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Fulltext Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia

Ng ESY, Wong PY, Kamaruddin ATH, Lim CTS, Chan YM

Int J Environ Res Public Health, 2020 Jul 16;17(14).
PMID: 32708766 DOI: 10.3390/ijerph17145144

Despite optimal control of serum phosphate level being imperative to avoid undesirable health outcomes, hyperphosphataemia is a highly prevalent mineral abnormality among the dialysis population. This study aimed to determine factors associated with hyperphosphatemia among hemodialysis patients in Malaysia. Multiple linear regression analysis was used to ascertain the possible factors that influence serum phosphate levels. A total of 217 hemodialysis patients were recruited. Hyperphosphatemia was prevalent. Only approximately 25% of the patients were aware that optimal control of hyperphosphatemia requires the combined effort of phosphate binder medication therapy, dietary restriction, and dialysis prescription. The presence of diabetes mellitus may affect serum phosphate levels, complicating dietary phosphorus management. Patients who were less depressive portrayed higher serum phosphate levels, implying intentional non-compliance. Better compliance on phosphate binder, longer sleep duration, and higher social support was associated with a lower level of serum phosphate. Despite sleep disturbance being one of the most prevalent and intense symptom burdens identified by hemodialysis patients, relatively few studies have addressed this issue. It is time to formulate sleep therapeutic interventions besides the encouragement of strong social support, hoping which many clinical outcomes including hyperphosphatemia can be better controlled among hemodialysis patients.

Matched MeSH terms: Sleep
Fulltext Long sleep duration and cardiovascular disease: Associations with arterial stiffness and blood pressure variability

Matsubayashi H, Nagai M, Dote K, Turana Y, Siddique S, Chia YC, et al.

J Clin Hypertens (Greenwich), 2021 03;23(3):496-503.
PMID: 33377597 DOI: 10.1111/jch.14163

Although short and long sleep duration are both risk factors of cardiovascular disease (CVD), the recent meta-analyses have been shown that long sleep duration was closely associated with CVD mortality. While the specific mechanism underlying the association between long sleep duration and CVD remains unclear, long sleep duration was shown to be associated with arterial stiffness and blood pressure variability (BPV) in many Asian populations. This review article will focus on the pathophysiology of long sleep duration, arterial stiffness, BPV and their effects on CVD. To set the stage for this review, we first summarize the current insights for the relationship between long sleep duration and CVD in relation to arterial stiffness and BPV.

Matched MeSH terms: Sleep
Fulltext The routine histopathological examination of tonsillectomy specimens at Hospital Universiti Sains Malaysia - retrospective study and its implication

Mohamad I, Hassan S, Salim R

Malays J Med Sci, 2007 Jul;14(2):19-21.
PMID: 22993487 MyJurnal

Tonsillectomy is performed for several indications, the two commonest in practice are infective ( chronic tonsillitis ) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of specimens post-tonsillectomy. In this paper, a retrospective evaluation of 480 specimens from 241 patient who has undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 ( 96.25 % ) were reactive lymphoid hyperplasia and 18 ( 3.75 % ) were follicular hyperplasia. None of them were found malignant. The result of this study indicate that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.

Matched MeSH terms: Sleep Apnea Syndromes
Improving detection of obstructive sleep apnoea by overnight oximetry in children using pulse rate parameters

Sahadan DZ, Davey MJ, Horne RS, Nixon GM

Sleep Breath, 2015 Dec;19(4):1409-14.
PMID: 25739713 DOI: 10.1007/s11325-014-1108-4

