[Frequency and distribution of sleep problems and insomnia in the adult population in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

[Validation of subjective complaints: differential diagnosis of "healthy suffering" using fatigue as an example]

Subjective complaints are of great importance in medicine. They have an impact on the diagnosis of illnesses, the assessment of illness severity, and treatment selection. There are no objective criteria for such symptoms, and clinicians have to rely on the report of patients only. Examples are complaints about pain, cardiac insufficiency, mood, or fatigue. There are many possibilities for distorted reports. Clinicians must therefore clarify what is meant and validate patient reports. A discrimination must be made between signs of illness and "healthy suffering," to avoid medicalization of daily nuisances and to avoid misdiagnoses and inadequate treatments. Diagnostic algorithms for healthy suffering are described, as this diagnosis is of importance in medicine. This is outlined using the example of fatigue.

Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes

Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.

Efficacy of a fish hydrolysate supplement on sleep quality: A randomized, double-blind, placebo-controlled, crossover clinical trial

BACKGROUND & AIMS

Sleep disturbances are widespread in modern societies and linked to a variety of diseases, creating an urgent need for the development of products that help combat sleep difficulties. One suitable nutritional supplement may be a fish hydrolysate composed of low molecular weight peptides.

METHODS

This two-arm, double-blind, randomized, placebo-controlled crossover study investigated the effect of a 4-week fish hydrolysate intervention on sleep in a healthy German population reporting poor sleep quality, assessed with the Pittsburgh Sleep Quality Index (PSQI). Further sleep parameters were measured using an online diary and a wrist wearable device. Additionally, questionnaires related to stress, anxiety, depression, and well-being were evaluated and salivary cortisol and product satisfaction were assessed.

RESULTS

The 4-week fish hydrolysate supplementation significantly improved subjective sleep quality measured with the PSQI-score (p = .002). Moreover, individuals reported improvements in sleep efficacy and a reduction in sleep disturbances and daytime sleepiness during fish hydrolysate intake (p = .013, p = .046, p = .004 respectively), but not during placebo phase (all p > .05). No significant intra-individual differences were found between fish hydrolysate and placebo supplementation (p > .05).

CONCLUSIONS

Although no significant intra-individual differences were found between fish hydrolysate and placebo supplementation, the significant improvement in subjective sleep quality from baseline to treatment phase suggests that fish hydrolysate is a safe nutritional supplement to support individuals with self-reported sleep problems.

CLINICAL TRIAL REGISTRATION

The study is registered at ClinicalTrials.gov with the Identifier NCT04983355.

Elevated prevalence and treatment of sleep disorders from 2011 to 2020: a nationwide population-based retrospective cohort study in Korea

OBJECTIVES

This study used National Health Insurance claims data from Korea to report the prevalence of sleep disorders and treatment status, including traditional Korean medicine, in the last 10 years.

METHODS

This is a retrospective cohort study in Korea. All diagnosis and prescription data, including herbal medicine claims, from the Health Insurance Review and Assessment Service from 2011 to 2020 were reviewed. Prevalence estimation, direct medical expenses and prescribed amounts for sleep disorders were recorded.

RESULTS

The prevalence of sleep disorders increased from 3 867 975 (7.62%) in 2011 to 7 446 846 (14.41%) in 2020, nearly doubling over 10 years. Insomnia was observed in 91.44% (n=9 011 692) of the patients. The mean number of hospital visits per patient for sleep disorders was 11.5 (±26.62). Benzodiazepines are the most commonly prescribed medications for sleep disorders, and gamma-isoyosan is the most frequently prescribed herbal medicine.

CONCLUSIONS

Sleep disorders are continuously increasing, as is the use of medical services-personal and social medical expenses are also increasing accordingly. Sleep disorders should be recognised as a significant health problem that needs to be actively addressed to improve quality of life.

Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial

BACKGROUND

Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life.

OBJECTIVE

This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design.

METHODS

Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health-related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation.

RESULTS

We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity.

CONCLUSIONS

A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531.

On the Efficacy of a CBT-I-Based Online Program for Sleep Problems: A Randomized Controlled Trial

There is an urgent need for easily accessible treatment options for sleep problems to reduce the current treatment gap in receiving cognitive behavioral therapy for insomnia (CBT-I). Using a randomized controlled trial, we evaluated the efficacy of a CBT-I-based online program on sleep. Fifty-three volunteers (21-71 years; MAge = 44.6 ± 12.5; 27 female) suffering from impaired sleep were randomly allocated either to the experimental group (EG, n = 27) or to an active control group (CG, n = 26). The EG participated in a 6-week CBT-I-based online program, while the CG received psychoeducation and sleep hygiene instructions. Sleep was assessed both objectively via ambulatory polysomnography (PSG) as well as subjectively via questionnaires at three time points (baseline, pre- and post-intervention). A one-month follow-up assessment was performed using questionnaires. The EG showed small but reliable improvements from pre- to post-intervention in PSG-derived wake after sleep onset (from 58.6 min to 42.5 min; p < 0.05) and sleep efficiency (from 86.0% to 89.2%; p < 0.05). Furthermore, subjective sleep quality (assessed via Pittsburgh Sleep Quality Index) improved significantly during intervention (p = 0.011) and follow-up (p = 0.015) in the EG alone. The Insomnia Severity Index decreased from pre- to post-intervention in both groups (EG: p = 0.003, CG: p = 0.008), while it further improved during follow-up (p = 0.035) in the EG alone. We show that a CBT-I-based online program can improve sleep not only subjectively but also objectively and can be a viable alternative when face-to-face interventions are not available.

Are sleep disorders associated with the risk of gastrointestinal cancer?-A case-control study

PURPOSE

Sleep disorders are among the most common health problems worldwide and are linked to a variety of physical and mental health problems. Recently, there has been increasing evidence of an association between sleep disorders and cancer risk. We aimed to investigate this association specifically for cancers of the gastrointestinal (GI) tract.

METHODS

Using the DA database (IQVIA), adult patients diagnosed with GI cancer between January 2010 and December 2022 were retrospectively compared to a 1:1 propensity score-matched cohort of patients without cancer. The outcome of the study was the association between sleep disorders and subsequent diagnosis of GI cancer. To determine whether sleep disorders were more common in patients with GI cancer than in patients without GI cancer, logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI).

RESULTS

After matching, 37,161 cases with GI cancer and 37,161 controls without cancer were available for analysis. No association with cancer was found for sleep disorders in the overall history before the index date (OR 1.04; 95% CI 0.96-1.12), but considering sleep disorders documented within 1 year before the index date showed a positive association with GI cancer overall (OR 1.20; 95% CI 1.08-1.34). Stratified analyses by cancer site revealed higher odds of sleep disorders prior to diagnosis of gastric, pancreatic, and colorectal cancer.

