51
|
Tscharaktschiew N, Ende L, Onderka C. [Better Sleep and Less Pain? Sleep Training in Orthopedic Rehabilitation]. REHABILITATION 2021; 61:35-42. [PMID: 34425599 DOI: 10.1055/a-1509-9247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE There is high comorbidity between chronic pain and insomnia. Not only does chronic pain impair sleep, poor sleep quality can also exacerbate the sensation of pain. However, usually, the respective symptoms are treated separately. We evaluate a new cognitive behavioral sleep-pain-training aiming at improving symptoms of both insomnia and chronic pain in the setting of ambulant orthopedic rehabilitation. METHODS N=41 patients participated in the study (with 15 participants being enrolled in the control group). The training consists of 4 modules á 90min and was explicitly developed for patients suffering from chronic pain and comorbid insomnia. It includes several methods of cognitive behavioral therapy for the treatment of insomnia and pain (e. g., sleep hygiene, sleep restriction, sleep-pain-protocol, cognitive restructuring) and specifically addresses the relationship between the two. Sleep quality, sleep related thoughts (focusing, rumination), internal health locus of control, pain intensity (day and night) as well as pain related thoughts (pain related anxiety, pain related depression/helplessness) were assessed pre and post training by means of a questionnaire. RESULTS Mixed ANOVAS revealed small (η²=: 0,010) to medium (η²=: 0,068) interaction effects for most dependent variables (sleep quality, sleep efficiency, focusing, rumination, internal health locus of control, average day and night pain, maximum night pain, pain related anxiety and pain related depression/helplessness) for the interaction of time and group. However, effects for rumination and average day pain were not significant. There was no interaction effect for maximum day pain. Effect sizes for single group analyses revealed medium (internal sleep locus of control: d=0,52) to large (sleep quality: d=1,73) significant effects for the training group and no (focusing: d=0,00) to small (maximum day pain: d=-0,43) and non-significant effects for the control group. CONCLUSION The training analyzed in this study may constitute a complement to existing treatment possibilities for patients suffering from chronic pain and should be further evaluated in larger samples.
Collapse
Affiliation(s)
| | - Luisa Ende
- Institut für Psychologie, Technische Universität Chemnitz
| | | |
Collapse
|
52
|
Retzer L, Feil M, Reindl R, Richter K, Lehmann R, Stemmler M, Graessel E. Anonymous online cognitive behavioral therapy for sleep disorders in shift workers-a study protocol for a randomized controlled trial. Trials 2021; 22:539. [PMID: 34399824 PMCID: PMC8369659 DOI: 10.1186/s13063-021-05437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample. Methods Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness. Conclusions The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers. Trial registration German Clinical Trials Register DRKS DRKS00017777. Registered on 14 January 2020—retrospectively registered.
Collapse
Affiliation(s)
- Lukas Retzer
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany. .,University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - Monika Feil
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany
| | - Richard Reindl
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany
| | - Kneginja Richter
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany.,University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Robert Lehmann
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany
| | - Mark Stemmler
- Department of Psychology, Friedrich-Alexander University Erlangen Nuremberg, Nuremberg, Germany
| | - Elmar Graessel
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| |
Collapse
|
53
|
Efficacy and Safety of Auricular Acupuncture for the Treatment of Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial. Cancers (Basel) 2021; 13:cancers13164082. [PMID: 34439234 PMCID: PMC8394534 DOI: 10.3390/cancers13164082] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40-70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η2p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η2p = 0.094), anxiety (p = 0.001; η2p = 0.192), and fatigue (p = 0.006; η2p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.
Collapse
|
54
|
|
55
|
Losert-Bruggner B, Hülse M, Hülse R. Muskuloskeletale Erkrankungen und die kraniomandibuläre Dysfunktion – eine mögliche Ursache für nichterholsamen Schlaf. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Methode
Kiefer- und Kopfgelenke bilden eine kybernetische Einheit. Ziel dieser Studie ist es, mögliche Zusammenhänge zwischen schlechtem Schlaf und der kraniozervikalen (CCD) bzw. kraniomandibulären Dysfunktion (CMD) zu ermitteln.
Ergebnisse
Von den 606 untersuchten CMD-CCD-Patienten mit schlechtem Schlaf waren 65,4 % der Patienten weiblich, 34,6 % männlich; 90,3 % erfüllten zusätzlich die diagnostischen Kriterien des Fibromyalgiesyndroms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Durch die synchrone Therapie der CMD bzw. CCD und der funktionellen Wirbelsäulenstörungen konnten bei 85 % der bislang therapieresistenten CMD-CCD-Patienten mit schlechtem Schlaf eine gute Besserung der Beschwerden im Körper und bei 81,5 % eine gute Schlafbesserung erzielt werden.
Diskussion
Die CMD/CCD kann als Folge chronischer Schmerzen auftreten. Umgekehrt kann eine CMD/CCD auch eine muskuloskeletale Störung hervorrufen oder unterhalten. Chronische Schmerzen können den Schlaf stören. Bei der Diagnose und Behandlung von Schlafstörungen muss auch auf eine CMD/CCD hin untersucht und diese ggf. mitbehandelt werden.
Collapse
|
56
|
[Arousal and regulatory systems in the system of research domain criteria]. DER NERVENARZT 2021; 92:907-914. [PMID: 34324012 DOI: 10.1007/s00115-021-01160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The RDoC (research domain criteria) domain arousal and regulatory systems plays an important role for psychiatric disorders. OBJECTIVE What is the association between physiology and function of arousal, sleep and circadian rhythms and psychiatric disorders? What are the therapeutic consequences? MATERIAL AND METHOD In this narrative review the most important findings related to the topic are presented briefly and concisely. First, the physiology and function of the systems are described. Then the association with various psychiatric disorders is elucidated and therapeutic approaches are discussed. RESULTS The treatment of disorders of the arousal system plays a role in a broad group of psychiatric disorders. It is especially important to incorporate the disturbance of the arousal system into therapeutic concepts of affective disorders, schizophrenia, attention deficit hyperactivity disorder (ADHD) and substance abuse. CONCLUSION The dimensional concept of RDoC is reflected in DSM‑5 in the simultaneous registration of sleep disturbances and psychiatric disorders, which has important therapeutic consequences. The relationship between sleep function and the development of psychiatric disorders needs continued intensive research.
Collapse
|
57
|
Hader S, Kratz O, Eichler A, Moll GH, Irlbauer-Müller V. [Sleep behavior and problems in children and adolescents of a psychiatric day clinic sample: results and requirements for systematic diagnostic]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 49:387-400. [PMID: 34238031 DOI: 10.1024/1422-4917/a000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sleep behavior and problems in children and adolescents of a psychiatric day clinic sample: results and requirements for systematic diagnostic Abstract. Sleep disorders are common in adults as well as children and adolescents. Children and adolescents in psychiatric treatment (CAP) are especially affected by sleep problems. Cognitive behavioral therapy represents the first-line treatment, preceded by a standardized procedure for sleep diagnostics. To date, no study has investigated sleep behavior in CAP day clinics in Germany. In this study, N = 46 children/adolescents receiving CAP treatment in a day clinic completed a sleep diary (7 days) and a sleep anamnesis scheme with the help of their parents, and their sleep behavior was assessed by a clinician. Furthermore, a parent- and a self-report questionnaire plus a clinical assessment of the mental disorders in the children/adolescents were collected. 52 % of the children/ adolescents exhibited sleep disorders or sleep abnormalities (= sleep disorder symptoms in the context of comorbid disorders), in particular problems falling asleep or to falling asleep and sleeping through the night (26 %). In addition, 33 % reported having nightmares. Their sleep behavior correlated significantly with their external behavior problems (r = .38 .61, p = .02-.04); their sex (female: p = .01-≤ .001, |d| = 1.57-2.50) and their age (older: p = .05, |d| = .78) also significantly influenced sleep behavior. Particularly external behavior problems were associated with sleep problems in this day-care population. In summary, a multi-method-multi-informant procedure should be established for the systematic diagnostics of sleep abnormalities, together with individualized cognitive-behavioral therapy of sleep problems, especially in patients with external behavior problems.