PURPOSE: Overnight oximetry is a simple tool for investigation of obstructive sleep apnoea (OSA) in children, but only severe cases will be detected, and children with obstructive events resulting in arousal, but not desaturation, will have a normal (inconclusive) result. We hypothesised that pulse rate rises using pulse rate indices per hour (PRI) and pulse rate standard deviation (PR-SD) automatically calculated from commercially available software would improve oximetry as a diagnostic tool.
METHODS: Children having home overnight oximetry for suspected OSA were identified over 12 months, and those with a normal result who went on to have polysomnography (PSG) were included. Oximetry, including PR-SD and PRI (rises of 8, 10 and 15 beats/min per hour), was analyzed using commercially available software. PR parameters were compared between those with OSA (obstructive apnoea-hypopnoea index (OAHI) >1 event/h) and those without OSA.
RESULTS: One hundred sixteen children had normal oximetry, of whom 93 (median age 4.5 years; 55 % M) had PSG. Fifty-seven of 93 (61 %) children had OSA (median OAHI 4.5 events/h, range 1.1-24). PR-SD was not different between the OSA and non-OSA groups (p = 0.87). PRI tended to be higher in those with OSA, but there was considerable overlap between the groups: PRI-8 (mean ± SD 58.5 ± 29.0/h in OSA group vs 48.6 ± 20.2/h in non-OSA group, p = 0.07), PRI-10 (45.1 ± 25.0 vs 36.2 ± 16.7, p = 0.06) and PRI-15 (24.4 ± 14.5 vs 18.9 ± 9.0, p = 0.04). A PRI-15 threshold of >35/h had specificity of 97 % for OSA.
CONCLUSION: The PRI-15 shows promise as an indicator of OSA in children with normal oximetry.

Matched MeSH terms: Sleep Apnea, Obstructive/diagnosis*
Fulltext Prevalence of sleep disordered breathing symptoms among Malay school children in a primary school in Malaysia

Fadzil Abdullah AA, Jamalludin AR, Norrashidah AW, Norzila MZ, Asiah Kassim K, Rus Anida A, et al.

Med J Malaysia, 2012 Apr;67(2):181-5.
PMID: 22822640 MyJurnal

Sleep disordered breathing (SDB) is increasingly being diagnosed in children. However, there is no prevalence study done in Malaysia. The study objective was to evaluate the prevalence of SDB symptoms based on parental reports and associated risk factors among Malay school children aged 6 to 10 years old in a primary school using a translated University Michigan Paediatric Sleep Questionnaire (Malay UM-PSQ). The children whose parents responded to the questionnaire and consented were examined, documenting height, weight, skin fold thickness, neck and abdominal circumference, tonsillar size, nostril examination and presence of micrognathia or retrognathia. There were 550 respondents. The prevalence of parental report of SDB symptoms was 14.9 % (95 % CI 11.9, 17.9). Two hundred and eighty-five (51.8%) school children were males with mean age of 8.5 years (SD 1.1). The associated risk factors for SDB symptoms are male, obesity, large neck and waist circumference, positive history of asthma, history of recurrent tonsillitis, enlarged tonsil (> 4+) and enlarged nasal turbinate. Multivariate analysis showed that male gender is the only significant independent risk factor of SDB symptoms

Matched MeSH terms: Sleep Apnea Syndromes/epidemiology*
Fulltext Effects of uvulopalatopharyngoplasty: a seven year review

Aneeza WH, Marina MB, Razif MY, Azimatun NA, Asma A, Sani A

Med J Malaysia, 2011 Jun;66(2):129-32.
PMID: 22106693 MyJurnal

To review the long term outcome of Uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnoea syndrome in a tertiary referral centre. 38 records were traced where UPPP was done from July 2000 to December 2007. 14 patients were followed up for one to seven years where the Epworth sleepiness scale was scored, long term side effects documented and post operative muller's manoeuvre done. Success of UPPP is defined as a reduction in apnoea hypopnea index (AHI) more than 50%. Sixty percent (60%) were successfully treated with UPPP in the long term. Mean ESS was significantly reduced from 12 +/- 6 to 7 +/- 4. 11 out of 14 patients (78.5%) were reported to develop long term side effects of UPPP, the highest being velopharyngeal insufficiency (42.8%). In conclusion, UPPP is effective in improving symptoms of OSA in the long term. However, in view of its side effects, uvula preserving surgery should be considered as a surgical option.

