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Dumont S, Bloch V, Lillo-Lelouet A, Le Beller C, Geoffroy PA, Veyrier M. Parasomnias and sleep-related movement disorders induced by drugs in the adult population: a review about iatrogenic medication effects. J Sleep Res 2024:e14306. [PMID: 39243188 DOI: 10.1111/jsr.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/19/2024] [Accepted: 07/24/2024] [Indexed: 09/09/2024]
Abstract
Parasomnias and sleep-related movement disorders (SRMD) are major causes of sleep disorders and may be drug induced. The objective of this study was to conduct a systematic review of the literature to examine the association between drug use and the occurrence of parasomnias and SRMD. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews, we searched PubMed databases between January 2020 and June 2023. The searches retrieved 937 records, of which 174 publications were selected for full-text screening and 73 drugs were identified. The most common drug-induced parasomnias were nightmares and rapid eye movement (REM) sleep behaviour disorders and sleepwalking. In terms of drug-induced SRMD, restless legs syndrome, periodic limb movement disorders (PLMD), and sleep-related bruxism were most frequent. Medications that inhibit noradrenergic, serotonergic, or orexin transmission could induce REM sleep (e.g., nightmares). Regarding sleepwalking, dysregulation of serotoninergic neurone activity is implicated. Antipsychotics are mentioned, as well as medications involved in the gamma-aminobutyric acid (GABA) pathway. A mechanism of desensitisation-autoregulation of GABA receptors on serotoninergic neurones is a hypothesis. SRMD and PLMD could involve medications disrupting the dopamine pathway (e.g., antipsychotics or opioids). Opioids would act on mu receptors and increase dopamine release. The role of adenosine and iron is also hypothesised. Regarding bruxism, the hypotheses raised involve dysregulation of mesocortical pathway or a downregulation of nigrostriatal pathway, related to medications involving dopamine or serotonin. Parasomnias are rarely identified in drug product labels, likely due to the recent classification of their diagnoses. An analysis of pharmacovigilance data could be valuable to supplement existing literature data.
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Affiliation(s)
- Sylvain Dumont
- Service Pharmacie, AP-HP, GHU Paris Nord, DMU PRISME, Hôpital Bichat-Claude Bernard, Paris, France
| | - Vanessa Bloch
- Service Pharmacie, AP-HP, GHU Paris Nord, DMU PRISME, Hôpital Larboisière-Fernand Widal, Paris, France
| | - Agnès Lillo-Lelouet
- Centre Régional de Pharmacovigilance, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Innovative Therapies in Hemostasis, INSERM, Paris, France
| | - Christine Le Beller
- Centre Régional de Pharmacovigilance, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Innovative Therapies in Hemostasis, INSERM, Paris, France
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry and Neurosciences, Paris, France
- Université Paris Cité, NeuroDiderot, INSERM, Paris, France
| | - Marc Veyrier
- Service Pharmacie, AP-HP, GHU Paris Nord, DMU PRISME, Hôpital Bichat-Claude Bernard, Paris, France
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Ramirez O. Predictors of Symptoms of Depression Among Black Seventh-Day Adventists in the United States. JOURNAL OF RELIGION AND HEALTH 2024; 63:567-576. [PMID: 37318669 DOI: 10.1007/s10943-023-01847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to estimate a regression model that best predict symptoms of depression among Black Seventh-day Adventists in the United States. The sample (n = 3,570) was drawn from the Biopsychosocial Religion and Health Study, a sub-study of the larger Adventist Health Study-2 consisting of a random sample (n = 10,998) of Adventists. The results of the study showed that poor sleep quality, hostility, stress, and perceived discrimination were all predictors of symptoms of depression, while religious involvement decreased the likelihood of experiencing those symptoms.
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Affiliation(s)
- Octavio Ramirez
- Department of Social Work, Fort Hays State University, 600 Park St., Hays, KS, 67601, USA.
