Autonomic responses to respiratory events and risk of chronic kidney disease in obstructive sleep apnea.

Study Objectives: Obstructive sleep apnea (OSA)-related hypoxemia, measured by hypoxic burden (HB), is associated with chronic kidney disease (CKD). OSA-related autonomic response may also be associated with CKD. This study examined whether individuals with high HB and varying autonomic responses to OSA have a different risk of CKD progression compared to those with low HB.

Respiratory Event-related Physiological Biomarkers and Cognitive Performance in Obstructive Sleep Apnea.

Rationale: Individuals with obstructive sleep apnea (OSA) are at increased risk of cognitive impairment. However, the physiologic mechanisms that link OSA to this impairment are unclear. We assessed the association between novel physiologic biomarkers (, respiratory event-related electroencephalographic (EEG) activity and autonomic responses) and the risk of cognitive impairment.

The feasibility of conducting non-pharmacological research studies in participants with mania: a grounded theory qualitative analysis of the Ottawa Sunglasses at Night study.

Background: Feasibility concerns around non-pharmacological interventions can be a barrier against clinical research in individuals with mania.

Methods: As part of a randomized controlled trial using blue-blocking vs lightly-tinted glasses, we interviewed participants who were hospitalized with mania and clinicians to gather insight on feasibility of recruitment and acceptability and implementation of tinted glasses according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework using a grounded theory approach. Semi-structured interviews with 24 participants and 10 clinicians were conducted.

The complex association between bedtime screen use and adult sleep health.

Objectives: To evaluate whether bedtime screen use is associated with sleep health and if this association varies by biological sex, age, and income among adults in Canada.

Methods: Data were collected through a national stratified random population-based phone interview on sleep health among adults (≥18 years) from Canada. Self-reported bedtime screen use (in bed or within 1 hour of bedtime) of the past month was used to classify participants into three groups: occasional ( View Article and Find Full Text PDF

Evidence for Internal Misalignment of Circadian Rhythms in Youth With Emerging Mood Disorders.

Despite evidence for links between circadian dysfunction and mood disorders, previous research has largely reported on single biological markers of circadian alignment. The available evidence on relationships between 2 internal phase markers (e.g.

Association of nocturnal hypoxemia and white blood cell count in a multicenter cohort.

Study Objectives: There is a higher risk of cardiovascular disease (CVD) in patients with obstructive sleep apnea (OSA) and innate immunity is a potential pathophysiologic pathway. The objective of this study was to determine whether nocturnal hypoxemia is associated with circulating markers of innate immunity in OSA.

Methods: This was a cross-sectional study of an observational cohort from the multicentre, clinic-based, Canadian Sleep and Circadian Network.

Sleep, Health Care-Seeking Behaviors, and Perceptions Associated With the Use of Sleep Wearables in Canada: Results From a Nationally Representative Survey.

Background: The popularity of sleep-tracking wearables has surged worldwide. Yet, there are significant gaps in understanding the real-life implications of this phenomenon. While wearables may offer insights about sleep and promote sleep health awareness, evidence remains mixed on whether they lead to improved sleep outcomes or fuel sleep anxiety.

Efficacy of cognitive behavioral therapy for insomnia and lemborexant medication for different subtypes of chronic insomnia: study protocol for a randomized controlled trial.

Introduction: Insomnia is a prevalent yet under-characterized disorder, particularly regarding the heterogeneity of patients and their associated responses to different treatment modalities. This often leads to suboptimal management. There is a need to consider personalized approaches tailored to the characteristics of insomnia phenotypes with regard to objective evidence of shortened sleep duration (< 6 h).

TRANSCENDENT (Transforming Research by Assessing Neuroinformatics across the Spectrum of Concussion by Embedding iNterdisciplinary Data-collection to Enable Novel Treatments): protocol for a prospective observational cohort study of concussion patients with embedded comparative effectiveness research within a network of learning health system concussion clinics in Canada.

Introduction: Concussion affects over 400 000 Canadians annually, with a range of causes and impacts on health-related quality of life. Research to date has disproportionately focused on athletes, military personnel and level I trauma centre patients, and may not be applicable to the broader community. The TRANSCENDENT Concussion Research Program aims to address patient- and clinician-identified research priorities, through the integration of clinical data from patients of all ages and injury mechanisms, patient-reported outcomes and objective biomarkers across factors of intersectionality.

Exploring the dissociative subtype of PTSD: The role of early-life trauma, cortisol, and inflammatory profiles.

