To investigate the effect of the coronavirus 2019 (COVID-19) lockdown on lifestyle behaviors and mood changes in the Croatian general population.
During ten days of the COVID-19 lockdown in Croatia, ...3027 respondents (70.3% female) from the general population completed an online, self-report questionnaire. Demographic data and data on lifestyle habits and mood changes before and during the COVID-19 lockdown were collected.
A total of 95.64% of respondents reported to follow most or all restrictions, with female sex (P<0.001) and higher education level (P<0.001) being associated with higher restriction compliance. Women smoked an increased number of cigarettes (P<0.001). The proportion of respondents of both sexes who did not drink or drank 7 drinks per week or more increased (P<0.001). Women also reported lower frequency (P=0.001) and duration of physical exercise (P<0.001). In total, 30.7% of respondents gained weight, with female sex (OR, 2.726) and higher BMI (OR, 1.116; both P<0.001) being associated with an increased likelihood of gaining weight. Both men and women felt more frequently afraid (P<0.001), discouraged (P<0.001), and sad (P<0.001).
Public health authorities should promote the adoption of healthy lifestyles in order to reduce long-term negative effects of the lockdown.
The aim of this cross-sectional study was to objectively assess the salivary flow rate and composition and periodontal inflammation in obstructive sleep apnoea (OSA) patients. The subjects, who ...underwent whole-night polysomnography or polygraphy, were referred for saliva sampling and periodontal examination. According to the severity of OSA based on the Apnoea Hypopnea Index (AHI) value, the subjects were classified into groups: no OSA (AHI < 5; N = 17), mild to moderate OSA (AHI 5-29.9; N = 109), and severe OSA (AHI > 30; N = 79). Salivary flow rate, pH, salivary electrolytes, and cortisol were measured from collected saliva samples. Periodontal examination included assessment of the number of teeth, dental plaque, bleeding on probing and periodontal measurements: gingival recession, probing pocket depth, clinical attachment level (CAL) and periodontal inflamed surface area (PISA) score. There were no significant differences in salivary flow rate, salivary pH, salivary electrolyte concentrations or electrolyte ratios among the groups classified according to the severity of OSA. However, subjects without OSA had higher salivary cortisol concentrations than OSA groups (p < 0.001). Increased plaque scores were associated with a higher AHI (r = 0.26; p = 0.003). According to the salivary flow rate, subjects with hyposalivation and reduced salivation had higher concentrations of salivary electrolytes and lower salivary pH than subjects with normal salivation. Subjects with hyposalivation had an increased Mg/PO
ratio (p < 0.001) and a reduced Ca/Mg ratio (p < 0.001). Furthermore, subjects with severe OSA tended to have higher CALs and plaque volumes. In conclusion, under pathological conditions, such as OSA, multiple interactions might impact salivary flow and electrolyte composition. Complex interrelationships might affect the integrity of oral health, especially considering OSA severity, inflammation, concomitant diseases and medications.
Objectives
This cross-sectional study investigated the stages of periodontitis in obstructive sleep apnea (OSA) patients and risk factors associated with periodontitis severity among them.
Materials ...and methods
A total of 194 patients underwent a polysomnography/polygraphy and were referred to periodontal examination. According to apnea–hypopnea index (AHI), patients were classified as mild OSA (AHI < 15) and moderate to severe OSA (AHI ≥ 15), whereas periodontitis severity was determined by the clinical attachment level (CAL) according to the recent Classification of Periodontal Diseases and Conditions. Patients were grouped into two categories: stages 1 and 2, and stages 3 and 4.
Results
Higher AHI values were reported in OSA patients exhibiting periodontitis stages 3 and 4 compared to OSA patients with periodontitis stages 1 and 2 (
p
= 0.043) and the non-periodontitis group (
p
= 0.044). A positive correlation was found between AHI and mean CAL (r = 0.215;
p
= 0.004), and between AHI and plaque scores (r = 0.292;
p
< 0.001). Following a multivariable regression analysis, AHI was a significant predictor of mean CAL (β = 0.169;
p
= 0.031), explaining 16.4% of variability in mean CAL (adjusted R
2
= 0.164;
p
< 0.001). Older patients had higher odds for an increased mean CAL (β = 0.266;
p
= 0.001), as well as patients smoking or formerly smoking (β = 0.305;
p
< 0.001) whereas visiting a dental medicine doctor once a year or more often was associated with a decreased mean CAL (β = − 0.182;
p
= 0.02).
Conclusions
OSA was associated with severe stages of periodontitis along with increased age, smoking, low frequency of dental visits, and poor oral hygiene.
Clinical relevance
Screening for periodontitis is recommended for patients with more severe forms of OSA.