Matched MeSH terms: Sleep Apnea, Obstructive/surgery*
Bed sharing among mother-infant pairs in Klang district, Peninsular Malaysia and its relationship to breast-feeding

Tan KL

J Dev Behav Pediatr, 2009 Oct;30(5):420-5.
PMID: 19827222 DOI: 10.1097/DBP.0b013e3181ba083a

OBJECTIVE: The aim of the study was to determine the prevalence of mother-infant bed sharing in Klang district, Peninsular Malaysia and to identify factors associated with bed sharing.

METHOD: This was a cross-sectional study involving 682 mother-infant pairs with infants up to 6 months attending government clinics in Klang district, Peninsular Malaysia. Data were collected by face-to-face interview using a pretested structured questionnaire for a 4-month period in 2006. Data regarding maternal, paternal, obstetric, infant, occupancy, breast-feeding characteristics, and bed-sharing practice were collected. Data on bed sharing were based on practice in the past 1-month period. Bed sharing was defined as an infant sharing a bed with mother, and infant must be within arms reach from the mother, whereas a bed was defined as either a sleeping mattress placed on a bed frame or placed on the floor. The prevalence of bed sharing was estimated. Relationship and magnitude of association between independent factors and bed sharing were examined using odds ratio and 95% confidence interval. Logistic regression analysis was used to control for confounding factors.

RESULTS: The prevalence of bed sharing among mothers with infants aged between 1 and 6 months was 73.5% (95% confidence interval: 70.0-76.7). In multivariate analysis, urban/rural differences, mothers' ethnicity, occupation, family income, husbands' support on bed sharing, number of children younger than 12 years staying in the house, and breast-feeding were associated with bed sharing.

CONCLUSIONS: These factors need to be considered in analyzing the overall risks and benefits of bed sharing, paying attention to breastfeeding practices.

Matched MeSH terms: Sleep*
Ramelteon: a melatonin receptor agonist for the treatment of insomnia

Devi V, Shankar PK

J Postgrad Med, 2008 2 26;54(1):45-8.
PMID: 18296808

Ramelteon is a novel MT1 and MT2 melatonin receptor selective agonist recently approved for the treatment of insomnia characterized by difficulty in sleep onset. It is a nonscheduled drug since it lacks the potential for abuse and does not interact with neurotransmitter receptors most associated with these phenomena. Although the effects of ramelteon use > 5 weeks are unknown, the available data confirms its safety and efficacy for short-term use. Clinical use and future research should uncover more information about ramelteon's properties.

Matched MeSH terms: Sleep Initiation and Maintenance Disorders/drug therapy*
Cranial base and airway morphology in adult malays with obstructive sleep apnoea

Banabilh SM, Suzina AH, Dinsuhaimi S, Singh GD

Aust Orthod J, 2007 Nov;23(2):89-95.
PMID: 18200785

Obstructive sleep apnoea (OSA) has been described as a public health problem comparable to smoking in its impacts upon society.

Matched MeSH terms: Sleep Apnea, Obstructive/pathology*
Fulltext A pilot study to determine the short-term effects of milk with differing glycaemic properties on sleep among toddlers: a randomised controlled trial