Post-traumatic stress disorder (PTSD) is a heterogeneous mental health condition, characterized by diverse symptom profiles and biological underpinnings. A dissociative subtype of PTSD has been identified, though the potential risk factors and underlying neurobiology are yet to be understood. The current study comprised Canadian Armed Forces (CAF) members and Veterans with a history of deployment, and with diagnoses of non-dissociative (n = 31) and dissociative subtypes of PTSD (n = 19), in addition to non-deployed healthy controls (n = 14).

Modulation of cardiac autonomic activity across consciousness states and levels of sleep depth in individuals with sleep complaints and bipolar disorder or unipolar depressive disorders.

Objective: Autonomic nervous system dysfunction and reduced heart rate variability (HRV) often co-exist with mood disorders, a phenomenon likely influenced by sleep disturbances. This study investigated heart rate (HR) and HRV across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep in individuals with sleep complaints and bipolar or unipolar depressive disorder.

Methods: Polysomnographic data was retrospectively collated for 120 adult patients with sleep complaints and depressive symptoms [60 diagnosed with bipolar disorder, 60 diagnosed with a unipolar depressive disorder], and 60 healthy controls.

Delphi consensus recommendations for the management of chronic insomnia in Canada.

Objective: The lack of current Canadian practice guidelines for the management of insomnia poses a challenge for healthcare providers (HCP) in selecting the appropriate treatment options. This study aimed to establish expert consensus recommendations for the management of chronic insomnia in Canada.

Composition Of The Committee: Sixteen multidisciplinary experts in sleep medicine and insomnia across Canada developed consensus recommendations based on their knowledge of the literature and their practical experience.

Longer-term impacts of the COVID-19 pandemic on obstructive sleep apnoea (OSA)-related healthcare: a province-based study.

Rationale: Following marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea (OSA) health services and service backlogs during the pandemic compared with pre-pandemic levels in Ontario (the most populous province of Canada).

Methods: In this retrospective population-based study using Ontario (Canada) health administrative data on adults, we compared rates of polysomnograms (PSGs), outpatient visits and positive airway pressure (PAP) therapy purchase claims during the pandemic (March 2020 to December 2022) to pre-pandemic rates (2015-2019).

Evidence for Locus Coeruleus-Norepinephrine System Abnormality in Military Posttraumatic Stress Disorder Revealed by Neuromelanin-Sensitive Magnetic Resonance Imaging.

Background: The complex neurobiology of posttraumatic stress disorder (PTSD) calls for the characterization of specific disruptions in brain functions that require targeted treatment. One such alteration could be an overactive locus coeruleus (LC)-norepinephrine system, which may be linked to hyperarousal symptoms, a characteristic and burdensome aspect of the disorder.

Methods: Study participants were Canadian Armed Forces veterans with PTSD related to deployment to combat zones (n = 34) and age- and sex-matched healthy control participants (n = 32).

All Obstructive Sleep Apnea Events Are Not Created Equal: The Relationship between Event-related Hypoxemia and Physiologic Response.

Obstructive sleep apnea (OSA) severity is typically assessed by the apnea-hypopnea index (AHI), a frequency-based metric that allocates equal weight to all respiratory events. However, more severe events may have a greater physiologic impact. The purpose of this study was to determine whether the degree of event-related hypoxemia would be associated with the postevent physiologic response.

Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study.

Background: The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs).

Methods: We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy.

State of the science and recommendations for using wearable technology in sleep and circadian research.

Wearable sleep-tracking technology is of growing use in the sleep and circadian fields, including for applications across other disciplines, inclusive of a variety of disease states. Patients increasingly present sleep data derived from their wearable devices to their providers and the ever-increasing availability of commercial devices and new-generation research/clinical tools has led to the wide adoption of wearables in research, which has become even more relevant given the discontinuation of the Philips Respironics Actiwatch. Standards for evaluating the performance of wearable sleep-tracking devices have been introduced and the available evidence suggests that consumer-grade devices exceed the performance of traditional actigraphy in assessing sleep as defined by polysomnogram.

Pandemic Effect on Healthcare Use and Death in Adults with Epilepsy: A Population Study.

Objectives: We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death.

Methods: Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models.

Aripiprazole, a Novel Option in the Management of Restless Legs Syndrome (RLS) Patients with Augmentation and/or Severe RLS Symptoms: A Report of 4 Cases.

Purpose: Restless Legs Syndrome (RLS) is a sensorimotor disorder associated with an unpleasant urge to move the limbs, relieved with movement, occurring in the evenings and with prolonged rest/inactivity. Treatment with dopamine agonists is effective for up to 60-90% of affected individuals. However, augmentation, ie, the paradoxical worsening of RLS symptoms after prolonged RLS treatment, is frequently reported, typically after 3-10 years of treatment.

Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers.

Aim: To refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity.

Background: Healthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues.