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Tag: Sleep Disorder

  • Sleep strategies may boost ultramarathon performance, study finds

    Sleep strategies may boost ultramarathon performance, study finds

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    A study published in the journal Sports Medicine – Open provides valuable information about the importance of adequate sleep and sleep management strategies in ultramarathon runners.

    Study: Sleep and Ultramarathon: Exploring Patterns, Strategies, and Repercussions of 1,154 Mountain Ultramarathons Finishers. Image Credit: EshanaPhoto / ShutterstockStudy: Sleep and Ultramarathon: Exploring Patterns, Strategies, and Repercussions of 1,154 Mountain Ultramarathons Finishers. Image Credit: EshanaPhoto / Shutterstock

    Background

    An adequate quantity of sleep is a prerequisite for optimal physical performance. Sleep deprivation of 24 – 30 hours can reduce reaction time and cognitive performance. An improvement in cognitive and motor performance has been observed in individuals following sleep management strategies.

    Besides performance, sleep deprivation can negatively affect recovery after a high-intensity training session. Athletes involved in high-intensity sports, such as offshore sailing and ultramarathon, frequently experience sleep deprivation due to irregular training timing, travel, and extended event duration.

    In this study, scientists have investigated sleep patterns and management strategies in ultramarathon runners and assessed the repercussions of sleep deprivation during and after the ultramarathon.

    Study design

    The study was conducted on 1,154 runners from two ultramarathons: a 165-kilometer race with 9,576 meters of positive elevation and a 111-kilometer race with 6,433 meters of elevation.

    The participants were asked to complete a survey questionnaire, which collected information on demographic characteristics, training characteristics, usual sleep profile, circadian typology, and sleep management strategies. The questionnaire was sent to the participants post-race to retrospectively collect the information from the pre-race, during-race, and after-race periods.

    The participants were categorized into three groups based on the number of nights they spent during the race: one night, two nights, and three nights. The scientists defined “spending a night in the race” as runners remaining in the race for at least four hours between 6:00 PM and 6:00 AM.

    Important observations

    About 86% of the study participants were men, and the mean age of the participants was 43 years. The age and gender of the participants were representative of overall race starters. The average finish time was 50 hours for the 165-kilometer race and 34 hours for the 111-kilometer race.

    The average daily sleep duration of the participants was 7.5 hours. However, they desired an average sleep duration of 8 hours daily. About 19% of the participants reported having a history of sleep disorder-related symptoms, including insomnia, sleep apnea, and sleep disorder-related depressive syndrome. About 5% reported taking sleeping pills.

    About 58% of the participants reported implementing at least one sleep management strategy in preparation for the race. About 18% of the participants reported deliberately experiencing sleep deprivation during their practice sessions for the race.

    About 61% of the participants reported modifying their normal sleep patterns one week before the race. Among them, about 55% reported increasing their daily sleep duration, 5% reported modifying their sleep schedule, and 1% reported reducing their daily sleep duration. Moreover, about 46% of the participants reported experiencing one night of partial sleep deprivation during the week before the race.

    Most of the participants reported an average total sleep debt of 50 minutes before the race. About 29% of the participants reported having sleep disorder-related symptoms one night before the race. About 13% of the participants reported using sleeping pills or other alternative therapies to get sleep the night before the race.

    Sleep during race

    About 84% and 53% of the 165-kilometer and 111-kilometer ultramarathon participants reported taking at least one nap during the race, respectively. During the 165-kilometer race, the cumulative sleep duration for each participant was 76 minutes. During the 111-kilometer race, the cumulative sleep duration for each participant was 27 minutes.      

    A significant correlation was observed between the cumulative sleep duration and finish time in both races. Most participants (82%) reported taking short naps lasting less than 30 minutes during the race. Regarding nap timing, about 80% of participants reported taking naps during the night, whereas only 15% reported taking daytime naps.

    Repercussions of sleep deprivation

    About 80% of the participants reported experiencing at least one symptom related to sleep deprivation. A variation in symptom prevalence was observed depending on the number of nights spent on the race. The most reported symptoms were reduced alertness and hallucination.

    A lower prevalence of sleep deprivation-related falls was observed among participants with increased average daily sleep duration before the race.

    Post-race recovery

    The participants reported regaining a normal state of wakefulness without drowsiness within two days after the race. About 22% of the participants believed that sleep deprivation during the race increased the risk of accidents in everyday life.      

    Study significance

    The study highlights the importance of sleep management in improving performance and alleviating the adverse health effects of sleep deprivation in ultramarathon runners.