Misra S, Khor GL, Mitchell P, Haque S, Benton D

BMC Pediatr, 2015;15:79.
PMID: 26174581 DOI: 10.1186/s12887-015-0393-9

BACKGROUND: Sleep is important for children as it directly impacts their mental and physical development. Sleep is not only influenced by the timing but also the macronutrient (carbohydrate and protein) content of meals. Glycaemic index (GI) and glycaemic load (GL) describe the quality of carbohydrates in a food and the burden of these foods on the body's blood glucose response. Diets with a high GI/GL may increase the risk of developing obesity and type 2 diabetes mellitus in adulthood. The present study is piloted to evaluate the short-term impact of milk products with differing glycaemic properties on the sleep patterns of toddlers.
METHODS: Toddlers were recruited from various day care centres. Informed consent was obtained from both the mothers and the centres. A double-blind randomised controlled trial with a between-subjects design was adopted. The toddlers were randomised to either one of two types of milk with a differing GI ("Low" = 23 and "High = 65") for a period of 3.5 days. There were no other dietary restrictions imposed except that the enrolled child did not consume any other milk during the study period. The sleep patterns were recorded using a Phillips Actiwatch-2, which was worn on the wrist for 24 h over 4 days. The parameters used to measure the sleep pattern were sleep-onset latency (SOL), total sleep time (TST), wake after sleep onset (WASO) and sleep efficiency (SE).
RESULTS: A total of 56 toddlers completed the study. The toddlers had a mean age of 19.9 +/- 4.3 months. There were no significant differences (p > 0.05) between the two GI groups for SOL, TST, WASO and SE at the end of the feeding period.
CONCLUSIONS: Sleep patterns of toddlers on low-GI milk did not differ from those with high-GI milk consumed over a short period. Future studies should consider the glycaemic effects of other foods, along with milk with differing GI, consumed for a longer feeding duration.
TRIAL REGISTRATION: ClinicalTrial.gov NCT01589003.

Matched MeSH terms: Sleep/physiology*
Parapharyngeal space lipoma causing sleep apnoea

Abdullah BJ, Liam CK, Kaur H, Mathew KM

Br J Radiol, 1997 Oct;70(838):1063-5.
PMID: 9404213

Lipoma of the parapharyngeal space is very rare, only three cases having been reported in the literature. A parapharyngeal space lipoma causing obstructive sleep apnoea has not been reported before. A 60-year-old man presented at the ear, nose and throat (ENT) clinic with a history of loud snoring associated with sleep apnoea secondary to a right parapharyngeal space lipoma. The causes of sleep apnoea and the radiological features of a parapharyngeal space lipoma are discussed.
Study site: ENT clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Sleep Apnea Syndromes/etiology*
Fulltext A portal recording system for the assessment of patients with sleep apnoea syndrome

Liam CK

Med J Malaysia, 1996 Mar;51(1):82-8.
PMID: 10967984

The gold standard for the diagnosis and evaluation of sleep apnoea is overnight polysomnography. However, full polysomnography is an expensive and labour intensive procedure which requires the patient to sleep overnight in a hospital sleep laboratory. This paper describes the use of a commercial ambulatory microprocessor based system (Edentrace II) for the evaluation of fifteen patients aged 24 to 68 years with clinical features suggestive of sleep apnoea syndrome. With this portable recording system, sleep studies can be carried out unattended in a hospital ward and computer-assisted scoring of respiratory events can be performed.
Study site: Chest clinic, wards, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Sleep Apnea Syndromes/diagnosis*
Fulltext Lethargy in a patient with cirrhosis

Chuah SY, Wong NW, Goh KL

Postgrad Med J, 1997 Mar;73(857):177-9.
PMID: 9135840 DOI: 10.1136/pgmj.73.857.177
Matched MeSH terms: Sleep Stages*
Effect of an extract of Erioglossum edule on the central nervous system

Sattar MA, Gan EK, Loke SE, Mah KF, Wong WH

J Ethnopharmacol, 1989 Apr;25(2):217-20.
PMID: 2747256
Matched MeSH terms: Sleep/drug effects
Fulltext Adeno-tonsillar hypertrophy as a cause of sleep apnoea syndrome

Ravindran VK

Med J Malaysia, 1983 Jun;38(2):164-6.
PMID: 6621450

An interesting case is described here in which partial airway obstruction resulted in sleep apnoea and which was relieved by adeno-tonsillectomy. Enlarged tonsils and adenoids causing upper airway obstruction represent one facet of a continuum of hypoventilation - sleep disorders and clinical examination with x-rays will help in determining patients at risk of developing these syndromes.

