Search Results (31)

Background: This study aimed to evaluate the effects of obstructive sleep apnea syndrome (OSAS) surgery on oxidative stress, antioxidant capacity, and oxidative protein modifications. Changes in Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Advanced Oxidation Protein Products (AOPP), Ischemia-Modified Albumin (IMA), and Total Thiol (TT) levels were analyzed in the preoperative and postoperative periods. Methods: Sixty-seven patients aged 18–65 years with an Apnea–Hypopnea Index (AHI) > 5 who underwent OSAS surgery were included. Demographic characteristics were recorded. Venous blood samples were collected at four time points: before anesthesia induction (T1), at the end of surgery (T2), on postoperative day 3 (T3), and at postoperative month 3 (T4). TOS, TAS, AOPP, IMA, and TT levels were measured and statistically evaluated. Results: Of the patients, 13.4% (n = 9) were female and 86.6% (n = 58) were male. No significant changes were observed in TOS, TAS, AOPP, or IMA levels between time points. However, TT levels at postoperative month 3 were significantly higher than those at earlier measurements (p < 0.05). Positive correlations were found between AHI and TOS, AOPP, and IMA levels, while TAS and TT showed no significant correlation with AHI. Conclusions: Surgery for OSAS did not produce significant postoperative improvements in oxidative stress parameters except for TT elevation. These results indicate that surgical intervention alone may be insufficient for biochemical recovery in OSAS and should be complemented by lifestyle and supportive therapies. Full article

Training distress is a multifactorial psychophysiological response resulting from the interaction of sustained high-intensity training, insufficient recovery, and additional psychosocial stressors. It manifests through mood disturbance, elevated perceived stress, fatigue, sleep disruption, and physical symptoms, and represents a precursor to maladaptive outcomes such as overtraining syndrome. The Multicomponent Training Distress Scale (MTDS) integrates these dimensions into a single monitoring framework; however, no validated Italian version has been available. The present study aimed to develop and provide a validation of the Italian Multicomponent Training Distress Scale (IMTDS). The IMTDS was administered to 536 Italian-speaking recreational and competitive sport participants (276 males, 260 females; age range = 16–35 years, M = 25.31, SD = 5.62). Exploratory Structural Equation Modeling supported the hypothesized six-factor structure (Depression, Vigor, Physical Symptoms, Sleep Disturbances, Stress, Fatigue), demonstrating acceptable model fit (CFI = 0.97, TLI = 0.92, RMSEA = 0.10). Internal consistency was satisfactory to high across subscales (ω = 0.82–0.88), and test–retest analyses indicated temporal stability. Intercorrelations among dimensions were consistent with theoretical expectations. These findings provide evidence that the IMTDS is a reliable instrument for monitoring training distress in Italian-speaking athletes. Full article

Background/Objectives: Obstructive sleep apnea (OSA) syndrome is characterized by recurrent upper airway obstruction during sleep and is closely associated with systemic inflammation and cardiometabolic risk. α-Klotho and fibroblast growth factor-23 (FGF-23) are emerging biomarkers with potential roles in vascular homeostasis, inflammation, and metabolic regulation. However, their relevance in OSA remains insufficiently elucidated. The aim of this study was to evaluate serum α-Klotho and FGF-23 levels in patients with OSA and to investigate their associations with disease severity. This represents a novel approach that may provide new insights into the pathophysiological mechanisms linking OSA with cardiometabolic risk. Methods: A total of 133 participants were included in this study and categorized into three groups according to apnea–hypopnea index: 1—simple snoring (n = 44); 2—non-severe OSA (n = 44); and 3—severe OSA (n = 45). Comparisons between two groups were performed using Student’s t-test for normally distributed variables. Comparisons among three or more groups were conducted using one-way ANOVA and the Kruskal–Wallis test. ANCOVA was applied to compare α-Klotho and FGF-23 levels between groups after adjustment for age, BMI, diabetes, hypertension, asthma, COPD, and thyroid disease. The predictive performance of α-Klotho and FGF-23 for severe obstructive sleep apnea was evaluated using ROC curve analysis. Results: Serum α-Klotho levels decreased significantly with increasing OSA severity (p = 0.001). Serum FGF-23 levels increased significantly across AHI groups (p = 0.001). After adjustment for age, BMI, diabetes, hypertension, asthma, thyroid disease, COPD and vitamin D levels, α-Klotho levels were lower in the severe and non-severe OSA group (p = 0.001, both) compared to the simple snoring group, whereas FGF-23 levels were higher in the severe and non-severe OSA group (p = 0.001; both) compared to the simple snoring group. In predicting the risk of severe OSA compared with non-severe OSA, an α-Klotho cut-off value of 280.3 yielded a sensitivity of 84.44% and specificity of 75%, whereas an FGF-23 cut-off value of 75.5 yielded a sensitivity of 62.2% and specificity of 72.7%. Conclusions: Serum α-Klotho levels significantly decrease while FGF-23 levels increase in correlation with OSA severity. α-Klotho exhibited superior predictive performance over FGF-23 in identifying severe OSA, suggesting its potential as a more sensitive biomarker for systemic involvement. These results indicate that the α-Klotho/FGF-23 axis is independently associated with OSA and may play a pivotal role in the pathophysiological mechanisms linking intermittent hypoxia to increased cardiometabolic risk. Full article

