Sleep disorders are commonly reported among patients diagnosed with multiple sclerosis (MS), particularly in the period following the disclosure of the diagnosis. The combination of psychological stress and the chronic nature of the disease contributes to significant sleep disturbances. Understanding the prevalence, causes, and implications of these disorders is crucial for improving patient care.

The aim of this study is to evaluate the prevalence and characteristics of sleep disorders in MS patients following the announcement of the diagnosis and to explore the contributing factors, including psychological and physical symptoms.

A descriptive and analytical cross-sectional study was conducted from March 1, 2023, to January 30, 2024, involving patients diagnosed with multiple sclerosis (MS)who were observed in the neurology department at Habib Bourguiba University Hospital in Sfax. We evaluated sleep disorders using the insomnia severity index scale which included 7 items to investigate sleep disturbance.

A total of 100 patients, with a mean age of 38 years ± 10 years, were included, with a strong majority of women (73%). No psychiatric history was noted. The median disease duration was 7.38 years (3-10.75). Among our patients, 64(64%) had attained a university level of education. In addition, 40(40%) were married, and 60 (60%) were single, divorced, or widowed.

The median Insomnia Severity Index was 5 (1-10.75). More than half of our patients (62%) did not suffer from insomnia. However, 9% had a mild subclinical form of insomnia, 10% had moderate clinical insomnia, and 19% suffered from severe clinical insomnia.

Primary education level was correlated significantly with mild sleep disorders n=33.3 (33.3%), (p=0.044). On the other hand, those with a higher education level showed a lower prevalence of mild sleep disorders n=22.2(22.2%) (p=0.01). However, a lower prevalence of severe sleep disorders was noted among married individuals (10.5% p=0.004), while a higher frequency was observed in divorced individuals (15.8%, p=0.). Only refusal of the diagnosis upon its initial announcement was significantly associated with severe sleep disorders (63.2%, p=0.012).

Addressing sleep disorders in MS patients requires a holistic approach that incorporates both psychological and symptom management strategies. Early interventions targeting anxiety, depression, and physical discomfort are essential for improving sleep quality and overall well-being in this patient population. Further research is needed to develop tailored therapeutic approaches that address the unique challenges faced by MS patient’s post-diagnosis.

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Individuals with an evening chronotype (i.e., a behavioral phenotype related to a preference for eveningness) commonly display metabolic alterations that predispose to cardiovascular disease and worse cardiometabolic health. While lifestyle habits may partly explain the adverse cardiometabolic findings, underlying independent biological mechanisms may also confer higher risk. However, metabolomics signatures associated with chronotype remain to be determined.

This study aimed to use nuclear magnetic resonance (NMR) metabolomics and phenotype data from the UK Biobank to characterize the metabolomics signatures of different chronotypes.

The population included approximately 245,000 participants with plasma metabolomics and questionnaire data on chronotype, both collected at the first assessment (2006-2010). The levels of 237 metabolites were compared in individuals with morning vs. more morning than evening vs. more evening than morning vs. evening chronotype via univariable and multivariable linear regression models adjusted by fasting time, age, sex, body mass index, economic status, physical activity and smoking status. The False Discovery Rate was applied to account for multiple testing. This research has been conducted using the UK Biobank Resource under application number 99811.

In unadjusted models, compared to morning types, individuals with more evening (163/237 metabolites, median estimate 0.01 SD) and definitely evening (203/237, -0.01 SD) chronotypes had significantly different profiles, suggestive of higher cardiometabolic risk (higher levels of the inflammation marker glycoprotein acetyls, of triglycerides and lipids in Very-Low-Density-Lipoproteins (VLDL), but lower levels of fatty acid unsaturation and of lipids in High-Density-Lipoproteins (HDL)). On the contrary, more morning than evening types had opposite profiles. After adjustments, the risky profiles of evening and intermediate-evening types attenuated partly, especially with respect to fatty acids. However, irrespective of adjustments, evening types had metabolic profiles characterized by less HDL and more VLDL lipoproteins than morning types, while HDL levels appeared less affected in intermediate-evening types. In adjusted models, intermediate-morning types had similar profiles as morning types.

Total or partial preference to eveningness was associated with a metabolic profile suggestive of higher cardiovascular risk. While these associations were partly explained by sociodemographic and lifestyle characteristics, several markers suggestive of higher cardiometabolic risks appeared intrinsic to the chronotype, and more evident in the evening types. Lifestyle habits may induce an even more favorable metabolic profile in intermediate-morning compared to pure morning types.

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The basis of this study is established on the unreliability of conventional heart rate variability metrics. The complex physiology of stress and the relaxed state cannot be drawn sufficiently, because the conventional heart rate variability metrics, presented by the established professional medical literatures, are dependent on the changes in the heart rate and thus cannot provide reliable data.

We introduced a novel, heart rate independent variability parameter, which is the normalized variability, and we contrasted it with the consensus-based parameters (RMSSD: root mean square of successive differences between normal heartbeats; SDNN: standard deviation of normal-to-normal interbeat intervals).

