***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Environmental stimulus , especially noise and light , is thought to disrupt sleep in patients in the intensive care unit ( ICU ) . This study aim ed to determine the physiological and psychological effects of ICU noise and light , and of earplugs and eye masks , used in these conditions in healthy subjects . Methods Fourteen subjects underwent polysomnography under four conditions : adaptation , baseline , exposure to recorded ICU noise and light ( NL ) , and NL plus use of earplugs and eye masks ( NLEE ) . Urine was analyzed for melatonin and cortisol levels . Subjects rated their perceived sleep quality , anxiety levels and perception of environmental stimuli . Results Subjects had poorer perceived sleep quality , more light sleep , longer rapid eye movement ( REM ) latency , less REM sleep when exposed to simulated ICU noise and light ( P < 0.05 ) . Nocturnal melatonin ( P = 0.007 ) and cortisol secretion levels ( P = 0.004 ) differed significantly by condition but anxiety levels did not ( P = 0.06 ) . Use of earplugs and eye masks result ed in more REM time , shorter REM latency , less arousal ( P < 0.05 ) and elevated melatonin levels ( P = 0.002 ) . Conclusions Earplugs and eye masks promote sleep and hormone balance in healthy subjects exposed to simulated ICU noise and light , making their promotion in ICU patients reasonable St and ardized diagnostic criteria determined by the International Restless Legs Syndrome Study Group were used to investigate the current prevalence of restless legs syndrome ( RLS ) . Possible associations between RLS and neuropsychiatric and somatic complaints were also investigated . A r and om sample of 4,000 men living in central Sweden were sent a question naire that included questions about sleep habits , symptoms of sleepiness , and somatic and neuropsychiatric complaints . Four symptom questions accepted as minimal diagnostic criteria for RLS were also included . Odds ( OR ) ratios and 95 % confidence interval ( CI ) for different variables were calculated by means of multivariate logistic regression ; 5.8 % of the men suffered from RLS . The prevalence of RLS increased with age . Sleep-related complaints were more frequent among the RLS sufferers . Complaints of headache at awakening and daytime headache were reported three to five times more frequently among RLS sufferers and there was a tendency toward reported social isolation related to RLS . Subjects with RLS more frequently reported depressed mood ( OR , 2.6 ; 95 % CI , 1.8 - 3.8 ) , and complained more often of reduced libido ( OR , 2.2 ; 95 % CI , 1.4 - 3.3 ) . RLS sufferers more frequently reported hypertension ( OR , 1.5 ; 95 % CI , 0.9 - 2.4 ) and heart problems ( OR , 2.5 ; 95 % CI , 1.4 - 4.3 ) . Results show that restless legs syndrome is common among men . It is hypothesized that RLS may be associated with several somatic and neuropsychiatric symptoms Objective : To evaluate if anger expression affects sleep quality in patients with coronary heart disease ( CHD ) . Research has indicated that poor sleep quality independently predicts adverse outcomes in patients with CHD . Risk factors for poor sleep quality include older age , socioeconomic factors , medical comorbidities , lack of exercise , and depression . Methods : We sought to examine the association of anger expression with sleep quality in 1020 out patients with CHD from the Heart and Soul Study . We assessed anger-in , anger-out , and anger temperament , using the  Spielberger State-Trait Anger Expression Inventory 2 , and measured sleep quality  , using items from the Cardiovascular Health Study and Pittsburgh Sleep Quality Index . We used multivariate analysis of variance to examine the association between anger expression and sleep quality , adjusting for potential confounding variables . Results : Each st and ard deviation ( SD ) increase in anger-in was associated with an 80 % greater odds of poor sleep quality ( odds ratio ( OR ) = 1.8 , 95 % Confidence Interval ( CI ) = 1.6–2.1 ; p < .0001 ) . This association remained strong after adjusting for demographics , comorbidities , lifestyle factors , medications , cardiac function , depressive symptoms , anger-out , and anger temperament ( adjusted OR = 1.4 , 95 % CI = 