Background and Objectives: Variations in serum 25-hydroxyvitamin D [25(OH)D] concentrations have been described among individuals working in different settings. Moreover, published evidence suggests an association between Obstructive Sleep Apnea Syndrome (OSAS) and 25(OH)D insufficiency. The aim of this study was to assess the association between certain exposures in the occupational environment and 25(OH)D levels, in relation to OSAS severity. Materials and Methods: For a period of 12 months, 25(OH)D serum levels were assessed in subjects consecutively investigated for OSAS. These were divided into group A (control subjects working indoors), group B (control subjects working outdoors), group C (OSAS patients working indoors) and group D (OSAS patients working outdoors). Results: A total of 189 subjects were included (155 males and 34 females), comprising 129 OSAS patients and 60 non-apnoeic controls. Serum 25(OH)D levels were significantly higher in group B compared to the other groups (32 ± 13 vs. 23 ± 7 ng/mL for group A, p = 0.001; vs. 15 ± 8 ng/mL for group C, p < 0.001; and vs. 23 ± 9 ng/mL for group D, p < 0.001). Additionally, serum 25(OH)D levels were higher in group A compared with group C (23 ± 7 vs. 15 ± 8 ng/mL, p = 0.001), while no significant difference was observed between groups A and D (p > 0.05). Regression analysis revealed that the apnoea–hypopnoea index (β = 0.02, OR = 1.02, 95% CI: 1.00–1.04, p = 0.02) and indoor occupation (β = 1.03, OR = 2.80, 95% CI: 1.17–6.70, p = 0.02) were independently associated with vitamin D insufficiency. Conclusions: Serum 25(OH)D levels are decreased in OSAS patients working indoors. Thus, the working environment should also be considered in the overall assessment of 25(OH)D status in OSAS patients. Full article

Background and Objectives: The conflicting findings in existing studies and insufficient evidence highlight the necessity for additional research on the relationship between sleep quality and coronary artery disease (CAD) in elderly acute coronary syndrome (ACS) patients. We aimed to investigate the association between sleep quality and the CAD severity of in geriatric patients with ACS. Materials and Methods: This retrospective observational cohort study analyzed data from 308 patients aged 65 years and older admitted with ACS who had undergone coronary angiography between May 2022 and June 2025 at a tertiary cardiology department. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at the 6-month follow-up, with scores > 5 indicating poor quality. CAD severity was quantified by SYNTAX score from angiograms. The primary endpoint was the relationship between PSQI and SYNTAX score, with secondary analyses concerning factors associated with clinical outcomes. Results: Poor sleep quality (PSQI > 5) was associated with higher SYNTAX scores (p < 0.001), lower ejection fraction (p < 0.001), higher CRP (median 5.1 vs. 4.05, p = 0.029), NT-proBNP (median 748.5 vs. 595, p = 0.034), lower glomerular filtration rate (p = 0.025), and higher hypertension prevalence (p = 0.034). ST-elevation myocardial infarction was more common in subjects with poor sleep. Multivariable logistic regression identified hypertension (p = 0.011), reduced ejection fraction (p = 0.030), STEMI (p = 0.045), intermediate SYNTAX (p = 0.003), and high SYNTAX (p = 0.009) as associated factors of poor sleep. Conclusions: Poor sleep quality is independently linked to greater CAD severity in geriatric ACS patients. This is a modifiable risk factor that can reduce morbidity and mortality in this high-risk group. Full article

