Miracle-dz/UniFAR-FTUs huggingface dataset:
Residual sleepiness in sleep apnea patients treated by continuous positive airway pressure

Hypoxic brain damage might explain persistent sleepiness in some continuous positive airway pressure‐compliant obstructive sleep apnea called residual excessive sleepiness. Although continuous positive airway pressure may not be fully efficient in treating this symptom, wake‐promoting drug prescription in residual excessive sleepiness is no longer allowed by the European Medicines Agency. The aim of this study is to describe residual excessive sleepiness phenotypes in a large prospective sample of patients with obstructive sleep apnea. Residual excessive sleepiness was defined by an Epworth Sleepiness Scale score ≥ 11. Eligible patients from the French National Sleep Registry attending follow‐up continuous positive airway pressure visits numbered 1047. Patients using continuous positive airway pressure < 3 h (n = 275), with residual apnea–hypopnea index > 15 h−1 (n = 31) or with major depression were excluded (n = 150). Residual excessive sleepiness prevalence in continuous positive airway pressure‐treated obstructive sleep apnea was 13% (18% for those with an initial Epworth Sleepiness Scale score > 11), and significantly decreased with continuous positive airway pressure use (9% in ≥ 6 h night−1 continuous positive airway pressure users, P < 0.005). At the time of diagnosis, patients with residual excessive sleepiness had worse subjective appreciation of their disease (general health scale, Epworth Sleepiness Scale and fatigue score), and complained more frequently of continuous positive airway pressure side‐effects. Residual excessive sleepiness prevalence was lower in severe obstructive sleep apnea than in moderate obstructive sleep apnea (11% when AHI > 30 h−1 versus 18% when AHI 15–30, P < 0.005). There was no relationship between residual excessive sleepiness and body mass index, cardiovascular co‐morbidities or diabetes. Continuous positive airway pressure improved symptoms in the whole population, but to a lower extent in patients with residual excessive sleepiness (fatigue scale: −5.2 versus −2.7 in residual excessive sleepiness− and residual excessive sleepiness+ patients, respectively, P < 0.001). Residual excessive sleepiness prevalence decreased with continuous positive airway pressure compliance. Hypoxic insult is unlikely to explain residual excessive sleepiness as obstructive sleep apnea severity does not seem to be critical. Residual symptoms are not limited to sleepiness, suggesting a true ‘continuous positive airway pressure‐resistant syndrome’, which may justify treatment by wake‐promoting drugs.
The effects of suppressing intrusive thoughts on dream content, dream distress and psychological parameters

Suppressing unwanted thoughts can lead to an increased occurrence of the suppressed thought in dreams. This is explainable by the ironic control theory, which theorizes why the suppression of thoughts might make them more persistent. The present study examined the influence of thought suppression on dream rebound, dream distress, general psychiatric symptomatology, depression, sleep quality and perceived stress. Thirty healthy participants (good sleepers) were investigated over a period of 1 week. Half were instructed to suppress an unwanted thought 5 min prior to sleep, whereas the other half were allowed to think of anything at all. Dream content was assessed through a dream diary. Independent raters assessed whether or not the dreams were related to the suppressed target thought. The results demonstrated increased target‐related dreams and a tendency to have more distressing dreams in the suppression condition. Moreover, the data imply that thought suppression may lead to significantly increased general psychiatric symptomatology. No significant effects were found for the other secondary outcomes.
Conceptualising and responding to self‐neglect: the challenges for adult safeguarding

