Sleep Disorders and Kidney Transplant Outcomes: Findings From an 18-Year (1997-2015) Historical Cohort Study

A historic cohort study of kidney transplant recipients with a failed graft was conducted to examine the associations between sleep disorders and kidney transplant outcomes. Adult kidney transplant recipients who were transplanted and failed or died with a functioning graft during the designated study time period (January 1, 1997 to September 1, 2015, inclusive) were included (n=299). The primary independent variables, any sleep disorder and any sleep-disordered breathing disorders, were defined through a diagnosis in a subject’s medical record. Transplant outcomes included: death with a functioning graft, graft survival time, and patient survival time after graft failure. Chi-square statistics were used to compare the proportion of death with a functioning graft between subjects with versus without any sleep disorder and to help inform the censoring approach for graft survival time. Kaplan Meier survival curves were used to examine the relationship of any sleep disorder to survival time. Cox regression models, examined the adjusted relationship of any sleep disorder to the outcomes, graft survival time and patient survival time after graft failure. Sub-analyses also examined associations between sleep-disordered breathing disorders and these outcomes. The prevalence of any sleep disorder in this cohort was 20%, with the majority consisting of sleep apnea diagnoses, a sleep-disordered breathing disorder. Given a statistically significant (p≤0.01, adjusted model) sleep disorder by transplant-year heterogeneity, Cox regression models were stratified by transplant-year for the graft survival outcome. Having a sleep disorder, namely, sleep apnea, was associated with a statistically significantly increased risk of graft failure or cardiovascular related death with a functioning graft among patients transplanted in 2009-2015 (adjusted HR=2.94, p In a single-center cohort of kidney transplant recipients with a failed graft, a sleep apnea diagnosis increased the risk of graft loss nearly three-fold among patients transplanted between 2009-2015. Further research is needed to better understand this relationship and whether prevention strategies, including treating sleep apnea, might increase longevity in kidney transplant patients

Lack of Communication Even When Using Alternative and Augmentative Communication Devices: Are We Forgetting About the Three Components of Language

[First paragraph] Starting in the early 90s, augmentative and alternative communication (AAC) devices were introduced in special education classrooms. These devices were intended to replace the picture-based communication approaches, such as PECS (Picture Exchange Communication System)

An Exploratory Study Examining the Associations between Sunlight Exposure, Sleep Behaviours and Sleep Outcomes during an Arctic Summer

Few evidence-based recommendations exist for maintaining healthy sleep during Arctic summers. Our study aimed to examine associations between sleep hygiene, sunlight exposure and sleep outcomes in workers living in and/or near the Arctic Circle during a 24-h light period. A survey was administered July 2017 to 19 workers at 3 Arctic base camps in Northeastern Alaska. Participants with poorer sleep hygiene reported increased sleepiness (r=.62, p=0.01); this correlation remained moderately strong, albeit not statistically significant (NS), after controlling for shift work (r=.46, p=0.06). No other statistically significant correlations between sleep hygiene and sleep outcomes were found. Weekly daytime (8pm) sunlight exposures, estimated from daily self-reported sunlight exposures for a typical workday and day off, were dichotomised, based on means, into: longer (\u3e45 h/week) versus shorter (/week) daytime exposures, and longer (\u3e16 h/week) versus shorter (/week) evening exposures. Participants reporting longer, versus shorter, weekly daytime sunlight exposure had statistically significantly (Mann-Whitney U=18.00, Z=-1.98, p/=.3 for longer, vis-a-vis shorter, daylight sunlight exposure suggest it could be related to poorer sleep outcomes, such as insufficient sleep and sleep quality, yet, as these correlations were NS, future work is needed to determine this. Weak or no correlations (and NS differences) were found for longer, versus shorter, weekly evening sunlight exposure and sleep outcomes. Findings support previous research suggesting self-regulation behaviours alone are not protective against poor sleep in Arctic environments. Sleep outcomes did not differ statistically significantly by evening sunlight exposure length. Longer weekly daytime sunlight exposure, versus shorter, was significantly associated with decreased sleep duration. Results from this exploratory study should be confirmed in studies using larger sample sizes

User-Centered Design and Augmentative and Alternative Communication Apps for Children With Autism Spectrum Disorders

Communication difficulties are among the most frequent characteristics of children with autism spectrum disorders (ASD). Lack of communication can have a significant impact on the child’s life. Augmentative and alternative communication (AAC) apps are a common form of AAC interventions that involve a combination of affordable technology with software that can be utilized to assist with communication. While AAC apps have been found to have some impact on improving the communication skills of children with ASD, current research exploring this topic is still limited. Focusing on the design process of AAC apps may provide better insight into improving clinical outcomes and user success. The user-centered design process incorporates a continuous cycle of user feedback to help inform and improve the functions and the capabilities of the technology, and it is an essential component in AAC app development. This article outlines how the user-centered design process could be adopted for the development of AAC apps for children with ASD

An exploratory study examining the associations between sunlight exposure, sleep behaviours and sleep outcomes during an Arctic summer

Few evidence-based recommendations exist for maintaining healthy sleep during Arctic summers. Our study aimed to examine associations between sleep hygiene, sunlight exposure and sleep outcomes in workers living in and/or near the Arctic Circle during a 24-h light period. A survey was administered July 2017 to 19 workers at 3 Arctic base camps in Northeastern Alaska. Participants with poorer sleep hygiene reported increased sleepiness (r=.62, p=0.01); this correlation remained moderately strong, albeit not statistically significant (NS), after controlling for shift work (r=.46, p=0.06). No other statistically significant correlations between sleep hygiene and sleep outcomes were found. Weekly daytime (8pm) sunlight exposures, estimated from daily self-reported sunlight exposures for a typical workday and day off, were dichotomised, based on means, into: longer (>45 h/week) versus shorter (16 h/week) versus shorter (<16 h/week) evening exposures. Participants reporting longer, versus shorter, weekly daytime sunlight exposure had statistically significantly (Mann-Whitney U=18.00, Z=−1.98, p≤0.05) decreased median sleep duration (6 h, 18 min versus 8 h, respectively) during the past month. Correlations of r≥.3 for longer, vis-à-vis shorter, daylight sunlight exposure suggest it could be related to poorer sleep outcomes, such as insufficient sleep and sleep quality, yet, as these correlations were NS, future work is needed to determine this. Weak or no correlations (and NS differences) were found for longer, versus shorter, weekly evening sunlight exposure and sleep outcomes. Findings support previous research suggesting self-regulation behaviours alone are not protective against poor sleep in Arctic environments. Sleep outcomes did not differ statistically significantly by evening sunlight exposure length. Longer weekly daytime sunlight exposure, versus shorter, was significantly associated with decreased sleep duration. Results from this exploratory study should be confirmed in studies using larger sample sizes