Introduction: Tumor- and/or treatment-associated hypothalamic damage results in reduced quality of life and increased morbidity due to sleep disorders in survivors of craniopharyngioma. Methods: The narrative review is based on a search of Web of Science, MEDLINE/PubMed, and Embase databases for the identification of publications. The search terms craniopharyngioma, sleep disorders, fatigue, and daytime sleepiness were used. Selected English language papers published 1970–2025 were included. Results: Circadian rhythms (wakefulness and sleep) are controlled by hypothalamic suprachiasmatic nuclei and regulated by melatonin. A dysregulation of circadian rhythms due to altered melatonin secretion can be observed in craniopharyngioma with hypothalamic involvement. Furthermore, sleep quality is regulated by lateral hypothalamic areas, the ventrolateral preoptic nucleus, and monoaminergic nuclei which function as the arousal system. Flexible changes between sleep and wakefulness can be achieved through interaction of arousal and sleep-promoting systems named “flip–flop” switch. Insomnia can be the result of damage to the ventrolateral preoptic nucleus. Excessive daytime sleepiness and disrupted sleep patterns can be observed due to dysregulation of lateral hypothalamic areas. Obesity, chronic fatigue, headache, and excessive daytime sleepiness can be the result of poor sleep quality. “Primary” hypothalamic sleep dysfunction, including narcolepsy, dysregulated sleep–wake cycles, and hypersomnia, can be observed due to hypothalamic dysfunction. “Secondary” sleep disturbances including obstructive sleep apnea, insufficient substitution medication for arginine vasopressin deficiency (nocturia), or psychosocial factors are sequelae in patients with craniopharyngioma and hypothalamic lesions. Conclusions: Further research on novel treatment approaches for sleep disorders due to hypothalamic syndrome are warranted to improve the outcome after craniopharyngioma. Full article

Background/Objectives: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. Methods: Between January and July 2025, 180 employees enrolled for a 30 min consultation including medical history review, lifestyle assessment, and evaluation of vaccination and screening status according to age, risk factors, and national guidelines. Standardized tools (PSS-14, PHQ-9) assessed perceived stress and mental well-being. Participants rated satisfaction and perceived care quality on a 10-point Likert scale. Results: Of 180 enrolled, 154 completed the evaluation. The majority of participants were female (68.8%), with a mean age of 54 years, and 42.9% held a higher education degree. Common lifestyle characteristics included current smoking (24.7%), regular alcohol consumption (9.8%), and insufficient sleep (mean 6.5 h/night). Overweight (40.3%) and obesity (29.2%) were prevalent. Chronic conditions were reported in 87.0% of participants, with dyslipidemia (54.5%), allergies (35.8%), and hypertension (26.9%) being the most frequent. Criteria for metabolic syndrome were found in 33.1% of participants with a higher prevalence in men (50.0% vs. 25.0%; p = 0.029). Mental health assessments revealed moderate stress levels (mean PSS-14: 23.7) and mostly minimal depressive symptoms (mean PHQ-9: 4.3). Preventive screening was variable, with higher adherence for mammography (79.2%) and lower for colonoscopy (40.2%). Service satisfaction was high, with significant increases in perceived usefulness (8.96 to 9.80, p < 0.001) and satisfaction (9.08 to 9.87, p < 0.001) after the intervention. Conclusions: This pilot revealed critical gaps in vaccination, cardiometabolic risk, and stress management among public employees. It was also shown that integrated workplace-based health models are both feasible and acceptable. These models can effectively deliver preventive actions on a scale and represent a promising strategy for strengthening occupational health in employed adult population. Full article