We tested the normalized variability parameter in two studies. During the first study, the work-related stress among professionals in the frontlines of healthcare was reduced during the work-shift via either heart rate variability-biofeedback training or through achieving a relaxed state by allowing the subjects of the test during breaks to relax in their own usual manner. Consequently, the sample of Study 1 was categorized into the heart rate variability biofeedback group (N = 21) and the habitual recreation group (N = 21). Comparatively, Study 2 was concluded on healthy students, where the subject sample consisted of N = 9 participants. In this case, stress response was triggered by one of two laboratory stress induction methods. This meant the application of either the Socially Evaluated Cold Pressor Test (SECPT) or, a novel stress induction procedure, the Socially Evaluated Stroop Test (SEST). Furthermore, we used the Kolmogorov-Smirnov test to compare the distribution of heart rate variability parameters, mean heart rate, logRMSSD, logSDNN, and normalized variability before, during, and after the stress-inducing and the stress-alleviating interventions.

According to our results, on the one hand, logRMSSD and logSDNN did not change significantly throughout the stress alleviation and stress inducing states; on the other hand, the distribution of normalized variability significantly changed during and after both stress decreasing methods (p ≤ 0.01) and between the period that preceded recreation and during the process of habitual recreation itself (p = 0.03). Normalized variability during and after the SECPT (p = 0.05) significantly changed as well; however, the heart rate did not change significantly under and during the test.

Normalized variability, a heart rate variability parameter that is independent of the heart rate of the patient, can be considered a sensitive stress indicator and suitable for investigating the complexity of the functions of the vegetative nervous system without the confounding effect of the heart rate.

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Chronic insomnia is prevalent in secondary care mental health populations and is associated with emotional distress, interpersonal impairment and reduced quality of life. In addition, it contributes to the aetiology of major mental health conditions and substance use. CBT for insomnia (CBTi) is a well-established evidence-based treatment approach for chronic insomnia and is recommended as the first-line treatment for adults in the UK by National Institute for Health and Care Excellence (NICE). Despite this, CBTi is not accessible for most secondary care mental health patients and therefore few benefit from this intervention.

To examine the feasibility and effectiveness of a 6-week group CBTi programme for people using secondary care mental health and addictions services with chronic insomnia, using a case series design.

Each participant underwent an initial screening assessment to evaluate their suitability for the programme, the nature and impact of their sleep problem, and exclude other causes of insomnia. Self-reported measures of insomnia, personality functioning and depression were examined pre- and post-intervention using the Pittsburgh Sleep Quality Index (PSQI), Level of Personality Functioning Scale (LPFS) and Patient Health Questionnaire-9 (PHQ-9) respectively. PSQI was also re-assessed at 3-months’ follow-up.

Of 42 people referred to the service (26 from mental health and 16 from addictions services), 25 attended baseline assessment, 19 started the group and 12 completed sessions. The most common primary diagnoses were Alcohol Use Disorder (n=8), Treatment Resistant Depression (n=5), Bipolar Affective Disorder (n=3) and Personality Disorder (n=3). There were 9 men and 16 women. The severity of sleep disturbance was high with a cohort average PSQI of 15.4 (s.d. 2.7, range 12-20). Additionally, the level of personality functioning was high (mean 31.0, s.d. 7.6 range 13-45) as well as depressive symptoms (PHQ-9 cohort mean 18.0, s.d. 5.5, range 7-26).

Among the completers, cohort mean PSQI score decreased from 14.1 to 12.0 (p=0.12). Of 10 patients with 3-month follow-up data, there was a relative reduction of 20.3% from baseline, to a cohort mean PSQI score of 11.5 (p=0.16). At 3-months other facets of sleep quality like total sleep time had improved in the cohort by 45 minutes, and onset latency reduced by 35 minutes. Post-group there were also reductions in cohort mean LPFS scores by a relative 10.3% (31.4 at baseline to 28.3 post-group, and in cohort mean PHQ-9 by 14.8% (16.4 to 13.8).

Group CBTi is a potentially scalable and feasible intervention that effectively treats chronic insomnia, depression and personality dysfunction in secondary care mental health and addictions populations. Further research should focus on replicating these findings in larger cohorts, and examine factors associated with uptake and completion of CBTi.

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Sleep is essential for one’s physical, emotional, and social well-being. Healthy sleep is particularly important for adolescents, individuals who undergo drastic developmental changes, making them susceptible to psychiatric disorders. Education and sleep health promotion to the public are urgently needed to improve population sleep health (Lim et al. Lancet Public Health 2023; 8 e820-e826). One novel way to improve sleep health communication is to engage adolescents with lived experiences of sleep disturbances in the development of sleep health innovations.

The designathon is a participatory innovation context that brings individuals to co-create communication packages to address a specific challenge within a short period. We aimed to present the process of crowdsourcing designathon to create sleep health communication packages for adolescents and the products produced in the event.