Collapse
Affiliation(s)
- Saskia Hader
- Kinder- und Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | - Oliver Kratz
- Kinder- und Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | - Anna Eichler
- Kinder- und Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | - Gunther H Moll
- Kinder- und Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | | |
Collapse
|
58
|
Stuck BA, Spiegelhalder K. Schlafmedizinische Qualifizierung in Deutschland – eine Bestandsaufnahme. SOMNOLOGIE 2021. [DOI: 10.1007/s11818-021-00304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Zusammenfassung
Einleitung
Einblicke in die schlafmedizinische Versorgungsroutine sind nicht ohne Weiteres zu erhalten, wären für eine strategische Steuerung und prospektive Versorgungsplanung jedoch hilfreich. Ziel der vorliegenden Publikation ist die Bestandsaufnahme der aktuellen schlafmedizinischen Qualifizierungsmaßnahmen in Deutschland mit Schwerpunkt auf die Bereiche schlafbezogene Atmungsstörungen und Insomnie.
Materialien und Methoden
Die Analyse basiert u. a. auf der Gesundheitsberichterstattung des Bundes, den von den Landesärztekammern und Kassenärztlichen Vereinigungen bereitgestellten Daten, dem Mitgliederverzeichnis der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) und den Daten der Kommission Zertifizierung und Qualitätssicherung der DGSM.
Ergebnisse
Die Gesundheitsberichterstattung des Bundes weist für 2018 insgesamt 1255 Schlafmedizinerinnen (im Folgenden wird zur besseren Lesbarkeit nur die weibliche Form genannt) in Deutschland aus. Nach den Daten der Landesärztekammern hingegen gab es 2020 insgesamt 1436 Schlafmedizinerinnen. Demnach verfügen nur etwa 0,4 % aller berufstätigen Ärztinnen über eine Zusatzbezeichnung Schlafmedizin. Die Mehrzahl sind Fachärztinnen für Innere Medizin (66,6 %), gefolgt von HNO-Heilkunde (12,5 %) und Neurologie (10,7 %). Deutlich höher ist die Anzahl der Ärztinnen mit Ermächtigung bzw. Zulassung zur Polygrafie. Laut DGSM gibt es in Deutschland derzeit 700 ärztliche Somnologinnen. Dies entspricht 0,17 % aller berufstätigen Ärztinnen. Die zertifizierten Schlaflabore werden zu etwa 70 % durch Pneumologinnen geleitet. Bislang haben 75 Personen einen freiwilligen Qualifikationsnachweis zur kognitiven Verhaltenstherapie bei Insomnie der DGSM erworben.
Schlussfolgerung
Die vorgelegten Daten machen deutlich, dass nur vergleichsweise wenige Fachärztinnen den Weg hin zu einer schlafmedizinischen Weiterbildung bzw. Qualifizierung wählen. Dies steht im erheblichen Kontrast zur weiten Verbreitung insbesondere der schlafbezogenen Atmungsstörungen und der Insomnien, die klassische Volkskrankheiten darstellen.
Collapse
|
59
|
|
60
|
Cattarius BG, Schlarb AA. How the Sleep of Couples Changes from Pregnancy to Three Months Postpartum. Nat Sci Sleep 2021; 13:251-261. [PMID: 33658879 PMCID: PMC7917313 DOI: 10.2147/nss.s259072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sleep disturbances are frequent during pregnancy and postpartum. However, detailed research of sleep in couples during pregnancy and postpartum is lacking. OBJECTIVE Changes of sleep for primi- and multiparous pregnant women and their partners from late pregnancy to three months postpartum. The particular focus of this study is on sex differences in sleep, sleep problems, mutual sleep influence of couples, and the influences of parity and feeding methods on couples' sleep. MATERIALS AND METHODS The sample included 69 pregnant couples in the last trimester of pregnancy (t1) and three months after birth (t2). Sleep was measured with sleep diary for both times of measurement. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep disturbances. Other variables as parity and infant feeding type were determined by questionnaire. Besides results for woman and men, also dyadic data are calculated. RESULTS Over the time women had a worse sleep quality than men. They had a prolonged sleep onset latency, higher frequency and longer duration of night wakings than men. Sleep efficiency for women was prepartal 83.32% and postpartal 83.6% below the clinically cut-off value of 85%. For 56.52% of women at t1 and for 55.07% at t2 PSQI scores exceeded the clinically cut-off of 5. However, men suffered from a sleep loss after birth of their child, too. In pregnancy and postpartum men reported lower total sleep time at both times of measurement in comparison to women. For 30.43% of men at T1 and for 24.64% at T2 PSQI score exceeded the clinically cut-off of 5. Sleep efficiency for men was prepartal 90.96% and postpartal 90.69%. Results indicate predictive links between prepartal PSQI of couples to postpartal PSQI. Neither parity nor feeding method could explain variance in postpartal PSQI-score. CONCLUSION This is one of the very rare studies incorporating dyadic data. Results show the need of diagnosing and treating existing sleep problems in pregnancy to prevent future sleep problems postpartum.
Collapse
Affiliation(s)
- Barbara G Cattarius
- Faculty Psychology and Sports Science, University of Bielefeld, Bielefeld, Germany
| | - Angelika A Schlarb
- Faculty Psychology and Sports Science, University of Bielefeld, Bielefeld, Germany
| |
Collapse
|
61
|
Haidl P, Jany B, Geiseler J, Andreas S, Arzt M, Dreher M, Frey M, Hauck RW, Herth F, Hämäläinen N, Jehser T, Kenn K, Lamprecht B, Magnet F, Oldenburg O, Schenk P, Schucher B, Studnicka M, Voshaar T, Windisch W, Woehrle H, Worth H. [Guideline for Long-Term Oxygen Therapy - S2k-Guideline Published by the German Respiratory Society]. Pneumologie 2020; 74:813-841. [PMID: 33291162 DOI: 10.1055/a-1252-1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Long-term oxygen therapy is of great importance both for reducing mortality and for improving performance in patients with chronic lung diseases. The prerequisites for Long-term oxygen therapy are adequate diagnostics and clearly defined indication. A causal distinction into chronic hypoxaemic and hypercapnic respiratory failure is reasonable, from which the differential indication for non-invasive ventilation results.The revised guideline covers the diagnostics and indication of chronic lung and heart diseases, the role of oxygen in terminal illness and gives a detailed description of available oxygen devices. The guideline is intended to help avoid undersupply, oversupply and false prescriptions. Furthermore, the chapter "Postacute Oxygen Therapy" discusses the procedure, relevant in everyday life, but not yet clearly defined, for prescribing oxygen therapy for the home at the end of an inpatient stay. Another important point, the correct prescription of mobile oxygen systems, is also presented in the guideline. This document is a revised version of the guideline for longterm oxygen therapy and replaces the version of 2008.
