CLINICAL FEATURES OF ANXIETY DISORDER IN POST-COVID-19 SYNDROME AND FINDING OF ITS PREDICTORS

the article summarizes and describes clinical features of anxiety disorders in post-COVID-19 syndrome. Mental and neurological disorders occupy a leading place in the structure of post-COVID syndrome. Recent studies indicate an increase in the incidence of anxiety disorders in individuals with COVID-19. However, no clinical or laboratory features of the post-COVID anxiety disorders have been identified. Therefore, our study aimed to describe the clinical features of anxiety disorders in the post-COVID period and to develop a mathematical prognostic model to identify potential predictors of post-COVID anxiety disorder. We conducted a case-control clinical study, which included 145 males and females, which were divided into 2 groups, namely: group 1 - patients who became ill with COVID-19 during the last 6 months and group 2 - persons who were not ill with COVID-19 during the last 6 months. The clinical interview included the registration of symptoms of the debut and the time of the debut relative to the episode of COVID-19. The Beck anxiety inventory was used for the assessment of the overall level of anxiety. The State-trait anxiety inventory was used to assess state and trait anxiety. Statistical analysis of the data was performed using the program EZR Statistics 1.54. Anxiety disorders during the first 6 months after COVID-19 develop more often than those who have not had the disease in the last six months. Patients who had COVID-19 in the last 5-24 weeks have an increased risk of anxiety disorders during this period and therefore require close medical supervision and sufficient awareness of the likely symptoms. People with a post-COVID anxiety disorder reported the presence of autonomic symptoms, including excessive sweating and tachycardia, a feeling of inner emptiness, as well as circadian rhythm disorders in the form of difficulty falling asleep and waking up at the desired time. It should be noted that the overall frequency of detection of anxiety disorders in the post-COVID period is increasing. It has been established that the risk of developing post-COVID disorder decreases with knowledge of the fact of contact with an infected person before the COVID onset and increases with a heightened level of prior personal anxiety. Circadian rhythm disorders, in particular sleep phase shift and abnormal fatigue, may be predictors of post-COVID anxiety disorder.

Polycystic Ovary Syndrome, Obesity and Melatonin: An Etiological Perspective

Although the reproductive and metabolic dysfunctions associated with polycystic ovary syndrome are clearly known, the mechanisms between these dysfunctions are still unclear. One of the hypotheses put forward for these mechanisms is related to circadian rhythm. To date, many reproductive and metabolic dysfunctions have been associated with circadian rhythm disorders. Especially in women with polycystic ovary syndrome, the relationship between melatonin rhythm, which lasts until late in the morning and starts early at night, and metabolic dysfunctions has been revealed by recent studies. When the relationship between obesity and melatonin is examined, it is clearly seen that melatonin exhibits its effect on energy expenditure rather than energy intake. This hormone affects energy expenditure through adipogenesis, thermogenesis, mitochondrial functions and adipocytokines release, and shows anti-obesity effect. It is thought that this review will shed light on further studies on the therapeutic use of melatonin in obesity associated with polycystic ovary syndrome and contribute to the development of strategies for the prevention of obesity.

Mechanisms of the Rapid Effects of Ketamine on Depression and Sleep Disturbances: A Narrative Review

Recently, sleep has been recognized as a crucial factor for health and longevity. The daily sleep/wake cycle provides the basis of biorhythm, which controls whole-body homeostasis and homeodynamics. Sleep disturbances can contribute to several physical and psychological disorders, including cardiovascular disease, obesity, depression, and cognitive dysfunction. The clinical use of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine began in the 1970s. Over the years, physicians have used it as a short-acting anesthetic, analgesic, and antidepressant; however, in-depth research has revealed new possible applications for ketamine, such as for treating sleep disturbances and circadian rhythm disorders. The aim of this narrative review is to examine the literature on the mechanistic role of the antidepressant ketamine in affecting sleep disturbance. Additionally, we discuss the pharmacologic and pharmacokinetic mechanisms of ketamine as an antidepressant and the predictive biomarkers for ketamine’s effect on sleep and cognitive function.

Circadian Dysregulation: A Mainstream Mess of the Present World

The physiological systems of humans and other organisms are periodic in nature. One such system is a circadian rhythm, a biological internal clock that is endogenous and entrainable. The circadian rhythm regulates essential functions such as the sleep/wake cycle, hormones, feeding behaviour, metabolism and cell division as well. Due to shift work or jet lag or even irregular sleep, diet, etc., circadian rhythm disorders are one of the most common problems in this century. It is a major factor that can trigger various diseases like depression, lung tumorigenesis, cancer, anxiety, depression and many more. The purpose of this review is to discuss circadian dysregulation and its potential long-term effects in cancer including lung tumor and mental illness including depression, anxiety. Loss of autonomous cells containing Bmal1 and Per2 (the core components of circadian rhythm) will increase growth and metabolism imbalance and increase in c-Myc levels. To treat circadian rhythm disorders, zeitgebers (external cues) should be used to entrain or synchronize the circadian rhythm and sleep phase chronotherapy can also be used.