The designathon was a two-day event held at a university building in Hong Kong. Adolescents were recruited from a summer programme about sleep and psychology and sorted into groups with a balance of educational backgrounds. A judging panel that included experts in sleep and mental health and a youth representative evaluated the communication packages. The products were scored based on content, accuracy, visuals, innovation, and delivery.

A total of 13 participants participated in the designathon. About 61.5% (n=8) of participants reported poor sleep quality. All three groups successfully created a sleep health communication package consisting of a poster, a leaflet, and a slideshow during the 2-day designathon event. One finalist was selected. The finalist package was a comprehensive package comprising psychoeducation and action elements to promote napping in school to address insufficient sleep and psychological health, and was described as structured, interesting, and informative although some information may be too technical to layperson based on judges’ comments.

Designathon is a novel and successful strategy to engage the community to co-create sleep health communication package for adolescents. It is promising to utilise crowdsourcing designathon to increase access to sleep educational information and improve knowledge in the public. Future studies are needed to evaluate the feasibility, impact, and implementation of the products.

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Healthcare-workers in medical imaging departments face a variety of professional challenges, including radiological risk, biomechanical constraints, and heavy workload. These cumulative constraints make the staff of these departments particularly vulnerable to stress.

The aim of this study was to evaluate perceived stress among radiology technicians and evaluate its associated factors.

A cross-sectional study was conducted among the staff of a medical imaging department in Sfax in April 2024 during periodic visits. The Perceived-Stress-Scale-10 (PSS-10) questionnaire was used to assess perceived stress. Radiation safety training level (TL), Radiation risk level (RL) and radiation protection level (PL) were auto-evaluated on a scale of 0 to 10.

Our population consisted of 32 paramedical staff, 80% of whom were radiology technicians. The median age was 37 with an interquartile range (IQR) [36; 43]. The sex ratio was 0.28. The median seniority in the job was 5.5 years IQR [4; 8]. The median TL, RL and PL were 3 IQR [2; 5], 6 IQR [5; 7] and 5 IQR [3; 6] respectively. The mean PSS-10 score was 19.3±4.9. In bivariate analysis, the PSS-10 score was inversely correlated with TL (r=-0.622; p=0.001), RL (r=-0.248; p=0.213) and correlated with PL (r=0.458; p=0.016).

Periodic visits in occupational medicine are an opportunity to detect perceived stress in this population and to strengthen their knowledge about radiation protection in order to ensure a healthier and safer working environment.

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Night-shift work significantly impacts sleep quality among nurses, leading to various adverse health outcomes.

This study aimed to assess the link between night-shift work and sleep quality among nurses.

The study was conducted with a sample of nurses in university hospitals of Sfax. Two groups of staff were defined based on their work schedule: the first group(G1) consisted of those working day shifts, either a regular morning schedule or alternating between morning and afternoon shifts, while the second group (G2) included those working night shifts, either fixed night shifts or alternating between morning, afternoon, and night shifts. Data collection was carried out using an anonymous self-questionnaire developed via an online interface hosted on Google Forms. Sleep disorders were screened using the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI).

The study population consisted of 114 nurses, with 37 nurses in G1 and 77 in G2. The average age of the workers was 33.8 years ± 7 years with extremes of 23 and 55 years. The average duration of night work was 5.9 years ± 4.64 years, ranging from a minimum of 1 year to a maximum of 25 years. The overall PSQI scale score was on average 6.86 ± 3.2. Based on this scale, 62% were classified as poor sleepers. In bivariate analysis, night-shift work was associated with a bad sleeper profile (p= 0.027, OR=2.44, IC95% [1.09-5;46]). However, day-shift work protected from the bad sleeper profile (p=0.04, OR=0.4, IC95% [0.18-0.91]).

The study highlights the negative association between night-shift work and sleep quality among nurses. it is essential for healthcare organizations to implement strategies that address the unique challenges faced by night-shift nurses, such as promoting better sleep hygiene and providing support resources.

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Sleep quality is a critical component of overall well-being, yet it is influenced by a variety of factors, including sociodemographic characteristics, lifestyle habits, and psychological conditions. Despite its importance, research on sleep quality among Bosnian young adults is scarce, making this study particularly valuable in filling that gap.

This study aimed to investigate the relationship between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and a range of sociodemographic, lifestyle, and psychological factors in a sample of Bosnian young adults.

A total of 283 Bosnian young adults were enrolled in the study through convenience sampling. The study assessed sociodemographic factors (age, gender, education level, religion, employment, residential area, marital status, income level), lifestyle factors (use of electronic devices before bedtime, daytime napping habits, exercise level, smoking, alcohol consumption, drug abuse, caffeine intake, diet, exposure to natural light, consistent sleep schedule), and psychological factors (mindfulness measured by the Five Facet Mindfulness Questionnaire (FFMQ), and stress, depression, and anxiety measured by the Depression Anxiety Stress Scales (DASS-21)). Descriptive statistics, correlation analysis, and multiple linear regression were used to analyze the data.

