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BACKGROUND AND OBJECTIVE: Individuals with asthma are more likely to develop sleep-disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms. METHODS: This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre- and post-intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health-related quality of life and anxiety and depression levels were conducted. RESULTS: Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma-symptom-free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma-related quality of life questionnaire and a reduction in anxiety symptoms. CONCLUSION: Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms.

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Abstract Background Ankylosing Spondylitis (AS) patients face several challenges due to the nature of the disease and its physical and psychological complications. Sleep disorders are among the most important concerns. Sleep disorders can aggravate the signs and symptoms of the disease and ultimately reduce the quality of patients' lives. This study uses a systematic review and meta-analysis to pool the reported prevalence of sleep disorders among AS patients. Methods To find related studies, the WoS, PubMed, ScienceDirect, Scopus, Embase, and Google Scholar databases were systematically searched without a lower time limit. Heterogeneity among the identified studies was checked using the I2 index, and the Begg and Mazumdar correlation test examined the existence of published bias. Comprehensive Meta-Analysis (v.2) software was adopted to analyze the data. Results In the review of 18 studies with a sample size of 5,840, the overall pooled prevalence of sleep disorders among AS patients based on the random effects method was found to be 53% (95% CI: 44.9-61). The highest and lowest prevalence was in Egypt at 90% and Australia at 19.2%, respectively. Our meta-regression results show that with the increase in 'sample size' and 'year of publication', the overall prevalence of sleep disorders in patients with AS decreases (p < 0.05). Conclusion The results of the present study indicate a high and significant prevalence of sleep disorders among AS patients. Thus, health policymakers and healthcare providers must focus on timely diagnosis and effective educational and therapeutic interventions for the prevention and proper treatment of sleep disorders in this population of patients.

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SUMMARY OBJECTIVE: Obesity is one of the etiological factors of sleep disorders (e.g., obstructive sleep apnea and restless leg syndrome). The aim of this study was to determine the effect of obesity on sleep quality by using the Pittsburgh Quality İndex and Berlin Question are and evaluate the association of sleep with anthropometric and metabolic parameters. METHODS: A total of 76 patients (41 females and 35 males) between the ages of 18 and 70 years with a body mass index >30 kg/m2 were included in this study. Homeostatic model assessment-insulin resistance, hemoglobin A1c, alanine aminotransferase, aspartate transaminase, total cholesterol, low-density lipoprotein, triglyceride, high-density lipoprotein, and thyroid-stimulating hormone levels were analyzed. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index, Berlin Questionnaire, and the Restless Leg Syndrome Questionnaire. RESULTS: A significant correlation was observed between Pittsburgh sleep quality index and body mass index, neck circumference, body fat index, muscle mass, hip and waist circumference, hemoglobin A1c, and homeostatic model assessment-insulin resistance (ps<0.005). The Pittsburgh sleep quality index median (2.5-97.5 percentile) value was 8 (2-18.6) in the patient group and 3.5 (0.1-7.9) in the control group (p<0.0001). Body mass index was found to be the predictor on Pittsburgh sleep quality index (R2=0.162, F=3.726, analysis of variance p=0.008). Notably, 88% (67) and 95% (57) of the poor sleepers were found to be at high risk for obstructive sleep apnea according to Berlin Questionnaire and Pittsburgh Sleep Quality Index, respectively. Also, the frequency of restless leg syndrome was 45% in obese individuals. CONCLUSIONS: We observed a significant correlation between Pittsburgh sleep quality index and the anthropometric and metabolic parameters. Also, the frequency of obstructive sleep apnea and restless leg syndrome was 88% and 45%, respectively, in obese individuals.

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Families' health, safety, and economic stability were jeopardized during the pandemic. Parental stress is a risk factor for hostile and less supportive parenting. Parenting styles are a set of attitudes, feelings and behaviors related to parenting that modulate the child's psychosocial functioning and might impact on the adaptability to a stressful time. OBJECTIVE: To investigate the group differences among children raised by negative and positive parenting families during COVID-19 pandemic. METHODS: We have done an online survey with 329 parents. Parents answer about parenting strategies and styles, children's behavior, Covid related questions, socio-economic information, sleep and gaming disorders. RESULTS: Parents' frequent use of negative strategies were a risk factor to have a negative outcome related to mental health, games, sleep, and children behavior. DISCUSSION: Parenting strategies are some targets pointed in this study for intervention. Parents' styles and strategies training to better manage children might be even more important to avoid negative consequences for children in stressful times.

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Cutaneous homeostasis can be modulated by sleep. Although there is little evidence about the efficacy of medications topically applied in the morning compared to those administered in the evening, they are commonly prescribed to be used overnight. Poor sleep may affect the tegument, but its repercussion on dermatological therapy is not clear. This communication aims to carry out an overview on the relationship between sleep and the skin, particularly in respect of the effectiveness of topical substances during the night versus the day; and the possible impact of sleep dysregulation on these treatments. Features related to this external organ, involving hydration, blood flow, and the permeability of the superficial barrier have physiological variations in sleep period. Our hypothesis is that sleep loss could alter drug absorption in the dermis and impair the success of the treatment. This can depend on the integrity of the mechanical skin barrier, and the enzymatic process after drug penetration, which may be influenced by the circadian rhythm. We raise the role of sleep disturbance in relation to skin aging and the cutaneous microbiota. The organ integrity and local immunology can be guided by sleep distress, which can modify the control of dermatological diseases. Future comparative analyses are warranted to explore the possible changes of the integumentary system influenced by circadian rhythm, and interference in response to topical dermal treatments. We emphasize the importance of sufficient sleep to improve the clinical management of several dermatosis and cosmetic complaints that need percutaneous therapeutics.

