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Solitary extramedullary plasmacytomas are uncommon neoplasms. They occur most frequently in the upper aerodigestive tract and account for 4% of the nonepithelial tumors in this site. The evolution of a plasmacytoma is unsteady and symptoms at presentation have included dystonia, dysphagia, oral pain, cough, and dyspnea on exertion. Plasmaeytoma of the upper aerodigestive tract has not been previously reported as a cause of obstructive sleep apnea.

Crucial research about suicidal thoughts and behaviors is often done in a cross-sectional manner that only considers limited risk factors. This research is limited in scope and rarely produces meaningful results to inform treatment. This study uses a longitudinal design to follow 93 participants over approximately 6 months. Participants are individuals with autism and social anxiety who were part of high-risk groups for suicidality, sleep problems, and social isolation. Participants recorded their sleep patterns and suicidal thoughts daily via the phone app MetricWire and continuously wore a GENEActiv actigraphy device to tract their objective sleep patterns. The Columbia Suicide Severity Rating Scale (C-SSRS): Baseline/Screening Version, C- SSRS: Since Last Visit Version; The Insomnia Severity Index (ISI); The Pittsburgh Sleep Quality Index (PSQI); and The Patient-Reported Outcome Measurement Information System (PROMIS) Level 2 Sleep Disturbance Adult Form were used to characterize the sample population. Data were analyzed using a longitudinal multilevel regression design. Findings indicate that perceived sleep quality was negatively correlated to suicide ideation over time. Self- reported sleep duration, gender, and Autism-Spectrum Quotient (AQ) score were not significant predictors of suicidal ideation over time. Liebowitz Social Anxiety Scale-Self Report (LSAS) score was positively correlated to suicide ideation. Clinical implications of these findings suggest a renewed effort must be made to assess for suicidality in persons reporting social anxiety and that effective intervention to improve sleep quality could reduce suicidal ideation.

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Fentanyl is a potent synthetic opioid that has been shown to produce sleep disturbances, and the deterioration of sleep quality is associated with drug abuse and relapse in humans. The hypocretin/orexin neuropeptide system is a plausible pharmacological target, and dual-hypocretin antagonists such as lemborexant may mitigate sleep disturbances associated with fentanyl dependence. The current study characterizes sleep macroarchitecture (time spent asleep or awake) and microarchitecture (the number of bouts, and NREM sleep spindle characterization) prior to fentanyl vapor exposure (baseline), following one week of drug abstinence, and four weeks of drug abstinence in female and male rats. Females and males showed a reduction in the amount of time spent in rapid eye movement (REM) sleep following one week of abstinence. The pre-treatment of lemborexant the following day increased the amount of time spent in REM, compared to vehicle at both one and four weeks of abstinence. While there was no effect of fentanyl abstinence on the amount of time spent in non-rapid eye movement (NREM) sleep and wakefulness, lemborexant increased the amount time spent in NREM and decreased the amount of time spent awake. Examination of microarchitecture demonstrated a decrease in the number of NREM bouts at one week of abstinence, which lemborexant subsequently brought back to baseline levels at weeks one and four. Abstinence from fentanyl did not impact the number of NREM sleep spindles, but indicated a trend showing a decrease in intra-spindle frequency at one week of abstinence. Lemborexant, however, increased the number of spindles at weeks one and four of abstinence. Presently, findings indicate that fentanyl abstinence produces changes in sleep macroarchitecture, particularly REM sleep disruptions, which may be alleviated by lemborexant. This highlights the need for further examination of the relationship between sleep disturbances and drug abstinence, and the use of dual-hypocretin antagonists as therapeutic intervention.

Sleep disturbance is one of the most prevailing symptoms of decreased performance and compromised overall health of the general public. This is also a national security threat because this problem is even more profound in the ranks of the United States military. Sleep disturbance after deployment is common among military personnel and during deployment, has many health and safety implications. There are many personal factors and environmental factors can affect quality and quantity of sleep in pre and post deployment settings. Occupational therapy intervention for special warfare servicemembers that have problems with function as a result of sleep insufficiency is an emerging need. However, there are no current programs offered that have addressed this important occupation. There is a need to develop an evidenced-based occupational therapy interventions that addresses sleep hygiene, as well as behavioral and environmental practices designed to improve both quality and quantity of sleep of this special population. In response to this need, the author designed an effective nonpharmacological occupational therapy intervention program designed to improve quality and quantity of sleep The project focused on 1) identifying evidence-based literature to support the benefit of non-pharmacological interventions for special warfare servicemembers, 2) designing a program that represented best practice while incorporating the holistic and occupation-based theoretical base of occupational therapy, 3) best practice for implementation the program, 4) conducting summative program evaluation, and 5) develop a dissemination plan and implementation budget.