The findings indicate that sleep quality is significantly predicted by several factors. Negative predictors of sleep quality included the Observe facet of mindfulness and maintaining a balanced diet. Conversely, positive predictors that were associated with poorer sleep quality included higher levels of stress, smoking, and the use of electronic devices before bedtime.

The study highlights the complex interplay between sociodemographic, lifestyle, and psychological factors in determining sleep quality among Bosnian young adults. These findings underscore the need for targeted interventions that address these specific factors to improve sleep quality in this population.

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Medical studies place significant academic pressure and high stress levels on students resulting in changes in their sleep patterns.and their academic performance, which are two keys of professional success. A hypothesis regarding a potential link between these two entitities could be proposed.

The objective of our study was to assess sleep quality and academic performance in a sample of students from the Faculty of Medicine of Sfax, Tunisia, as well as the link between these two entities.

It was a cross-sectional, descriptive and analytical study, conducted using GOOGLE FORMS during February and March 2024, involving a sample of students from the Faculty of Medicine in Sfax, Tunisia. We used a questionnaire including an information sheet and two psychometric tests : the Pittsburgh Sleep Quality Index (PSQI) aiming to assess sleep quality over the past month and the Study Management and Academic Results Test (SMART) allowing the assessment of students’ attitudes towards their studies and academic performance based on four dimensions : “Academic Competence”, “Test Competence”, “Time Management” and “Strategic Studying”.

Our study involved 154 participants with a sex ratio (M/F) of 0.54 and a median age of 22 years (IQR = [20 – 23 years]).

The median PSQI score was 6 (IQR = [3 – 9]). Using a threshold value of 5, we found that 86 students had poor sleep, resulting in a prevalence of 55.8%.

Median scores of the four dimensions were 3.4 (IQR = [3 – 3.8]) for the “Academic Competence”, 2.8 (IQR = [2.2 – 3.2]) for the “Test Competence”, 2.4 (IQR = [2 – 3]) for the “Time Management” and 3.2 (IQR = [2 .8 – 3.6]) for the “Strategic Studying”.

By conducting a bivariate analysis, we found that “Academic Competence” and “Time Management” dimensions were significantly better among students with good sleep quality. In contrast, the dimensions “Test Competence” and “Strategic Studying” were not statistically associated with sleep quality (Table 1).

Table 1: Associations between the sleep quality and the Study Management and Academic Results Test dimensions

Our study revealed that more than half of the medical students suffer from poor sleep quality. The analysis of academic performance revealed that the most affected dimensions were the test competence and the time managemement. The lack of sleep among these students had detrimental consequences on their academic performance. Therefore, it is important to encourage good sleep hygiene to enhance both well-being and academic performance in medical students. Additionally, providing balanced study resources, offering therapy and counseling services, and promoting stress management strategies are key to optimizing academic success.

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Sleep health is s an essential aspect of a healthy lifestyle, and sleep problems are prevalent among individuals with mental disorders. However, this relationship appears complex to explore with classic observational studies, due to bidirectional effects and residual confounding. Additionally, the different measures of sleep quality and the diversity of mental disorders make comprehensive assessment challenging.

In the current study, we aimed at investigating the causal relationship between six sleep factors, derived from twelve indicators, and thirteen mental disorders. Specifically, we examined the impact on Alzheimer disease, attention-deficit and hyperactivity disorder (ADHD), anorexia nervosa, anxiety disorder, autism spectrum disorder, alcohol use disorder, bipolar disorder (BD), cannabis use disorder (CUD), major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder, suicide attempt, and schizophrenia (SZ).

Using Genomic Structural Equation Modeling, we estimated genome-wide associations for six sleep factors in the UK Biobank. Next, we examined bidirectional causal relationships with mental disorders in the Psychiatric Genomics Consortium, using Two-sample Mendelian Randomization (MR). Results are presented as inverse-variance weighted betas (B) with 95% confidence intervals (95%CI), representing log-odds for sleep-to-mental disorder causality (forward MR) and linear regression coefficients for mental disorder-to-sleep causality (backward MR).

Our investigation confirmed previous evidence of a six-factor model of sleep, comprising alertness (AF), circadian preference (CPF), efficiency, duration (DF), regularity, and insomnia (IF). MR analyses showed bidirectional causal relationship between IF and ADHD (B:0.747[95%CI:0.392;1.10] and B:0.029[95%CI:0.020;0.040] for forward and backward, respectively). Unidirectional causal effects were found for BD on AF (B:-0.113[95%CI:-0.153;-0.072]), SZ on AF (B:-0.057[95%CI:-0.077;-0.037]), BD on CPF (B:-0.066[95%CI:-0.104;-0.027]), CPF on ADHD (B:-0.074[95%CI:-0.113;-0.035]), BD on DF (B:0.038[95%CI:0.026;0.050]), SZ on DF (B:0.022[95%CI:0.016;0.029]), IF on CUD (B:0.764[95%CI:0.130;1.40]), and IF on SZ (B:-0.504[95%CI:-0.802;-0.206]).