CONCLUSION

Our findings suggest that sleep disorders might be indicative of short-term health outcomes, including GI cancer, suggesting a role for sleep disorder screening in the context of cancer prevention efforts.

[New Therapeutic Approaches for Chronic Insomnia]

Insomnia represents one of the most common syndromes with far-reaching health and socioeconomic consequences. After a long period of stagnation, recent years have seen promising advances in the nonpharmacological and pharmacological treatment of patients with chronic insomnia. This article highlights these new therapeutic approaches in the context of established treatment options.

Chronic Vestibular Hypofunction Is Associated with Impaired Sleep: Results from the DizzyReg Patient Registry

Temporary or permanent vestibular hypofunction has been hypothesized to affect circadian rhythm, sleep, and thermoregulation. Chronic or long-term vestibular disorders such as unilateral vestibular hypofunction may have an even greater negative impact on sleep quality than acute vestibular problems. This study examines self-reported sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), and its association with vestibular symptom duration in a group of patients with vestibular disorders. We used data from the cross-sectional DizzyReg patient registry of the German Center for Vertigo and Balance Disorders outpatient clinic. Vestibular diagnoses were ascertained based on the International Classification of Vestibular Disorders. A total of 137 patients were included (60% female, mean age 55.4 years, standard deviation, SD, 16.7). The mean PSQI total score was 6.3 (SD = 3.2), with 51% reporting overall poor sleep quality. Patients who had vertigo for two years or longer reported significantly poorer global sleep quality (63% vs. 37%, p = 0.021) and significantly more difficulties with sleep latency (79% vs. 56%, p = 0.013) and sleep efficiency (56% vs. 34%, p = 0.022). The association of poor sleep quality with a longer duration of vertigo remained significant after multivariable adjustment. Further research should investigate the interaction of vestibular disorders, sleep, and their potential mechanisms.

Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial

BACKGROUND

A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use.

OBJECTIVE

This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep.

METHODS

In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment.

RESULTS

We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good.

CONCLUSIONS

An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.

Traffic-Related High Sleep Disturbance in the LIFE-Adult Cohort Study: A Comparison to the WHO Exposure-Response-Curves

Sleep is negatively affected by environmental noise. In the present study, we investigated self-reported high sleep disturbances (being "highly sleep disturbed"-HSD) from road traffic (primary and secondary road networks), rail (train and tram) and air traffic noise in the LIFE-Adult cohort study in Leipzig, Germany. For this, we used exposure data from 2012 and outcome data of Wave 2 (collected during 2018-2021). HSD was determined and defined according to internationally standardized norms. The highest risk for transportation noise-related HSD was found for aircraft noise: the odds ratio (OR) was 19.66, 95% CI 11.47-33.71 per 10 dB increase in L_night. For road and rail traffic, similar risk estimates were observed (road: OR = 2.86, 95% CI 1.92-4.28; rail: OR = 2.67, 95% CI 2.03-3.50 per 10 dB L_night increase). Further, we compared our exposure-risk curves with the curves of the WHO environmental noise guidelines for the European region. The proportion of individuals with HSD for a given noise level was lower for rail traffic but higher for aircraft noise in the LIFE study than in the WHO curves. For road traffic, curves are not directly comparable because we also included the secondary road network. The results of our study add to the body of evidence for increased health risks by traffic noise. Moreover, the results indicate that aircraft noise is particularly harmful to health. We recommend reconsidering threshold values for nightly aircraft exposure.

[Digital health applications in otorhinolaryngology]

BACKGROUND

With the passing of the "Digital Care Act" by the German Bundestag at the end of 2019, it was made possible, among other things, for digital health applications to be reimbursed by statutory health insurance companies under certain conditions. The aim of this work is to identify digital health applications related to ear, nose, and throat medicine and to describe the underlying evidence.

MATERIALS AND METHODS

The digital health applications register was analyzed to identify digital health applications with an indication area relating to an otorhinolaryngologic disease. Digital health applications were included that were either permanently or provisionally included, or currently deleted if further information was available. The underlying evidence was assessed according to the recommendations of the Oxford Center for Evidence-Based Medicine for therapeutic studies.

RESULTS

A total of six digital health applications with a direct or indirect connection to otorhinolaryngology were identified, three of which were permanently and two provisionally included in the directory. One digital health application has currently been withdrawn by the manufacturer. The permanently recorded digital health applications are based on evidence level 1b.

CONCLUSION

The introduction of digital health applications is sometimes also discussed critically, but they represent an innovative approach and various digital health applications with a high level of underlying evidence are already available, especially for the ear, nose, and throat area.

Frequency and evolution of sleep-wake disturbances after ischemic stroke: A 2-year prospective study of 437 patients

OBJECTIVE

In the absence of systematic and longitudinal data, this study prospectively assessed both frequency and evolution of sleep-wake disturbances (SWD) after stroke.

METHODS

In 437 consecutively recruited patients with ischemic stroke or transient ischemic attack (TIA), stroke characteristics and outcome were assessed within the 1^st week and 3.2 ± 0.3 years (M±SD) after the acute event. SWD were assessed by interview and questionnaires at 1 and 3 months as well as 1 and 2 years after the acute event. Sleep disordered breathing (SDB) was assessed by respirography in the acute phase and repeated in one fifth of the participants 3 months and 1 year later.

RESULTS

Patients (63.8% male, 87% ischemic stroke and mean age 65.1 ± 13.0 years) presented with mean NIHSS-score of 3.5 ± 4.5 at admission. In the acute phase, respiratory event index was >15/h in 34% and >30/h in 15% of patients. Over the entire observation period, the frequencies of excessive daytime sleepiness (EDS), fatigue and insomnia varied between 10-14%, 22-28% and 20-28%, respectively. Mean insomnia and EDS scores decreased from acute to chronic stroke, whereas restless legs syndrome (RLS) percentages (6-9%) and mean fatigue scores remained similar. Mean self-reported sleep duration was enhanced at acute stroke (month 1: 07:54 ± 01:27h) and decreased at chronic stage (year 2: 07:43 ± 01:20h).

CONCLUSIONS

This study documents a high frequency of SDB, insomnia, fatigue and a prolonged sleep duration after stroke/TIA, which can persist for years. Considering the negative effects of SWD on physical, brain and mental health these data suggest the need for a systematic assessment and management of post-stroke SWD.