1.5–1.7 ; p = .001 ) . In the same model , each SD increase in anger-out was associated with a 21 % decreased odds of poor sleep quality ( OR = 0.79 , 95 % CI = 0.64–0.98 ; p = .03 ) . Anger temperament was not independently associated with sleep quality . Conclusions : Anger suppression is associated with poor sleep quality in patients with CHD . Whether modifying anger expression can improve sleep quality or reduce cardiovascular morbidity and mortality deserves further study . BMI = body mass index ; CHD = coronary heart disease ; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision ; MI = myocardial infa rct ion ; REM = rapid eye movement ; STAXI-2 = Spielberger State-Trait Anger Expression Inventory 2 ; BP = blood pressure ; HR = heart rate ; SD = st and ard deviation ; ANOVA = analysis of variance ; CI = confidence interval ; OR = odds ratio ; PHQ = Patient Health Question naire ; COPD = chronic obstructive pulmonary disease AIM To evaluate the prevalence of Sleep Apnea-Hypopnea Syndrome ( SAHS ) in patients who were admitted with Acute Coronary Syndrome ( ACS ) to the Coronary Care Unit ( CCU ) and the clinical predictors of SAHS in patients with ACS and to compare the results of the simple sleep test ( SST ) with polysomnography ( PSG ) . METHODS This was a prospect i ve study that included patients who were admitted to the CCU with ACS , which was confirmed by coronary angiography .  Demographic and anthropometric data , cardiovascular risk factors and measures on the Epworth Sleepiness Scale were collected . The SST was conducted with the ApneaLink(TM ) device during hospitalization or after discharge . Patients with an  apnea-hypopnea index ( AHI ) ≥ 10/h were invited to participate in PSG . RESULTS Ninety-one patients with ACS were consecutively included over 4 months . Of the fifty-eight patients who completed the study 43 ( 74.1 % ) were male . The mean age was 61.7±12.2 years , and the mean body mass index was 27.4±3.5 kg/m(2 ) . The median time for  SST  performance was 17.5 days . This study was compatible with SAHS in 25 cases ( 43.1 % ) . Patients who had an AHI ≥ 10/h in the SST were su bmi tted to PSG and SST simultaneously . The median interval between the ACS and the execution of PSG was 30 days . PSG confirmed that all of the cases that were detected by SST were positive . CONCLUSION In our study , we found a high prevalence of SAHS in patients who were admitted to the CCU with ACS ( 43.1 % ) . These results support the need for SAHS screening in patients who are hospitalized with ACS .  The SST may have a role in the screening of SAHS in this population To test the hypothesis that feelings of exhaustion are predictive of future coronary heart disease , a prospect i ve study was done among 3877 males , aged 39 - 65 .  Feelings of exhaustion were assessed by the Maastricht Question naire . Among those who were free of coronary heart disease at screening , 59 subjects experienced a fatal or non-fatal myocardial infa rct ion during the 4.2 year follow-up period . A multiple logistic regression analysis revealed that feelings of exhaustion were predictive of future myocardial infa rct ion when controlling simultaneously for blood pressure , smoking , cholesterol , age and the use of antihypertensive drugs Background — Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease . The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women . Methods and Results — A total of 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospect i ve longitudinal epidemiological study . After adjustment for multiple risk factors , obstructive sleep apnea was a significant predictor of incident coronary heart disease ( myocardial infa rct ion , revascularization procedure , or coronary heart disease death ) only in men ≤70 years of age ( adjusted hazard ratio 1.10 [ 95 % confidence interval 1.00 to 1.21 ] per 10-unit increase in apnea-hypopnea index [ AHI ] ) but not in older men or in women of any age . Among men 40 to 70 years old , those with AHI ≥30 were 68 % more likely to develop coronary heart disease than those with AHI < 5 . Obstructive sleep apnea predicted incident heart failure in men but not in women ( adjusted hazard ratio 1.13 [ 95 % confidence interval 1.02 to 1.26 ] per 10-unit increase in AHI ) . Men with AHI ≥30 were 