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Michaud AL, Bice B, Miklos E, McCormick K, Medeiros-Nancarrow C, Zhou ES, Recklitis CJ. Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA): Protocol for an Efficacy Trial. JMIR Res Protoc 2023; 12:e52315. [PMID: 38019571 PMCID: PMC10719817 DOI: 10.2196/52315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Young adult cancer survivors (YACS) are at elevated risk for chronic insomnia, even years after completing treatment. In addition to potential health consequences, insomnia can interrupt social, educational, and vocational development just as they are trying to "make up" for time lost to cancer. Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment for insomnia but remains largely unavailable to YACS due to several barriers (ie, shortage of trained providers, geographic limitations, financial limitations). Traditional CBTI has not been adapted to meet YACS' unique developmental and circadian challenges. To improve availability of effective behavioral insomnia treatment for this population, we developed the Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA), a low-intensity educational intervention delivered virtually online. OBJECTIVE In this phase 2 "proof of concept" trial, primary aims are to test the efficacy of STEP-YA to improve insomnia symptoms and mood in YACS and assess the utility of individualized coaching to improve treatment effects. A secondary aim will explore participant variables associated with clinically significant response to STEP-YA. METHODS This 2-arm randomized prospective trial will enroll 74 off-treatment YACS aged 20 years to 39 years with clinically significant insomnia. Each participant completes the STEP-YA intervention in a 1-on-1 synchronous online session led by a trained interventionist following a structured outline. The 90-minute intervention presents educational information on the development of insomnia after cancer and offers specific suggestions for improving insomnia symptoms. During the session, participants review the suggestions and develop a personalized sleep action plan for implementing them. After the session, participants are randomized to either the coaching condition, in which they receive 2 telephone coaching sessions, or the no-coaching condition, which offers no subsequent coaching. The Insomnia Severity Index (ISI) and the Profile of Mood States: Short Form (POMS-SF) are assessed at baseline and 4 and 8 weeks postintervention. RESULTS Enrollment began in November 2022, with 28 participants currently enrolled. We anticipate recruitment will be completed in 2024. The primary endpoint is a change in ISI score from baseline to 8 weeks postintervention. The secondary endpoint is change in mood symptoms (POMS-SF) from baseline to 8 weeks postintervention. Change scores will be treated as continuous variables. Primary analyses will use ANOVA methods. A within-subjects analysis will examine if the STEP-YA intervention is associated with significant changes in insomnia and mood over time. A 2-way ANOVA will be used to evaluate the utility of coaching sessions to improve treatment effects. CONCLUSIONS Chronic insomnia has significant negative effects on YACS' medical, educational, and psychological functioning. STEP-YA aims to address their needs; study results will determine if the intervention warrants future effectiveness and dissemination studies and if individualized coaching is necessary for adequate treatment response. TRIAL REGISTRATION ClinicalTrials.gov NCT05358951: https://clinicaltrials.gov/study/NCT05358951. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52315.