Seasonality of human sleep: Polysomnographic data of a neuropsychiatric sleep clinic

While short-term effects of artificial light on human sleep are increasingly being studied, reports on long-term effects induced by season are scarce. Assessments of subjective sleep length over the year suggest a substantially longer sleep period during winter. Our retrospective study aimed to investigate seasonal variation in objective sleep measures in a cohort of patients living in an urban environment. In 2019, three-night polysomnography was performed on 292 patients with neuropsychiatric sleep disturbances. Measures of the diagnostic second nights were averaged per month and analyzed over the year. Patients were advised to sleep "as usual" including timing, except alarm clocks were not allowed. Exclusion criteria: administration of psychotropic agents known to influence sleep (N = 96), REM-sleep latency > 120 min (N = 5), technical failure (N = 3). Included were 188 patients: [46.6 ± 15.9 years (mean ± SD); range 17-81 years; 52% female]; most common sleep-related diagnoses: insomnia (N = 108), depression (N = 59) and sleep-related breathing disorders (N = 52). Analyses showed: 1. total sleep time (TST) longer during winter than summer (up to 60 min; not significant); 2. REM-sleep latency shorter during autumn than spring (about 25 min, p = 0.010); 3. REM-sleep longer during winter than spring (about 30 min, p = 0.009, 5% of TST, p = 0.011); 4. slow-wave-sleep stable winter to summer (about 60-70 min) with 30-50 min shorter during autumn (only significant as % of TST, 10% decrease, p = 0.017). Data suggest seasonal variation in sleep architecture even when living in an urban environment in patients with disturbed sleep. If replicated in a healthy population, this would provide first evidence for a need to adjust sleep habits to season.

Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills

BACKGROUND

Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.

METHODS

Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.

RESULTS

From T1 to T3, the intervention group significantly improved on global symptom severity (d = -0.43, p = .031), depression among a depressed subsample (d = -0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = -0.28, p = .037) and clinically significant changes (ß = -0.24, p = .042).

CONCLUSIONS

The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.

Loneliness, perceived isolation and sleep quality in later life. Longitudinal evidence from a population-based German study

OBJECTIVES

To date, there is restricted knowledge regarding the association between loneliness, perceived social isolation and sleep quality based on longitudinal studies. Our aim was therefore to clarify the association between loneliness, perceived social isolation and sleep quality stratified by sex using a longitudinal approach.

METHODS

Longitudinal data (wave 5 and wave 6) were used from a nationally representative sample of community-dwelling individuals ≥ 40 years in Germany. In our analytical sample, n equaled 8784 observations. The Bude and Lantermann tool was used to quantify perceived social isolation and the De Jong Gierveld tool was used to measure loneliness. Relying on key items of the Pittsburgh Sleep Quality Index, sleep quality was assessed.

RESULTS

Increases in loneliness were associated with worsening sleep quality (in men: in two outcomes; in women: in all three outcomes). Moreover, in men, increases in perceived social isolation was associated with decreases in overall sleep quality (β = 0.10, p < 0.01), but not with the other outcomes. In contrast, perceived social isolation was not associated with changes in any of the outcome measures in women.

CONCLUSIONS

Increases in loneliness were particularly associated with worsening sleep quality among women, whereas the overall sleep quality decreases when perceived social isolation increases in men. Efforts to reduce perceived social isolation (men) and loneliness (in men, but particularly in women) can contribute to sleep quality in individuals aged 40 years and over in Germany.

Comparative effectiveness of three versions of a stepped care model for insomnia differing in the amount of therapist support in internet-delivered treatment: study protocol for a pragmatic cluster randomised controlled trial (GET Sleep)

INTRODUCTION

It is unclear how internet-delivered cognitive-behavioural therapy for insomnia (CBT-I) can be integrated into healthcare systems, and little is known about the optimal level of therapist guidance. The aim of this study is to investigate three different versions of a stepped care model for insomnia (IG1, IG2, IG3) versus treatment as usual (TAU). IG1, IG2 and IG3 rely on treatment by general practitioners (GPs) in the entry level and differ in the amount of guidance by e-coaches in internet-delivered CBT-I.

METHODS AND ANALYSIS

In this randomised controlled trial, 4268 patients meeting International Classification of Diseases, Tenth Revision (ICD-10) criteria for insomnia will be recruited. The study will use cluster randomisation of GPs with an allocation ratio of 3:3:3:1 (IG1, IG2, IG3, TAU). In step 1 of the stepped care model, GPs will deliver psychoeducational treatment; in step 2, an internet-delivered CBT-I programme will be used; in step 3, GPs will refer patients to specialised treatment. Outcomes will be collected at baseline, and 4 weeks, 12 weeks and 6 months after baseline assessment. The primary outcome is insomnia severity at 6 months. An economic evaluation will be conducted and qualitative interviews will be used to explore barriers and facilitators of the stepped care model.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethics Committee of the Medical Centre-University of Freiburg. The results of the study will be published irrespective of the outcome.

TRIAL REGISTRATION NUMBER

DRKS00021503.

[Prevalence of sleep disturbance in intensive care nurses: a post hoc analysis of a cross-sectional study]

Background

Intensive care nurses have irregular and unusual working hours due to shift work, which can disrupt the natural light-dark rhythm and thus increase the risk for sleep disorders.

Aim of the work

The aim of this post hoc analysis was to investigate the prevalence of self-reported sleep problems and associated factors among intensive care nurses working in Germany.

Methods

This analysis was a post hoc analysis of a cross-sectional study, which was performed as an online survey. Collected data were sociodemographic, work-related and health-related data. These data were used to calculate the prevalence and respective 95% confidence intervals (95% CI) of sleep problems. Factors associated with sleep problems were identified using the χ2-test, Fisher's exact test, and logistic regression analysis.

Results

The link to the online survey was accessed 1163 times and 490 intensive care nurses participated in the survey. A total of 432 intensive care nurses were included in this analysis, of whom 82.87% were women. A total of 57.64% (95% CI: 52.83-62.35%) reported sleep problems. Significantly associated with sleep problems were age (50-59 years odds ratio [OR]: 2.05, 95% CI: 1.00-4.21, p = 0.047 vs. 20-29 years) and living in a family (OR: 0.50, 95% CI: 0.27-0.93, p = 0.029 vs. single/living alone). In addition, depression (OR: 1.09, 95% CI: 1.06-1.12, p ≤ 0.001), anxiety (OR: 1.10, 95% CI: 1.06-1.14, p ≤ 0.001) and stress (OR: 1.09, 95% CI: 1.06-1.12, p ≤ 0.001) levels were significantly associated with sleep problems.

Conclusion

Sleep problems were present in one out of every two participating intensive care nurses and in particular mental health was associated with sleep problems.

Analysis of the correlations between insomnia and mental health during the COVID-19 pandemic in Germany

Objective

This study evaluates correlations between insomnia and mental health during the COVID-19 pandemic in Germany.