Purpose: The research reported here aimed to scope the concept of self-neglect as it is explored in the literature and interpreted in practice by professionals involved in adult safeguarding. Design: The approach taken included a systematic search and thematic analysis of English-language literature on self-neglect, workshops with UK-based adult safeguarding leads and practitioners from social services, police and health services, and scrutiny of Safeguarding Adults Boards' documentation. Findings: The concept of self-neglect is complex with contrasting definitions and aetiology, accompanied by debates on the principles that guide intervention. Decision-making capacity is a key pivot upon which professional responses to self-neglect turn. Intervention in self-neglect requires careful exploration in the context of principles of personalisation, choice, control and empowerment that underpin policy in adult social care and safeguarding. Research limitations/implications: As a conceptual scoping review, this study sought to establish broad themes of use to practitioners working with self-neglect. It thus does not carry out full quality review of the literature identified and discussed, but serves as a base for this to be done in future. Practical implications: Assessment in self-neglect should consider the influence of a number of possible causative factors, and intervention must balance respect for autonomy on the one hand and a perceived duty to preserve health and wellbeing on the other. Value: This article summarises and critically analyses the emerging key features of evidence-informed practice in the challenging field of self-neglect.
Sleep respiratory disturbances and arousals at moderate altitude have overlapping electroencephalogram spectral signatures

An ascent to altitude has been shown to result in more central apneas and a shift towards lighter sleep in healthy individuals. This study employs spectral analysis to investigate the impact of respiratory disturbances (central/obstructive apnea and hypopnea or periodic breathing) at moderate altitude on the sleep electroencephalogram (EEG) and to compare EEG changes resulting from respiratory disturbances and arousals. Data were collected from 51 healthy male subjects who spent 1 night at moderate altitude (2590 m). Power density spectra of Stage 2 sleep were calculated in a subset (20) of these participants with sufficient artefact‐free data for (a) epochs with respiratory events without an accompanying arousal, (b) epochs containing an arousal and (c) epochs of undisturbed Stage 2 sleep containing neither arousal nor respiratory events. Both arousals and respiratory disturbances resulted in reduced power in the delta, theta and spindle frequency range and increased beta power compared to undisturbed sleep. The similarity of the EEG changes resulting from altitude‐induced respiratory disturbances and arousals indicates that central apneas are associated with micro‐arousals, not apparent by visual inspection of the EEG. Our findings may have implications for sleep in patients and mountain tourists with central apneas and suggest that respiratory disturbances not accompanied by an arousal may, none the less, impact sleep quality and impair recuperative processes associated with sleep more than previously believed.
The evolving science of atherothrombotic disease

Atherosclerosis is a systemic inflammatory disease characterized by the accumulation of inflammatory cells in the intima of large arteries. The presence of platelets at the site of inflammation and endothelial injury has been known since the early 1960s. In the following years, it was generally accepted that rupture or erosion of advanced atherosclerotic lesions initiates platelet activation and aggregation on the thrombogenic surface of a disrupted atherosclerotic plaque. Thrombotic vascular occlusion is associated with ischaemic episodes in the retina, brain, heart, and other organs. While it is widely accepted that platelets play a significant role in thromboembolic events generated by atherosclerotic lesions (atherothrombosis), their involvement in the initiation of the atherosclerotic process has not been widely recognized by the scientific community. An expanding body of evidence on the role of platelets in the development of atherosclerotic lesions continues to build. Platelets bind to leukocytes and endothelial cells, and initiate the transformation of monocytes into macrophages. Additionally, platelets internalize oxidized phospholipids and promote foam cell formation, as well as recruit progenitor cells that are able to differentiate into foam or endothelial cells. In total, platelets play a key role in the initiation, development, and total extent of atherosclerotic lesions.
Influence of α‐thalassemia trait on spleen function in sickle cell anemia patients with high HbF