This study provide evidence that mental disorders negatively affect sleep quality rather than vice versa. These findings highlight the need to improve detection of sleep problems in mental health care settings and support efforts to identify intervention targets to improve sleep health among individuals with mental disorders.

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Narcolepsy is known as an autoimmune disease which altered metabolic functions. It is believed that narcolepsy makes more pregnancy complications. However clinical evidence in narcolepsy patients, especially in pregnant women, is limited.

We aim to find out whether there is relationship between narcolepsy and pregnancy complications.

We examined data from the South Korean nationwide health insurance claims database from 2010 to 2019. Out study included women narcolepsy patients who gave birth, and age- and sex- matched controls without narcolepsy. We estimated the odds ratio of narcolepsy with pregnancy complications and control group with pregnancy complications using multivariate logistic regression analysis.

Our study included 1,836 women with narcolepsy who gave birth and 28,796 women who gave birth without narcolepsy. We found that women with narcolepsy have a slightly high risk of preterm birth (OR, 1.191; 95% CI, 1.034-1.372). Patients with narcolepsy were at a significantly lower risk of spontaneous abortion, caesarean and gestational diabetes (OR, 0.763; 0.682-0.854, OR, 0.679; 95% CI, 0.560-0.824 and OR, 0.656; 95% CI, 0.556-0.774, respectively).

This study is the first study about pregnancy complications in narcolepsy patients in South Korea. We found that preterm birth happened more in the patient with narcolepsy during pregnancy. But patient had lower risk of spontaneous abortion, caesarean, gestational diabetes compared to heath control group. These findings suggest that narcolepsy is not a definite risk factor for pregnancy complications. Further research is needed to investigate the reasons why narcolepsy patients had lower risk of spontaneous abortion, caesarean, gestational diabetes compared to health control.

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Obstructive Sleep Apnea (OSA) significantly complicates psychiatric conditions, yet its systematic screening within psychiatric settings is not common. We present a unique collaborative initiative within a tertiary care psychiatric hospital in South Bronx, USA, with approximately 3000 outpatients. We aim to bridge this gap by implementing a comprehensive OSA screening and referral process to improve patient outcomes.

• - Implement a standardized Obstructive Sleep Apnea screening in psychiatric outpatient care.

• - Enhance collaboration between psychiatry and sleep medicine for integrated care.

• - Address compliance barriers by offering at-home sleep diagnostic options.

Starting in April 2024, patients in the Adult Outpatient Psychiatry Department are being screened for Obstructive Sleep Apnea using the STOP-Bang questionnaire, with this process ending in October 2024. High-risk patients identified through screening will receive WatchPAT Home Sleep Apnea Testing devices, with distribution and testing to be completed by December 2024. Data collected will include the number of patients screened, proportion identified as high-risk, HSAT completion rates, diagnostic outcomes, and subsequent referrals to sleep medicine services.

The STOP-Bang questionnaire has been successfully integrated into routine clinical assessments for psychiatric outpatients, and the screening phase will conclude in October 2024. Preliminary data shows that a substantial number of patients were identified as high risk for Obstructive Sleep Apnea. The distribution of WatchPAT Home Sleep Apnea Testing devices to these high-risk individuals is underway and will be completed by December 2024. Initial results indicate effective triaging of patients and a high rate of compliance with at-home sleep testing. Detailed findings, including the exact number of patients screened, high-risk identification rates, HSAT completion rates, and diagnostic outcomes, will be presented upon project completion.

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Early findings from this Quality Improvement project suggest that integrating Obstructive Sleep Apnea screening into psychiatric outpatient care is feasible and beneficial. By identifying at-risk patients and providing accessible, at-home diagnostic tools, we aim to enhance patient care and address the underdiagnosed issue of sleep disturbances in psychiatric populations. The project demonstrates the potential for a streamlined, interdisciplinary approach to improve outcomes and set a scalable model for comprehensive patient management in similar settings. Further analysis will focus on the impact of this intervention on psychiatric care and overall patient health outcomes.

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Physical activity has been associated with improved sleep health, yet the specific impact on individuals with depressive disorders remains underexplored. This study aims to investigate the relationship between regular physical exercise and sleep duration in individuals diagnosed with a depressive disorder, utilizing data from the Behavioral Risk Factor Surveillance System (BRFSS). Understanding this relationship could inform integrative approaches to managing depressive symptoms and improving overall sleep health in this population.

• - To analyze the impact of regular physical exercise on sleep duration among individuals with a depressive disorder.

• - To assess the potential role of physical exercise in mitigating inadequate and prolonged sleep patterns within this population.

Data from the BRFSS for the years 2013, 2014, 2016, 2018, 2020, and 2022 were analyzed to explore the relationship between physical exercise and sleep duration in individuals with depressive disorders. The study included 518,214 participants who reported having a depressive disorder. Of these, 342,276 (weighted 68.5%) reported engaging in physical exercise within the past 30 days. Sleep duration was categorized, and regression analysis was used to assess the association between recent physical exercise and sleep duration.