Collapse
Affiliation(s)
- P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg
| | - B Jany
- Klinikum Würzburg Mitte (KWM), Klinik für Innere Medizin, Pneumologie und Beatmungsmedizin, Standort MissioKlinik, Würzburg
| | - J Geiseler
- Klinikum Vest, Medizinische Klinik IV: Pneumologie, Beatmungs- und Schlafmedizin, Marl
| | - S Andreas
- Lungenfachklinik Immenhausen, Universitätsmedizin Göttingen, Immenhausen
| | - M Arzt
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Regensburg
| | - M Dreher
- Universitätsklinikum Aachen, Klinik für Pneumologie und Internistische Intensivmedizin, Aachen
| | - M Frey
- Klinik Barmelweid, Rombach, Schweiz
| | - R W Hauck
- Klinikum Altötting, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Altötting
| | - F Herth
- Thoraxklinik, Abteilung für Pneumologie und Beatmungsmedizin, Universität Heidelberg, Heidelberg
| | | | - T Jehser
- Gemeinschaftskrankenhaus Havelhöhe, Palliativstation, Berlin
| | - K Kenn
- Philips Universität Marburg, Lehrstuhl für pneumologische Rehabilitation, Marburg
| | - B Lamprecht
- Kepler Universitätsklinikum, Med Campus III, Linz, Österreich
| | - F Magnet
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Fakultät für Gesundheit - Department für Humanmedizin, Köln
| | - O Oldenburg
- Clemenshospital, Klinik für Kardiologie, Münster
| | - P Schenk
- Landesklinikum Hochegg, Abteilung für Pulmologie, Grimmenstein, Österreich
| | - B Schucher
- LungenClinic Grosshansdorf, Großhansdorf
| | - M Studnicka
- Landeskrankenhaus Salzburg, Universitätsklinikum der PMU, Universitätsklinik für Pneumologie, Salzburg, Österreich
| | - T Voshaar
- Krankenhaus Bethanien Lungenzentrum, Medizinische Klinik III, Moers
| | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Fakultät für Gesundheit - Department für Humanmedizin, Köln
| | | | - H Worth
- Facharztzentrum Fürth, Fürth
| | | | | | | | | | | | | | | | | | | |
Collapse
|
62
|
Kage P, Simon JC, Treudler R. Atopic dermatitis and psychosocial comorbidities. J Dtsch Dermatol Ges 2020; 18:93-102. [PMID: 32026645 DOI: 10.1111/ddg.14029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/03/2019] [Indexed: 01/04/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease that may be associated with a number of comorbidities including psychosocial disorders, which are the primary focus of this article. The data presented is based on a literature search in PubMed and subsequent screening of relevant review articles and guidelines. There is a greater prevalence of depression, anxiety, sleep disorders and suicidal ideation among individuals with AD. The disease negatively impacts patients' quality of life. Children with AD have been shown to more commonly exhibit signs of attention-deficit/hyperactivity disorder. Only little data exists on the association of AD with schizophrenia, eating disorders or obsessive-compulsive disorder. There is a great need for research in the field of AD-related comorbidities, especially with respect to the question as to whether and how novel treatment options may potentially affect these comorbidities.
Collapse
Affiliation(s)
- Paula Kage
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| | - Jan-Christoph Simon
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| |
Collapse
|
63
|
Frase L, Acker J, Cohrs S, Danker-Hopfe H, Frohn C, Göder R, Mauche N, Norra C, Pollmächer T, Richter K, Riemann D, Schilling C, Weeß HG, Wetter TC, Nissen C. [Recommendations on performing polygraphy or polysomnography in the fields of psychiatry and psychotherapy : Position paper of the working group on sleep medicine of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. DER NERVENARZT 2020; 91:843-853. [PMID: 31853578 DOI: 10.1007/s00115-019-00855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Difficulties in falling asleep and maintaining sleep, nonrestorative sleep and decreased daytime wakefulness represent very common but relatively unspecific health complaints. Around 100 specific sleep-related disorders will be classified in their own major chap. 7 (sleep wake disorders) for the first time in the upcoming 11th version of the International Classification of Diseases (ICD 11). With respect to the disciplines of psychiatry and psychotherapy there is a bidirectional relationship between mental health and sleep wake disorders. Sleep wake disorders can be an independent risk factor for the onset of a mental disorder and have a negative influence on the course of the disease. In addition, sleep wake disorders can also precede a mental disease as an early symptom and therefore be an important indication for early recognition. Many sleep wake disorders can be diagnosed based on the anamnesis and routine clinical investigations. In special cases, examination in a specialized sleep laboratory and treatment in a sleep medicine center following a staged care approach can be mandatory. Polysomnography represents the gold standard for the differential diagnostics; however, there is no legal foundation in the field of neuropsychiatric disorders for remuneration in the German healthcare system. This review summarizes the current guidelines with respect to the criteria for an investigation in a sleep laboratory from the perspective of the disciplines of psychiatry and psychotherapy. From this the requirements for guideline-conform diagnostics and treatment are derived.
Collapse
Affiliation(s)
- Lukas Frase
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland.
| | - Jens Acker
- Klinik für Schlafmedizin, Bad Zurzach, Schweiz
| | - Stefan Cohrs
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Rostock, Rostock, Deutschland
| | - Heidi Danker-Hopfe
- Kompetenzzentrum Schlafmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Corinna Frohn
- Medizinisches Versorgungszentrum Bethanien, Solingen, Deutschland
| | - Robert Göder
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Nicole Mauche
- Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Christine Norra
- LWL-Klinik Paderborn, Psychiatrie Psychotherapie Psychosomatik, Medizinische Fakultät Ruhr-Universität Bochum, Bochum, Deutschland
| | - Thomas Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - Kneginja Richter
- Universitätsklinik für Psychiatrie und Psychotherapie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - Dieter Riemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland
| | - Claudia Schilling
- Zentralinstitut für Seelische Gesundheit, Schlaflabor, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Hans-Günter Weeß
- Interdisziplinäres Schlafzentrum am Pfalzklinikum, Klingenmünster, Deutschland
| | - Thomas C Wetter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Schlafmedizinisches Zentrum, Regensburg, Deutschland
| | - Christoph Nissen
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland
- Universitätsklinik für Psychiatrie und Psychotherapie, Bern, Schweiz
| |
Collapse
|
64
|
Schmid SR, Nissen C, Riemann D, Spiegelhalder K, Frase L. Auditorische Stimulation während des Schlafs. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungDie Insomnie, d. h. eine Ein- und/oder Durchschlafstörung, die sich negativ auf die Leistungsfähigkeit und Tagesbefindlichkeit auswirkt, ist eine der häufigsten Erkrankungen in der Allgemeinbevölkerung. Sie wird derzeit meistens pharmakologisch und/oder psychotherapeutisch behandelt, wobei die pharmakologische Behandlung mit Benzodiazepin-Rezeptor-Agonisten zu Abhängigkeit führen kann und die Verfügbarkeit von für die Insomnie-Therapie ausgebildeten Psychotherapeuten momentan nicht in ausreichendem Maße gegeben ist. Durch innovative Behandlungsmethoden könnte hier eine Versorgungslücke effektiv geschlossen werden. Hierzu zählt die auditorische Stimulation, welche vorhandene Sinneskanäle nutzt, um den Schlaf zu beeinflussen. Bisher wurde die auditorische Stimulation vor allem zur Untersuchung von Prozessen der Gedächtniskonsolidierung bei gesunden Probanden angewendet, wobei erfolgreich eine Erhöhung langsamer Oszillationen erreicht wurde, welche vor allem während des Tiefschlafs auftreten. Erste Befunde und sekundäre Outcome-Parameter liefern Hinweise, dass die Potenzierung langsamer Oszillationen durch auditorische Stimulation den Schlaf vertiefen kann, jedoch wurde hierzu bislang keine Studie mit Insomniepatienten durchgeführt. Weitere Forschung bezüglich des Einflusses der Potenzierung langsamer Oszillationen auf die Linderung von Ein- und Durchschlafproblemen bei vorliegender nichtorganischer Insomnie erscheint daher geboten zu sein, um der hohen Beschwerdelast dieser Patientengruppe entgegenzuwirken.