Matched MeSH terms: Sleep Apnea Syndromes/etiology*
Psychosocial factors and the health of the elderly Malaysian

Chen PC

Ann Acad Med Singap, 1987 Jan;16(1):110-4.
PMID: 3592576

Consequent to rapidly declining mortality and birth rates, developing countries, including Malaysia, can expect a rapid increase in the population aged 60 years and above. The health of the elderly is intimately tied up with both biophysical as well as psychosocial factors which include status loss, loneliness, fear of illness and death, poverty, harmful life-styles and deterioration of the quality of life. The effects of these psychosocial factors can manifest as sleep difficulties, worry and anxiety, depression, loss of interest, and a feeling of tiredness. In extreme cases, there may be auditory or visual hallucinations or paranoia. In the present paper, which is based upon a WHO sponsored study of 1001 elderly Malaysians, it is noted that 36% of the elderly have sleep difficulties, 47% "feel tired", 31% have a "loss of interest" and 22% are "worried tense". However 71% of the elderly are able to correctly perform at least 12 of 15 cognitive tests. 20% of elderly men smoke 15 or more cigarettes a day while 44% smoke at least one cigarette a day. 40% of elderly men indicate that their families complain about the amount of alcohol they drink. Undoubtedly primary health care programmes need to be re-oriented to the problems and needs of the elderly in countries such as Malaysia.

Matched MeSH terms: Sleep Wake Disorders/psychology
The social impact of oral and facial pain in an industrial population

Jaafar N, Razak IA, Zain RB

Ann Acad Med Singap, 1989 Sep;18(5):553-5.
PMID: 2619246

The aim of this study is to determine the social impact of oral and facial pain in a sample involving an industrial population. Out of a total of 355 subjects interviewed, nearly one-half claimed to have oral and facial pain in the previous one month prior to the survey. The most common type of pain was that related to hot or cold fluids or sweet things followed by toothache. On the average, the pain lasted for 4.2 days (SD = 4.9) per person in the past one-month. About one in five persons with pain reported that it was severe enough to disrupt sleep. About one in ten persons reporting pain had to take sick leave because of the pain. However, only one in four persons with pain consulted a doctor or dentist. More than one-third tried to cope with the pain and did nothing while the rest tried various means of self-cure. It is therefore postulated that in this population, pain per se is a poor predictor of utilisation of dental services. Further research into pain coping behaviour and how this affects of pattern of utilisation of dental services is indicated in order to formulate a strategy to encourage the habit of seeking prompt dental care by the target population.

Matched MeSH terms: Sleep Wake Disorders/physiopathology
Dietary Factors and Sleep Quality Among Hemodialysis Patients in Malaysia

Ho LL, Chan YM, Daud Z'M

J Ren Nutr, 2021 Apr 07.
PMID: 33838975 DOI: 10.1053/j.jrn.2021.02.003

OBJECTIVES: Poor sleep quality is a commonly seen problem in hemodialysis patients. This study investigated the associations between dietary factors and sleep quality among hemodialysis patients.
DESIGN AND METHODS: This is a cross-sectional study conducted among 184 eligible hemodialysis patients at four dialysis units in Malaysia. Three days dietary recall were used in the analysis of dietary intake and behavior. Sleep quality was assessed through Pittsburgh Sleep Quality Index.
RESULTS: More than half of the patients were poor sleepers. Among the sleep components, sleep latency affected patients the most, with the use of sleep medications was relatively low. A majority of the patients had inadequate dietary intake of energy (88%) and protein (75%). Dietary protein, potassium adjusted for body weight, and sodium intake were significantly increased in poor sleepers. Lower percentage of energy from carbohydrates; higher percentage of energy from fats; higher intakes of dietary protein, fat, phosphorus, and sodium were correlated with poorer sleep quality and its components. Skipping dinner on non-dialysis days and having supper on dialysis days were associated with poor sleep quality.
CONCLUSION: Poor sleep is prevalent among hemodialysis patients. Sleep quality of hemodialysis patients was highly associated with certain dietary factors. Periodical assessment of sleep quality and dietary intake is necessary to identify poor sleepers with inappropriate dietary intake to allow effective clinical and nutritional interventions to improve the sleep quality and nutritional status of these patients.