Cardiovascular–Kidney–Metabolic syndrome, introduced by the American Heart Association in 2023, represents a complex and interconnected spectrum of diseases driven by shared pathophysiological mechanisms. However, this framework notably excludes the liver—an organ fundamental to metabolic regulation. Building on this concept, Cardiovascular–Renal–Hepatic–Metabolic (CRHM) syndrome incorporates the liver’s pivotal role in this interconnected disease spectrum, particularly through its involvement via metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the increasing prevalence of CRHM syndrome, unified management strategies remain insufficiently explored. This review addresses the following critical question: How can novel anti-diabetic agents, including sodium–glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dual gastric inhibitory polypeptide (GIP)/GLP-1RA, offer an integrated approach to managing CRHM syndrome beyond the boundaries of traditional specialties? By synthesizing evidence from landmark clinical trials, we highlight the paradigm-shifting potential of these therapies. SGLT2is, such as dapagliflozin and empagliflozin, have emerged as cornerstone guideline-directed treatments for heart failure (HF) and chronic kidney disease (CKD), providing benefits that extend beyond glycemic control and are independent of diabetes status. GLP-1RAs, e.g., semaglutide, have transformed obesity management by enabling weight reductions exceeding 15% and improving outcomes in atherosclerotic cardiovascular disease (ASCVD), diabetic CKD, HF, and MASLD. Additionally, tirzepatide, a dual GIP/GLP-1RA, enables unprecedented weight loss (>20%), reduces diabetes risk by over 90%, and improves outcomes in HF with preserved ejection fraction (HFpEF), MASLD, and obstructive sleep apnea. By moving beyond the traditional organ-specific approach, we propose a unified framework that integrates these agents into holistic management strategies for CRHM syndrome. This paradigm shift moves away from fragmented, organ-centric management toward a more unified approach, fostering collaboration across specialties and marking progress in precision cardiometabolic medicine. Full article

Study design: Systematic review. Objective: Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains debatable. This review provides an overview of the incidence of airway obstructive outcomes related to different surgical modalities. Methods: A systematic search was performed on the 1st of February following the PRISMA guidelines and registered on PROSPERO (CRD42022299715). The following databases were reviewed: Medline, EMBASE, Web of Science, Google Scholar, and the Cochrane Library databases. Studies that included data on the occurrence of OSA following velopharyngeal surgery in children with a repaired non-syndromic cleft palate were included. Non-English articles and studies that included syndromic cleft palate patients were excluded. Results: Twenty-eight articles met the inclusion criteria. The surgical procedures are classified into three groups: pharyngeal flap procedure (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR). Incidence of post-operative OSA and symptoms of OSA were lowest after PMR compared to SP and PF (3%; 34%; 29%, respectively). Pharyngeal flap procedures resulted in the best speech outcomes. Conclusions: PMR results in fewer postoperative complications in terms of OSA and achieves a satisfactory reduction in hypernasal speech. PF procedure carries a higher risk of developing OSA postoperatively but seems to be superior in the reduction in hypernasality. Full article

Sleep disorders in children have a negative impact on mental and physical development, and a lack of sleep is one of the most important problems in infancy. At the age when naps are commonly accepted, the judgment of whether the amount of sleep is adequate has been based on the total amount of sleep per day. In other words, the idea is that even if the amount of sleep at night is insufficient, it is not considered insufficient if it is compensated for by taking a long nap or sleeping late on weekend mornings. However, these lifestyle habits disrupt the circadian rhythm and cause social jet lag, which is not appropriate for healthy mental and physical development. Therefore, in this review, I present the average required nighCime basic sleep duration (NBSD) of 10 h for Japanese and 11 h for Caucasian children as a judgment standard. (1) If the child sleeps less than 8 h at night, and (2) if the child sleeps less than 9 h at night or 30 to 60 min less than the required NBSD, immediate treatment is recommended. I also discuss briefly how to address sleep insufficiency in childhood. Full article

Background: Age-related changes can lead to dietary insufficiency in older adults. The inclusion of high-quality, nutrient-dense foods such as ruminant milks can significantly improve health outcomes. However, many older adults worldwide do not meet daily milk intake recommendations because of digestive discomfort and health concerns. Ovine and caprine milks are increasingly popular for their perceived digestive and nutritional benefits. While preclinical studies suggest differences in milk digestion, human studies investigating acute postprandial responses remain inconclusive, and the impacts of sustained milk consumption remain uncertain. Objectives: Hence, we present a randomized controlled trial investigating how the sustained consumption of bovine, caprine, or ovine milk influences digestion, nutrition, and metabolism in older women. Methods: A total of 165 healthy older women were randomized to receive bovine, caprine, or ovine milk, or no milk, twice daily for 12 weeks. The primary outcome is the impact of milk consumption on digestive comfort assessed via the Gastrointestinal Syndrome Rating Scale (GSRS). Secondary outcomes include changes in nutrient intake, plasma amino acid and lipid appearance, bowel habits, the gut microbiota, cardiometabolic health, physical function, physical activity, sleep, mood, sensory perception, and emotional response. Conclusions: The findings could inform dietary recommendations for older women and facilitate the development of targeted functional food products. Full article