Methods

The internet-based International COVID-19 Sleep Study (ICOSS) questionnaire including sociodemographic questions as well as sleep- and emotion-related scales was distributed in Germany during the COVID-19 pandemic from May 1 to September 30, 2020. Insomnia and mental state were assessed using the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder (GAD-2), and visual analogue scale. Qualitative analyses of demographic characteristics were performed and correlation analyses of the variables calculated.

Results

A total of 1103 individuals participated and 858 valid questionnaires (70.61% females) were obtained. Mean age and body mass index were 41.97 ± 12.9 years and 26 ± 5.9 kg/m2, respectively. Most participants were married (n = 486, 56.6%), living in the city (n = 646, 75.3%), and white (n = 442, 51.5%). The prevalence of insomnia, anxiety, and depression was 19.5% (ISI > 7), 6.6% (GAD-2 > 3), and 4.8% (PHQ-2 > 3), respectively. Compared to the insomnia group, the mean and median ISI, PHQ‑4, PHQ‑2, and GAD‑2 scores of the non-insomnia group were lower, while their mean and median quality of life and quality of health scores were significantly higher (P < 0.05). Pearson correlation analysis showed a positive correlation between the ISI and PHQ‑2 (r = 0.521, P < 0.001), GAD‑2 (r = 0.483, P < 0.001), and PHQ‑4 scores (r = 0.562, P < 0.001); however, the ISI score negatively correlated with the quality of life (r = -0.490, P < 0.001) and quality of health scores (r = -0.437, P < 0.001).

Conclusion

Insomnia, anxiety, and depression were very prevalent during the pandemic. Anxiety and depression were more severe in the insomnia than in the non-insomnia group, and insomnia and mental health are closely related.

Patient Related Outcome and Therapy Effects in Stimulation Treatment of Sleep-Related Breathing Disorders

Several neurostimulation devices exist for the treatment of various sleep-related breathing diseases. The most data for hypoglossal nerve stimulation (HNS) in the therapy of obstructive sleep apnea (OSA) derive the HNS with respiratory sensing. Herewith, daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) was improved in several publications by 5 points with a stability shown for up to several years. Sleep related quality of life, documented with the Functional Outcomes of Sleep Questionnaire, increased by 2 points. In many cohorts showed a mean usage of 5 to 6 hours per night. Under the consideration of shorter follow-ups and smaller group sizes, the ESS improved by 4 under unilateral continuous HNS and by 3 under bilateral HNS. Transvenous stimulation of the phrenic nerve is approved for the treatment in central sleep apnea. In a pivotal trial with 5 year follow-up data, an ESS reduction is documented by 3 points. There is one publication describing a usage of more than 5 hours. The daytime enoral neuromuscular electrical therapy improved ESS (2 points) and sleep-related quality of life of the snoring patients and the bed partner. The daytime training for the effects during the night adherence is given with 83%. For all described devices, there are running or announced studies and/or registry trials that consider patient related outcome.

[Sleep medicine in psychiatry and psychotherapy]

Sleep medicine is a cross-disciplinary subject with high relevance for psychiatry and psychotherapy. The three most common sleep disorders (insomnia, sleep apnea syndrome and restless legs syndrome) are presented here with practical relevance. Cognitive behavioral therapy is the treatment of choice for insomnia, whereas symptomatic drug treatment (especially with GABA receptor agonists) should be used with caution. Sleep-related breathing disorders have a high prevalence of around 24% among psychiatric inpatients in Germany. Typical symptoms of obstructive sleep apnea syndrome should lead to a staged diagnostic process and, if necessary, cardiorespiratory polysomnography. It is not unusual for restless legs syndrome to be caused by psychopharmacological treatment. The primary form was usually treated with dopamine or dopamine agonists but due to the risk of augmentation, alternatives should be considered more often.

Patient characteristics as predictors of sleep disturbances in multimorbid primary care patients - A secondary analysis

OBJECTIVE

The aim of the study was to identify patient characteristics (adult attachment, health status, number and severity of chronic conditions, social support) predictive sleep disturbances after 12 months.

METHODS

In a secondary analysis of a prospective longitudinal study dealing with adult attachment and self-management, attachment- and health-related characteristics, socio-demographic data at baseline and symptoms of insomnia at the follow up (12 month later) was recorded by 219 patients between the ages of 50 and 85 years with multimorbidity in primary care. Adult attachment was measured by the ECR-RD12. The overall health status was measured using a visual analogue scale (VAS) and a standardized list of chronic conditions. The number and severity of chronic diseases (CIRS-G) was assessed by general practitioners (GPs). Sleep disturbances was measured by the ISI 12 month later.

RESULTS

Approximately 19% of the respondents were found to have clinically relevant symptoms of insomnia, and a further 34% to be subclinical insomnia. Attachment-related anxiety, a poorer perceived social support, the number of chronic conditions and a better general health status could predict higher levels of sleep disturbance after 12 month.

CONCLUSION

Sleep disorders can play a major role in patients with multimorbidity. Attachment anxiety and lack of social support may also be possible risk factors for the development of sleep disturbances.

Can You Sleep? - Effect of Retrospective Recall of Child Maltreatment on Sleep Parameters and the Mediating Role of Psychological Distress Among Students of Two German Universities

PURPOSE

Child maltreatment may be linked with long-term sleeping disorders and limited coping with stress. Yet, the potential relationships are only marginally studied.

PATIENTS AND METHODS

Based on a sample of young adults (n = 312) this study aims at exploring the effects of child maltreatment and the experience of threat to personal safety and life in childhood on sleep disturbances in early adulthood. Data were collected at the two study sites, Ulm University and Bielefeld University, by an online survey. For both risk factors, child maltreatment and the experience of threat to personal safety and life in childhood, a direct impact on sleep disturbances and an indirect path via psychological distress were tested using Structural Equation Modelling (SEM).

RESULTS

In these models, the direct path to sleep disturbances turned out to be significant for the experience of threat to personal safety and life (Path C: b = 0.18, p = 0.013), but not for child maltreatment (Path C: b = 0.05, p = 0.491). However, the current level of psychological distress was found to have a mediating effect on sleep disturbances for both risk factors, thereby confirming indirect significant effects.

CONCLUSION

Considering that the etiological pathway of child maltreatment on sleeping disturbances is mediated via psychological distress, this provides a venue to test in future research whether stress reduction interventions can reduce the negative consequences of child maltreatment on sleep disorders.

