Clarifying sleep characteristics and analyzing risk factors of sleep disorders to promote a predictive, preventive, and personalized medicine in patients with burn scars

Abstract

Purpose This study assessed sleep quality in patients with burn scars and investigated risk factors of sleep disorders to guide clinical therapy. From the strategy of predictive, preventive, and personalized medicine (PPPM/3PM), we proposed that risk assessment based on clinical indicators could prompt primary prediction, targeted prevention, and personalized interventions to improve the management of sleep disorders present in patients with burn scars. Methods This retrospective study recruited patients with burn scars and healthy volunteers from the Shanghai Burn Treatment Center between 2017 and 2022. Relevant information and data, including demographic characteristics, scar evaluation, and sleep quality, were obtained through the hospital information system, classical scar scale, and self-report questionnaires. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and monitored using a cardiopulmonary-coupled electrocardiograph. Pain and pruritus were assessed using the visual analog scale (VAS). Scar appearance was assessed using the modified Vancouver scar scale (mVSS). Results The sample was comprised of 128 hypertrophic scar (HS) patients, with 61.7% males, a mean age of 41.1 ± 11.6 years, and burn area of 46.2 ± 27.9% total body surface area (TBSA). Patients with PSQI ≥ 7 accounted for 76.6%, and the global PSQI score was 9.4 ± 4.1. Objective sleep data showed that initial enter deep sleep time, light sleep time, awakening time, light sleep efficiency, and sleep apnea index were higher but deep sleep time, sleep efficiency, and deep sleep efficiency were lower in HS patients than that in healthy controls. Preliminary univariate analysis showed that age, hyperplasia time of scar, narrow airway, microstomia, VAS for pain and pruritus, and mVSS total (comprised of pigmentation, vascularity, height and pliability) were associated with the PSQI score ( p < 0.1). Multivariable linear regression showed narrow airway, VAS for pain and pruritus, and mVSS specifically height, were the risk factors for PSQI score ( p < 0.1). Conclusions This study model identified that narrow airway, pain, pruritus and scar appearance specifically height may provide excellent predictors for sleep disorders in HS patients. Our results provided a basis for the predictive diagnostics, targeted prevention, and individualized therapy of somnipathy predisposition and progression of HS patients in the setting of PPPM/3PM health care system, which contributed to a paradigm shift from reactive cure to advanced therapy.

Gut Microbiota Profiles in Myopes and Nonmyopes

“…This finding may be explained with the results of Liu et al who found an increased risk of allergic conjunctivitis, resulting from decreased level of Catenibacterium. 76 Children with allergic conjunctivitis have a 2.35-fold higher incidence and risk of myopia compared with children without allergic conjunctivitis. 77 Nonetheless, there is limited research on Catenibacterium in relation to the eye.…”

Application of mendelian randomization in ocular diseases: a review

“…By using techniques like inverse variance weighted (IVW) estimation, Zhang et al ultimately reached their conclusion that attention deficit hyperactivity disorder was not related to allergic conjunctivitis [9]. Since previous observational studies show growing evidence that gut microbiota associate with the incidence of AC closely, Liu et al came to the conclusion that gut microbiota may be involved in immunomodulation and lower the incidence of allergic conjunctivitis, except for Oscillospira flora, which produces substances linked to inflammatory diseases and contributes to the incidence of allergic conjunctivitis [10]. To further estimate genetic associations between polyunsaturated fatty acids and allergy disorders, a two-sample MR analysis was used to identify that: omega-3 fatty acids had a preventive effect on the development of AC, while omega-6:3 fatty acids raised the risk of AC, taking into account age, economic status, BMI, and daily behavioral habits [11].…”

Effects of acupressure on sleep quality and anxiety of patients with second- or third-degree burns: a randomized sham-controlled trial

“…Among these, anxiety is a common annoying problem, often due to patient’s concerns about their appearance, the painful nature of therapeutic procedures (i.e., wound debridement, wound dressing change, and repair surgeries), and monetary and occupational problems [ 11 – 13 ]. In addition to high anxiety, recent surveys documented poor perceived sleep quality following burn injuries, which could be experienced mainly due to pain, narrow airway, pruritus, and scar appearance during different stages of the recovery process [ 14 – 16 ]. Studies also show a bivariate relationship between anxiety and sleep disturbances among burn sufferers so that high burn-induced anxiety leads to insomnia and poor sleep quality; sleep deprivation also triggers or exacerbates anxiety [ 17 ].…”