The analysis indicated that individuals with a depressive disorder who engaged in physical exercise in the past 30 days were less likely to experience inadequate sleep (6-7 hours, Odds Ratio [OR] = 0.83, p < 0.05) and more likely to achieve adequate sleep (7-9 hours, OR = 1.18, p < 0.001) compared to those who did not exercise. They were slightly less likely to have prolonged sleep (9-12 hours, OR = 0.9, p < 0.05). No significant associations were found for very inadequate sleep (<6 hours, OR = 1.34) and very prolonged sleep (>12 hours, OR = 0.6) with physical exercise (p > 0.05).

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Regular physical exercise appears to be associated with better sleep outcomes in individuals with depressive disorders, particularly in promoting adequate sleep duration (7-9 hours). Exercise was linked to a reduced likelihood of inadequate sleep (6-7 hours) and a slight decrease in prolonged sleep (9-12 hours). However, no significant associations were found for very short (<6 hours) or very prolonged (>12 hours) sleep durations. These findings highlight the potential role of physical exercise in managing sleep health within this population. Incorporating regular physical activity into treatment plans for depression may improve sleep quality and contribute to better overall health outcomes. Further research is needed to understand the mechanisms and long-term effects of exercise on sleep patterns in those with depressive disorders.

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Abnormal motor and behavioral phenomena during sleep are part of a broader category of sleep behaviour disorder, which may manifest during different stages—either during sleep, wakefulness, or the transitions between these states. Such occurrences are particularly prevalent during early childhood, affecting approximately 15-20% of pediatric populations, while about 4% of adults experience similar events. These sleep disturbances are generally categorized into simple behaviors or more complex behaviors.

This case report describes a clinical presentation involving defenestration in the context of parasomnia, with initial concerns about a possible suicide attempt. The objective is to highlight the diagnostic challenges in such cases and emphasize the importance of distinguishing between parasomnia-related behavior and intentional self-harm.

The patient is a 24-year-old male, born in the US, and currently living in Barcelona as part of a study exchange program. He has been consuming 1SCU of cannabis daily since adolescence. He denies any personal or family psychiatric history but reports experiencing episodes of sleepwalking during his childhood and teenage years.

On presentation, the patient sustained multiple traumatic injuries following an accidental fall from a second-floor window. The event was witnessed by neighbors, who alerted emergency services. The patient has no memories of the event and denies suicidal intent. In the hours preceding the incident, the patient consumed approximately 2SDE of alcohol, but he denies the use of any other substances at the time. Additional testing, including CT of the brain and EEG, revealed no significant abnormalities.

This case presents a diagnostic dilemma, as initial suspicions pointed toward a possible suicide attempt. However, the patient’s history of sleepwalking, especially during childhood, suggests a parasomnia-related etiology. It is crucial to differentiate between childhood-onset sleepwalking, which is often linked to genetic and developmental factors, and sleepwalking that persists or re-emerges in adulthood, which is more strongly associated with psychopathological factors. The persistence of parasomnias in adults may indicate an underlying psychiatric condition.

This case underscores the complexities in diagnosing parasomnias, particularly when severe and potentially dangerous behaviors are involved. While the patient’s history of sleepwalking and lack of psychiatry history suggest a parasomnia-related etiology, the persistence of such behaviors into adulthood warrants careful evaluation for underlying psychopathological factors. Early recognition and accurate diagnosis are paramount to providing effective care and preventing recurrence of such episodes. This case highlights the importance of a multidisciplinary approach, integrating neurology and psychiatry to offer tailored interventions.

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Nurses often face situations where they must deal with aggression from patients or even coworkers. This challenge can have negative consequences for both medical staff and patients.

The aim of this study is to examine the relationship between the level of aggression, the severity of fatigue, and the occurrence of sleep disorders among nursing staff.

The study was conducted in Szczecin and was survey-based, involving 241 nurses working in surgical wards, medical wards, outpatient clinics, and the emergency department. The following tools were used to collect data: a custom survey, the Fatigue Severity Scale (FSS), the Athens Insomnia Scale (AIS), the Buss-Perry Aggression Questionnaire (BPAQ), and the Pittsburgh Sleep Quality Index (PSQI).

It was found that a greater tendency toward overall aggression, verbal aggression, and higher levels of anger and hostility were associated with more severe insomnia problems (p<0.05). Data analysis showed statistically significant correlations (p<0.05) between overall, physical, and verbal aggression, as well as hostility (based on BPAQ) and sleep quality (based on PSQI). A statistically significant positive correlation (p<0.05) was also found between fatigue levels (FSS) and sleep quality (PSQI) — the higher the level of fatigue, the worse the sleep quality.

Table 1. Comparison of results according to BPAQ and AIS, PSQI

There is a link between aggression levels, fatigue, and sleep disorders. Individuals with stronger tendencies toward aggression were more likely to experience insomnia and sleep problems. Those with higher levels of fatigue also experienced more frequent insomnia and sleep disturbances. Preventive and therapeutic measures are necessary to improve the health of nursing staff.

