Sleep quality and associated factors among the elderly living in rural Chiang Rai, northern Thailand

OBJECTIVES This study aimed to characterize the prevalence of poor sleep quality and to identify associated factors among community-dwelling elderly individuals in northern Thailand. METHODS A cross-sectional study was conducted among 266 randomly selected elderly people in a sub-district in rural Chiang Rai Province, northern Thailand. The participants were interviewed using the Thai version of the Pittsburgh Sleep Quality Index (PSQI). RESULTS Roughly 44.0% of the participants had poor sleep quality (PSQI score, >5), 9.4% used sleep medication, 27.1% had poor family relationships, and 12.0% had mild depression. Multiple logistic regression analysis indicated that being female (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.10 to 3.02), a higher education level (OR, 3.03; 95% CI, 1.34 to 6.86 for primary school; OR, 2.48; 95% CI, 1.31 to 5.44 for higher than primary school), mild depression (OR, 2.65; 95% CI, 1.11 to 6.36), and poor family relationships (OR, 3.65; 95% CI, 1.98 to 6.75) were significantly associated with poor sleep quality. CONCLUSIONS The prevalence of poor sleep quality among the elderly was moderately high. Healthcare providers should regularly conduct screenings for sleep quality and depression; provide sleep health education; and conduct interventions to encourage participating in family activities, resolving conflicts, sharing ideas, and making compromises within the family

The effects of CPAP treatment on task positive and default mode networks in obstructive sleep apnea patients: an fMRI study.

INTRODUCTION: Functional magnetic resonance imaging studies enable the investigation of neural correlates underlying behavioral performance. We investigate the effect of active and sham Continuous Positive Airway Pressure (CPAP) treatment on working memory function of patients with Obstructive Sleep Apnea Syndrome (OSAS) considering Task Positive and Default Mode networks (TPN and DMN). METHODS: An experiment with 4 levels of visuospatial n-back task was used to investigate the pattern of cortical activation in 17 men with moderate or severe OSAS before and after 2 months of therapeutic (active) or sub-therapeutic (sham) CPAP treatment. RESULTS: Patients with untreated OSAS had significantly less deactivation in the temporal regions of the DMN as compared to healthy controls, but activation within TPN regions was comparatively relatively preserved. After 2 months of treatment, active and sham CPAP groups exhibited opposite trends of cerebral activation and deactivation. After treatment, the active CPAP group demonstrated an increase of cerebral activation in the TPN at all task levels and of task-related cerebral deactivation in the anterior midline and medial temporal regions of the DMN at the 3-back level, associated with a significant improvement of behavioral performance, whereas the sham CPAP group exhibited less deactivation in the temporal regions of Default Mode Network and less Task Positive Network activation associated to longer response times at the 3-back. CONCLUSION: OSAS has a significant negative impact primarily on task-related DMN deactivation, particularly in the medial temporal regions, possibly due to nocturnal hypoxemia, as well as TPN activation, particularly in the right ventral fronto-parietal network. After 2 months of active nasal CPAP treatment a positive response was noted in both TPN and DMN but without compete recovery of existing behavioral and neuronal deficits. Initiation of CPAP treatment early in the course of the disease may prevent or slow down the occurrence of irreversible impairment

Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis

Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings

Task Positive and Default Mode Networks during a Parametric Working Memory Task in Obstructive Sleep Apnea Patients and Healthy Controls

Functional magnetic resonance imaging (fMRI) studies enable the investigation of neural correlates underlying behavioral performance. We investigate the working memory (WM) function of patients with untreated obstructive sleep apnea (OSA) from the view point of task positive and default mode networks (TPN and DMN, respectively) and compare the results to those of healthy controls (HC)

Brain regions showing significant task-related deactivation in the 0vs3-back contrast in A) 1) CPAP group at baseline AND HC (red); 2) CPAP group post-treatment AND HC (blue; purple indicates overlap between 1 and 2); and in B) sham-CPAP group at baseline AND HC (red); 2) sham-CPAP group post-treatment AND HC (blue; purple indicates overlap between 1 and 2).

<p>Green arrows indicate increased deactivation in the tDMN after CPAP treatment (regions in blue), orange arrows indicate decreased deactivation in the tDMN after sham-CPAP treatment (regions in red) (neurological presentation, p<0.05, FDR corrected for multiple comparisons).</p

TPN (red) and DMN (yellow) masks derived from 3vs0 contrast task-related activation and deactivation respectively of HC (corrected for multiple comparisons, p = 0.05, presented in neurological convention).

<p>TPN (red) and DMN (yellow) masks derived from 3vs0 contrast task-related activation and deactivation respectively of HC (corrected for multiple comparisons, p = 0.05, presented in neurological convention).</p

CPAP and sham-CPAP groups compared to HC: cerebral regions showing significant task-related activation and deactivation in TPN and DMN regions in 1vs0, 2vs0 and 3vs0 contrasts in active and sham-CPAP patient' groups as compared to HC (MNI coordinates, corrected for multiple comparisons, p = 0.05).

<p>CPAP and sham-CPAP groups compared to HC: cerebral regions showing significant task-related activation and deactivation in TPN and DMN regions in 1vs0, 2vs0 and 3vs0 contrasts in active and sham-CPAP patient' groups as compared to HC (MNI coordinates, corrected for multiple comparisons, p = 0.05).</p