Spleen function was studied in a group of 20 Kuwaiti SS patients (aged 2–12 years), using 99mTc‐labeled tin colloid scintigraphy. They were screened for the α‐thalassemia determinants which are prevalent in the Arabian Peninsula [‐α (3.7 kb) deletion, α2‐globin gene polyadenylation signal (AATAAA → AATAAG) mutation, and 5′ IVS‐I splice junction pentanucleotide (GAGGTGAGG → GAGG) deletion] with a combination of polymerase chain reaction and allele‐specific oligonucleotide (ASO) hybridization techniques. The patients were divided into three groups depending on the result of their colloid uptake. Group I consisted of 7 patients (35.0%) with normally visualized spleens, Group II consisted of 5 (25.0%) with partial visualization, and in Group III there were 8 (40.0%) in whom the spleen was not visualized at all. The significant distinguishing features among those in Groups I and III were mean corpuscular volumes (MCVs) of 74.1 ± 5.1 and 90.1 ± 6.6 fl (P < 0.0001) and mean corpuscular hemoglobins (MCHs) of 22.4 ± 2.7 and 27.5 ± 4.0 pg (P < 0.05), respectively. The overall frequency of α‐thalassemia determinants in the study was 35.0%; however, the frequencies in Groups I, II, and III were 57.1, 30.0, and 18.8%, respectively. α‐Thalassemia trait, therefore, appears to be associated with normal splenic function in these patients. © 1996 Wiley‐Liss, Inc.
The effect of lavender aromatherapy on pain perception and intrapartum outcome in primiparous women

Introduction: Labour pain is a main preoccupation of pregnant women. In this study, the authors determined the effect of lavender aromatherapy on pain intensity perception and intrapartum outcome in primiparous women. Methods: In this randomised controlled trial, 160 participants were divided into two groups. The aroma group received 0.1 ml of lavender essential oil mixed with 1 ml of distilled water via tissues attached to their gowns close to their nostrils. Meanwhile, the control group received 2 ml of distilled water in a similar way. Pain intensity perception was measured by Visual Analogue Scale (VAS) before the intervention and at 30 and 60 minutes afterwards. Results: The mean of pain intensity perception in the aroma group was lower than that of the control group at 30 and 60 minutes after the intervention (p←0.001). Conclusion: This study revealed that aromatherapy decreased the labour pain, but did not affect the duration of labour phases and Apgar score.
Evidence that fertility trades off with early offspring fitness as males age

Models of ageing predict that sperm function and fertility should decline with age as sperm are exposed to free radical damage and mutation accumulation. However, theory also suggests that mating with older males should be beneficial for females because survival to old age is a demonstration of a male's high genetic and/or phenotypic quality. Consequently, declines in sperm fitness may be offset by indirect fitness benefits exhibited in offspring. While numerous studies have investigated age-based declines in male fertility, none has taken the integrated approach of studying age-based effects on both male fertility and offspring fitness. Here, using a cohort-based longitudinal study of zebrafish (Danio rerio), we report a decline in male mating success and fertility with male age but also compensating indirect benefits. Using in vitro fertilization, we show that offspring from older males exhibit superior early survival compared to those from their youngest counterparts. These findings suggest that the high offspring fitness observed for the subset of males that survive to an old age (approx. 51% in this study) may represent compensating benefits for declining fertility with age, thus challenging widely held views about the fitness costs of mating with older males.
Treatment options in narcolepsy

Introduction: Narcolepsy is a rare disorder classified as hypersomnia of central origin. Its core symptoms are excessive daytime sleepiness (EDS) and cataplexy. Associated symptoms, hypnagogic hallucinations, sleep paralysis, automatic behavior, and sleep fragmentation, are unspecific. Genetic, autoimmune, and environmental factors contribute to hypocretin deficiency. Areas covered: This article focuses on therapies for narcolepsy symptoms and comorbid disorders. Despite the enormous increase of knowledge about narcolepsy's pathologies no substance has been developed that can cure the disease. So far hypocretin substitution is not available. Substances targeting the autoimmune mechanism have failed to show objective improvement despite subjective improvement. The standard medication in adults comprises stimulants and anticataplectics. Only few substances are capable of improving core and associated symptoms. Within the last years, only modafinil and its enantiomer armodafinil and sodium oxybate have been approved as new substances. Expert opinion: The choice of stimulants to treat excessive daytime sleepiness in narcolepsy needs to be expanded and anticataplectic medication needs to be approved for the indication. Head-to-head comparisons between the established medications, studies of high evidence in older non-evidence-based medications, in children, pregnant women, and of behavioral therapy need to be performed including the long-term effects on metabolic and cardiovascular risks. Narcolepsy is a model disease for so many sleep disorders, among which it has the most severe daytime sleepiness. New insights into its etiology have advanced sleep medicine immensely. Still it stays an orphan in terms of treatment options which are challenging because narcolepsy covers so many symptoms from neuropsychological metabolic-, cardiovascular-, endocrinological-, movement disorders, and parasomnias to name a few.
Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial