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The diagnosis of persistent insomnia according to DSM-5 and ICD 11 is based on clinical criteria, specially in relation to dissatisfaction with the quantity/quality of sleep and the discomfort or impairment of social and occupational functioning that it generates. On the other hand, in 2023, Spain has positioned itself as the world leader in the consumption of benzodiazepines.

We present the case of a 62-year-old man admitted to neurosurgery for a cerebrospinal fluid fistula and evaluated by the liaison psichiatry for persistent insomnia. The patient was abusing benzodiazepines to improve his night’s rest. Different drugs are prescribed to improve sleep and avoid abusive consumption of benzodiazepines such as trazodone, quetiapine, clotiapine, gabapentin with little or no improvement of insomnia. Finally, a dual orexin receptor antagonist, daridorexant, is prescribed and its effectiveness is evaluated.

The aim of this work is to evaluate the effectiveness of daridorexant in persistent insomnia, as well as to assess the possibility of its use in benzodiazepine addiction for hypnotic purposes.

The Oviedo Sleep Questionnaire (COS), which is a structured and hetero-applied instrument, was administered to facilitate the diagnosis and monitoring of sleep pre and post treatment.

A literature search was carried out in PubMed and the conclusions found in the literature were compared with the clinical case presented.

Permission is requested from the patient to present this case anonymously.

After 30 days of treatment with daridorexant, the COS score decreased, and improvement was also observed in the anamnesis, without verbalizing complaints that could be interpreted as side effects.

Regarding lorazepam consumption, this could be gradually reduced until its withdrawal.

Daridorexant is a drug that may be effective in resolving persistent insomnia in patients addicted to benzodiazepines for hypnotic purposes.

The review of the available literature suggests that daridorexant is a safe and effective option for the treatment of persistent insomnia. This has been fulfilled in our patient, given that he has not reported side effects, that the analytical parameters have not changed since its introduction and that it has improved in general terms the quality of sleep and functionality during the day. On the other hand, since the hypnotic purpose of lorazepam was replaced by daridorexant, the former could be withdrawn, which opens the door to the possibility that we are dealing with a drug that reduces the consumption of benzodiazepines.

It should be borne in mind that in Spain daridorexant was recently approved in September 2023, with not much experience in practice.

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Insomnia, affecting about one-third of adults and worsening with age, impacts individual’s health, social life, and occupational functioning. Therefore, untreated insomnia can lead to depression. Although it can appear as an independent symptom, it most often presents as a comorbid disorder.

This paper discusses the case of a 71-year-old man with acute necrotizing pancreatitis and history of multiple admissions for recurrent abdominal pain, was assessed by Psychiatry for a possible adaptive disorder. He was diagnosed with persistent insomnia linked to his medical condition and secondary low mood. Sleep hygiene and various medications were recommended but proved ineffective. Eventually, an orexin antagonist, daridorexant, was prescribed.

The aim of this work is to orient, within the wide range of psychopharmacology available for the treatment of insomnia, the effectiveness and advantages of the use of daridorexant in patients with comorbid medical pathology.

To evaluate the efficacy of the drug in improving the quantity and quality of sleep, and the diurnal impact of insomnia, the Athens scale, consisting of 8 items, was used. It has been completed with a sleep diary that provides specific information on sleep. The results obtained were compared with those published by means of a literature search in PubMed.

Permission is requested from the patient to present this case anonymously.

After 30 days of treatment with daridorexant, the Athens Scale score decreased, with a perceived improvement in nocturnal rest (quantity and quality of sleep) and daytime impact of insomnia, with good tolerance and no side effects.

The pharmacological treatment of insomnia has undergone important advances in the last two decades. The treatment of insomnia is multidisciplinary and will depend on its etiology. There seems to be no single, first-choice pharmacological treatment for insomnia, which is why the options are varied and wide-ranging.

The management of this disorder seeks two fundamental objectives: to improve the quality of sleep and to improve daytime symptoms. Both are improved in this patient with the help of daridorexant. The review of the available literature supports the observed case, being daridorexant a safe and effective option for the treatment of insomnia. It is worth mentioning that in Spain, daridorexant has been approved in September 2023, so the clinical experience at present is scarce.

In our patient the drug has been well tolerated, with no reported side effects or variations in analytical parameters. With respect to insomnia, anxious and negative expectations regarding sleep, concern about the potential consequences of not sleeping enough or not sleeping well have decreased and, in short, the quality of sleep, functionality during the day, and even mood have improved in general terms.

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According to literature, the link between childhood trauma and mental health disorders is well-established. However, focusing on the mechanisms explaining this pathway remains insufficiently studied mainly among incarcerated population.

The current study aimed to assess the mediation effect of sleep disorders in the path from childhood physical neglect and emotional abuse to suicide and self harm behaviors among male prisoners.