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Affiliation(s)
- Alexis L Michaud
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Briana Bice
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Eva Miklos
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Katherine McCormick
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | | | - Eric S Zhou
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Liu R, Shao W, Lai JK, Zhou L, Ren M, Sun N. Identification of comprehensive geriatric assessment-based risk factors for insomnia in elderly Chinese hospitalized patients. Aging Med (Milton) 2021; 4:26-34. [PMID: 33738377 PMCID: PMC7954828 DOI: 10.1002/agm2.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Insomnia is a common problem in older persons and is associated with poor prognosis from a functional or clinical perspective. The purpose of this study was to investigate the prevalence of insomnia and identify comprehensive geriatric assessment (CGA) based clinical factors associated with insomnia in elderly hospitalized patients. METHODS Standardized face-to-face interviews were conducted and CGA data were collected from 356 Chinese hospitalized patients aged 60 years or older. Insomnia was defined as self-reported sleep poor quality according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-Ⅴ). Multivariate logistic regression analysis was applied to assess the association between patient clinical factors together with domains within the CGA and insomnia. RESULTS Among the 365 patients, insomnia was found in 48.31% of the participants. Difficulty in initiating sleep (DIS), early morning awakening (EMA), difficulty in maintaining sleep (DMS), and snoring were found in 33.99%, 9.55%, 13.48%, and 1.69% of patients, respectively. Significant associations were found between insomnia and several covariates: female gender (P = 0.034), depression (P = 0.001), activities of daily living (ADL) (P = 0.034), instrumental activities of daily living (IADL; P = 0.009), falling (P = 0.003), chronic pain (P = 0.001), and poor nutritional status (P = 0.038). According to the results of the adjustment multivariate logistic regression analysis, female sex (odds ratio [OR] = 2.057, confidence interval [CI] = 1.179-3.588, P = 0.011), depression (OR = 1.889, CI = 1.080-3.304, P = 0.026), and chronic pain (OR = 1.779, CI = 1.103-2.868, P = 0.018) were significant independently predictors associated with insomnia. CONCLUSIONS Our study revealed that female sex, depression, and chronic pain were independently predictors of insomnia in hospitalized patients. Early identification of elderly patients with these risk factors using the CGA may improve the quality of life and treatment outcomes.
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Affiliation(s)
- Rong Liu
- Department of Geriatrics Ward 2The First Hospital of Lanzhou UniversityLanzhouChina
| | - Wenchao Shao
- Department of CardiologyUnion Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jonathan King‐Lam Lai
- Storr Liver Center, Westmead Institute for Medical ResearchUniversity of Sydney and Westmead HospitalSydneyNew South WalesAustralia
| | - Lingshan Zhou
- Department of Geriatrics Ward 2The First Hospital of Lanzhou UniversityLanzhouChina
| | - Man Ren
- Department of Geriatrics Ward 2The First Hospital of Lanzhou UniversityLanzhouChina
| | - Nianzhe Sun
- The First Clinical Medicine School of Lanzhou UniversityLanzhouChina
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Hu N, Ma Y, He J, Zhu L, Cao S. Alcohol consumption and incidence of sleep disorder: A systematic review and meta-analysis of cohort studies. Drug Alcohol Depend 2020; 217:108259. [PMID: 32927195 DOI: 10.1016/j.drugalcdep.2020.108259] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/09/2020] [Accepted: 08/23/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the association between alcohol consumption and incidence of sleep disorder. METHODS PubMed, EMBASE and OVID were searched systematically until March 2020 for cohort studies quantitatively investigating the effect of alcohol on incident sleep disorder. We conducted a random-effects meta-analysis to calculate the summary ORs (odds ratios) and 95 %CIs (confidence intervals) on the incidence of sleep disorder in relation to alcohol consumption. RESULTS The pooled analysis of eleven included cohort studies demonstrated that general drinking was significantly associated with incidence of sleep disorder (OR:1.37, 95 %CI:1.22,1.54,I² = 0.0 %) while heavy drinking was not (OR:1.22, 95 %CI:0.94,1.60, I² = 81.1 %). (general drinking (women <24 g/day; men <48 g/day; < 4 times/week), heavy drinking (women ≥24 g/day; men ≥48 g/day; ≥ 4times/week)). CONCLUSIONS Findings from the present systematic review and meta-analyses showed that there was no evidence that alcohol consumption diminished sleep problems, and some evidence that general drinking might increase the sleep problems, but further study is necessary.