While high levels of activity and exercise training have been associated with improvements in sleep quality, minimum levels of activity likely to improve sleep outcomes have not been explored. A two‐armed parallel randomized controlled trial (N=41; 30 females) was designed to assess whether increasing physical activity to the level recommended in public health guidelines can improve sleep quality among inactive adults meeting research diagnostic criteria for insomnia. The intervention consisted of a monitored program of ≥150 min of moderate‐ to vigorous‐intensity physical activity per week, for 6 months. The principal end‐point was the Insomnia Severity Index at 6 months post‐baseline. Secondary outcomes included measures of mood, fatigue and daytime sleepiness. Activity and light exposure were monitored throughout the trial using accelerometry and actigraphy. At 6 months post‐baseline, the physical activity group showed significantly reduced insomnia symptom severity (F8,26 = 5.16, P = 0.03), with an average reduction of four points on the Insomnia Severity Index; and significantly reduced depression and anxiety scores (F6,28 = 5.61, P = 0.02; and F6,28 = 4.41, P = 0.05, respectively). All of the changes were independent of daily light exposure. Daytime fatigue showed no significant effect of the intervention (F8,26 = 1.84, P = 0.18). Adherence and retention were high. Internationally recommended minimum levels of physical activity improve daytime and night‐time symptoms of chronic insomnia independent of daily light exposure levels.
Identity and Intimacy Crises and Their Relationship to Internet Dependence among College Students

In an attempt to test Kandell's proposition that internet dependents used the internet as a coping mechanism against underlying psychological issues, this study investigated the extent to which the fifth and sixth Eriksonian crises (identity, intimacy), were related to internet dependence (online chatting, gaming) among college students. Students spending more than 10 hours per week on chatting/gaming were classified as dependents. On the basis of a national sample of freshmen in Taiwan, this study found that the dependents scored significantly lower on most of the measures that reflected the successful resolution of the crises, and higher on the measures that reflected unsuccessful resolution of the crises. Kandell's proposition was supported.
Recent prey capture experience and dynamic habitat quality mediate short-term foraging site fidelity in a seabird

Foraging site fidelity allows animals to increase their efficiency by returning to profitable feeding areas. However, the mechanisms underpinning why animals ‘stay’ or ‘switch’ sites have rarely been investigated. Here, we explore how habitat quality and prior prey capture experience influence short-term site fidelity by the little penguin (Eudyptula minor). Using 88 consecutive foraging trips by 20 brooding penguins, we found that site fidelity was higher after foraging trips where environmental conditions were favourable, and after trips where prey capture success was high. When penguins exhibited lower site fidelity, the number of prey captures relative to the previous trip increased, suggesting that switches in foraging location were an adaptive strategy in response to low prey capture rates. Penguins foraged closer to where other penguins foraged on the same day than they did to the location of their own previous foraging site, and caught more prey when they foraged close together. This suggests that penguins aggregated flexibly when prey was abundant and accessible. Our results illustrate how foraging predators can integrate information about prior experience with contemporary information such as social cues. This gives insight into how animals combine information adaptively to exploit changing prey distribution in a dynamic environment.
Tip-dating and homoplasy: reconciling the shallow molecular divergences of modern gharials with their long fossil record