Matched MeSH terms: Sleep Initiation and Maintenance Disorders; Sleep
Fulltext Sleep Disturbances in Children With Autism Spectrum Disorder at a Malaysian Tertiary Hospital

Koo HW, Ismail J, Yang WW, Syed Zakaria SZ

Front Pediatr, 2020;8:608242.
PMID: 33537265 DOI: 10.3389/fped.2020.608242

Introduction: Children with autism spectrum disorder (ASD) have a variety of co-morbid medical problems, including sleep disturbances. Prevalence of sleep disorders has been reported to be higher in this group as compared to the general population. Identifying sleep problems in children with ASD may help increase awareness and improve the overall quality of care for them. The aim of this study was to determine the prevalence of sleep problems and associated factors in a group of Malaysian children aged 6-16 years, with ASD. Method: This is a cross-sectional study at the Child Development Centre of UKM Medical Centre (UKM MC) on ASD children aged 6-16 years. Demographic data was obtained and the Sleep Disturbances Scale for Children (SDSC) questionnaire was completed by the main caregiver. Logistic regression analysis was used to determine factors related to higher total SDSC scores. Results: A total of 128 patients were recruited (111 boys) with a median age of 8 years 3 months (IQR: 2 years 10 months). Forty-seven (36.7%) of them obtained total SDSC scores in the pathological range with 19 (14.8%) scoring high for overall disturbances and 28 (21.9%) for at least one subtype of sleep disorders: 25 (19.5%) DIMS, 18 (14.1%) SBD, 10 (7.8%) DOES, 5 (3.9%) DOA, 6 (4.7%) SWTD, and 3 (2.3%) SHY. More than half of the children (57.8%) were reported to have sufficient sleep duration of 8-11 h, but longer sleep latency of at least 15 min (82.8%). Half of the ASD children also had co-morbidities in which one-third (34.4%) had attention-deficit hyperactivity disorder (ADHD). Using logistic regression analysis, four factors were significantly associated with higher total SDSC scores; female gender (p = 0.016), older age group (11-16 years old) (p = 0.039), shorter sleep length (p = 0.043), and longer sleep latency (p < 0.001). Conclusion: The prevalence of sleep disturbances is high among Malaysian children with ASD, especially DIMS. Female gender, older age group, shorter sleep length, and longer sleep latency were found to be associated with the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with ASD.

Matched MeSH terms: Sleep; Sleep Wake Disorders
Fulltext The association between sleep quality and quality of life among undergraduate student in private university

Len Xen Mei, ThavamalarParamasivam, Ng Siow Fam, Lim Pek Hong, Fong Ka Ling, Mohammed Abdul Razzaq Jabbar, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):16-0.
MyJurnal

Introduction: Studies found that low sleep quality (SQ) is associated with many factors such as health, quality of life (QOL), work or academic performance and co-curriculum activities. Hence, improvement to maintain SQ to en- hance students’ QOL is important. Approximately 43% of Malaysian were unaware of their sleep problem and how it affects their physical and mental health, especially among the younger generation. The study aims to investigate the association between SQ and QOL among undergraduate students in UTAR Sungai Long Campus. Method: A cross-sectional study among 256 undergraduate students recruited by purposive sampling was conducted. The Pitts- burgh Sleep Quality Index (PSQI) and the World Health Organization Quality of Life Instruments (WHOQOL-BREF) were administered to evaluate SQ and QOL, respectively. Self-reported demographic data were collected with a structured sociodemographic profile. Associations were evaluated using Spearman’s correlation coefficient, Chi- square test and independence t-test. The level of significance was p< 0.05. Result: Results showed more than one half of students had poor SQ (F=137, 53.5%) and poor QOL (F= 159, 62.1%). All seven PSQI components were significantly associated with at least one QOL domain. Sleep disturbances, sleep latency and daytime dysfunction were correlated with all four QOL domains which are physical health, psychological, social relationships, and envi- ronment. Among the sociodemographic variables, only time travelled from place of stay to campus was associated to SQ (p = 0.04). However, there was no significant association between SQ and the selected sociodemographic vari- ables such as gender, working part-time job, and travel distance from place of stay to campus. Conclusion: Overall, the results from this study showed one half of students suffered from poor SQ and QOL. SQ among undergraduate students is vital in developing good QOL.

Matched MeSH terms: Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders

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