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Affiliation(s)
- Nan Hu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yibin Ma
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jie He
- Wuhan Union Hospital of China, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Lichen Zhu
- Wuhan Union Hospital of China, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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Li Y, Zhang B, Zhou Y, Wang D, Liu X, Li L, Wang T, Zhang Y, Jiang M, Tang H, Amsel LV, Fan F, Hoven CW. Gut Microbiota Changes and Their Relationship with Inflammation in Patients with Acute and Chronic Insomnia. Nat Sci Sleep 2020; 12:895-905. [PMID: 33177907 PMCID: PMC7652227 DOI: 10.2147/nss.s271927] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The major purpose of this study was to detect the changes in gut microbiota composition and inflammatory cytokines production associated with acute and chronic insomnia. This study also evaluated the relationship between gut microbiota changes and increased inflammatory cytokines in insomnia patients. PATIENTS AND METHODS Outpatients with acute and chronic insomnia (aged 26-55 years; n=20 and 38, respectively) and age/gender-matched healthy controls (n=38) were recruited from a southern China region. Participants' gut microbiome, plasma cytokines, and self-reported sleep quality and psychopathological symptoms were measured. RESULTS The gut microbiomes of insomnia patients compared with healthy controls were characterized by lower microbial richness and diversity, depletion of anaerobes, and short-chain fatty acid (SCFA)-producing bacteria, and an expansion of potential pathobionts. Lachnospira and Bacteroides were signature bacteria for distinguishing acute insomnia patients from healthy controls, while Faecalibacterium and Blautia were signature bacteria for distinguishing chronic insomnia patients from healthy controls. Acute/chronic insomnia-related signature bacteria also showed correlations with these patients' self-reported sleep quality and plasma IL-1β. CONCLUSION These findings suggest that insomnia symptomology, gut microbiota, and inflammation may be interrelated in complex ways. Gut microbiota may serve as an important indicator for auxiliary diagnosis of insomnia and provide possible new therapeutic targets in the field of sleep disorders.
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Affiliation(s)
- Yuanyuan Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
- Expressive Arts Therapy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Ya Zhou
- Department of Psychology, Lund University, Lund, Sweden
| | - Daoming Wang
- School of Future Technology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xianchen Liu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lin Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Tong Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Yuechu Zhang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Min Jiang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Huilan Tang
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Lawrence V Amsel
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Fang Fan
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Ivgy-May N, Hajak G, van Osta G, Braat S, Chang Q, Roth T. Efficacy and safety of esmirtazapine in adult outpatients with chronic primary insomnia: a randomized, double-blind placebo-controlled study and open-label extension. J Clin Sleep Med 2020; 16:1455-1467. [PMID: 32351205 DOI: 10.5664/jcsm.8526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Esmirtazapine (1.5-4.5 mg) has demonstrated short-term sleep-promoting effects in nonelderly outpatients with chronic insomnia. This phase 3, randomized, double-blind study (NCT00631657) and its open-label extension (NCT00750919) investigated efficacy and safety of long-term esmirtazapine treatment in adult outpatients with chronic insomnia. METHODS Participants were randomized to receive esmirtazapine 4.5 mg or placebo for 6 months; those receiving esmirtazapine were then rerandomized to esmirtazapine or placebo for an additional 7 days. Participants could enter the 6-month open-label extension with esmirtazapine 4.5 mg. The primary objective of the double-blind study was to assess long-term efficacy of esmirtazapine vs placebo on self-reported total sleep time. Assessing long-term safety and tolerability were secondary and primary objectives of the double-blind and extension studies, respectively. RESULTS Overall, 457 participants received treatment in the double-blind study (esmirtazapine, n = 342; placebo, n = 115) and 184 participants (prior esmirtazapine, n = 136; prior placebo, n = 48) received esmirtazapine in the extension. In the double-blind study, a 48.7-minute increase in average nightly total sleep time was observed for esmirtazapine vs placebo (95% confidence interval, 35.0-62.5; P < .0001) at months 4-6. There was no evidence of residual effects on next-day alertness or daytime functioning and no evidence of rebound insomnia or withdrawal symptoms upon treatment discontinuation. Esmirtazapine was generally well tolerated; somnolence and weight gain were the most common adverse events. CONCLUSIONS Esmirtazapine improved sleep duration vs placebo over at least 6 months. There was no evidence of next-day residual effects or of withdrawal symptoms or rebound insomnia following abrupt treatment discontinuation. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A 6-Month Efficacy and Safety Study of Org 50081 in Adult Patients With Chronic Primary Insomnia (21106/P05701/MK-8265-002); URL: https://clinicaltrials.gov/ct2/show/NCT00631657; Identifier: NCT00631657; and Registry: ClinicalTrials.gov; Name: Twenty-Six Week Extension Trial of Org 50081 (Esmirtazapine) in Outpatients With Chronic Primary Insomnia (176003/P05721/MK-8265-007); URL: https://clinicaltrials.gov/ct2/show/NCT00750919); Identifier: NCT00750919.