    The study finds that increasing daily sleep duration before a race effectively reduces the risk of sleep deprivation-related falls during the race.

    The study identifies “short naps” as the most popular sleep management strategy during the race.

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  • Study links sleep disorders to higher healthcare use in chronically ill children

    Study links sleep disorders to higher healthcare use in chronically ill children

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    The risk of increased health care utilization among children with a chronic medical condition is higher for those who also have a sleep disorder, according to a new study that examined Medicaid claims data.

    The study found that among children who had a chronic medical condition, those who also had a diagnosed sleep disorder were nearly two times more likely to have increased health care utilization (odds ratio = 1.83) than those who had no sleep disorder. The most common sleep disorder diagnosis was sleep-disordered breathing, which was present in 1,796 children. Those who had sleep-disordered breathing were 1.5 times more likely to have increased health care utilization (OR=1.51). The researchers adjusted the analyses for potential confounders including age, race, and chronic medical conditions.

    The results were impressive, suggesting a clear role of sleep disorders in health care utilization in children with chronic medical conditions.”


    Dr. Pranshu Adavadkar, principal investigator and lead author, associate professor in the department of pediatrics at the University of Illinois Chicago and director of pediatric sleep medicine at the UI Health Sleep Sciences Center

    The study results appear in the April 1 issue of the Journal of Clinical Sleep Medicine, the official publication of the American Academy of Sleep Medicine.

    The researchers extracted Illinois Medicaid claims data for 16,325 children up to 18 years of age. The study population was predominantly urban, with most participants representing ethnic minority groups with low socioeconomic status. Each child had at least one chronic medical condition such as asthma, obesity, diabetes, or attention-deficit/hyperactivity disorder, and 77% of the children had multiple chronic medical conditions. Participants were divided into three levels of health care utilization based on their hospitalizations and emergency department visits in the 12 months prior to study enrollment: low (no hospitalization or ED visit), medium (one to two hospitalizations or one to three ED visits), and high (three or more hospitalizations or four or more ED visits).

    Chronic medical conditions and sleep disorders were identified using codes from the International Classification of Diseases, 9th Revision and ICD-10. Sleep-disordered breathing -; which included diagnoses of apnea only, snoring only, and apnea and snoring combined -; was found in 14.2% of children with medium health care utilization and 20.6% of those with high utilization.

    Adavadkar noted that children with chronic medical conditions tend to have disproportionately higher health care utilization and costs, and families with lower socioeconomic status -; including those covered by the Medicaid insurance program -; tend to bear the brunt of these costs. Therefore, one strategy to reduce these costs is to treat comorbid sleep disorders.

    “Understanding the specific sleep disorders that significantly increase health care utilization risk can inform targeted interventions and screenings for better management of these high-risk children,” said Adavadkar.

    The authors noted that sleep disorders tend to be underdiagnosed in pediatric populations, so the association between sleep disorders and health care utilization may be even stronger than the results of this study demonstrate.

    Source:

    American Academy of Sleep Medicine

    Journal reference:

    Adavadkar, P. A., et al. (2024). Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. Journal of Clinical Sleep Medicine. doi.org/10.5664/jcsm.10936.

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  • Skin biopsy for α-synuclein detection proves effective

    Skin biopsy for α-synuclein detection proves effective

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    In a recent study published in JAMA, researchers evaluated the positivity rate of cutaneous phosphorylated alpha-synuclein protein (P-SYN) deposition among individuals with dementia with Lewy body presence (DLB), Parkinson’s disease (PD), pure autonomic failure (PAF), and multiple system atrophy (MSA).

    Study: Skin Biopsy Detection of Phosphorylated α-Synuclein in Patients With Synucleinopathies. Image Credit: BLACKDAY/Shutterstock.comStudy: Skin Biopsy Detection of Phosphorylated α-Synuclein in Patients With Synucleinopathies. Image Credit: BLACKDAY/Shutterstock.com

    Background

    Synucleinopathies are neurodegenerative illnesses that cause P-SYN accumulation in the peripheral and central nervous systems. They include PD, MSA, DLB, and PAF. These illnesses share clinical characteristics, including progressive impairment and neurodegeneration.

    Current pharmacology lacks disease-modifying medication for these illnesses, and many individuals diagnosed with synucleinopathies face diagnostic delays or misdiagnoses.

    A reliable biomarker for identifying synucleinopathies, such as immunohistochemistry of cutaneous phosphorylated α-synuclein, is urgently needed. This test might be sensitive and specific.