Walking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life. The study objective was to determine the psychometric ...properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12) among pwMS in Croatia and to examine the association between MSWS-12 and Depression, Anxiety, and Stress Scale-21 (DASS-21), and Multiple Sclerosis Impact Scale-29 (MSIS-29).
A cross-sectional study included a sample of pwMS (N = 148). Psychometric properties were examined by estimating the validity and reliability of the MSWS-12. The predictive validity of MSWS-12 and demographic and disease-related factors were assessed by a hierarchical regression model using MSIS-29 and DASS-21 as criterion variables.
Scale reliability was good for the MSWS-12 scale, expressed by Cronbach's alpha coefficient (α = 0.98). Correlations between MSWS-12 and DASS-21 (0.20-0.27) and between MSWS-12 and MSIS-29 subscales (0.47-0.83) provided initial support for the convergent validity. Factor analysis demonstrated the unidimensional structure of the MSWS-12.
The Croatian version of the MSWS-12 is a reliable, valid, and clinically useful tool for assessing walking impairments in pwMS.
Implications for rehabilitation
Walking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life.
Multiple Sclerosis Walking Scale (MSWS-12) is a measure of the disease's impact on walking abilities from the patient's perspective.
MSWS-12 is a reliable scale for assessing walking speed, endurance, and gait quality in multiple sclerosis and is validated in several languages (Korean, Italian, Brazilian, and Persian).
The Croatian version of the MSWS-12 is a reliable, predictive, and valid tool for screening walking impairments in pwMS.
Sleep disturbances and poor sleep are a common complaint in the population with multiple sclerosis (MS) disease. The most commonly reported scale is the Pittsburgh Sleep Quality Index (PSQI), ...measuring seven components of sleep quality. Yet, till today, the PSQI instrument has not been validated in people with multiple sclerosis (pwMS). The objective of our study was to add precision in sleep quality assessment by investigating the psychometric properties of PSQI (factor structure, reliability, validity based on relations with other variables, cut-off scores) in pwMS. The cross-sectional study included data on a total of 87 patients with MS and 216 control subjects. Demographic information, education level, and MS-related variables were ascertained. Psychometric properties were examined by estimating the validity, including factor structure, metric invariance, and relations with other MS- and non-MS-related variables, reliability, and discrimination ability of the PSQI. The Croatian version of the PSQI had a two-factor structure which demonstrated loading and partial intercept invariance between pwMS and the control group. The global score and both subscales had high internal consistencies (McDonald's omega and Cronbach's alpha coefficients) in pwMS and showed expected relations with demographic and MS-related variables. PwMS differed significantly in the PSQI global score from the control groups, although receiver operating characteristics (ROC) curve analysis did not indicate a clear cut-off point. The PSQI is a reliable and valid scale and can be applied in clinical settings for assessing sleep quality in pwMS.
Coordinated activation of sympathetic and respiratory nervous systems is crucial in responses to noxious stimuli such as intermittent hypoxia. Acute intermittent hypoxia (AIH) is a valuable model for ...studying obstructive sleep apnea (OSA) pathophysiology, and stimulation of breathing during AIH is known to elicit long-term changes in respiratory and sympathetic functions. The aim of this study was to record the renal sympathetic nerve activity (RSNA) and phrenic nerve activity (PNA) during the AIH protocol in rats exposed to monoanesthesia with sevoflurane or isoflurane. Adult male Sprague-Dawley rats (
= 24; weight: 280-360 g) were selected and randomly divided into three groups: two experimental groups (sevoflurane group,
= 6; isoflurane group,
= 6) and a control group (urethane group,
= 12). The AIH protocol was identical in all studied groups and consisted in delivering five 3 min-long hypoxic episodes (fraction of inspired oxygen, FiO
= 0.09), separated by 3 min recovery intervals at FiO
= 0.5. Volatile anesthetics, isoflurane and sevoflurane, blunted the RSNA response to AIH in comparison to urethane anesthesia. Additionally, the PNA response to acute intermittent hypoxia was preserved, indicating that the respiratory system might be more robust than the sympathetic system response during exposure to acute intermittent hypoxia.
Benzodiazepines are the most commonly used sedatives for the reduction of patient anxiety. However, they have adverse intraoperative effects, especially in obstructive sleep apnea (OSA) patients. ...This study aimed to compare dexmedetomidine (DEX) and midazolam (MDZ) sedation considering intraoperative complications during transurethral resections of the bladder and prostate regarding the risk for OSA. This study was a blinded randomized clinical trial, which included 115 adult patients with a mean age of 65 undergoing urological procedures. Patients were divided into four groups regarding OSA risk (low to medium and high) and choice of either MDZ or DEX. The doses were titrated to reach a Ramsay sedation scale score of 4/5. The intraoperative complications were recorded. Incidence rates of desaturations (44% vs. 12.7%, p = 0.0001), snoring (76% vs. 49%, p = 0.0008), restlessness (26.7% vs. 1.8%, p = 0.0044), and coughing (42.1% vs. 14.5%, p = 0.0001) were higher in the MDZ group compared with DEX, independently of OSA risk. Having a high risk for OSA increased the incidence rates of desaturation (51.2% vs. 15.7%, p < 0.0001) and snoring (90% vs. 47.1%, p < 0.0001), regardless of the sedative choice. DEX produced fewer intraoperative complications over MDZ during sedation in both low to medium risk and high-risk OSA patients.