Collapse
|
65
|
Blume C, Hauser T, Gruber WR, Heib DP, Winkler T, Schabus M. "How does Austria sleep?" self-reported sleep habits and complaints in an online survey. Sleep Breath 2020; 24:735-741. [PMID: 31838623 PMCID: PMC7289773 DOI: 10.1007/s11325-019-01982-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/23/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022]
Abstract
During the past years, the prevalence of sleep problems has been increasing steadily in industrial societies and represents a major social and socioeconomic burden. The situation in Austria was last evaluated in 2007 by Zeitlhofer and colleagues in a representative sample of 1000 participants. In the current study, we sought to evaluate the sleep behaviour of the Austrian population in an ongoing online survey, in which we have collected data from 986 participants (66% women, mean age 40.9 ± 16.4 years) between March 2018 and May 2019. Sleep duration was appropriate in 52% of the respondents (i.e. 7-9 h per night). However, we found an alarmingly high number of self-reported sleep problems (46%), and only 31% of the participants classified themselves as "good sleepers" using a validated self-report questionnaire (Pittsburgh Sleep Quality Index, PSQI). Furthermore, many participants reported suffering from sleep problems for a very long time (86% > 6 months; 37% > 5 years) suggesting that currently available treatment options are either ineffective or not employed. Possible reasons for sleep problems could include irregular sleep-wake cycles, increased perceived stress levels, and the use of electronic devices just before sleep.
Collapse
Affiliation(s)
- Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Theresa Hauser
- Laboratory for Sleep, Cognition, and Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Walter R Gruber
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Dominik Pj Heib
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
- Laboratory for Sleep, Cognition, and Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Thomas Winkler
- Laboratory for Sleep, Cognition, and Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
- Laboratory for Sleep, Cognition, and Consciousness Research, University of Salzburg, Salzburg, Austria.
| |
Collapse
|
66
|
T. Simon*1 S, Pralong*1 A, Radbruch L, Bausewein*2 C, Voltz*2 R. The Palliative Care of Patients With Incurable Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:108-115. [PMID: 32164823 PMCID: PMC7081049 DOI: 10.3238/arztebl.2020.0108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/07/2019] [Accepted: 12/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of palliative medicine is to optimize the quality of life of patients with incurable, progressive diseases. The care delivered in actual clinical practice is not uniform and often takes insufficient account of the currently available scientific evidence. METHODS In accordance with the methodological directives on systematic literature reviews and consensus-finding that have been issued by the German Oncology Guideline Program (Leitlinienprogramm Onkologie), a nationwide, representative group of experts updated the previously published seven chapters of the S3 (evidence-based and consensus-based) guideline and formulated new recommen- dations on a further eight topics in palliative care. RESULTS Non-drug options for the treatment of fatigue include aerobic exercise and psycho-educative methods, particularly cognitive behavioral therapy. Sleep distur- bances can be treated with improved sleep hygiene and relaxation techniques, as well as with drugs: Z substances for short-term and sedating antidepressants for intermediate-term treatment. For nausea and vomiting, the first line of treatment consists of antidopaminergic drugs, such as haloperidol, or drugs with an antido- paminergic effect combined with a further receptor affinity, such as metoclopramide. For patients suffering from malignant intestinal obstruction (MIO), an important con- sideration for further treatment is whether the obstruction is complete or incomplete. Psychotherapeutic interventions are indicated for the treatment of anxiety. CONCLUSION Multiple studies have confirmed the benefit of the early integration of palliative care for achieving the goals of better symptom control and maintenance of derate quality of evidence supporting the management of certain symptoms in patients with incurable cancers.
Collapse
Affiliation(s)
- Steffen T. Simon*1
- *These two authors share the position of first author
- University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine
- University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD)
| | - Anne Pralong*1
- *These two authors share the position of first author
- University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine
- University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD)
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn
| | - Claudia Bausewein*2
- *These two authors share the position of last author
- Ludwig-Maximilians-University Munich, Munich University Hospital, Department of Palliative Medicine
| | - Raymond Voltz*2
- *These two authors share the position of last author
- University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine
- University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD)
| |
Collapse
|
67
|
Chronisch-obstruktive Lungenerkrankung (COPD) und Schlaf. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
68
|
Spiegelhalder K, Acker J, Baumeister H, Büttner-Teleaga A, Danker-Hopfe H, Ebert DD, Fietze I, Frase L, Klein S, Lehr D, Maun A, Mertel I, Richter K, Riemann D, Sauter C, Schilling C, Schlarb AA, Specht M, Steinmetz L, Weeß HG, Crönlein T. Digitale Behandlungsangebote für Insomnie – eine Übersichtsarbeit. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei Erwachsenen durchweg sehr effektiv ist mit allenfalls leicht geringeren Effektstärken als die gleiche Behandlung mit physischer Präsenz von Therapeuten und Patienten. Behandlungseffekte zeigen sich dabei auch für sekundäre Outcome-Parameter wie Depressivität, Angst, Fatigue und Lebensqualität. Hingegen lassen die Forschung zur Wirksamkeit der internetbasierten KVT‑I bei Erwachsenen mit komorbiden psychischen Störungen oder körperlichen Erkrankungen sowie die Forschung zur Frage, wieviel Therapeutenkontakt in die Behandlung integriert werden sollte, anscheinend noch keine abschließenden Antworten zu. In diesen Bereichen scheint weitere Forschung notwendig zu sein scheint.
Collapse
|
69
|
Buth S, Verthein U, Holzbach R. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:98-99. [PMID: 32102732 PMCID: PMC7075454 DOI: 10.3238/arztebl.2020.0098b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sven Buth
- *Zentrum für interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie
| | - Uwe Verthein
- *Zentrum für interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie
| | - Rüdiger Holzbach
- **Klinik für Psychiatrie, psychotherapie und Psychosomatik, Klinikum Hochsauerland
| |
Collapse
|
70
|
Kage P, Simon J, Treudler R. Atopische Dermatitis und psychosoziale Komorbidität. J Dtsch Dermatol Ges 2020; 18:93-102. [DOI: 10.1111/ddg.14029_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Paula Kage
- Klinik für Dermatologie Venerologie und Allergologie Leipziger Interdisziplinäres Centrum für Allergologie – LICA‐CAC Universität Leipzig
| | - Jan‐Christoph Simon
- Klinik für Dermatologie Venerologie und Allergologie Leipziger Interdisziplinäres Centrum für Allergologie – LICA‐CAC Universität Leipzig
| | - Regina Treudler
- Klinik für Dermatologie Venerologie und Allergologie Leipziger Interdisziplinäres Centrum für Allergologie – LICA‐CAC Universität Leipzig
| |
Collapse
|
71
|
Richter K, Kellner S, Miloseva L, Frohnhofen H. [Treatment of insomnia in old age]. Z Gerontol Geriatr 2020; 53:105-111. [PMID: 31965284 DOI: 10.1007/s00391-019-01684-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Insomnia is one of the most frequent health disorders in old age. It causes suffering and numerous health problems. Therefore, treatment is often indicated. Behavioral therapy is the treatment of choice even in older individuals. In addition, light therapy also has an important role. Pharmacological treatment measures are less well studied, the benefits in long-term use are unclear and should only be applied in the short term to reduce suffering as well as being integrated into a comprehensive treatment concept.
Collapse
Affiliation(s)
- Kneginja Richter
- Universitätsklinik für Psychiatrie und Psychotherapie, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - Stefanie Kellner
- Institut für E-Beratung, Fakultät für Sozialwissenschaften, Technische Hochschule Nürnberg, Nürnberg, Deutschland
| | - Lence Miloseva
- Fakultät für Medizinwissenschaften, Universität Goce Delcev, Stip, Stip, Nordmazedonien
| | - Helmut Frohnhofen
- Fakultät für Gesundheit, Universität Witten Herdecke, Witten, Deutschland
| |
Collapse
|
72
|
Riemann D, Krone LB, Wulff K, Nissen C. Sleep, insomnia, and depression. Neuropsychopharmacology 2020; 45:74-89. [PMID: 31071719 PMCID: PMC6879516 DOI: 10.1038/s41386-019-0411-y] [Citation(s) in RCA: 330] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022]
Abstract
Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.