Nachtlärminduzierte Schlafstörungen und Herz-Kreislauf-Risiko

Beeinträchtigungen des Schlafes im Sinne von Insomnien, d. h. Ein- und Durchschlafschwierigkeiten, frühmorgendliches Erwachen und ein chronisch unerholsamer Schlaf, sind weit verbreitet in der Bevölkerung und gehen mit einer Vielzahl von körperlichen und psychischen Gesundheitsstörungen einher. Die umweltbedingten Ursachen für Schlafstörungen umfassen eine ganze Reihe von Faktoren, wobei nächtlicher Lärm als eine wichtige Ursache gilt. Aktuelle Daten der Europäischen Umweltagentur zeigen, dass Umgebungslärm (Straßenverkehrs-, Schienen-, Flug- und Industrielärm) für starke Schlafstörungen bei 6,5 Millionen Personen in Europa sorgt. Neue epidemiologische und mechanistische Feldstudien zeigen, dass vor allem nächtlicher Verkehrslärm unter anderem zu einer eingeschränkten Gefäßfunktion, thromboinflammatorischen Veränderungen, einem Anstieg von Stresshormonen und einem erhöhten Blutdruck führen kann, die bedeutsame Risikofaktoren für Herz-Kreislauf-Erkrankungen darstellen. Gemäß der Europäischen Umweltagentur führt der Umgebungslärm jährlich zu 48000 zusätzlichen Fällen von ischämischen Herzerkrankungen sowie 12000 vorzeitigen Todesfällen.

Is unemployment associated with inefficient sleep habits? A cohort study using objective sleep measurements

Unemployed people could be at risk of developing inefficient sleep habits by spending excessive time in bed, as they lack a structuring activity. This could impact their mental health and reintegration into labour. This study aims to analyse possible associations between employment status and sleep parameters using actigraphy. Subjects (148 employed and 50 unemployed) were drawn from a German population-based cohort. Sleep parameters were measured with the SenseWear Bodymedia Pro 3 armband. Comparison of means concerning sleep duration, sleep efficiency, time of sleep and sleep fragmentation was performed separately for week days and weekends. Multiple linear regression analysis was performed to analyse group differences controlling for covariates. Finally, we defined cut-off scores for each sleep variable, and analysed the distribution of subjects above and below these values. Unemployed people did not sleep significantly longer than employed people. However, on week days, they displayed night sleep efficiency reduced by on average > 5% points, they lay down for 28 min longer, had later mid sleep time (38 min) and sleep offset (55 min), as well as more frequent awakenings after sleep onset accounting for being awake 28 min longer (all p ≤ 0.005). Sleep in unemployed subjects compared with employed subjects aged 41-64 years was less efficient, more fragmented and shifted to a later point of the night. Results support prior findings that unemployment has a negative influence on sleep quality. Unemployed individuals could benefit from intervention programmes aiming at the adoption of healthier sleep habits.

Quality of Sleep in the Cypriot Population and Its Association With Multimorbidity: A Cross-Sectional Study

Poor sleep is a relatively common condition with possibly serious adverse health consequences. Lack of sleep affects the endocrine, immune, and nervous systems. In Cyprus, there is no information about the quality of sleep in the population. The goal of this study was to assess the quality of sleep in the Cypriot population and evaluate its association with multimorbidity. A representative sample of the adult population of Cyprus was selected in 2018-2019 among the five government-controlled municipalities of the Republic of Cyprus using stratified sampling. Data on sleep quality as well as on the presence of chronic, clinical, and mental health conditions were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision (ICD-10). A total of 1,140 Cypriot men and women over 18-years of age (range: 18-94) participated in the study. The median Pittsburgh sleep quality index score of the participants was 5 (first quartile = 3, third quartile = 7) with the maximum score being 17, which suggests that the Cypriot population has a relatively good quality of sleep overall, although, almost one-third of the study population had a poor quality of sleep. Women, residents of Paphos, and married people had a poorer quality of sleep (p < 0.05). Having a poor quality of sleep was associated with higher odds of multimorbidity (OR = 2.21, 95% CI: 1.55, 3.16), even after adjusting for demographics, socioeconomic, and lifestyle factors. Adopting good sleep habits could be beneficial and would potentially help reduce the risk of multimorbidity. Public health guidelines regarding the importance of sleep and its association with multimorbidity should be considered.

Subtypen der Insomnie – exemplarische Ansätze und offene Fragen

Verschiedene Autorinnen und Autoren nehmen an, dass es klinisch nützlich und wissenschaftlich erkenntnisbringend sein könnte, Subtypen der Insomnie zu identifizieren, um diese spezifisch und damit möglicherweise effektiver zu behandeln, als dies derzeit geschieht. Im vorliegenden Beitrag werden folgende exemplarisch ausgewählte Ansätze zur Einteilung der Insomnie in Subtypen vorgestellt: 1) Einteilungen nach klinischen Symptomen; 2) Primäre vs. sekundäre Insomnie; 3) Subtypen nach ICSD‑2; 4) Insomnie mit und ohne objektiv messbare kurze Schlafdauer; 5) Subtypen aus der Netherlands Sleep Registry. Anschließend werden die Stabilität der Zuordnung von einzelnen Patienten zu den verschiedenen Subtypen sowie die klinische Relevanz der Einteilungen kritisch diskutiert.

Consequences of child maltreatment: A glimpse at stress and sleep

The present study goal was to provide further information on the association of maltreatment experiences in childhood (CM) and impaired sleep taking the hyperarousal theory of insomnia and stress reaction into account. In all, 62 participants took part in the study. CM history (Childhood Trauma Questionnaire) and subjective sleep quality (Pittsburgh Sleep Quality Index) were assessed before study commencement. In addition, participants wore an actigraph for 6-7 consecutive nights and completed a sleep log during this time. After 3-4 days, the participants took part in a laboratory stress paradigm (Maastricht Acute Stress Test) with 29 participants in the experimental and 31 in the control condition. Saliva cortisol samples were taken before and after the experiment and heart rate variability was assessed. CM was positively correlated with impaired subjectively assessed sleep in adulthood. The stress manipulation led to heightened subjective and physiological stress. Although lower cortisol changes after and lower mean heart rate values during the stress induction were found in the CM group, the differences were not statistically significant. There was no observable sleep reactivity on the stress induction. Stress and CM appear to have long-term effects on subjective sleep. Acute social stress does not directly worsen sleep quality, neither in participants with nor without a history of CM. However, the association underlines the importance of prevention and intervention. When treating sleep impairments, potential CM experiences should be taken into account.

Muskuloskeletale Erkrankungen und die kraniomandibuläre Dysfunktion – eine mögliche Ursache für nichterholsamen Schlaf

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.

