Home parenteral nutrition, sleep patterns, and depressive symptoms: Secondary analysis of cross-sectional data

BACKGROUND

Patients receiving home parenteral nutrition (HPN) are known to experience psychological distress and have profoundly disrupted sleep. The aim of this analysis was to examine the relationship between sleep patterns with depressive symptoms and HPN characteristics.

METHODS

The study was a secondary analysis of cross-sectional data examining sleep patterns using subjective and objective measures. Sleep was assessed by surveys and 7-day actigraphy. The Patient Health Questionnaire-8 was used to evaluate depressive symptoms. Participants provided information on HPN. Spearman correlations were calculated between sleep measures with depressive symptoms and HPN characteristics. Correlations were further examined in multivariable linear regression models.

RESULTS

Thirty-two adults (age = 53 years; 75% female; 94% White) were included. Lower sleep quality (r = 0.54-0.60; P < 0.001) and later sleep timing (r = -0.35; P = 0.049) were correlated with higher depressive symptoms. Sleep patterns were also correlated with several HPN characteristics (r = -0.47 to 0.51). In linear regression models, rate of infusion was associated with sleep duration (β = -0.004 [0.002] h; P = 0.046) in which each 100 mL/h was associated with 24-min shorter duration. Higher total energy was associated with lower sleep quality (β = 0.0004 [0.0002] log-unit; P = 0.042), and higher volume was associated with longer sleep onset latency (β = 0.0006 [0.0003] log-min; P = 0.049).

CONCLUSIONS

We provide evidence supporting the link between poor and later sleep with higher depressive symptoms and identify potentially modifiable infusion characteristics (notably, slower rate of infusion and lower total energy and volume) that, on further verification, may support sleep among those receiving HPN.

Comparison between self-reported and actigraphy-derived sleep measures in patients receiving home parenteral nutrition: Secondary analysis of observational data

BACKGROUND

Patients receiving home parenteral nutrition (HPN) frequently report disrupted sleep. However, there are often inconsistencies between objectively measured and questionnaire-derived sleep measures. We compared sleep measures estimated from wrist actigraphy and self-report in adults receiving HPN.

METHODS

In this secondary analysis, we pooled data from two sleep-related studies enrolling adults receiving habitual HPN. We compared measures from 7-day averages of wrist actigraphy against comparable responses to a sleep questionnaire. Sleep measures included bedtime, wake time, time in bed, total sleep time, and sleep onset latency (SOL). Spearman correlation coefficients, Bland-Altman plots, and linear regression models for each set of sleep measures provided estimates of agreement.

RESULTS

Participants (N = 35) had a mean age of 52 years, body mass index of 21.6 kg/m2 , and 77% identified as female. Correlation coefficients ranged from 0.35 to 0.90, were highest for wake time (r = 0.90) and bedtime (r = 0.74), and lowest for total sleep time (r = 0.35). Actigraphy overestimated self-reported bedtime, wake time, and total sleep time and underestimated self-reported time in bed and SOL. Regression coefficients indicated the highest calibration for bedtime and wake time and lower calibration for time in bed, total sleep time, and SOL.

CONCLUSION

We observed strong-to-moderate agreement between sleep measures derived from wrist actigraphy and self-report in adults receiving HPN. Weaker correlations for total sleep time and SOL may indicate low wrist actigraphy sensitivity. Low-quality sleep resulting from sleep disruptions may have also contributed to an underreporting of perceived sleep quantity and lower concordance.

76 Osteogenesis imperfecta: a case report on 4 cases

Background

Osteogenesis imperfecta, or “glass bone disease”, is a rare genetic disorder due to an abnormality in the production of type 1 collagen. It is characterised by bone fragility and low bone mass, leading to repeated fractures. Osteogenesis imperfecta (OI) can be classified into several types ranging from lethal at birth to benign forms that may be discovered incidentally in adulthood.

We report four observations of OI that caught our attention.

Observation 1: Mr H.A, aged 15 years, with no particular pathological history (atcd), he presented since the age of 4 years old iterative low-energy fractures (06 fractures). The clinical examination finds dorsal scoliosis, deformities of the long bones, blue staining of the sclerae. Radiography showed diffuse bone hypertransparency, thinned cortices and curvature of the long bones. Osteoporosis with a Z-score of -3.8 DS in the spine and -3.1 DS in the femur on bone densitometry (BMD). The patient received 20 courses of pamidronic acid at a dose of 07 mg/kg/year with good clinical (decrease in the number of fractures) and osteodensitometric improvement and good tolerance.