Collapse
Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lukas B Krone
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Departments of Radiation Sciences & Molecular Biology, Umea University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umea University, Umeå, Sweden
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| |
Collapse
|
73
|
Schlüssel S, Gensichen J. ["Tired, weak and exhausted" - which diagnostic steps make sense in the GP's practice?]. MMW Fortschr Med 2020; 162:31-34. [PMID: 31960308 DOI: 10.1007/s15006-020-0056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sabine Schlüssel
- Institut für Allgemeinmedizin, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, D-80336, München, Deutschland.
| | - Jochen Gensichen
- Institut für Allgemeinmedizin, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, D-80336, München, Deutschland
| |
Collapse
|
74
|
Brakemeier EL, Wirkner J, Knaevelsrud C, Wurm S, Christiansen H, Lueken U, Schneider S. Die COVID-19-Pandemie als Herausforderung für die psychische Gesundheit. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2020. [DOI: 10.1026/1616-3443/a000574] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Zusammenfassung. Die COVID-19-Pandemie als multidimensionaler und potenziell toxischer Stressfaktor führt auch in Deutschland zu psychischen Problemen in der Allgemeinbevölkerung und wird voraussichtlich einen Anstieg der Inzidenz- und Prävalenzraten psychischer Störungen bedingen. In diesem Positionspapier erfolgt daher eine wissenschaftlich differenzierte Betrachtung der psychologischen Auswirkungen der COVID-19-Pandemie auf verschiedene Altersstufen sowie psychische Vulnerabilitäten und Störungsbilder, wobei auch Chancen für die psychische Gesundheit und psychotherapeutische Versorgung diskutiert werden. Basierend auf den Befunden werden abschließend u. a. folgende gesundheitspolitische Ziele und Maßnahmen abgeleitet: Implementierung von universellen und indizierten modularen Präventionsangeboten sowie Anpassung der evidenzbasierten Richtlinienpsychotherapien hinsichtlich Bedarf, Inhalt und Modalität. Die Klinische Psychologie und Psychotherapie stellt aufgrund ihrer ausgewiesenen Expertise im Bereich der psychischen Gesundheit zentrales Wissen für die erfolgreiche Bewältigung der COVID-19-Pandemie zur Verfügung und kann in interdisziplinären und interprofessionellen Kooperationen dazu beitragen, die Herausforderungen für die psychische Gesundheit anzugehen.
Collapse
Affiliation(s)
- Eva-Lotta Brakemeier
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Greifswald
- Abteilung für Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Janine Wirkner
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Greifswald
| | | | - Susanne Wurm
- Abteilung für Präventionsforschung und Sozialmedizin, Universitätsmedizin Greifswald
| | - Hanna Christiansen
- Abteilung für Klinische Kinder- und Jugendpsychologie, Philipps-Universität Marburg
| | - Ulrike Lueken
- Abteilung für Psychotherapie, Humboldt-Universität zu Berlin
| | - Silvia Schneider
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| |
Collapse
|
75
|
Baglioni C, Altena E, Bjorvatn B, Blom K, Bothelius K, Devoto A, Espie CA, Frase L, Gavriloff D, Tuuliki H, Hoflehner A, Högl B, Holzinger B, Järnefelt H, Jernelöv S, Johann AF, Lombardo C, Nissen C, Palagini L, Peeters G, Perlis ML, Posner D, Schlarb A, Spiegelhalder K, Wichniak A, Riemann D. The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. J Sleep Res 2019; 29:e12967. [PMID: 31856367 DOI: 10.1111/jsr.12967] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022]
Abstract
Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.
Collapse
Affiliation(s)
- Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Ellemarije Altena
- UMR 5287, Institut de Neurosciences Intégratives et Cognitives d'Aquitaine, Neuroimagerie et Cognition Humaine, CNRS, Université de Bordeaux, Bordeaux, France
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kerstin Blom
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Huddinge Hospital, Stockholm, Sweden
| | | | | | - Colin A Espie
- Nuffield Department of Clinical Neuroscience, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dimitri Gavriloff
- Nuffield Department of Clinical Neuroscience, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Hion Tuuliki
- Nordic Sleep Centre, Tallinn, Estonia.,Tartu University Hospital, Tartu, Estonia
| | - Andrea Hoflehner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Finland
| | - Susanna Jernelöv
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Huddinge Hospital, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Caterina Lombardo
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Laura Palagini
- Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Geert Peeters
- Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
| | - Michael L Perlis
- Department of Psychiatry, Upenn Behavioral Sleep Medicine Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Donn Posner
- Stanford University School of Medicine, Stanford, CA, USA
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Adam Wichniak
- Sleep Medicine Centre and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
76
|
Why Z-drugs are used even if doctors and nurses feel unable to judge their benefits and risks-a hospital survey. Eur J Clin Pharmacol 2019; 76:285-290. [PMID: 31732756 DOI: 10.1007/s00228-019-02783-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many patients receive Z-drugs for hospital-associated sleep problems, in spite of well-known risks. The aim of this study was to learn more about the attractiveness of Z-drugs, seen from the doctors' and nurses' perspective. METHODS Using a standardized questionnaire, doctors (63/116) and nurses (73/243) in a German general hospital were surveyed about the risks and benefits of Z-drugs, compared with benzodiazepines. RESULT "Reduced time to get to sleep" was perceived by doctors (51%) and nurses (53%) to be a strong benefit of Z-drugs; "confusion" and "falls" were perceived by ca. 10% of doctors and ca. 15% of nurses to be a frequent problem. Compared with benzodiazepines, respondents more often answered "unable to judge" for Z-drugs; e.g. for doctors, 18% (benzodiazepines) vs. 45% (Z-drugs) were unable to judge "improved daytime functioning" and 12% (benzodiazepines) vs. 37% (Z-drugs) were unable to judge "falls." CONCLUSION Z-drugs seem to be attractive because experiential knowledge overemphasizes their benefits and fails to take risks such as drug-related falls and confusion into account. Difficulties to judge a drug's risk-benefit ratio do not prevent doctors and nurses from using them. Interventions for reducing Z-drug usage should incorporate local quality assurance data about relevant patient risks.
Collapse
|
77
|
Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P. Sleep-Related Disorders in Neurology and Psychiatry. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:681-688. [PMID: 31709972 PMCID: PMC6865193 DOI: 10.3238/arztebl.2019.0681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/07/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep-related disorders are a group of illnesses with marked effects on patients' quality of life and functional ability. Their diagnosis and treatment is a matter of common interest to multiple medical disciplines. METHODS This review is based on relevant publications retrieved by a selective search in PubMed (Medline) and on the guide- lines of the German Society for Sleep Medicine, the German Neurological Society, and the German Association for Psychiatry, Psychotherapy and Psychosomatics. RESULTS A pragmatic classification of sleep disorders by their three chief complaints-insomnia, daytime somnolence, and sleep-associated motor phenomena-enables tentative diagnoses that are often highly accurate. Some of these disorders can be treated by primary care physicians, while others call for referral to a neurologist or psychiatrist with special experience in sleep medicine. For patients suffering from insomnia as a primary sleep disorder, rather than a symptom of another disease, meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes. These patients, like those suffering from secondary sleep disorders, can also benefit from drug treatment for a limited time. Studies have shown marked improvement of sleep latency and sleep duration from short-term treatment with benzodiazepines and Z-drugs (non- benzodiazepine agonists such as zolpidem and zopiclone), but not without a risk of tolerance and dependence. For sleep disorders with the other two main manifestations, specific drug therapy has been found to be beneficial. CONCLUSION Sleep disorders in neurology and psychiatry are a heterogeneous group of disorders with diverse manifestations. Their proper diagnosis and treatment can help prevent secondary diseases and the worsening of concomitant conditions. Care structures for the treatment of sleep disorders should be further developed.