Simultaneously analysing morphological, molecular and stratigraphic data suggests a potential resolution to a major remaining inconsistency in crocodylian evolution. The ancient, long-snouted thoracosaurs have always been placed near the Indian gharial Gavialis, but their antiquity (ca 72 Ma) is highly incongruous with genomic evidence for the young age of the Gavialis lineage (ca 40 Ma). We reconcile this contradiction with an updated morphological dataset and novel analysis, and demonstrate that thoracosaurs are an ancient iteration of long-snouted stem crocodylians unrelated to modern gharials. The extensive similarities between thoracosaurs and Gavialis are shown to be an almost ‘perfect storm’ of homoplasy, combining convergent adaptions to fish-eating, as well resemblances between genuinely primitive traits (thoracosaurs) and atavisms (Gavialis). Phylogenetic methods that ignore stratigraphy (parsimony and undated Bayesian methods) are unable to tease apart these similarities and invariably unite thoracosaurs and Gavialis. However, tip-dated Bayesian approaches additionally consider the large temporal gap separating ancient (thoracosaurs) and modern (Gavialis) iterations of similar long-snouted crocodyliforms. These analyses robustly favour a phylogeny which places thoracosaurs basal to crocodylians, far removed from modern gharials, which accordingly are a very young radiation. This phylogenetic uncoupling of ancient and modern gharial-like crocs is more consistent with molecular clock divergence estimates, and also the bulk of the crocodylian fossil record (e.g. all unequivocal gharial fossils are very young). Provided that the priors and models attribute appropriate relative weights to the morphological and stratigraphic signals—an issue that requires investigation—tip-dating approaches are potentially better able to detect homoplasy and improve inferences about phylogenetic relationships, character evolution and divergence dates.
Oxygen desaturation during night sleep affects decision‐making in patients with obstructive sleep apnea

This study assessed decision‐making and its associations with executive functions and sleep‐related factors in patients with obstructive sleep apnea. Thirty patients with untreated obstructive sleep apnea and 20 healthy age‐ and education‐matched controls performed the Iowa Gambling Task, a decision‐making task under initial ambiguity, as well as an extensive neuropsychological test battery. Patients, but not controls, also underwent a detailed polysomnographic assessment. Results of group analyses showed that patients performed at the same level of controls on the Iowa Gambling Task. However, the proportion of risky performers was significantly higher in the patient group than in the control group. Decision‐making did not correlate with executive functions and subjective ratings of sleepiness, whereas there was a significant positive correlation between advantageous performance on the Iowa Gambling Task and percentage of N2 sleep, minimal oxygen saturation, average oxygen saturation and time spent below 90% oxygen saturation level. Also, the minimal oxygen saturation accounted for 27% of variance in decision‐making. In conclusion, this study shows that a subgroup of patients with obstructive sleep apnea may be at risk of disadvantageous decision‐making under ambiguity. Among the sleep‐related factors, oxygen saturation is a significant predictor of advantageous decision‐making.
Differences of brain electrical activity between moderate and severe obstructive sleep apneic patients: a LORETA study

The effects of initiation of continuous positive airway pressure (CPAP) therapy on electroencephalographic (EEG) background activity were investigated in patients exhibiting both moderate (n = 13) and severe (n = 12) obstructive sleep apnea syndromes in the testing of the potential differences of alterations of brain electrical activity caused by chronic hypoxia between these two groups. A normal control group (n = 14) was also examined. Two EEG examinations were achieved in each group: before and after first‐time CPAP therapy. Low‐resolution electromagnetic tomography (LORETA) was implemented towards localizing the generators of EEG activity in separate frequency bands. Prior to CPAP treatment, as a common direction of change, analysis with LORETA demonstrated increased activity in comparison with the patient and control groups. In the moderate group, significant changes were detected in the alpha2 band in the posterior cingulate cortex as well as in the beta1 band in the right posterior parietal cortex and the left supramarginal gyrus. In the severe group, significant changes were found in theta and alpha1 bands in the posterior cingulate cortex. Following CPAP treatment, these significant differences vanished in the severe group. In the moderate group, significantly decreased activity was seen in the beta3 band in the right fusiform gyrus. These findings potentially suggest a normalizing effect of CPAP therapy on EEG background activity in both groups of obstructive sleep apnea syndrome patients. Compensatory alterations of brain electrical activity in regions associated with influencing successful memory retrieval, emotional perception, default mode network, anorexia and fear network caused by chronic intermittent hypoxia could possibly be reversed with the use of CPAP therapy.