Balachundhar Subramaniam

Background: Long COVID affects millions of adults, causing fatigue, dyspnea, cognitive symptoms, and mood disturbances. Effective treatments are limited, and many patients cannot access multidisciplinary rehabilitation because of symptom fluctuation, distance, or specialist shortages. Web-based mind-body interventions may offer accessible, scalable support alongside existing care. Objective: We assessed the feasibility and efficacy of a 3-week web-based yogic breathing and meditation program for long COVID symptoms. Methods: In this completed, parallel-group, 6-week waitlist-controlled, mixed methods randomized trial, adults aged 18‐70 years with physician-confirmed long COVID were recruited from US clinics and self-referral and randomized 1:1 to immediate intervention or waitlist control, crossing over at week 3. The program included live webinars and video guides for daily self-practice. The primary outcome was adherence, defined as practicing at least 1 of 3 techniques on ≥4 days/week across all 3 active-intervention weeks. Secondary outcomes included perceived stressmood, quality of life, dyspnea, and somatic symptom burden, assessed at baseline, 3 weeks, and 6 weeks. Quantitative outcomes were analyzed using linear mixed-effects models. Semistructured interviews and focus groups underwent conventional content analysis and were integrated with quantitative findings via joint display. Results: Of 189 randomized participants, 1 was excluded post-randomization for a protocol deviation; 188 (96 intervention, 92 waitlist) began the study. Of these, 124 reached the active intervention period. Among 58 with complete adherence data, 55% met the adherence threshold (60% intervention, 50% waitlist). Secondary analyses included 185 participants with ≥1 assessment. No adverse events were reported. Compared with waitlist control, the intervention group showed greater reductions in total mood disturbance (MD=−10; 95% CI −19 to −1.6; P=.02), negative mood (MD=−7.5; 95% CI −15 to −0.44; P=.04), fatigue (MD=−2.9; 95% CI −4.6 to −1.2; P=.001), MDP immediate perception (MD=−5.5; 95% CI −9.4 to −1.6; P=.007), MDP sensory dimension (MD=−5.1; 95% CI −8.5 to −1.7; P=.003), and somatic symptom burden (MD=−2.0; 95% CI −3.6 to −0.38; P=.02), and greater increases in positive mood (MD=2.9; 95% CI 0.66 to 5.1; P=.01) and vigor (MD=1.7; 95% CI 0.18 to 3.2; P=.03). Stress and quality of life did not differ significantly. Qualitative findings identified medical-system struggles, digital delivery, online support, and practices’ effects on resilience and identity. Integration showed convergence for dyspnea and mood, divergence for stress and quality of life, and expansion through themes of medical-system experience, identity, and social connection. Conclusions: This web-based yogic breathing and meditation program appears feasible and accessible for people with long COVID. By combining 3 practices in a brief protocol and integrating quantitative and qualitative evidence, this study provides novel insight into both symptom outcomes and dimensions of recovery not captured by standardized measures. Further evaluation should assess longer-term effects and integration into scalable telehealth and virtual rehabilitation pathways.

Background: Anxiety and other non-motor symptoms can greatly diminish quality of life in people with Parkinson's Disease (PD). Yet, few randomized controlled trials (RCTs) have assessed accessible, non-pharmacological mental health treatments for people with PD. Objective: To assess the feasibility and impact of brief, remotely-delivered meditation and breathwork on neuropsychiatric symptoms in people with PD. Methods: In this 18-week RCT, intervention participants attended weekly webinars for six weeks, while waitlisted controls maintained their usual routine before crossing over at six weeks. Participants were assessed for weekly compliance trends (primary outcome) and changes in anxiety (primary outcome), depression, perceived stress, and other non-motor symptoms at 6-week intervals: baseline and weeks 6 (T2), 12 (T3), and 18 (T4). Weekly compliance was collected in each group for 12 weeks. Anxiety was measured using the Parkinson's Anxiety Scale. Results: There was a significant decrease in the primary outcome, anxiety, in the intervention group (n = 17) compared to the waitlist control (n = 21) after 6 weeks of meditation and breathwork practice (mean difference (MD)= −5.0, 95% CI [−9.5, −0.49], P = .03). Within-group analysis further confirmed a significant reduction in anxiety (MD = −4.7, 95% CI [2.10,7.33], P < .001) in the intervention group (n = 28). Thirty-one percent of participants met the compliance definition. Conclusion: Remotely-delivered meditation and breathwork through the BSM program significantly reduced anxiety in individuals with PD in our study and may be a promising non-pharmacological therapy. A larger RCT with continuous wellness coaching is warranted to more rigorously assess efficacy and optimize protocols. Clinical trial registration: ClinicalTrials.gov, NCT05335850, https://clinicaltrials.gov/study/NCT05335850