Collapse
Affiliation(s)
- Jan Rémi
- Department of Neurology, Medical Center of the Ludwig-Maximilians–University of Munich (LMU), Germany
| | | | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Medical Faculty, University of Freiburg, Germany
| | - Claudia Trenkwalder
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany and Department of Neurosurgery, University Medical Center Göttingen, Germany
| | - Peter Young
- Specialized Clinic for Therapies in Neurology, Medical Park Reithofpark, Bad Feilnbach, Germany
| |
Collapse
|
78
|
Frase L, Duss SB, Gieselmann A, Penzel T, Wetter TC, Pollmächer T. [Internet-based cognitive behavioral therapy of insomnia and nightmare disorder]. DER NERVENARZT 2019; 91:617-623. [PMID: 31471620 DOI: 10.1007/s00115-019-00803-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cognitive behavioral therapeutic interventions are considered to be one of the most effective forms of treatment of various mental disorders. Besides being very frequent, sleep disorders, such as insomnia and nightmare disorder are often not treated effectively and guideline-conform, mainly due to the lack of qualified psychotherapists. Implementation of modern technical options, such as web-based psychotherapy can help to overcome this problem. This article presents the current situation in the treatment of insomnia and nightmare disorders as particularly well-suited fields of application. For insomnia there are several English language and also recently German language options, which for example were also evaluated for the application to work-related stress and sleep disorders. In this respect, procedures with and without contact to a therapist or multicomponent procedures and single interventions can be differentiated. For nightmare disorders imagery rehearsal therapy provides a structure, which can also easily be transferred to an internet-based therapy program. The currently beginning use of internet-based treatment of sleep disorders does not yet utilize all theoretically available technical possibilities. The potential of internet-based therapy is extremely versatile and it remains for medical sleep experts to consider which method can be used for which indications.
Collapse
Affiliation(s)
- Lukas Frase
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland.
| | - Simone B Duss
- Universitäres Schlaf-Wach-Epilepsie-Zentrum, Universitätsklinik für Neurologie, Universitätsspital (Inselspital) Bern, Bern, Schweiz
| | - Annika Gieselmann
- Abteilung Klinische Psychologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Thomas Penzel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Thomas C Wetter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Regensburg am Bezirksklinikum Regensburg, Regensburg, Deutschland
| | - Thomas Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| |
Collapse
|
79
|
Foellner S, Guth P, Jorde I, Lücke E, Ganzert C, Stegemann-Koniszewski S, Schreiber J. Prevention of leakage due to mouth opening through applying an oral shield device (Sominpax™) during nasal CPAP therapy of patients with obstructive sleep apnea. Sleep Med 2019; 66:168-173. [PMID: 31884409 DOI: 10.1016/j.sleep.2019.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVE The first line treatment for obstructive sleep apnea (OSA) is nasal continuous positive airway pressure (nCPAP), for which a variety of masks are available. While nasal masks (NM) are the first choice; oronasal masks (ONM) are also frequently used to prevent mouth dryness resulting from mouth opening. Our cross-sectional, prospective, randomized, un-blinded study addressed the efficacy of wearing an oral shield in addition to NM in preventing mouth leakage METHODS: Patients with OSA and established therapy using NM and complaining about mouth dryness (n = 29) underwent three polysomnographies (PSGs) using NM, ONM or a nose mask in combination with an oral shield (NMS). Mask leakage was continuously documented and objective sleep quality was assessed. RESULTS There were significant differences in the apnea-hypopnea-index (AHI) between ONM (8.5/h; SD 6,7) and NM/nasal mask combined with oral shield device (NMS) (2.6/h; SD 2,3; 2.7/h; SD 2,6) (p < 0,05) as well as in leakage [ONM (39.7 l/min SD 12,4); NM (34.6 l/min SD 9,4); NMS (33.1 l/min SD 9,6)] (p = 0.011). Furthermore, analysis of sleep quality (NREM3) favored NM and NMS over ONM (p = 0.02). There were no significant differences between NM and NMS in any objective outcome. CONCLUSIONS Our data consistently confirmed the NM as the first choice for continuous positive airway pressure (CPAP) therapy of OSA. Notably, we demonstrated a high potential of the oral shield for patients with mouth opening to achieve additional comfort and thereby possibly compliance, without affecting nCPAP therapy effectiveness.
Collapse
Affiliation(s)
- Sebastian Foellner
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany.
| | - Patricia Guth
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Ilka Jorde
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Eva Lücke
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Christine Ganzert
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Sabine Stegemann-Koniszewski
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Jens Schreiber
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| |
Collapse
|
80
|
Staub C. Concept of diverse sleep treatments in physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1505948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cristina Staub
- Ausgeschlafen.ch: Physiotherapy and Sleep Consulting, Zürich, Switzerland
| |
Collapse
|
81
|
Brupbacher G, Straus D, Porschke H, Zander-Schellenberg T, Gerber M, von Känel R, Schmidt-Trucksäss A. The acute effects of aerobic exercise on sleep in patients with depression: study protocol for a randomized controlled trial. Trials 2019; 20:352. [PMID: 31196147 PMCID: PMC6567535 DOI: 10.1186/s13063-019-3415-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Unipolar depression is one of the most important mental disorders. Insomnia is a symptom of cardinal importance in depression. It increases the risk to develop depression, negatively affects disease trajectory, is the most common symptom after remission, increases the risk of relapse, and is associated with higher suicide rates. Existing therapies for insomnia in depression have limitations. Further adjuvant therapies are therefore needed. Acute aerobic exercise has been shown to have beneficial effects on sleep in healthy individuals and patients with insomnia. We therefore hypothesize that a single session of aerobic exercise has a positive impact on sleep in patients with unipolar depression. This trial aims to investigate the effects of a single bout of aerobic exercise on the subsequent night's sleep in patients with depression. METHODS/DESIGN This is a two-arm parallel group, randomized, outcome assessor blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression (without a psychotic episode) are included. Exclusion criteria are regular use of hypnotic agents, opioids, and certain beta-blockers, as well as the presence of factors precluding exercise, history of epilepsy, restless legs syndrome, moderate obstructive sleep apnea, and a BMI > 40. The intervention is a single bout of aerobic exercise, performed for 30 min on a bicycle ergometer at 80% individual anaerobic threshold. The control group sits and reads for 30 min. The primary outcome is sleep efficiency measured by polysomnography. Secondary outcomes include further polysomnographic variables, subjective pre-sleep arousal, nocturnal cardiovascular autonomic modulation, subjective sleep quality, daytime sleepiness, and adverse events. According to the sample size calculation, a total of 92 patients will be randomized using minimization. DISCUSSION This trial will add new information to the body of knowledge concerning the treatment of insomnia in patients with depression. Thereby, the results will inform decision makers on the utility of acute aerobic exercise. TRIAL REGISTRATION Clinicaltrials.gov, NCT03673397 . Protocol version 1 registered on 17 September 2018.