58 % more likely to develop heart failure than those with AHI < 5 . Conclusions — Obstructive sleep apnea is associated with an increased risk of incident heart failure in community-dwelling middle-aged and older men ; its association with incident coronary heart disease in this sample is equivocal BACKGROUND AND PURPOSE The aim of this study was to estimate the prevalence of restless legs syndrome ( RLS ) symptoms in the US adult population and to relate frequency of RLS symptoms to self-reported general health , depressive and anxiety symptoms , daytime sleepiness , and cardiovascular disease . PATIENTS AND METHODS Data were obtained from a survey  , conducted in 2002 , of 2821 participants in the Wisconsin Sleep Cohort , a prospect i ve community-based epidemiology study . Classification of RLS symptoms was based on the following four symptoms at the 2002 survey : ' repeated urge to move your legs ' and ' strange and uncomfortable feelings in the legs ' , ' when sitting or lying down ' which occur at least weekly , ' get better when you get up and start walking ' and ' disrupt your sleep ' . RESULTS Prevalence of RLS symptoms occurring at least weekly was 10.6 % , with no statistical difference between males ( 9.9 % ) and females ( 11.2 % ) . Individuals with symptoms of RLS occurring at least weekly were older than those without such symptoms ( P<0.02 ) . Those with Daily RLS symptoms had statistically more frequent excessive daytime sleepiness , poorer self-reported general health , an elevation in depressive and anxiety symptoms , and an increased prevalence of cardiovascular disease compared to those with no RLS symptoms . All of these associations were stronger in subjects with Daily RLS symptoms than those with RLS symptoms 1 - 6 times per week . CONCLUSIONS RLS symptoms are associated with multiple physical and psychological indices of impaired health . Longitudinal studies are required to determine whether RLS symptoms are causally related to excessive daytime sleepiness , poor general health , elevated depression and anxiety symptoms , and cardiovascular disease BACKGROUND From a mechanistic st and point , obstructive sleep apnea ( OSA ) may further disturb cardiovascular homeostasis in the setting of acute coronary syndrome ( ACS ) . OBJECTIVE We sought to investigate if a st and ardized clinical diagnosis of OSA , in acute coronary syndrome patients , predicts the risk of cardiovascular events during hospitalization . METHODS In a prospect i ve cohort study , a group of 200 patients diagnosed with ACS between September 2005 and November 2007 were stratified by the Berlin Question naire ( BQ ) regarding the risk for OSA ( high or low risk ) . We tested if the subgroup of high risk for OSA was prone to a higher frequency of cardiovascular events . The primary endpoint evaluated was a composite outcome of cardiovascular death , recurrent cardiac ischemic events , acute pulmonary edema and stroke during hospitalization . RESULTS Ninety four ( 47 % ) patients assessed by the BQ were likely to have OSA . High risk for OSA was associated with a non-significant higher mortality ( 4.25 % vs 0.94 % ; p=0.189 ) , but a significant higher incidence of composite cardiovascular events ( 18.08 % vs 6.6 % ; p=0.016 ) . In the logistic regression model , multivariate predictors of composite cardiovascular events were age ( OR= 1.048 ; 95 % CI 1.008 to 1.090 ; p=0.019 ) , left ventricular ejection fraction ( OR= 0.954 ; 95 % CI 0.920 to 0.989 ; p=0.010 ) , and higher risk for OSA ( OR= 3.657 ; 95 % CI 1.216 to 10.996 ; p=0.021 ) . CONCLUSION The use of a simple and vali date d question naire ( BQ ) to identify patients with higher risk for OSA may help in the prediction of cardiovascular outcome during hospitalization . Moreover , our data suggests that OSA is very common in patients with ACS Abstract Little is known about the nature of the depressive symptomatology preceding myocard 
    Output:
    
Factor analysis provided a question naire of 23 items on 5 dimensions of sleep disturbance in coronary patients : " sleep onset and continuity disorder , " " disorder in daytime functioning , " " sleep disturbance caused by environmental factors , " " sleep disturbance as a result of cardiac diseases , " and " respiratory disorders during sleep .