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Ell J, Schmid SR, Benz F, Spille L. Complementary and alternative treatments for insomnia disorder: a systematic umbrella review. J Sleep Res 2023; 32:e13979. [PMID: 37527850 DOI: 10.1111/jsr.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 08/03/2023]
Abstract
Insomnia is a common disorder and cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment. However, CBT-I is not widely distributed and infrequently available while medication is not indicated for long-term use. To close this evident gap in supply, alternative treatments could be utilised. High-quality research on this topic is scarce, and there is currently no comprehensive publication on the effectiveness of alternative treatments. To address this pressing question, we systematically summarised the existing research on alternative treatments for insomnia. A comprehensive search of systematic reviews and (network) meta-analyses of randomised controlled trials investigating the efficacy of alternative treatments compared to waiting-list control or placebo in adults with insomnia disorder with or without comorbidities was conducted in PubMed, MEDLINE, PsycInfo, and PsycArticles on December 6, 2022, yielding 391 records. Finally, 15 eligible studies were included. Evidence on acupuncture, exogenous melatonin, mind-body interventions and exercise, repetitive transcranial magnetic stimulation (rTMS), valerian, and light exposure was found. Acupuncture, rTMS and mind-body exercises significantly improved sleep quality and insomnia severity but effects on objectively assessed outcomes were inconclusive. Melatonin led to a reduction in both self-reported and objectively assessed sleep onset latency. Light exposure and valerian did not significantly improve sleep outcomes. Overall, the quality of studies was rated as low. Results indicate that alternative treatments are effective mostly on subjective outcomes. However, evidence on the efficacy of some intervention types is sparse and there is a need for high-quality original studies. Future research could investigate whether combining different alternative treatment aspects with CBT-I improves individual treatment.
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Affiliation(s)
- Johanna Ell
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Sarah R Schmid
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lukas Spille
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
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Ell J, Schiel JE, Feige B, Riemann D, Nyhuis CC, Fernandez-Mendoza J, Vetter C, Rutter MK, Kyle SD, Spiegelhalder K. Sleep health dimensions and shift work as longitudinal predictors of cognitive performance in the UK Biobank cohort. Sleep 2023:7099635. [PMID: 37004209 DOI: 10.1093/sleep/zsad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 04/03/2023] Open
Abstract
STUDY OBJECTIVES The long-term effects of sleep health and shift work on cognitive performance are unclear. In addition, research has been limited by small sample sizes and short follow-up periods. We conducted one of the largest examinations of the longitudinal influence of sleep health dimensions and shift work on cognitive performance in people of middle and old age using data from the UK Biobank. The hypothesis was that poor sleep health and shift work would predict lower cognitive performance. METHODS Self-reported sleep duration, daytime sleepiness, insomnia symptoms, chronotype and shift work status were assessed as predictors at baseline. Cognitive performance was operationalised by a touchscreen test battery at follow-up between 7.4 ± 2.2 and 9.0 ± 0.9 years after baseline assessment, depending on the specific task. Models were performed for each cognitive domain including relevant confounders (e.g., depression). The alpha level was set at p<0.01 for all analyses. RESULTS The study sample comprised 9,394 participants for the reasoning task, 30,072 for the reaction time task, 30,236 for the visual memory task, 2,019 for the numeric memory task and 9,476 for the prospective memory task. Shift work without night shifts (ß= -2.0x10- 1 ± 6.5x10- 2, p=0.002) and with night shifts (ß= -1.9x10- 1 ± 7.2x10- 2, p=0.010) predicted a significantly reduced performance in the reasoning task. Short sleep duration (ß= -2.4x10- 1 ± 7.9x10- 2, p=0.003) and shift work without night shifts (ß= -3.9x10- 1 ± 1.2x10- 1, p=0.002) predicted a significantly lower performance in the task probing prospective memory. CONCLUSIONS Our results suggest that, after controlling for confounding variables, shift work and short sleep duration are important predictors for cognitive performance in people of middle and old age. Further work is required to examine causal mechanisms of the observed associations.