Obstructive sleep apnea (OSA) is a prevalent disease associated with increased risk for cardiovascular and metabolic diseases and shortened lifespan. The aim of this study was to explore the ...possibility of using N-glycome as a biomarker for the severe form of OSA. Seventy subjects who underwent a whole-night polysomnography/polygraphy and had apnea-hypopnea index (AHI) over 30 were compared to 23 controls (AHI under 5). Plasma samples were used to extract 39 glycan peaks using ultra-high-performance liquid chromatography (UPLC) and 27 IgG peaks using capillary gel electrophoresis (CGE). We also measured glycan age, a molecular proxy for biological aging. Three plasma and one IgG peaks were significant in a multivariate model controlling for the effects of age, sex, and body mass index. These included decreased GP24 (disialylated triantennary glycans as major structure) and GP28 (trigalactosylated, triantennary, disialylated, and trisialylated glycans), and increased GP32 (trisialylated triantennary glycan). Only one IgG glycan peak was significantly increased (P26), which contains biantennary digalactosylated glycans with core fucose. Patients with severe OSA exhibited accelerated biological aging, with a median of 6.9 years more than their chronological age (
< 0.001). Plasma N-glycome can be used as a biomarker for severe OSA.
This cross-sectional study investigated the level of daytime sleepiness and sleep-related behaviors in preschool children and compared their self-evaluations with the evaluations of their parents. It ...was conducted in Split-Dalmatian County, Croatia, among 196 preschool children aged 6-7 years seen at regular medical examinations, accompanied by their parents, using the Epworth sleepiness scale for children and parents/caregivers. Compared to their child's reports, parents tended to underestimate their child's sleepiness while sitting in a classroom at school (
= 0.001) and overestimate their child's sleepiness when lying down to rest or nap in the afternoon (
< 0.001). Boys were sleepier while sitting in a classroom at school during the morning than girls (
= 0.032). As much as 48.2% of preschool children had their own cellphones/tablets. Boys used video games (
< 0.001) and cellphones/tablets more than girls did (
= 0.064). Parental estimation of children playing video games at bedtime was lower than the child's report (
< 0.001). Children who had a TV in their bedroom reported more daytime sleepiness (
= 0.049), and those who played video games at bedtime went to sleep later during the weekend (
= 0.024). Also, children owning cellphone/tablets had longer sleep latency during the weekend compared to children not owning a cellphone (
= 0.015). This study confirmed that parents tend to underestimate children's habits of playing video games at bedtime and children's sleepiness during morning classes. Preschool children who use electronic devices at bedtime more frequently have prolonged sleep latency. These findings provide further evidence of the effects of electronic media devices on preschoolers' sleep patterns and daytime sleepiness.
Aim To construct a single-format questionnaire on sleep habits and mood before and during the COVID-19 pandemic in the general population. Methods We constructed the Split Sleep Questionnaire (SSQ) ...after a literature search of sleep, mood, and lifestyle questionnaires, and after a group of sleep medicine experts proposed and assessed questionnaire items as relevant/irrelevant. The study was performed during 2021 in 326 respondents distributed equally in all age categories. Respondents filled out the SSQ, the Pittsburgh Sleep Quality Index (PSQI), and State Trait Anxiety Inventory (STAI), and kept a seven-day sleep diary. Results Cronbach alpha for Sleep Habits section was 0.819, and 0.89 for Mood section. Test-retest reliability ranged from 0.45 (P = 0.036) for work-free day bedtime during the pandemic to 0.779 (P <0.001) for sleep latency before the pandemic. Workday and work-free day bedtime during the COVID-19 pandemic assessed with SSQ were comparable to the sleep diary assessment (P = 0.632 and P = 0.203, respectively), as was the workday waketime (P=0.139). Work-free day waketime was significantly later than assessed in sleep diary (8:19 + or - 1:52 vs 7:45 + or - 1:20; P<0.001). No difference in sleep latency was found between the SSQ and PSQI (P=0.066). Conclusion The SSQ provides a valid, reliable, and efficient screening tool for the assessment of sleep habits and associated factors in the general population during the COVID-19 pandemic.
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