We conducted a cross sectional study among incarcerated males in Mahdia prison on April 2023. The participation was anonymous, voluntary and the measurement tool was self-administrated. Illiterate participants were interviewed by investigator doctors. We assessed physical and emotional abuse using items from the validated Arabic version of the World Health Organization ACE questionnaire. Self-directed violent behaviors were subdivided into suicidal behaviours and self harm. The Hospital Anxiety and Depression Scale and The Pittsburgh sleep quality index were also used.

A total of 540 prisoners were recruited with a response rate of 74.6%. Their mean age was 33.75± 10.89 years. Among participants, 73% reported emotional abuse and 39.2% had experienced physical neglect during their childhood. In the six previous months, 35% of them had suicidal thoughts and 45.9% were engaged in self-harm. Anxiety and depression were screened among 83.2% and 79.6% of them respectively. During incarceration, 88.4% of prisoners reported sleep disorders.

After adjusting for anxiety and depression, we found that physical neglect and emotional abuse predict self harm behaviors through sleep disorders among male prisoners (%mediated= 28.5% and 15% respectively, p< 0.001).

Our study emphasize the need for preventing and screening childhood trauma and implementing mental health approaches in jail in order to deal with sleep disorders and to prevent suicidal behaviors among prisoners.

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COVID-19 infections had a variety of symptoms, including a range of sleep disorders such as insomnia.

The objective of the study was to assess the prevalence of insomnia among healthcare workers (HCWs) following COVID-19 infection and to identify factors associated with its persistence over time.

This prospective descriptive study was conducted at Charles-Nicolle Hospital in Tunis, monitoring HCWs infected with COVID-19 over a six-month period (January-July 2022). Insomnia severity was evaluated at infection onset (T0), at three months, and at six months post-infection, using the Insomnia Severity Index (ISI) in its French version. The presence of anxiety and depression was assessed via the Hospital Anxiety and Depression Scale (HAD) to determine potential associations.

The study included 155 healthcare workers, with an average age of 40.2 ± 10.3 years and an average work tenure of 14,1 ± 10 years. At baseline (J0), 42.5% of participants reported no insomnia, 21.3% had mild sub-clinical insomnia, 31% had moderate clinical insomnia, and 5.2% experienced severe clinical insomnia. At three months, the rates shifted, with 11.6% reporting no insomnia, 35.5% experiencing mild sub-clinical insomnia, and 7.1% having moderate clinical insomnia. By six months, 7.7% had no insomnia, 6.5% reported mild sub-clinical insomnia, and 3.9% continued to experience moderate clinical insomnia. Factors significantly associated with insomnia included a history of discopathy (p < 10⁻³), hospitalization (p < 10⁻³), and the death of a close relative due to COVID-19 (p = 0.012). Additionally, significant associations were found between persistent insomnia and anxiety and/or depression (p = 0.03).

Persistent insomnia post-COVID-19 infection in HCWs underscores the importance of integrating mental health and sleep quality interventions into healthcare protocols to improve overall well-being and aid in their professional recovery.

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COVID-19 infections had a variety of symptoms, including a range of sleep disorders such as daytime sleepiness.

The objective of the study was to determine the frequency and persistence of daytime Sleepiness among HCWs post-COVID-19 and analysis of related risk factors.

A prospective descriptive study was conducted over six months (January-July 2022) among HCWs at Charles-Nicolle Hospital in Tunis who contracted COVID-19. Daytime sleepiness was evaluated at three intervals: during the infection (T0), at three months, and at six months post-infection, using the Epworth Sleepiness Scale (ESS) in its French version. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HAD) to examine their association with sleep disturbances.

The study included 155 HCWs, with an average age of 40.2 ± 10.3 years and an average work seniority of 14,1 ± 10 years. The assessment of anxiety-depressive disorders in the study population using the HAD scale showed that anxiety symptoms were certain in 27.3% of the personnel, while depressive symptoms were certain in 21.4% of cases. Additionally, 48.1% of participants showed no signs of anxiety, with 24.7% exhibiting doubtful symptoms. For depression, 59.1% had no symptoms, and 19.4% presented with doubtful symptomatology.

àAt baseline (T0), 47.1% of healthcare workers reported normal levels of sleepiness, 16.8% had moderate sleepiness, and 36.1% experienced abnormal sleepiness. By three months, these levels shifted, with 20.6% reporting normal sleepiness, 21.9% reporting moderate sleepiness, and 11.6% experiencing abnormal sleepiness. At six months, 7.7% reported normal sleepiness, 3.9% had moderate sleepiness, and 6.5% continued to experience abnormal sleepiness. Factors significantly associated with prolonged daytime sleepiness included obesity (p = 0.005), thrombophilia (p = 0.004), non-medical professional category (p = 0.019), hospitalization requiring oxygen therapy (p < 10⁻³), and the death of a close relative due to COVID-19 (p =0.016). Anxiety and/or depression, as assessed by the HAD scale, were also significantly associated with persistent sleepiness (p = 0.03).

Persistent daytime sleepiness among HCWs post-COVID-19 infection highlights the need for targeted interventions focused on sleep quality and mental health support, which could enhance well-being and facilitate their occupational reintegration.

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