EFFECT OF MELATONIN ON PAIN SYNDROME IN DELAYED SLEEP PHASE DISORDER IN PATIENTS WITH PARKINSON'S DISEASE

Parkinson’s disease is characterized mainly by damage to the neurons of the substantia nigra and other brain structures and manifested by motor and non-motor symptoms. In patients with Parkinson’s disease receiving dopaminergic therapy, a later onset of sleep has been identified that is associated with the development of the delayed sleep phase disorder. The delayed sleep phase disorder is characterized by a persistent delay in the circadian rhythm that causes a delay in the desired time of falling asleep and waking up. According to clinical guidelines for the treatment of delayed sleep phase disorder, exogenous melatonin is recommended. Along with this, its analgesic properties have been reported. At the same time circadian regulation of fluctuations of painful sensations transmission by either peripheral or central alarm system has been reported. In particular, the two-way connection between the nociceptive system and the circadian rhythm in the human body determines the possibility of mutual influence between these systems. However, the question of the therapeutic effect of melatonin in the presence of concomitant pathology on the circadian rhythm disorders, and, in particular, delayed sleep phase disorder that is a topical issue for patients with Parkinson's disease, is still remaining unexplored. The aim of the study is to compare the changes in subjective perception of pain in patients with Parkinson's disease, who received melatonin therapy and who did not, in delayed sleep phase disorder. We conducted a prospective study that included 48 patients with Parkinson's disease. Circadian rhythm disorders were diagnosed according to the criteria of the International Classification of Sleep Disorders-3. The diagnosis of delayed sleep phase disorder was made on the basis of a clinical interview, filling in a sleep diary and daily thermometry for 7 days. The examined patients were divided into 2 groups according to the chosen method of treatment: group 1 - patients with Parkinson's disease and delayed sleep phase disorder receiving melatonin; group 2 - patients with Parkinson's disease and delayed sleep phase disorder receiving only general recommendations for improving sleep quality and daily functioning without medical intervention. The Unified Parkinson's Disease Rating Scale was used to assess the severity of patients’ clinical condition. The intensity of the pain syndrome was assessed on a visual-analogue scale. The McGill Questionnaire was used to analyze subjective experiences of pain. The patients of group 1 were prescribed to take melatonin, 1 tablet in a dose of 3 mg at 22:00. Individuals in group 2 received general recommendations on the schedule of sleep-wake cycles, light regime and sleep hygiene. Patients with Parkinson's disease and delayed sleep phase disorder have been diagnosed with mild to moderate pain. Treatment of delayed sleep phase disorder in patients with Parkinson's disease reduces the intensity and modality of the pain syndrome, which may be due to improved functioning of the descending pain modulation system and restoration of rhythmic expression of internal clock genes. The administration of melatonin as part of a comprehensive approach to the treatment of circadian rhythm disorders helps to reduce sensory sensations and affective experiences caused by pain that indicates the potential antinociceptive effect of melatonin in the treatment of circadian disorders.

Circadian Disorders, Insomnia, and Parasomnias

Circadian rhythm disorders have misalignment between the desired sleep schedule and the circadian (24-hour) sleep-wake rhythm. Many persons experience this misalignment with jet lag. Other common circadian rhythm disorders include delayed sleep-phase disorder, advanced sleep-phase disorder, and shift-work sleep disorder. Insomnia is one of the most common medical concerns, and its prevalence increases with age. Patients may have difficulty initiating sleep or maintaining sleep and generally have a poor quality of sleep. Causes of insomnia are multifactorial.

P114 The effect of light interventions on sleep macro- and micro-architecture in sleep and circadian rhythm disorders: A scoping review

Introduction Light interventions have been used to treat sleep and circadian rhythm disorders. However, there are limited studies on the effect of light on electroencephalographic (EEG) activity during sleep. Therefore, we aimed to provide an overview of research using light intervention on sleep macro- and micro-architecture. Methods We searched for randomised controlled trials that used light interventions and examined the effect on sleep measured using EEG in MEDLINE, PubMed, CINAHL, CENTRAL and PsycINFO databases. We included studies that examined the light intervention on sleep EEG in participants with a sleep or circadian rhythm disorder. Results Four studies met the inclusion criteria in patients with insomnia only. These studies reported only sleep macro-architecture outcomes with three studies showing no effect of the timing or intensity of light intervention on total sleep time, wake after sleep onset, sleep efficiency and sleep stage duration. Only one study reported a significantly higher sleep efficiency after night-time light intervention (>4,000 lx, 21:00-23:00 h) compared with afternoon light intervention (>4,000 lx, 15:00-17:00 h). However, none of these studies reported sleep micro-architecture (power spectral analysis). Conclusion Overall, there was limited evidence about the effect of light intervention on EEG sleep measures and studies were confined to insomnia patients only. This review could not find any data on sleep EEG spectral power related to light interventions. Research needs to be conducted into the effect of lighting interventions in clinical populations on sleep macro- and micro-architecture to better understand the effect on objective sleep timing and quality.

Abstract P131: RISK FACTORS AND WAYS OF INFLUENCING MASKED UNCONTROLLED HYPERTENSION

Purpose: to establish risk factors of masked uncontrolled hypertension (MUCH) and clarify how fixed combinations can affect blood pressure (BP) control. Methods: We examined 70 patients with hypertension. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients, 63 were able to reach essential office BP reduction point (these patients were additionally scheduled for ABPM). Results: Among 63 patients in whom hypertension was controlled according to office BP data, 58.7% had insufficient BP control according to ABPM data. Among patients with insufficient control of out-of-office BP, there were significantly more patients with circadian rhythm disorders (p=0.000). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 78.4%, male sex - in 59.5%, smoking - in 70.3%, stress - in 78.4%, various sleep disorders - in 45.9%, diabetes mellitus (DM) - in 56.8%, obesity - in 67.6%, insulin resistance (IR) - in 73%, chronic kidney disease (CKD) - in 35.1% patients with MUCH. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients - free dual combinations, and 21 patients - fixed dual combinations. For patients with MUCH, antihypertensive therapy was strengthened: patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (both drugs acted for 24 hours), and those patients who received double fixed combinations were transferred to triple fixed combinations. Evaluation of therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 86.5% (in the remaining 13.5%, despite sufficient office BP control, MUCH was maintained according to ABPM data). Conclusions: In inadequate control of out-of-office BP, disturbances of the circadian rhythm are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out-of-office BP in 86.5% of patients with previously established MUCH.