Does app-based unguided self-management improve mental health literacy, patient empowerment and access to care for people with mental health impairments? Study protocol for a randomised controlled trial

INTRODUCTION

Mental disorders pose a huge burden to both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in comorbidity and chronification. Besides limited resources in healthcare systems, the treatment-gap is-to a large extent-caused by within-person barriers impeding early treatment seeking. These barriers include a lack of trust in professionals, fear of stigmatisation, or the desire to cope with problems without professional help. While unguided self-management interventions are not designed to replace psychotherapy, they may support early symptom assessment and recognition by reducing within-person barriers. Digital self-management solutions may also reduce inequalities in access to care due to external factors such as regional unavailability of services.

METHODS AND ANALYSIS

Approximately 1100 patients suffering from mild to moderate depressive, anxiety, sleep, eating or somatisation-related mental disorders will be randomised to receive either a low-threshold unguided digital self-management tool in the form of a transdiagnostic mental health app or care as usual. The primary outcomes will be mental health literacy, patient empowerment and access to care while secondary outcomes will be symptom distress and quality of life. Additional moderator and predictor variables are negative life events, personality functioning, client satisfaction, mental healthcare service use and application of self-management strategies. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. Data will be analysed using multiple imputation and analysis of covariance employing the intention-to-treat principle, while sensitivity analyses will be based on different multiple imputation parameters and a per-protocol analysis.

ETHICS AND DISSEMINATION

Approval was obtained from the Ethics Committee of the Faculty of Educational Science and Psychology at the Freie Universität Berlin. The results will be submitted to peer-reviewed specialised journals and presented at national and international conferences.

TRIAL REGISTERATION

The trial has been registered in the DRKS trial register (DRKS00022531);Pre-results.

Family aggregation of sleep characteristics: Results of the Heinz Nixdorf Recall and the Multi-Generation Study

INTRODUCTION

Poor sleep is a risk factor for adverse health events. For health prevention, it may be helpful to know whether poor sleep or sleep disorders in individuals are associated with sleep problems in their partners or children.

METHODS

In the MultiGeneration Study (MGS, conducted from 2013 to 2016), 1237 partners (aged 27 to 90 years) and 1660 adult children (aged 18 to 66 years) of index persons were recruited. Index persons are participants of the Heinz Nixdorf Recall Study, a population-based cohort study in the Ruhr area (study start 1999-2001, 4841 participants aged 45-75 years). We used two analysis populations: one with 1181 index persons whose partners were in MGS, and one with 1083 index persons with at least one adult child in MGS. Sleep characteristics were assessed using questionnaires (including the Pittsburgh Sleep Quality Index). The exposure was the presence of a sleep characteristic of the index subject.

RESULTS

Children showed the investigated sleep characteristics more often if these were also present in their parent (e.g., RR (relative risk) = 1.28 (95% CI: 1.06-1.55) for poor sleep quality). In partners, strong associations were observed for rising times and napping, but only weak associations for snoring, poor sleep quality and sleep disorders. Snoring of the bed partner is a risk factor for poor sleep (e.g., RR = 1.67 (0.91-3.07) for difficulties falling asleep).

CONCLUSION

Aggregation is observed for many sleep characteristics in people living in partnerships as well as in parents and their adult children.

Schlafmedizinische Qualifizierung in Deutschland – eine Bestandsaufnahme

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.

Nighttime road traffic noise exposure at the least and most exposed façades and sleep medication prescription redemption-a Danish cohort study

STUDY OBJECTIVES

Traffic noise has been associated with poor sleep quality and short sleep duration. This study investigates the association between nighttime road traffic noise at the least and most exposed façades of the residence and redemption of sleep medication.

METHODS

In a cohort of 44,438 Danes, aged 50-64 at baseline (1993-1997), we identified all addresses from 1987 to 2015 from a national registry and calculated nighttime road traffic noise at the most and least exposed façades. Using Cox Proportional Hazard Models we investigated the association between residential traffic noise over 1, 5, and 10 years before redemption of the first sleep medication prescription in the Danish National Prescription Registry. During a median follow-up time of 18.5 years, 13,114 persons redeemed a prescription.

RESULTS

We found that 10-year average nighttime exposure to road traffic noise at the most exposed façade was associated with a hazard ratio (HR) of 1.05, 95% confidence interval (CI) (1.00 to 1.10) for Ln greater than 55 as compared to not more than 45 dB, which when stratified by sex was confined to men (HR 1.16, 95% CI 1.08 to 1.25). For the least exposed façade the HR for Ln >45 vs ≤35 dB was 1.00, 95% CI (0.95 to 1.05). For the most exposed façade, the overall association was strongest in smokers and physically inactive.

CONCLUSIONS

Long-term residential nighttime noise exposure at the most exposed façade may be associated with a higher likelihood of redeeming prescriptions for sleep medication, especially among men, smokers, and physically inactive.

Modularized iCBT‑I self-learn training for university staff-prevention and early intervention in the SARS-CoV-2 crisis: A pilot study

Background

Insomnia is a widespread disease in adults and has a high prevalence rate. As sleep disturbances are a risk factor concerning mental and physical health, prevention and early intervention are necessary. Thus, the aim of this study was to implement a self-learning prevention and early intervention training for university staff members. We adapted an established cognitive behavioral therapy for insomnia (CBT-I) intervention as an online version for use during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) crisis.

Methods

Development and adaptation procedure of the internet-based CBT‑I (iCBT-I) prevention and early intervention training is described. Sessions and topics are shown in detail. The Online Sleep Prevention and Treatment Acceptance questionnaire (OSTA) and the Online Sleep Prevention and Treatment Feedback questionnaire (OSTF) were used to assess acceptance. Sleep problems of university staff members were assessed using the Pittsburgh Sleep Questionnaire (PSQI).

Results

The online-adapted version consisted of seven modules. Contents of sessions and topics were implemented based on video clips. Drawings were added to information regarding sleep and sleep hygiene as well as addressing stress and cognitions. In all, 15 individuals participated in this pilot study. The new iCBT‑I self-learning prevention training was well accepted. In addition, participants scored the online version as helpful based on the OSTA. Prior to online training, 89% of the participants reported impaired sleep quality or insomnia symptoms, and 56% had a PSQI score over 10. After training 78% of participants showed reduced sleep problems according to PSQI and 56% reached clinically significant enhancement. In addition, after training 44% were healthy sleepers.

Discussion

This is the first iCBT‑I prevention and early intervention training for university staff members. The training by participants was very well accepted and they scored the videos as very helpful. Sleep problems decreased after online training. However, further studies with larger samples and more sleep-related assessment strategies, e.g., actigraphy and sleep log, are necessary.