    About the study

    In the present prospective, multicenter, cross-sectional study, researchers investigated whether skin biopsy could detect P-SYN in PD, MSA, DLB, and PAF patients.

    The researchers enrolled clinically confirmed cases of DLB, PD, PAF, or MSA recruited from 19 community-based and 11 academic neurology practices between February 2021 and March 2023, aged between 40 and 99 years.

    Individuals without history or clinical features indicative of a synucleinopathy (such as constipation, hyposmia, dementia, rapid-eye movement [REM] sleep disorder, or mild cognitive impairments) or neurodegenerative disorders comprised the control group.

    The researchers excluded individuals with biopsy-associated risks and synucleinopathy-mimicking diseases. They also excluded those with missing data from questionnaires and clinical examinations. The study exposure was a cutaneous biopsy for P-SYN detection.

    The primary outcome was cutaneous P-SYN detection frequency among individuals with MSA, PD, PAF, or DLB and controls.

    The researchers obtained skin biopsy specimens from the posterior cervical area, 3.0 cm from the spinous process of C-7, and the distal aspects of the leg at a distance of 10 cm from the lateral malleolus, and the thigh 10 cm from the lateral knee.

    The team examined the participants using the Hoehn and Yahr scale, the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS), the Montreal Cognitive Assessment, and orthostatic blood pressure.

    The participants filled out questionnaires such as the 39-component Parkinson’s Disease Questionnaire, the European Quality of Life questionnaires (EQ-VAS and EQ-5D), the MSA Quality of Life assessment Questionnaire, the rapid eye movement (REM) sleep disorder questionnaire, and the Orthostatic Hypotension Questionnaire.

    The researchers obtained disease symptom and duration data from participant medical records. The referral physician, who evaluated the individual, provided a clinical diagnosis.

    The participant history, examination scores, medical records, and ancillary test results were transmitted to two disease specialists for central review to validate the diagnosis of the particular synucleinopathy based on specified consensus and eligibility criteria for diagnoses or controls.

    Results

    Out of 428 patients (277 with synucleinopathy and 151 controls), 343 were included in the primary analysis [mean age, 70 years; 175 (51%) men]; 223 fulfilled the consensus criteria for synucleinopathy, and 120 met the criterion as controls following expert panel evaluation.

    Among those with synucleinopathy, 96 (28%) were diagnosed with Parkinson’s disease, 50 (15%) with Lewy body dementia, 55 (16%) with multiple system atrophy, and 22 (6.4%) with complete autonomic failure.

    The proportion of participants with P-SYN in their skin was 93% (n = 89) with Parkinson’s disease, 98% (n=54) with multiple system atrophy, 96% (n=48) with Lewy body dementia, and 100% (n=22) with complete autonomic failure; 3.30% (n=4) of controls had cutaneous phosphorylated-SYN deposition.

    P-SYN detection in the subepidermal plexus varied by synucleinopathy subtype, with MSA (49%, n=27) having a higher prevalence than Parkinson’s disease (3.1%, n=3), DLB (10%, n=5), or PAF (9.1%, n=2). There were no infections or significant problems.

    The length-dependent small fiber neuropathy varies amongst synucleinopathy subtypes. Neuropathy was most prevalent in DLB patients (78%, n=39), followed by those with Parkinson’s disease (63%, n = 60), PAF (46%, n=10), and MSA (22%, n=12).

    The overall P-SYN for all research participants corresponded with their exam results and surveys. P-SYN deposition by the study participants was associated with the period since MSA, PAF, and PD diagnosis.

    Conclusions

    The study findings showed that skin biopsy may identify phosphorylated alpha-synuclein among individuals with DLB, PD, PAF, and MSA. The findings demonstrated that cutaneous P-SYN in >92% of participants, with skin biopsies, was tolerated well with minor side effects.

    However, there were 21% of misdiagnosed cases. Accurate diagnosis is critical for patient and family counseling, starting symptomatic treatment, and conducting clinical studies of possible disease-modifying medications.

    Cognitive neurology experts recommend skin biopsy as a novel method for movement problems. The findings might speed up medication development for synucleinopathies by enhancing patient homogeneity in clinical trials.

    More studies are needed to confirm the findings and better understand the potential relevance of skin biopsy detection in clinical treatment.

    Journal reference:

    • Christopher H. Gibbons, MD, MMSc, et al., (2024) Skin Biopsy Detection of Phosphorylated α-Synuclein in Patients With Synucleinopathies, JAMA 2024, doi: 10.1001/jama.2024.0792.

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