Collapse
Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Doris Straus
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Thea Zander-Schellenberg
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| |
Collapse
|
82
|
Crönlein T, Spiegelhalder K. Die insomnische Störung. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-0207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
83
|
Frase L, Selhausen P, Krone L, Tsodor S, Jahn F, Feige B, Maier JG, Mainberger F, Piosczyk H, Kuhn M, Klöppel S, Sterr A, Baglioni C, Spiegelhalder K, Riemann D, Nitsche MA, Nissen C. Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls. Brain Stimul 2019; 12:674-683. [DOI: 10.1016/j.brs.2019.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022] Open
|
84
|
|
85
|
Schlafen kann man lernen: Leitlinienbasierte Diagnostik und Behandlung von Insomnien und Alpträumen im Kindes- und Jugendalter. Prax Kinderpsychol Kinderpsychiatr 2019; 68:93-109. [DOI: 10.13109/prkk.2019.68.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
86
|
Vochem J, Strobel C, Maier L, Spiegelhalder K, Hertenstein E, Riemann D, Feige B. Pre-Sleep Arousal Scale (PSAS) and the Time Monitoring Behavior-10 scale (TMB-10) in good sleepers and patients with insomnia. Sleep Med 2019; 56:98-103. [PMID: 30853192 DOI: 10.1016/j.sleep.2019.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Pre-sleep arousal and time monitoring behavior are two putative factors involved in the development and maintenance of insomnia. We investigate two questionnaires measuring these factors in good sleepers and patients with insomnia. PARTICIPANTS A sample of 96 patients with non-organic insomnia according to ICD-10 and 208 good sleepers completed the Pre-Sleep Arousal Scale (PSAS), the Time Monitoring Behavior-10 scale (TMB-10), the Beck Depression Inventory (BDI)-II, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI) and the State-Trait Anxiety Inventory (STAI). METHODS In this study, 95% quantile cut-off scores were determined for good sleeper in the age and gender mathed subgroups of the insomnia group. Multiple logistic regression analysis was used to determine variables predicting above-threshold values in the two target questionnaires. Included predictors were age, gender as well as ISI, BDI-II, STAI-1 and -2 total scores. RESULTS Good sleepers showed 95% quantiles between 12.2 and 23.8 for PSAS and between 7.5 and 12.7 for TMB-10. Approximately 40% of patients with insomnia had scores above these cut-offs for PSAS and ca. 25% for TMB-10. Female gender and anxiety were variables associated with scores above cut-off on the PSAS. Insomnia severity and anxiety were associated with scores above cut-off on the TMB-10. CONCLUSIONS These findings underline the importance of PSAS and TMB-10 in the diagnostic investigation of insomnia and indicate that time monitoring is related to increased insomnia severity. Further research may investigate the impact of the corresponding two constructs on response rates to cognitive-behavioral treatment for insomnia.
Collapse
Affiliation(s)
- Juliana Vochem
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christine Strobel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Lena Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Elisabeth Hertenstein
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| |
Collapse
|
87
|
Palagini L, Domschke K, Benedetti F, Foster RG, Wulff K, Riemann D. Developmental pathways towards mood disorders in adult life: Is there a role for sleep disturbances? J Affect Disord 2019; 243:121-132. [PMID: 30243192 DOI: 10.1016/j.jad.2018.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/01/2018] [Accepted: 09/09/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Mood disorders are among the most prevalent and serious mental disorders and rank high among to the leading global burdens of disease. The developmental psychopathology framework can offer a life course perspective on them thus providing a basis for early prevention and intervention. Sleep disturbances, are considered risk factors for mood disorders across childhood, adolescence and adulthood. Assuming that sleep disturbances may play a pivotal role in the pathogenesis of mood disorders from a life course point of view, we reviewed the data on developmental pathways towards mood disorders in adult life in relation to sleep disturbances. METHOD From February 2017, a systematic search was conducted in PubMed, PsycINFO and Embase electronic databases for literature on developmental pathways to mood disorders in adult life in relation to sleep disturbances and to 1) pre-natal stress, 2) early brain developmental processes, and 3) temperaments, character and attachment style. RESULTS Eleven, 54 and 15 articles were respectively selected. CONCLUSIONS Experimental and clinical studies revealed that exposure to prenatal/early life stress results in sleep disturbances such as poor sleep and altered circadian regulation phases and may predict or even precipitate mood disorders in adulthood. Chronic sleep disruption may interfere with neuronal plasticity, connectivity and the developing brain thus contributing to the development of mood disorders. In addition sleep and circadian dysregulations have been shown to be related to those temperaments, character and attachment styles which are considered precursors of mood disorders. Sleep and circadian behaviours may serve as early targets regarding mood disorders.
Collapse
Affiliation(s)
- Laura Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology, Scientific Institute Ospedale San Raffaele, Via Stamira d'Ancona 20, 20127 Milano, Italy
| | - Russell G Foster
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, UK
| | - Katharina Wulff
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, UK
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
88
|
Feige B, Baumgartner B, Meyer D, Riemann D. The Relationship Between PSG and Morning/Evening Emotional Parameters in Patients With Insomnia Disorder and Good Sleepers. Front Psychol 2019; 9:2712. [PMID: 30687172 PMCID: PMC6335271 DOI: 10.3389/fpsyg.2018.02712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/17/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives and Introduction: It is as yet unclear how polysomnographically determined sleep parameters determine emotional well-being both generally and particularly in patients with Insomnia Disorder (ID). ID is a frequent and disabling health condition associated with both day- and nighttime hyperarousal, linked to negative sleep-related ruminations as a cognitive component. Information on the immediate influence of objective sleep quality on emotional parameters is important for therapeutic approaches. Methods: The relationship between objective sleep parameters and two emotional questionnaire items obtained both for evening and morning, relaxation and emotional balance, was determined for both sleep lab nights in 161 ID patients and 161 age and gender matched good sleepers (retrospective sample from the Freiburg data base, 98 female, 63 male in each group, age ID: 42.16 ± 11.55, GSC: 41.91 ± 11.30 years). Multivariate mixed effects analysis, corrected for global influences of group, age and first/second night, was employed to determine between- and within-subject influences of sleep and emotional parameters. Results: Main effects: Within-subject, relaxation in the evening was strongly associated with sleep efficiency, REM latency and low arousal index in NREM sleep. No such influence was significant for emotional balance. Also between subjects, evening relaxation was related to increased sleep efficiency. Group interactions: Patients with larger relaxation values in the evening showed a larger reduction of the number of wake periods and the awakening index in NREM sleep than GSC subjects. Discussion: Unexpectedly, no general influence of emotional balance on sleep was found. The subjective feeling of relaxation, however, was associated with sleep efficiency, REM latency and low NREM sleep arousal index. While the first association may be obvious, a direct link to REM latency and NREM arousal index has not previously been shown. We could also directly observe that the number of wake periods in the PSG is more strongly influenced by evening relaxation in ID patients than in good sleepers, asserting the importance of sleep perception and attitude toward sleep in the therapeutic process.
Collapse
Affiliation(s)
- Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | |
Collapse
|
89
|
Acker JG, Cordi MJ. [Sleep Disturbances in General Practitioners' Offices: From Screening to Initial Therapy - Update 2019]. PRAXIS 2019; 108:103-109. [PMID: 30722730 DOI: 10.1024/1661-8157/a003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sleep Disturbances in General Practitioners' Offices: From Screening to Initial Therapy - Update 2019 Abstract. The field of sleep medicine has established internationally as an interdisciplinary specialization. Due to prevailing evidence, sleep disturbances are listed in a separate chapter in the new ICD 11 classification system. With the International Classification of Sleep Disorders (ICSD-3rd version) a standalone classification system exists. In Switzerland, one third of the population suffers from sleep disturbances. Even differential diagnosis is hard to establish. The current article aims at practitioners, who are frequently confronted with sleep complaints and must categorize, triage and initially treat their patients with simple screening methods.