Observation 2: Mr D.A, 16 years old, without any particular pathological atcd, the onset of the disorders goes back to the age of 13 years marked by the installation of repeated fractures following minimal trauma. The patient presents with growth retardation, deformities of the long bones and blue sclera. Radiography showed diffuse bone hypertransparency, thinned cortices, curvature of the long bones with bilateral coxa profonda. BMD showed osteoporosis with a Z score of -4.8DS. He was treated with pamidronic acid at 07 mg/kg/year (09 courses) with satisfactory improvement and good tolerance.

Observation 3: Mr A.N aged 41 years with no particular pathological atcd. The history of the disease shows repeated low-energy fractures (06 fractures) since the age of 11 years. On clinical examination, there is an exaggerated kyphosis, blue sclera and bilateral hearing loss on the right. On imaging, diffuse bone hypertransparency, thinned cortices, curvature of the long bones and right acetabular protrusion were noted. On BMD, osteoporosis with a Z-score of -4.0 DS at the spine and femur. The patient received zoledronic acid 04 mg/06 months. The patient improved well with a decrease in the number of fractures and an improvement in bone densitometry.

Observation 4: Mrs B.Z aged 40 years without any particular pathological atcd, having made iterative low energy fractures since the age of 01 month (05 fractures). The patient presents a dorsal scoliosis, deformations of the long bones, growth retardation, blue sclera and translucent teeth. The radiograph shows diffuse bone hypertransparency, thinned cortices and curvature of the long bones. BMD and adequate treatment were not done as the patient was lost to follow-up.

Conclusion

Osteogenesis imperfecta is a rare disease with a polymorphous clinical expression. Late diagnosis delays the initiation of adequate treatment and consequently the persistence of fractures. Bisphosphates improve bone mass and reduce the incidence of fractures and are generally well tolerated.

P095 Camptodactyly, arthropathy, coxa-vara, pericarditis syndrome: a case report

Background

Camptodactyly, arthropathy, coxa vara, pericarditis (CACP) syndrome is a rare genetic disorder with autosomal recessive transmission including camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and non-inflammatory pericarditis. We report the observation of a case.

Observation

S.Y aged 8.5 years, from a consanguineous marriage, presented with a chronic arthropathy affecting wrists, knees and ankles that had been evolving for 6 years and currently, elbows are also affected. The history includes surgery for claw deformity of the hands at the age of 3. No similar cases in the family.

Osteoarticular examination showed symmetrical swelling of the elbows, wrists (Fig. 1),knees (Fig. 2) and ankles (Fig. 3.The affected joints were neither red, painful nor warm on palpation, with normal mobility.

The onset of symptoms could not be determined due to the indolence of the condition and the rest of the clinical examination was unremarkable.

Discussion

CACP syndrome is a more common condition in the Middle East and North Africa, with about 20 cases reported worldwide. This syndrome is still poorly understood and is often confused with juvenile idiopathic arthritis. It should be suspected in the presence of any congenital claw deformity of the hands (camptodactyly) with a chronic non-inflammatory arthropathy, which are constant signs. Coxa-vara and pericarditis (found respectively in 60 and 30% of cases) should be systematically sought. The consanguinity reported in the literature is also present in our case. However, there are no similar cases in siblings. The diagnosis is important, thus avoiding the initiation of unnecessary treatments such as corticosteroids, DMARDs or biotherapy.

Biology

no inflammatory syndrome, FAN negatives.

Standard X-ray of the pelvis

presence of a coxa-vara on the right

Joint ultrasound

common tenosynovitis of the extensors of the fingers, effusion with synovial hypertrophy without a Doppler catch of the elbows, knees and ankles

Myelogram without abnormality.

Cardiac ultrasound without pericarditis.

The diagnosis of CACP was made in view of: a history of camptodactyly, chronic non-inflammatory arthropathy and coxa-vara.

Analgesic treatment was instituted in case of pain, with cardiac monitoring by ultrasound every 6 months.

Conclusion

CACP syndrome is a rare disease often confused with juvenile idiopathic arthritis. Congenital camptodactyly and non-inflammatory arthropathy are very evocative of the diagnosis. The absence of similar cases in siblings makes our observation special.