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Affiliation(s)
| | - Goeran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | | | | | - Qing Chang
- Merck & Co., Inc., Kenilworth, New Jersey
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La YK, Choi YH, Chu MK, Nam JM, Choi YC, Kim WJ. Gender differences influence over insomnia in Korean population: A cross-sectional study. PLoS One 2020; 15:e0227190. [PMID: 31917784 PMCID: PMC6952093 DOI: 10.1371/journal.pone.0227190] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/04/2019] [Indexed: 12/11/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is the most common sleep disorder with significant psychiatric/physical comorbidities in the general population. The aim of this study is to investigate whether socioeconomic and demographic factors are associated with gender differences in insomnia and subtypes in Korean population. METHOD The present study used data from the nationwide, cross-sectional study on sleep among all Koreans aged 19 to 69 years. The Insomnia Severity Index (ISI) was used to classify insomnia symptoms and their subtypes (cutoff value: 9.5). The Pittsburgh Sleep Quality Index (PSQI), Goldberg Anxiety Scale (GAS) and Patient Health Questionnaire-9 (PHQ-9) were used to measure sleep quality, anxiety and depression. RESULTS A total of 2695 participants completed the survey. The overall prevalence of insomnia symptoms was 10.7%, including difficulty in initiating sleep (DIS) (6.8%), difficulty in maintaining sleep (DMS) (6.5%) and early morning awakening (EMA) (6.5%), and these symptoms were more prevalent in women than in men. Multivariate analysis showed that female gender, shorter sleep time and psychiatric complications were found to be independent predictors for insomnia symptoms and subtypes. After adjusting for covariates among these factors, female gender remained a significant risk factor for insomnia symptoms and their subtypes. As for men, low income was related to insomnia. CONCLUSION Approximately one-tenth of the sample from the Korean general population had insomnia symptoms. The prevalence of insomnia symptom and the subtypes were more prevalent in women than men. Gender is an independent factor for insomnia symptoms.
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Affiliation(s)
- Yun Kyung La
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Ho Choi
- Department of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Mo Nam
- Department of Preventive Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Chul Choi
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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CORR Insights®: The Pediatric Toronto Extremity Salvage Score (pTESS): Validation of a Self-reported Functional Outcomes Tool for Children with Extremity Tumors. Clin Orthop Relat Res 2019; 477:2142-2144. [PMID: 31389898 PMCID: PMC7000102 DOI: 10.1097/corr.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol 2018; 175:3190-3199. [PMID: 29318587 PMCID: PMC6057895 DOI: 10.1111/bph.14116] [Citation(s) in RCA: 387] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 02/06/2023] Open
Abstract
In mammals, a central circadian clock, located in the suprachiasmatic nuclei (SCN) of the hypothalamus, tunes the innate circadian physiological rhythms to the ambient 24 h light-dark cycle to invigorate and optimize the internal temporal order. The SCN-activated, light-inhibited production of melatonin conveys the message of darkness to the clock and induces night-state physiological functions, for example, sleep/wake blood pressure and metabolism. Clinically meaningful effects of melatonin treatment have been demonstrated in placebo-controlled trials in humans, particularly in disorders associated with diminished or misaligned melatonin rhythms, for example, circadian rhythm-related sleep disorders, jet lag and shift work, insomnia in children with neurodevelopmental disorders, poor (non-restorative) sleep quality, non-dipping nocturnal blood pressure (nocturnal hypertension) and Alzheimer's disease (AD). The diminished production of melatonin at the very early stages of AD, the role of melatonin in the restorative value of sleep (perceived sleep quality) and its sleep-anticipating effects resulting in attenuated activation of certain brain networks are gaining a new perspective as the role of poor sleep quality in the build-up of β amyloid, particularly in the precuneus, is unravelled. As a result of the recently discovered relationship between circadian clock, sleep and neurodegeneration, new prospects of using melatonin for early intervention, to promote healthy physical and mental ageing, are of prime interest in view of the emerging link to the aetiology of Alzheimer's disease. LINKED ARTICLES: This article is part of a themed section on Recent Developments in Research of Melatonin and its Potential Therapeutic Applications. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.16/issuetoc.