Collapse
|
90
|
Richter K, Miloseva L, Köck M, Hillemacher T, Weeß HG. Verhaltenstherapeutische Behandlung von Insomnie im Alter – wann und wie behandeln? SOMNOLOGIE 2018. [DOI: 10.1007/s11818-018-0187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
91
|
Hertenstein E, Feige B, Gmeiner T, Kienzler C, Spiegelhalder K, Johann A, Jansson-Fröjmark M, Palagini L, Rücker G, Riemann D, Baglioni C. Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Med Rev 2018; 43:96-105. [PMID: 30537570 DOI: 10.1016/j.smrv.2018.10.006] [Citation(s) in RCA: 535] [Impact Index Per Article: 89.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 12/31/2022]
Abstract
Previous research has identified insomnia as a predictor for the onset of depression. The aim of this meta-analysis is to investigate whether insomnia also predicts the onset of other mental disorders. Longitudinal studies were eligible for inclusion if they investigated insomnia at baseline (including nighttime- and daytime-symptoms) as a predictor of the later onset of psychopathology within a follow-up time-frame of at least 12 mo. Thirteen primary studies were included. The results suggest that insomnia is a significant predictor for the onset of depression (10 studies, OR 2.83, CI 1.55-5.17), anxiety (six studies, OR 3.23, CI 1.52-6.85), alcohol abuse (two studies, OR 1.35, CI 1.08-1.67, and psychosis (one study, OR 1.28, CI 1.03-1.59). The overall risk of bias in the primary studies was moderate. This meta-analysis provides evidence that insomnia increases the risk for psychopathology. A future research agenda should include more prospective studies using established diagnostic criteria, assessing insomnia at baseline and including long-term follow-up intervals evaluating a wider range of mental disorders. In addition, prospective long-term interventional studies investigating the efficacy of insomnia treatment for the prevention of mental disorders are called for.
Collapse
Affiliation(s)
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Tabea Gmeiner
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Christian Kienzler
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Anna Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | | | | | - Gerta Rücker
- Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| |
Collapse
|
92
|
Kauffmann L, Heinemann S, Himmel W, Hußmann O, Schlott T, Weiß V. [Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective]. Pflege 2018; 31:291-300. [PMID: 30325264 DOI: 10.1024/1012-5302/a000639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective Abstract. BACKGROUND Elderly patients suffer from sleep disturbances during hospitalization. These patients often receive hypnotics and sedatives; despite of the known risks and although non-pharmacological treatments are available. AIM The study investigates the experiences of nurses when using non-pharmacological treatments for elderly patients with sleeping problems. METHODS Semi-structured interviews with 13 nurses from a general hospital were analyzed according to Mayring's qualitative content analysis. RESULTS Nurses used a variety of non-pharmacological treatments for elderly inpatients with sleeping problems: (1) structural measures (regulation of temperature and light), (2) organizational measures (more time for conversation during the nightshift), (3) nursing measures (asking about night-time routines) and (4) household remedies. From the nurses' perspective, the more intensive contact required when applying non-pharmacological treatments can lead to higher patient satisfaction and a lower bell frequency during the night shift. Barriers result from limited time and personnel, a lack of standards and individual patient needs. CONCLUSION Nurses know several kinds of non-pharmacological treatments to help elderly inpatients sleep better. A lack of resources as well as a lack of professional consensus about the treatment of temporary sleeping disturbances can be an obstacle to their use. A professional climate should restrict the use of drugs for sleeping problems as far as possible.
Collapse
Affiliation(s)
- Lea Kauffmann
- 1 Stabsstelle Pflegewissenschaft, Medizinische Hochschule Hannover.,2 Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| | | | - Wolfgang Himmel
- 2 Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| | - Olaf Hußmann
- 3 Pflegedirektion, Evangelisches Krankenhaus Göttingen-Weende
| | - Thilo Schlott
- 4 Fachbereich Pflege und Gesundheit, Hochschule Fulda
| | - Vivien Weiß
- 2 Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| |
Collapse
|
93
|
Frase L, Nissen C, Riemann D, Spiegelhalder K. Making sleep easier: pharmacological interventions for insomnia. Expert Opin Pharmacother 2018; 19:1465-1473. [DOI: 10.1080/14656566.2018.1511705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- University Hospital of Psychiatry and Psychotherapy, University Psychiatric Services, Bern, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
94
|
Schlarb AA. [Therapy of insomnia and nightmares in childhood and adolescence]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:383-391. [PMID: 30141741 DOI: 10.1024/1422-4917/a000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Therapy of insomnia and nightmares in childhood and adolescence Abstract. Sleep problems and sleep disorders have a high prevalence in childhood and adolescence. Normally, such conditions persist and often become chronic. Daytime impairments are widespread with concentration deficits, mental problems, and also a higher suicide risk. Therefore, early and effective interventions are necessary. As symptoms change with age, therapy should be adjusted accordingly. Various strategies for infants and toddlers, schoolchildren, and adolescents will be named. In addition, evidence of these therapy strategies will be shown. All in all, more randomized controlled studies addressing children and adolescents are needed. Furthermore, studies with children and adolescents suffering from comorbid disorders or mental disorders and sleep problems should be conducted.
Collapse
Affiliation(s)
- Angelika A Schlarb
- 1 Abteilung für Psychologie, Fakultät für Psychologie und Sportwissenschaft, Bielefeld
| |
Collapse
|
95
|
Schlafendoskopie und komplett konzentrischer Weichgaumenkollaps bei CPAP-Nutzungsproblemen. HNO 2018; 66:837-842. [DOI: 10.1007/s00106-018-0550-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
96
|
Complete concentric collapse at the soft palate in sleep endoscopy: what change is possible after UPPP in patients with CPAP failure? Sleep Breath 2018; 22:933-938. [PMID: 29766410 DOI: 10.1007/s11325-018-1657-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/21/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this work was to assess whether uvulopalatopharyngoplasty in patients with failure for positive airway pressure not only reduces the degree of obstructive sleep apnea but also to determine as well if it changes the collapse pattern of the soft palate and thereby fulfills the qualifications for implementing upper airway stimulation (UAS) as an adjunctive solution. METHOD Fifteen patients with intolerance for positive airway pressure were included in this retrospective cohort study. Polygraphy and drug-induced sleep endoscopy were used in order to evaluate the reduction of the apnea-hypopnea index (AHI), as well as the change of collapse pattern at the soft palate level before and about 3 months after uvulopalatopharyngoplasty and tonsillectomy (TE-UPPP). RESULTS In 93% of the patients, a postoperative change of the initially complete concentric palatal collapse pattern could be found during drug-induced sleep endoscopy. In one patient, no obstruction at all was seen at the soft palatal level. Only one patient still presented with a complete concentric collapse at velum level. AHI decreased from mean 34.7 events per hour to 20.2/h and oxygen desaturation index from 25.3 events per hour to 16.1/h. CONCLUSION Patients seeking for positive airway pressure alternatives could not only benefit from reduction of AHI by TE-UPPP postoperatively; additionally, by changing the collapse pattern at the soft palate, they might also fulfill criteria for upper airway stimulation (UAS) in case of persistent OSA of at least moderate degree.
Collapse
|
97
|
Best V, Riedel A, Feige B, Tebartz van Elst L, Riemann D, Spiegelhalder K. Subjektive schlafbezogene Parameter bei Patienten mit Autismus-Spektrum-Störung. SOMNOLOGIE 2018. [DOI: 10.1007/s11818-018-0156-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
98
|
Feige B, Nanovska S, Baglioni C, Bier B, Cabrera L, Diemers S, Quellmalz M, Siegel M, Xeni I, Szentkiralyi A, Doerr JP, Riemann D. Insomnia—perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia. Sleep 2018; 41:4845543. [DOI: 10.1093/sleep/zsy032] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedict Bier
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laura Cabrera
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah Diemers
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Quellmalz
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Siegel
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ireni Xeni
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andras Szentkiralyi
- Institute for Epidemiology and Social Medicine, University of Münster, Germany
| | - John-Peter Doerr
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
99
|
Sleep-disordered breathing is associated with disturbed cardiac repolarization in patients with a coronary artery bypass graft surgery. Sleep Med 2018; 42:13-20. [DOI: 10.1016/j.sleep.2017.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 12/18/2022]
|
100
|
|