECENT FINDINGS COVID-19 has led to significant changes in the practice of sleep medicine, including the care of patients with OSA. An OSA diagnosis may portend a worse prognosis with COVID-19, whilst prior COVID-19 may have an impact on sleep breathing. SUMMARY The pandemic has caused marked difficulties with access to diagnostic sleep studies and reduced capacity for CPAP initiation. Conversely, adherence to CPAP therapy may have improved, and use of remote consultations and telemonitoring has increased. An OSA diagnosis may be associated with increased risk of severe COVID-19, although any apparent relationship may be attributable to confounding factors, such as obesity and metabolic disease. Small studies have reported some increase in CPAP requirements in OSA patients following COVID-19 infection. More generally, the pandemic has been associated with a deterioration in subjective sleep quality across the population; much of this appears because of increased anxiety and stress. Finally, studies assessing putative links between COVID-19 and REM sleep issues are ongoing.
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Liu L, Ni SY, Yan W, Lu QD, Zhao YM, Xu YY, Mei H, Shi L, Yuan K, Han Y, Deng JH, Sun YK, Meng SQ, Jiang ZD, Zeng N, Que JY, Zheng YB, Yang BN, Gong YM, Ravindran AV, Kosten T, Wing YK, Tang XD, Yuan JL, Wu P, Shi J, Bao YP, Lu L. Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine 2021; 40:101111. [PMID: 34514362 PMCID: PMC8424080 DOI: 10.1016/j.eclinm.2021.101111] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic, and has been found to be closely associated with mental and neurological disorders. We aimed to comprehensively quantify the association between mental and neurological disorders, both pre-existing and subsequent, and the risk of susceptibility, severity and mortality of COVID-19. METHODS In this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, PsycINFO, and Cochrane library databases for studies published from the inception up to January 16, 2021 and updated at July 7, 2021. Observational studies including cohort and case-control, cross-sectional studies and case series that reported risk estimates of the association between mental or neurological disorders and COVID-19 susceptibility, illness severity and mortality were included. Two researchers independently extracted data and conducted the quality assessment. Based on I2 heterogeneity, we used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (95% CI). Subgroup analyses and meta-regression analysis were also performed. This study was registered on PROSPERO (registration number: CRD 42021230832). FINDING A total of 149 studies (227,351,954 participants, 89,235,737 COVID-19 patients) were included in this analysis, in which 27 reported morbidity (132,727,798), 56 reported illness severity (83,097,968) and 115 reported mortality (88,878,662). Overall, mental and neurological disorders were associated with a significant high risk of infection (pre-existing mental: OR 1·67, 95% CI 1·12-2·49; and pre-existing neurological: 2·05, 1·58-2·67), illness severity (mental: pre-existing, 1·40, 1·25-1·57; sequelae, 4·85, 2·53-9·32; neurological: pre-existing, 1·43, 1·09-1·88; sequelae, 2·17, 1·45-3·24), and mortality (mental: pre-existing, 1·47, 1·26-1·72; neurological: pre-existing, 2·08, 1·61-2·69; sequelae, 2·03, 1·66-2·49) from COVID-19. Subgroup analysis revealed that association with illness severity was stronger among younger COVID-19 patients, and those with subsequent mental disorders, living in low- and middle-income regions. Younger patients with mental and neurological disorders were associated with higher mortality than elders. For type-specific mental disorders, susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder (ADHD); illness severity was associated with both pre-existing and subsequent mood disorders as well as sleep disturbance; and mortality was associated with pre-existing schizophrenia. For neurological disorders, susceptibility was associated with pre-existing dementia; both severity and mortality were associated with subsequent delirium and altered mental status; besides, mortality was associated with pre-existing and subsequent dementia and multiple specific neurological diseases. Heterogeneities were substantial across studies in most analysis. INTERPRETATION The findings show an important role of mental and neurological disorders in the context of COVID-19 and provide clues and directions for identifying and protecting vulnerable populations in the pandemic. Early detection and intervention for neurological and mental disorders are urgently needed to control morbidity and mortality induced by the COVID-19 pandemic. However, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. More studies are needed to explore long-term mental and neurological sequela, as well as the underlying brain mechanisms for the sake of elucidating the causal pathways for these associations. FUNDING This study is supported by grants from the National Key Research and Development Program of China, the National Natural Science Foundation of China, Special Research Fund of PKUHSC for Prevention and Control of COVID-19, and the Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Shu-Yu Ni
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Qing-Dong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yi-Miao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Ying-Ying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Huan Mei
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jia-Hui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Yan-Kun Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Shi-Qiu Meng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Zheng-Dong Jiang
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian-Yu Que
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Bei-Ni Yang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yi-Miao Gong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | | | - Thomas Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang-Dong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center and Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jun-Liang Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Lin Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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Grote L, Theorell-Haglöw J, Ulander M, Hedner J. Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services-Longitudinal Data from the Swedish Sleep Apnea Registry. Sleep Med Clin 2021; 16:409-416. [PMID: 34325820 PMCID: PMC8258548 DOI: 10.1016/j.jsmc.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment.
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Affiliation(s)
- Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, 40530 Gothenburg, Sweden; Respiratory Department, Sleep Disorders Center, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset ing 40, 75185 Uppsala, Sweden; Respiratory Department, The Sleep Apnea Center, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, 58185 Linköping, Sweden; Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 58185 Linköping, Sweden
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, 40530 Gothenburg, Sweden; Respiratory Department, Sleep Disorders Center, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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