A significant number of adolescents experience sleepiness, primarily due to sleep deprivation. The detrimental effects of inadequate sleep on both physical and mental health are well documented, particularly during adolescence—a critical developmental stage that has far-reaching implications for later life outcomes. The International Classification of Diseases 11th Revision recently introduced the disorder termed ‘insufficient sleep syndrome,’ characterized by a persistent reduction in sleep quantity. However, diagnosing this condition based solely on sleep duration is challenging due to significant individual variation in what constitutes optimal sleep. Despite this, managing sleep debt remains difficult without a clear understanding of individual optimal sleep needs. This review aims to reassess recommended sleep durations, with a focus on enhancing sleep literacy. Beginning with an exploration of insufficient sleep syndrome, this review delves into research on optimal sleep duration and examines foundational studies on sleep debt’s impact on the developing brain. Finally, it addresses the challenges inherent in sleep education programs from the perspective of sleep literacy. By doing so, this review seeks to contribute to a deeper understanding of the chronic sleep debt issues faced by adolescents, particularly those affected by insufficient sleep syndrome. Full article

Background and Objectives: To investigate (1) the prevalence of sleep disorder symptoms in caregivers of children with autism spectrum disorder (ASD) and (2) the relationships between caregiver sleep problems and their health-related quality of life and family quality of life. Materials and Methods: Descriptive cross-sectional study of caregivers (N = 62) of children aged 6 to 11 years old diagnosed with ASD and receiving care at a regional autism research and resource center. Results: Participants completed the Sleep Habits Questionnaire (SHQ), the Medical Outcomes Study (MOS) SF-12, and the Beach Center Family Quality of Life Scale (FQoL). Caregivers with longer sleep duration reported better mental health and better family quality of life. Caregivers who reported insomnia symptoms, non-restorative sleep, and insufficient sleep were more likely to report poorer mental health than caregivers who did not report these sleep disorder symptoms. Caregivers with obstructive sleep apnea and restless legs syndrome experienced worse physical quality of life. Conclusions: The physical and mental health of the primary caregiver is essential to the support of the child with ASD and to the functioning of the family. The study findings point to the importance of future research and interventions to enhance sleep health in order to improve quality of life for caregivers of children with ASD. Full article

At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or ‘post-acute COVID-19 syndrome’ emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients’ quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients’ prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions. Full article

Parkinson’s disease (PD) is a common multidimensional neurological disorder characterized by motor and non-motor features and is more prevalent in the elderly. Sleep disorders and cognitive disturbances are also significant characteristics of PD. Sleep is an important physiological process for normal human cognition and physical functioning. Sleep deprivation negatively impacts human physical, mental, and behavioral functions. Sleep disturbances include problems falling asleep, disturbances occurring during sleep, abnormal movements during sleep, insufficient sleep, and excessive sleep. The most recognizable and known sleep disorders, such as rapid-eye-movement behavior disorder (RBD), insomnia, excessive daytime sleepiness (EDS), restless legs syndrome (RLS), sleep-related breathing disorders (SRBDs), and circadian-rhythm-related sleep–wake disorders (CRSWDs), have been associated with PD. RBD and associated emotional disorders are common non-motor symptoms of PD. In individuals, sleep disorders and cognitive impairment are important prognostic factors for predicting progressing neurodegeneration and developing dementia conditions in PD. Studies have focused on RBD and its associated neurological changes and functional deficits in PD patients. Other risks, such as cognitive decline, anxiety, and depression, are related to RBD. Sleep-disorder diagnosis is challenging, especially in identifying the essential factors that disturb the sleep–wake cycle and the co-existence of other concomitant sleep issues, motor symptoms, and breathing disorders. Focusing on sleep patterns and their disturbances, including genetic and other neurochemical changes, helps us to better understand the central causes of sleep alterations and cognitive functions in PD patients. Relations between α-synuclein aggregation in the brain and gender differences in sleep disorders have been reported. The existing correlation between sleep disorders and levels of α-synuclein in the cerebrospinal fluid indicates the risk of progression of synucleinopathies. Multidirectional approaches are required to correlate sleep disorders and neuropsychiatric symptoms and diagnose sensitive biomarkers for neurodegeneration. The evaluation of sleep pattern disturbances and cognitive impairment may aid in the development of novel and effective treatments for PD. Full article