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Affiliation(s)
- Johanna Ell
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian E Schiel
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Martin K Rutter
- Centre for Biological Timing, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ell J, Brückner H, Johann A, Feige B, Steinmetz L, Frase L, Järnefelt H, Riemann D, Lehr D, Spiegelhalder K. Does online-delivered Cognitive Behavioural Therapy for Insomnia improve insomnia severity in nurses working shifts? Protocol for a randomised-controlled trial. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Storck K, Ell J, Regn S, Rittler-Ungetüm B, Mayer H, Schantz T, Müller D, Buchberger M. Optimization of in vitro cultivation strategies for human adipocyte derived stem cells. Adipocyte 2015; 4:181-7. [PMID: 26257991 PMCID: PMC4496977 DOI: 10.4161/21623945.2014.987580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/16/2014] [Accepted: 11/10/2014] [Indexed: 01/07/2023] Open
Abstract
With adipose-derived stem cells being in the focus of research in regenerative medicine, the need arises for fast reliable cultivation protocols. We have tested the cultivation of human adipose-derived stem cells in endothelial cell growth medium prior to induction and differentiation, against the long-established use of DMEM/F12 medium-based cultivation protocols. We found that cultivation in endothelial cell growth medium not only accelerates growth before induction and differentiation, but also allows shorter induction and differentiation times than those following precultivation with DMEM/F12 medium with regard to the formation of mature adipocytes and to the viability undifferentiated cells. These results were first observed morphologically but could be confirmed by performing adiponectin ELISA and cell proliferation assays.
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Affiliation(s)
- K Storck
- Department of Oto- Rhino- Laryngology; Head and Neck Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - J Ell
- Department of Oto- Rhino- Laryngology; Head and Neck Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - S Regn
- Department of Oto- Rhino- Laryngology; Head and Neck Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - B Rittler-Ungetüm
- Department of Oto- Rhino- Laryngology; Head and Neck Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - H Mayer
- Department of Oto- Rhino- Laryngology; Head and Neck Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - T Schantz
- Department of Plastic and Reconstructive Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - D Müller
- Department of Plastic and Reconstructive Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
| | - M Buchberger
- Department of Oto- Rhino- Laryngology; Head and Neck Surgery; Klinikum Rechts der Isar der TU München; Munich, Germany
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Hayes M, Parker G, Ell J, Sillence D. Basilar impression complicating osteogenesis imperfecta type IV: the clinical and neuroradiological findings in four cases. J Neurol Neurosurg Psychiatry 1999; 66:357-64. [PMID: 10084535 PMCID: PMC1736265 DOI: 10.1136/jnnp.66.3.357] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the clinical and neuroradiological features of basilar impression in patients with osteogenesis imperfecta type IV. METHODS Four patients with basilar impression were ascertained in a population study of osteogenesis imperfecta. All four had detailed clinical and neuroradiological examination with both CT and MRI of the craniocervical junction and posterior fossa structures. RESULTS All four showed significant compression of the posterior fossa structures and surgical decompression was performed with relief of symptoms. CONCLUSION Symptoms of cough headache and trigeminal neuralgia occurring in patients with osteogenesis imperfecta are indications for detailed clinical and neuroradiological investigation to document basilar impression.
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Affiliation(s)
- M Hayes
- Department of Neurology, Concord Hospital, NSW, Australia
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Abstract
We described a profoundly intellectually disabled 24-year-old man with Wolf-Hirschhorn syndrome, left hemiplegia, epilepsy, atrophy of the right cerebral hemisphere, and dilatation of the right ventricle. The patient had a small ventricular septal defect, was wheelchair bound, and totally dependent. He had no speech, but vocalised to show his feelings. In this patient, the del(4)(p15) was subtle and arose due to the inheritance of a recombinant chromosome (4) from a maternal pericentric inversion-46,XX,inv(4) (p15.32q35). Fluorescence in situ hybridisation with probe D4S96 confirmed the deletion. This is the second case of Wolf-Hirschhorn syndrome resulting from a large pericentric inversion of chromosome 4.