Insomnia Interventions in the Workplace: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to identify and evaluate the impact of interventions to improve or reduce insomnia in the workforce through randomized clinical trials. Following the recommendations of the PRISMA and MARS statement, a systematic literature search was carried out on the PubMed, Web of Science, CINHAL, and PsycINFO databases, with no restrictions on the language or publication date. For the meta-analysis, a random-effects model and the Insomnia Severity Index were used as outcome measures. To assess the risk of bias and the quality of evidence, the Cochrane Collaboration tool and the GRADE method were used, respectively. Twenty-two studies were included in the systematic review and 12 studies in the meta-analysis, making a total of 14 intervention groups with a sample of 827 workers. Cognitive behavioral therapy was the most widely used intervention. According to the estimated difference between the means, a moderate effect for the reduction of insomnia symptoms after the intervention (MD -2.08, CI 95%: [-2.68, -1.47]) and a non-significant degree of heterogeneity were obtained (p = 0.64; I² = 0%). The quality of the evidence and the risk of bias were moderate. The results suggest that interventions on insomnia in the workplace are effective for improving workers' health, and that improvements in the quality of sleep and a decrease in the symptoms of insomnia are produced, thanks to an increase in weekly sleeping hours and a reduction in latency at sleep onset. As regards work, they also led to improvements in productivity, presenteeism, and job burnout.

"How does Austria sleep?" self-reported sleep habits and complaints in an online survey

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.

Clinical pharmacology of the dual orexin receptor antagonist ACT-541468 in elderly subjects: Exploration of pharmacokinetics, pharmacodynamics and tolerability following single-dose morning and repeated-dose evening administration

BACKGROUND

The dual orexin receptor antagonist ACT-541468 showed sedative pharmacodynamic effects during initial clinical testing in adult subjects. The present study explored pharmacokinetics, pharmacodynamics and tolerability in healthy elderly subjects.

METHODS

Double-blind, placebo-controlled, randomised, single-ascending dose study in 24 male/female elderly (65-80 years, 5, 15 and 25 mg in the morning, 6/2 active/placebo per group). Additionally, 10 subjects (8/2 active/placebo) received 25 mg for 7 days in the evening. Pharmacokinetics, pharmacodynamics (saccadic peak velocity, adaptive tracking, body sway, visual analogue scales according to Bowdle and Bond and Lader, Karolinska Sleepiness Scale) and tolerability were assessed. In particular, pharmacodynamics results are to be interpreted exploratorily.

RESULTS

Absorption was quick with a median time to maximum concentration of ∼ 1.0 h. The mean elimination half-life was 8.5-9.8 h, the area under the curve and the maximum plasma concentration increased proportionally with dose. Following repeated evening administration of 25 mg, minimal accumulation was observed. There were no pharmacodynamic effects at 5 mg. At 15 mg, saccadic peak velocity (degree/s; SD) was reduced (69; 38), while other variables showed no effects. At 25 mg, effects on all objective pharmacodynamic parameters were observed. At 8-12 h post-dose, there were no differences to placebo and no next-day effects on pharmacodynamic variables after evening administration. Elderly subjects reported fewer adverse events compared to adults in previous studies.

CONCLUSION

ACT-541468 in elderly subjects was well tolerated and pharmacokinetics and pharmacodynamics are compatible with a drug for the treatment of insomnia. Clinicaltrials.gov: NCT02571855.

Digitale Behandlungsangebote für Insomnie – eine Übersichtsarbeit

Digital 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.

Somatic Symptoms in the German General Population from 1975 to 2013

The study determines how burden and patterns of somatic symptom reporting developed over almost four decades in the general German population. Additionally, we studied how socio-demographic factors affected the degree of somatic symptoms. Population-based samples representative for West Germany between 18 and 60 years of age were analyzed comparing three cross-sectional samples of 1975 (N = 1601), 1994 (N = 1416), and 2013 (N = 1290) by conducting a three-way analysis of variance (sex, age, survey). The prevalence rates for somatic symptoms in men and women were lower in the more recent surveys; this affected women most strongly. Exhaustion and musculoskeletal complaints remained leading symptoms (affecting 25%, resp. 11% of the men and 30%, resp. 19% of the women). There was a slight increase in women’s prevalence of exhaustion from 1994 (15%) to 2013 (19%). As determined by stepwise multiple regression, somatic symptoms were consistently associated with female sex and higher age. In the 2013 survey, education became an additional negative predictor of somatic symptom load, while the impact of age and sex on somatic symptoms reporting decreased. Somatic symptoms remain a major burden in the general population. Findings are interpreted with regard to improved living and health care conditions, different cohort experiences, and more public health information.

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

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.

[Gambling and Gaming disorders and physical health of players: A critical review of the literature]

CONTEXT

Gambling and gaming disorders have been introduced as addictions in the DSM-5 and have been announced for the next edition of the ICD. Links between gambling and gaming and psychiatric comorbidities have been thoroughly investigated, but so far the impact of gambling and gaming on physical health has been overlooked.

OBJECTIVE

Our aim was to evaluate the impact of gaming and gambling disorders on the physical health of gamers and gamblers.

SOURCES

We conducted a systematic review of the literature, using PubMed/Medline to retrieve studies with the following: keywords: "gambling" ; "pathological gambling" ; "gambling health" ; "gaming" ; "pathological gaming" and "gaming health".

PAPERS SELECTION

Selected studies all reported on the physical health of gamers and gamblers with addiction. We obtained 133 articles from the Medline database. After screening abstracts and introductions and full reading of papers we retrieved 25 articles for this review. Seventeen articles reporting 56,179 subjects with gambling disorder and 8 articles reporting 63,887 subjects with gaming disorder.

RESULTS

All papers described the physical health of individuals with gaming and gambling disorders. For gambling, data showed the existence of digestive disorder (20 to 40%), sleeping disorders (35 to 68%), headaches (20 to 30%) and cardiovascular disorders: tachycardia (9%) and coronary artery disease (2 to 23%). Results were mostly significant when compared to the general population. For gaming, available studies reported qualitative data. Most frequently reported symptoms were sleeping complaints, joint pain, headaches and visual problems. These symptoms were more frequently described for teenagers. Sleeping complaints were the most frequently reported symptom.

LIMITS

Although we found that the physical health of gamers and gamblers with addiction was impaired, no study investigated the causal role of addiction, gaming, and gambling. Further studies are needed to better understand how behavioral addictions impact physical heath.

CONCLUSION

Data reported in this review documented that individuals with gaming or gambling disorders have an impaired physical health. Knowledge of the symptoms reported could help primary care physicians to better screen for gambling and gaming disorders among their patients.

[Wearables in the treatment of neurological diseases-where do we stand today?]