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OBJECTIVES: This study aims to assess the health effects on mining workers of exposure to chronic intermittent hypoxia (CIH) at high- and very high-altitude mining compared with similar work at lower altitudes in Chile, and it also aims to constitute the baseline of a 5-year follow-up study. METHODS: We designed a cross-sectional study to assess health conditions in 483 miners working at 2 levels of altitude exposure: 336 working at a very high or high altitude (HA; 247 above 3900-4400 m, and 89 at 3000-3900 m), and 147 below 2400 m. Subjects were randomly selected in two stages. First, a selection of mines from a census of mines in each altitude stratum was made. Secondly, workers with less than 2 years of employment at each of the selected mines were recruited. The main outcomes measured at the baseline were mountain sickness, sleep alterations, hypertension, body mass index, and neurocognitive functions. RESULTS: Prevalence of acute mountain sickness (AMS) was 28.4% in the very high-altitude stratum (P = 0.0001 compared with the low stratum), and 71.7% experienced sleep disturbance (P = 0.02). The adjusted odds ratio for AMS was 9.2 (95% confidence interval: 5.2-16.3) when compared with the very high- and low-altitude groups. Motor processing speed and spatial working memory score were lower for the high-altitude group. Hypertension was lower in the highest-altitude subjects, which may be attributed to preoccupational screening even though this was not statistically significant. CONCLUSIONS: Despite longer periods of acclimatization to CIH, subjects continue to present AMS and sleep disturbance. Compromise of executive functions was detected, including working memory at HA. Further rigorous research is warranted to understand long-term health impacts of high-altitude mining, and to provide evidence-based policy recommendations.

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OBJECTIVE: To examine the association between sleep disturbances and cardiovascular health in Brazilian adults. METHODS: We analyzed cross-sectional data from a nationally representative sample of 36,480 Brazilian adults ages 18 and over. Multivariate Poisson regression models were used to assess the association between sleep disturbances (difficulty falling asleep, frequent interruptions in sleep, or sleeping more than usual) and Life's Simple 7 (LS7) cardiovascular health (CVH) scores through consideration of four behaviors (smoking, physical activity, body mass index, and diet) and three biological factors (hypercholesterolemia, hypertension, and diabetes). RESULTS: Adults with no sleep disturbances had better CVH, with higher mean LS7 CVH scores (4.2, 95% confidence interval [CI]: 4.1; 4.2) when compared to those experiencing some level of sleep disturbance within a 2-week timespan (3.8, 95% CI: 3.7; 3.8). Specifically, compared to those with no sleep disturbance, adults reporting sleep disturbances for half of the weekdays had significantly lower LS7 CVH mean scores (ß = -0.02, 95% CI: -0.04; 0.01). Adults who had disturbances more than half of the weekdays had even lower scores (ß = -0.06, 95% CI: -0.09; -0.02), followed by those who reported disturbances almost every day (ß = -0.08, 95% CI: -0.11; -0.04), even after adjusting for age, sex, education status, depressive symptoms, and night shift work. CONCLUSION: Brazilian adults with sleep disturbances are less likely to achieve ideal CVH. Given that sleep disturbances seem to be increasingly common in Brazil, recent gains in CVH mortality may be affected.

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Abstract Objective The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance. Methods The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups. Results The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively. Conclusions The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance. Trial registration The present study was registered by the name "Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders" with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).

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STUDY OBJECTIVES: The aim was to identify predictive factors for sleep bruxism (SB) severity among polysomnographic parameters, salivary cortisol levels, temporomandibular disorders, age, and sex. METHODS: Young adults (19-30 years) were screened for self-/roommate reports of teeth grinding/clenching during sleep associated with clinical signs of tooth wear. Individuals positive for both conditions were administered a polysomnographic exam to provide a definite diagnosis of SB (n = 28). Healthy participants without SB signs/symptoms were also included (n = 15). The Research Diagnostic Criteria for Temporomandibular Disorders was applied to determine functional, muscular, and articular domains of the Temporomandibular Index. Cortisol awakening levels were measured in saliva. Principal component analysis was used to extract the latent components emerging from polysomnographic results, and 2 regression models were adjusted to predict the number and duration of bruxism episodes. RESULTS: Principal component analysis resulted in 4 components-C1: %N1, total sleep time, sleep efficiency, arousals/microarousals; C2: %N2, %N3; C3: periodic limb movements and apneas; C4: %REM and REM latency. The number of SB episodes/h was predicted by increasing muscular scores and C2 (decrease in %N2 and increase in %N3) (adjusted R² = 45%; P =.001). The total time of SB episodes was predicted by decreased articular and increased functional scores, age, and female sex (adjusted R² = 36%; P = 0.010). Salivary cortisol levels were not associated with SB severity and did not differ between groups. CONCLUSIONS: The findings showed that SB severity was predicted by muscular and functional scores, female sex, and distinct polysomnographic patterns, contributing to the deeper knowledge of the underlying pathophysiology of SB severity; additionally, the findings can help to formulate health approaches that are specific to the patient and will better assist in treating this condition.

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