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Affiliation(s)
- Nava Zisapel
- Department of Neurobiology, Faculty of Life SciencesTel‐Aviv University and Neurim PharmaceuticalsTel AvivIsrael
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Huang KY, Liang S, Grellet A, Zhang JB. Acupuncture and moxibustion for primary insomnia: A systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hou CL, Li Y, Cai MY, Ma XR, Zang Y, Jia FJ, Lin YQ, Ungvari GS, Chiu HFK, Ng CH, Zhong BL, Cao XL, Tam MI, Xiang YT. Prevalence of Insomnia and Clinical and Quality of Life Correlates in Chinese Patients With Schizophrenia Treated in Primary Care. Perspect Psychiatr Care 2017; 53:80-86. [PMID: 26388498 DOI: 10.1111/ppc.12139] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/23/2015] [Accepted: 08/11/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describe the prevalence and clinical correlates of insomnia in schizophrenia patients treated in primary care. DESIGN AND METHODS Six hundred and twenty-three schizophrenia patients from 22 primary care services were recruited. FINDINGS The prevalence of at least one type of insomnia was 28.9% (180/623), while those of difficulty initiating sleep, difficulty maintaining sleep, and early morning wakening were 20.5%, 19.6%, and 17.7%, respectively. Only 53.3% of patients suffering from insomnia received treatment. PRACTICE IMPLICATIONS Insomnia is common in Chinese patients with schizophrenia treated in primary care and the rate of treatment appears low.
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Affiliation(s)
- Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yan Li
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mei-Ying Cai
- Department of Community, Guangzhou Yuexiu Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Xin-Rong Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia Province, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yong-Qiang Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Gabor S Ungvari
- Marian Centre, The University of Notre Dame Australia, Perth, Western Australia, Australia.,School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Bao-Liang Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Guangzhou, Hong Kong SAR, China
| | - Xiao-Lan Cao
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Man-Ian Tam
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
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Dela Peña IJI, Kim HJ, de la Peña JB, Kim M, Botanas CJ, You KY, Woo T, Lee YS, Jung JC, Kim KM, Cheong JH. A tryptic hydrolysate from bovine milk αs1-casein enhances pentobarbital-induced sleep in mice via the GABAA receptor. Behav Brain Res 2016; 313:184-190. [PMID: 27401107 DOI: 10.1016/j.bbr.2016.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 11/27/2022]
Abstract
Studies have shown that enzymatic hydrolysis of casein, the primary protein component of cow's milk, produces peptides with various biological activities, and some of these peptides may have sleep-promoting effects. In the present study, we evaluated the sedative and sleep-promoting effects of bovine αS1-casein tryptic hydrolysate (CH), containing a decapeptide αS1-casein known as alpha-casozepine. CH was orally administered to ICR mice at various concentrations (75, 150, 300, or 500mg/kg). An hour after administration, assessment of its sedative (open-field and rota-rod tests) and sleep-potentiating effects (pentobarbital-induced sleeping test and EEG monitoring) were conducted. Although a trend can be observed, CH treatment did not significantly alter the spontaneous locomotor activity and motor function of mice in the open-field and rota-rod tests. On the other hand, CH (150mg/kg, respectively) enhanced the sleep induced by pentobarbital sodium in mice. It also promoted slow-wave (delta) EEG activity in rats; a pattern indicative of sleep or relaxation. These behavioral results indicate that CH has sleep-promoting effects, but no or has minimal sedative effects. To elucidate the probable mechanism behind the effects of CH, we examined its action on intracellular chloride ion influx in cultured human neuroblastoma cells. CH dose-dependently increased chloride ion influx, which was blocked by co-administration of bicuculline, a competitive GABAA receptor antagonist. Taken together, the results of the present study suggest that CH has sleep-promoting properties which are probably mediated through the GABAA receptor-chloride ion channel complex.