Fitness and lifestyle trackers raise the awareness for wearable sensors in medical applications for clinical trials and healthcare. Various functional impairments of patients with neurological diseases are an ideal target to generate wearable-derived and patient-centered parameters that have the potential to support prevention, prediction, diagnostic procedures and therapy monitoring during the clinical work-up; however, substantial differences between clinical grade wearables and fitness trackers have to be acknowledged. For the application in clinical trials or individualized patient care distinct technical and clinical validation trials have to be conducted. The different test environments under laboratory conditions during standardized tests or under unsupervised home monitoring conditions have to be included in the algorithmic processing of sensor raw data in order to enable a clinical decision support under real-life conditions. This article presents the general understanding of the technical application for the most relevant functional impairments in neurology. While wearables used for sleep assessment have already reached a high level of technological readiness due to the defined test environment (bed, sleep), other wearable applications, e.g. for gait and mobility during home monitoring require further research in order to transfer the technical capabilities into real-life patient care.

Psychophysical stress and strain of maritime pilots in Germany. A cross-sectional study

Introduction

Maritime pilots work in an irregular deployment system (rotation system) with unpredictable work assignments under high levels of physical and mental stress. Fatigue or chronic diseases, e.g. coronary heart disease, peptic ulcers or gastritis can occur as a consequence. This can lead to long-term limitations of pilots’ work ability. The aim of this study is to analyse current stress and strain in maritime pilots.

Methods

Initially, all German pilots were interviewed with an online questionnaire about their living and working situation (response rate 43%). Subsequently, a medical and psychological examination of a random sample was carried out with pilots working in a 4-month rotation system compared with those working in a 1-week system. Most of the measurements took place at the beginning and the end of continuous work assignments each lasting several weeks (pre vs post-rotation). The questionnaires RESTQ-work 27, Resilience Scale RS-13 and Berlin Questionnaire were used as well as a sleeping diary. Furthermore, cardiovascular parameters (during rest and under ergometric stress), activity and blood parameters, urine stress hormones, and the pupillary unrest index were surveyed.

Results

60 pilots were recorded with an average age of 48.7 years (SD 8.3 years). Among the parameters collected, there were no significant differences between pre and post-rotation examinations. Pilots with a 4-month rotation system experienced a much higher subjective strain level in RESTQ work-27 (OR 10.12 (95% CI 1.21–84.59)). According to the sleep diaries of the pilots working in a 4-month rotation system, reduced levels were found concerning the pre and post-rotation subjective performance level (p = 0.042 and 0.029), subjective sleep duration (p = 0.032) and current subjective feeling post-rotation (p = 0.036). Objectively measured arterial hypertension was significantly more frequent among pilots working 4 months at a time (OR 21.41 (95% CI 1.26–364.05)). In addition, elevated levels of total cholesterol, triglycerides and uric acid were more common among this group of pilots (p = 0.038, p = 0.033 and p = 0.038). In particular, the risk of hypertriglyceridemia was increased (OR 4.41 (95% CI 1.15–16.91)).

Discussion

Maritime pilotage represents a very straining profession that has been studied very little up to this point. The present results indicate that 4-month rotation systems lead to higher levels of subjective and objective strain than 1-week rotation systems. Interventions are therefore recommended; especially a change in the rotation system should be considered.

Over-indebtedness and its association with sleep and sleep medication use

BACKGROUND

Over-indebtedness is currently rising in high-income countries. Millions of citizens are confronted with the persistent situation when household income and assets are insufficient to cover payment obligations and living expenses. Previous research shows that over-indebtedness increases the risk of various adverse health effects. However, its association with sleep problems has not yet been examined. The objective of this study was to investigate the association between over-indebtedness and sleep problems and sleep medication use.

METHODS

A cross-sectional study on over-indebtedness (OID survey) was conducted in 70 debt advisory centres in Germany in 2017 that included 699 over-indebted respondents. The survey data were combined with the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). We limited analyses to participants with complete data on all sleep variables (OID: n = 538, DEGS1: n = 7447). Descriptive analyses and logistic regression analyses were used to examine the association between over-indebtedness and difficulty initiating and maintaining sleep, and sleep medication use.

RESULTS

A higher prevalence of sleep problems and sleep medication use was observed among over-indebted individuals compared to the general population. After adjustment for socio-economic and health factors (age, sex, education, marital status, employment status, subjective health status and mental illness), over-indebtedness significantly increased the risk of difficulties with sleep onset (adjusted odds ratio (aOR) 1.79, 95%-confidence interval (CI) 1.45-2.21), sleep maintenance (aOR 1.45, 95%-CI 1.17-1.80) and sleep medication use (aOR 3.94, 95%-CI 2.96-5.24).

CONCLUSIONS

Evidence suggests a strong association between over-indebtedness and poor sleep and sleep medication use independent of conventional socioeconomic measures. Considering over-indebtedness in both research and health care practice will help to advance the understanding of sleep disparities, and facilitate interventions for those at risk.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00013100 (OID survey, ArSemü); Date of registration: 23.10.2017; Date of enrolment of the first participant: 18.07.2017, retrospectively registered.

[Quality of sleep in caregiving relatives of people with dementia: investigation of the prevalence and possible predictors]

BACKGROUND

Caregiving relatives of people with dementia (PwD) are exposed to exhausting tasks all day long. The results of a current study suggest that personality traits, sociodemographic and caregiving variables could be associated with poor sleep quality of caregivers of PwD. Nevertheless, the detailed impact of these variables on sleep quality of caregivers is still unknown.

METHOD

This study is based on secondary data from the Tele.TAnDem project. First, descriptive data of 322 caregivers were analyzed regarding prevalence rates of poor sleep quality and high rates of daytime sleepiness in comparison to non-caregivers. Second, hierarchical regression analyses were conducted to calculate the predictive effect of interpersonal and caregiving related variables on subjective sleep quality and daytime sleepiness.

RESULTS

With respect to the prevalence, descriptive data indicate a poorer subjective sleep quality and higher rates of daytime sleepiness of caregivers of PwD compared to non-caregivers. Regression analyses revealed significant effects for gender, disturbed day-night rhythm, burden of caregiving, stress coping strategies and depressive symptoms regarding subjective sleep quality. The number of disturbed behavior patterns, the burden of caregiving and depressive symptoms were significantly associated with higher rates of daytime sleepiness.

CONCLUSION

Caregiving of PwD affects subjective sleep quality as well as daytime sleepiness of caregiving relatives. Both dimensions of sleep quality were associated with several personal and caregiving related variables. Chronic poor sleep quality is a high-risk factor for psychological and physical health problems and should be considered in further research and development of interventions for caregiving relatives of PwD.