Patients recovering from cardiac surgery in the intensive care unit (ICU) do not sleep well. Commonly used sedative-hypnotic medications can disrupt sleep architecture and increase the risk of delirium in critically ill patients after surgery. The orexin receptor antagonist suvorexant, improves sleep onset and duration in patients with chronic insomnia. We hypothesized that suvorexant improves sleep onset and duration while also reducing the incidence of delirium after cardiac surgery. This multicentric, double-blind, randomized controlled trial was conducted at two university-based cardiac ICUs. One hundred adult patients were enrolled after admission to the ICU following cardiac surgery. Enrollment occurred between March 2020 and February 2025. Participants were randomized to receive either a once daily oral dose of suvorexant 20 mg or placebo. Treatment began on the first night after extubation and continued until hospital discharge or for a maximum of seven days, whichever occurred first. Sleep was recorded using an electroencephalography (EEG) monitor (SedLine, Masimo Corp., California, USA) on the first night after extubation and was scored blindly by an experienced registered polysomnographic technologist. The primary outcome was wakefulness after persistent sleep onset (WASO). Sleep onset was defined as the first 30-second epoch classified by rapid eye movement (REM) or non-REM stages 1, 2, 3 after lights off. Wakefulness was defined as an awake period of 30s or longer. Sleep questionnaires were administered and delirium screenings were conducted every morning until hospital discharge. One hundred patients were randomized to receive suvorexant (n = 49) or placebo (n = 51). EEG analysis indicated that neither the median [inter-quartile range] nighttime WASO (200.7 [112.1, 328.4] minutes vs. 184.2 [80.4, 304.2] minutes; p = 0.33) nor total sleep time (224.0 [112.0, 379.0] minutes vs. 253.0 [68.0, 420.0] minutes; p = 0.92) differed significantly between the groups. There was no significant difference in rescue medication (melatonin, dexmedetomidine, benzodiazepine) utilization between the groups. Subjective sleep quality, incidence of delirium, and delirium-free days did not differ between the two groups. Clinical Trials Registry no. NCT04092894, Registration Date 09/17/2019. Among patients recovering in the ICU who underwent cardiac surgery with cardiopulmonary bypass, the suvorexant treatment did not affect wakefulness after sleep onset or post-operative delirium.

BACKGROUND Long COVID imposes severe functional impairments and strains health systems. Web-based mind-body interventions may offer scalable support for multidisciplinary care. OBJECTIVE We assessed the feasibility and efficacy of a 3-week web-based yogic breathing and meditation program on quality of life in individuals with long COVID. METHODS : In this 6-week waitlisted, mixed-methods randomized controlled trial, participants were recruited from U.S. long COVID clinics and self-referrals and randomized to intervention or waitlist control groups. The meditation and breathwork intervention was delivered via instructor-guided live webinars supplemented with video guides for daily self-practice. Weekly logs tracked compliance, and secondary outcomes including perceived stress (PSS), mood (POMS), quality of life (SF-12), multidimensional dyspnea (MDP), and somatic symptom burden (SS8), were assessed at baseline, 3 weeks, and 6 weeks. The data was analyzed using linear mixed effects models with qualitative insights regarding experience with long COVID and the intervention contextualizing quantitative findings. RESULTS Of the 68 participants who completed the study, 50 (74%) were compliant. Linear mixed-effects models showed significant between-group improvements favoring the intervention group, with small to medium effect sizes. Compared with the waitlisted control, the intervention group demonstrated greater reductions in total mood disturbance (Mean Difference (MD) = -10; 95% CI [-19 to -1.6]; p = .02), immediate perception (MD = -5.5; 95% CI [-9.4 to -1.6]; P = .007) and sensory dimension (MD = -5.1; 95% CI [-8.5 to -1.7; P = .003] of dyspnea, and somatic symptom burden ( MD = -2.0; 95% CI [-3.6 to -0.38]; P = .02) over time in the intervention group compared to the waitlisted control. No meaningful differences were found in stress and quality of life. Qualitative findings complemented the quantitative result revealing four key themes: (1) meditation building resilience, (2) online support networks, (3) benefits and challenges of digital delivery, and (4) struggles with the medical system. CONCLUSIONS This web-based, low-burden yogic breathing and meditation program appears feasible and accessible for people with Long COVID. In three weeks, participants demonstrated meaningful improvements across validated clinical scales for mood, dyspnea, and somatic symptoms as well as in their lived experience of symptom management. These findings support further evaluation of this scalable approach as a supportive intervention while more definitive medical treatments continue to evolve. CLINICALTRIAL ClinicalTrials.gov (NCT05139979); https://clinicaltrials.gov/study/NCT05139979

Background: With evolving techniques for analysis of blood pressure (BP) variability, the importance of sampling resolution for intra-operative BP still remains to be examined. This study aims at comparing BP data with beat-by-beat vs. 15 second resolution. Methods: This is a retrospective analysis of intra-arterial BP data obtained from cardiac surgical patients from the intra-operative period. Data was collected from two sources for each patient, one with beat-by-beat frequency, other at a frequency of once every 15 seconds. The fraction of time and area under the curve beyond systolic BP thresholds of 95 – 135 mmHg were calculated using data from both sources, for each patient. These were compared using Wilcoxon ranked sum test for paired samples using R-statistics version 3.4.3. Results: There was a statistically significant difference (P < 0.001) between the parameters from the two sources. This was especially true for parameters below and outside the thresholds. Only time fraction showed significant difference above the 135 mmHg threshold. Conclusion: Our preliminary analysis shows a definitive difference between BP descriptors, depending on sampling resolution. But the impact of this difference on the outcome predicting models of the parameters stands to be ascertained. Future larger studies, powered to examine the impact of sampling resolution on outcome predictive ability of BP descriptors, with special emphasis on dynamic markers of complexity are warranted.