Attitudes towards treatment among patients suffering from sleep disorders. A Latin American survey

BACKGROUND: Although sleep disorders are common, they frequently remain unnoticed by the general practitioner. Few data are available about the willingness and reasons of patients with sleep disturbances to seek for medical assistance. METHODS: The results of a cross-sectional community-based multinational survey in three major Latin American urban areas, i.e. Buenos Aires, Mexico City and Sao Paulo, are reported. Two-hundred subjects suffering sleep disturbances and 100 non-sufferers were selected from the general population in each city (total number: 600 sufferers vs. 300 non-sufferers). A structured interview was conducted, sleep characteristics, feelings about sleep disturbances and strategies to cope with those problems being recorded. Data were analyzed by employing either t-test or analysis of variance (ANOVA) to the Z-transformed proportions. RESULTS: 22.7 ± 3.5 % (mean ± SEM) of subjects reported to suffer from sleep disturbances every night. About 3 out of 4 (74.2 ± 2.0 %) considered their disorder as mild and were not very concerned about it. Only 31 ± 2 % of sufferers reported to have sought for medical help. Although 45 ± 2 % of sufferers reported frequent daily sleepiness, trouble to remember things, irritability and headaches, they did not seek for medical assistance. Among those patients who saw a physician with complaints different from sleep difficulties only 1 out of 3 (33 ± 2 % of patients) were asked about quality of their sleep by the incumbent practitioner. Strategies of patients to cope with sleep problems included specific behaviors (taking a warm bath, reading or watching TV) (44 ± 1.6 %), taking herbal beverages (17 ± 1.2 %) or taking sleeping pills (10 ± 1.1 %). Benzodiazepines were consumed by 3 ± 0.6 % of sufferers. CONCLUSION: Public educational campaigns on the consequences of sleep disorders and an adequate training of physicians in sleep medicine are needed to educate both the public and the general practitioners about sleep disorders

How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights

Aljohara S Almeneessier,1,2 Ahmed S BaHammam1 1Department of Medicine, University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia Abstract: Mealtimes and feeding schedules may interfere with the circadian system and impact sleep. The practice of intermittent fasting (IF) in its different formats is increasing worldwide. However, most studies addressing the effect of IF on circadian rhythms, daytime sleepiness, and sleep architecture have been conducted during diurnal IF for Ramadan. In this article, we analyze the effect of diurnal IF on the circadian clock, sleep, and daytime sleepiness. In free-living, unconstrained environments that do not control for lifestyle changes such as sleep/wake schedules, sleep duration, and light exposure, studies have demonstrated sudden and significant delays in bedtime and wake time during diurnal intermittent fasting for Ramadan. However, subsequent studies that accounted for lifestyle factors and sleep/wake patterns have reported no changes in markers of the biological clock, daytime sleepiness, or sleep parameters. Nevertheless, several researchers have demonstrated a reduction in the proportion of rapid eye movement stage sleep as the significant alteration in sleep architecture during fasting. Keywords: mealtime, Ramadan, chronotype, sleep architecture, alertness, food, light, caloric restrictio

Immune-mediated comorbidities in Saudi patients with narcolepsy

Majed Alomar,1 Aljohara S Almeneessier,1,2 Awad H Olaish,1 Abdulrahman Alshiban,1 Abdullah Alomar,1 Ahmed S BaHammam1,31The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, King Saud University, Riyadh, Saudi ArabiaBackground: Autoimmunity has been proposed as a cause of narcolepsy. A few studies have assessed comorbid autoimmune diseases in patients with narcolepsy, with conflicting results; however, no study has assessed autoimmune diseases in Arab narcolepsy patients. This study aimed to assess the coexistence of immune-mediated conditions such as allergies, autoimmune diseases, and autoinflammatory diseases in patients with narcolepsy type 1 (with cataplexy) (NT1) and narcolepsy type 2 (without cataplexy) (NT2).Methods: Personal and family history of autoimmune/autoinflammatory and allergic disorders was collected using a questionnaire in 80 consecutive Saudi patients with narcolepsy (46 NT1 and 24 NT2), who were diagnosed according to the International Classification of Sleep Disorders, Third Edition. The control group comprised 222 adults from the general population.Results: Comorbid autoimmune/autoinflammatory diseases were reported by 21.4% of the NT1 patients, and 12.2% of the controls, with no significant difference between cases and controls in a model adjusted for confounding covariates. However, allergic disorders were significantly more prevalent among NT1 patients. Both comorbid autoimmune/autoinflammatory and allergic disorders were significantly more prevalent among NT2 patients compared to controls. No differences in demographic and clinical characteristics were detected between narcolepsy patients with and without autoimmune/autoinflammatory diseases.Conclusion: NT1 is not associated with increased comorbid autoimmune diseases in the studied sample of Saudi patients. However, autoimmune diseases are associated with NT2, and allergic disorders are associated with both NT1 and NT2. These findings suggest the existence of dysregulation in the immune system of narcolepsy patients that requires further research.Keywords: cataplexy, hypersomnolence, hypersomnia, allergy, narcoleps