Sleep duration and efficiency predict heart rate variability during work hours in intensive care unit nurses.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an antibody-mediated autoimmune encephalitis characterized by IgG antibodies directed against the GluN1 subunit of the NMDAR (, ). The syndrome frequently evolves over days to weeks, often beginning with psychiatric symptoms before seizures, speech disturbance, dyskinesias, impaired consciousness, or autonomic instability (). Because early manifestations may resemble primary psychiatric disease, infectious encephalitis, toxic-metabolic delirium, medication-related delirium or other autoimmune encephalitides, diagnosis can be delayed unless autoimmune encephalitis is considered early. Young women are disproportionately affected, and ovarian teratomas are among the most important associated tumors (, ). Teratomatous neural tissue may express NMDAR-related antigens, providing a plausible source for intrathecal antibody production (). For this reason, tumor screening and timely tumor removal are considered disease-directed interventions in addition to immunotherapy (). Anti-NMDAR encephalitis during pregnancy is rare and requires close collaboration among neurologists, obstetricians, gynecologists, intensivists, infectious disease specialists, anesthesiologists, psychiatrists, neonatologists, and rehabilitation teams (–). We report a severe first-trimester case at 10–11 weeks of gestation associated with bilateral mature ovarian teratomas, hypoventilation requiring mechanical ventilation, and individualized pregnancy management.