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Sleep Diary Approach of Sleep-Wake Cycle Disturbances in Cholera

Donatien Moukassa, Alain Buguet

Title: Sleep diary approach of sleep-wake cycle disturbances in cholera.

Background: Cholera is a pandemic caused by Vibrio cholerae (0:1 or 0:139 serotypes) that provokes a dramatic intestinal infection. Its endotoxin triggers abundant vomiting and diarrhoea leading to acute dehydration. Untreated, cholera is fatal in 25-30% of cases. Intensive rehydration and antibiotherapy reduces mortality toll to approximately 1%. Cholera reached sub-Saharan Africa in 1971 during the ongoing seventh pandemic. No sleep investigation having been reported previously in bedridden cholera patients, we analysed potential sleepwake disturbances during the 2013 epidemic at Pointe-Noire (Congo).

Methods and Findings: Nurses completed a sleep diary in 33 cholera patients, who stayed 3.4 ± 0.2 days in isolation at the hospital (Trial registration number: 2013-002-MSP-HGL-DAM). The 24-hour sleep-wake alternation was deregulated, sleep episodes occurring without day and night differences. In the daytime, sleep duration varied from Day 1 to Day 4 (ANOVA, P=0.0203), being shorter on Day 1 vs Day 2 (P= 0.0351) and longer on Day 2 vs Day 3 (P=0.0042). The number of sleep episodes was higher on Day 2 and Day 4 vs Day 1 (P=0.0055 and P=0.0399, respectively) and vs Day 3 (P=0.0007 and P=0.0084, respectively). At night, a time effect affected total sleep duration (P=0.0052), with a tendency for the number of sleep episodes (P=0.0671). Nocturnal sleep duration was longer on Day 1 and Day 2 vs Day 4 (P=0.0088 and P=0.0495, respectively). The number of sleep episodes was higher on Day 1 vs Day 4 (P=0.0487). During the 24 hours, a time effect was observed for total sleep duration (P=0.0001), with higher values on Day 2 vs Day 3 (P=0.0450).

Conclusions: Sleep-wake alterations were observed in cholera patients during the acute phase of the disease and were reversed during the rehydration process. The easy to use sleep diary may be thought of as a non-invasive tool for follow-up of cholera recovery and prognosis.