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Affiliation(s)
- R Ogle
- Department of Genetics, Children's Hospital, Camperdown, NSW, Australia
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Dexter MA, Parker GD, Besser M, Ell J, Fulham MJ. MR and positron emission tomography with fludeoxyglucose F 18 in gliomatosis cerebri. AJNR Am J Neuroradiol 1995; 16:1507-10. [PMID: 7484643 PMCID: PMC8338084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 16-year-old girl presented with a unilateral third nerve palsy and predominant gray matter involvement on MR and positron emission tomography with fludeoxyglucose F 18. These findings were manifestations of gliomatosis cerebri. The antemortem diagnosis was made by partial temporal lobectomy.
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Affiliation(s)
- M A Dexter
- Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, Australia
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Ell J. Dizziness--organic or functional? Aust Fam Physician 1992; 21:1431-3, 1436. [PMID: 1444969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The author discusses a specific case to illustrate the problem of chronic, uncompensated asymmetrical vestibular function, which can present with seemingly bizarre symptoms. Simple guidelines to distinguish between organic and functional dizziness are offered.
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Affiliation(s)
- J Ell
- Royal Prince Alfred Hospital, Sydney, New South Wales
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Paul M, Joshua D, Rahme N, Pollard J, Ell J, Gibson J, Bonnet D. Fatal peripheral neuropathy associated with axonal degeneration after high-dose cytosine arabinoside in acute leukaemia. Br J Haematol 1991; 79:521-3. [PMID: 1661126 DOI: 10.1111/j.1365-2141.1991.tb08067.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M Paul
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
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Abstract
Lymphomatoid granulomatosis is an uncommon clinical problem and even more rarely presents to the ophthalmologist. A case is described in which a 60-year-old Fijian woman presented with sudden, sequential, complete visual loss in association with signs of scleritis. Direct eyewall biopsy and nasal mucosal biopsy confirmed the diagnosis of lymphomatoid granulomatosis. Despite intensive high-dose oral prednisone therapy her vision remained at no light perception and she developed recrudescence of disease necessitating the use of radiotherapy. All systemic investigations failed to show any other organ involvement by the disease process and she remains well. This is the first report of lymphomatoid granulomatosis presenting as sudden blindness.
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Affiliation(s)
- D McKay
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Western Australia
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Abstract
Ten patients with an accepted diagnosis of Friedreich's ataxia have been examined neuro-otologically, and oculomotor, vestibular and auditory function assessed. Brainstem auditory evoked potentials (BAEPs) were also recorded. A high incidence of various eye movement disorders was noted. Some of these were indicative of cerebellar dysfunction. Reduced vestibular function and impaired hearing were common to most of the patients. BAEPs were also abnormal in the majority; reasons underlying these abnormalities are discussed. Neuro-otologically, the patients did not constitute an homogeneous group. The findings cast doubt upon the accuracy and validity of the currently accepted criteria for the diagnosis and classification of the spinocerebellar degenerations.
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Abstract
The effects of the "vestibular sedative" drug Flunarizine upon the oculomotor functions of pursuit and voluntary saccades and upon the vestibular response (to rotational stimuli) were assessed in twenty volunteer subjects. The study was then extended to three patients with chronic imbalance of central origin who had reported a beneficial symptomatic response to the drug. Three of the volunteer subjects were found to have a directional preponderance (presumed to arise from peripheral dysfunction). In the remaining seventeen normal subjects Flunarizine was found to reduce the amplitudes of fast phases of vestibular nystagmus. The directional preponderance in the other three subjects was redressed through production of fast phases which were of lower and more uniform amplitude. In the patients, in addition to a reduction in fast phase amplitude, there was a reduction or abolition of after nystagmus. In no case was any reduction in slow phase velocity observed. Pursuit and voluntary saccades were unaffected by the drug. It was concluded, on the basis that the fast phases of nystagmus are centrally generated, that Flunarizine has a central action rather than a depressant effect upon the vestibular end organ. In view of known oculomotor physiology and pharmacology it is proposed that vestibular sedatives act by depression of Type II vestibular neurons, and modification of the functional relationships between the vestibular nuclei, the perihypoglossal nuclei and the flocculus of the cerebellum. A trial of vestibular active drug is indicated particularly in patients in whom asymmetry of the vestibular response and/or abnormal after nystagmus is demonstrated.
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