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Affiliation(s)
- Irene Joy I Dela Peña
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Hee Jin Kim
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - June Bryan de la Peña
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Mikyung Kim
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Chrislean Jun Botanas
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Kyung Yi You
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Taeseon Woo
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Yong Soo Lee
- Department of Pharmacy, Duksung Women's University, 33 Samyang-ro 144-gil, Dobong-gu, Seoul, 01369, Republic of Korea
| | - Jae-Chul Jung
- Life Science Research Institute, NOVAREX Co., Ltd., Ochang, Cheongwon, Chungbuk 28126, Republic of Korea
| | - Kyung-Mi Kim
- Life Science Research Institute, NOVAREX Co., Ltd., Ochang, Cheongwon, Chungbuk 28126, Republic of Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea.
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15
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Zust BL, Gruenberg ME, Sendelbach SE. Exploring the Lived Experience of Difficult Sleep and Good Sleep Among Psychiatric Inpatients. Issues Ment Health Nurs 2016; 37:90-7. [PMID: 26864839 DOI: 10.3109/01612840.2015.1118174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this qualitative study was to explore psychiatric inpatients' reflections on their experiences with sleep throughout their lives. Fourteen patients in an acute care behavioral health unit agreed to participate in this study. Participants met individually with a researcher to reflect on times in their lives when they experienced good sleep; times when they had difficulty sleeping; and times when difficult sleep was resolved. The major findings of the study indicated that feeling alone with life problems triggered difficult sleep; while feelings of belonging and purpose were associated with good sleep.
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Affiliation(s)
- Barbara Lois Zust
- a Gustavus Adolphus College , Department of Nursing , Saint Peter , Minnesota , USA
| | - Marjorie E Gruenberg
- b Abbott Northwestern Hospital , Behavioral Health Services , Minneapolis , Minnesota , USA
| | - Susan Ellen Sendelbach
- c Abbott Northwestern Hospital , Department of Nursing Research , Minneapolis , Minnesota , USA
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16
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Ivgy-May N, Roth T, Ruwe F, Walsh J. Esmirtazapine in non-elderly adult patients with primary insomnia: efficacy and safety from a 2-week randomized outpatient trial. Sleep Med 2015; 16:831-7. [DOI: 10.1016/j.sleep.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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17
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Lande RG, Gragnani C. Relationships between polypharmacy and the sleep cycle among active-duty service members. J Osteopath Med 2015; 115:370-5. [PMID: 26024330 DOI: 10.7556/jaoa.2015.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Sleep disorders are frequent clinical presentations, especially among active-duty service members. Medications are one factor that can affect sleep in many ways. OBJECTIVE To determine the effect of increasing numbers of medications on the sleep cycle of active-duty service members. METHODS Medical records for active-duty service members who completed enhanced sleep assessments at the Psychiatry Continuity Service at Walter Reed National Military Medical Center from October 1, 2010, through November 30, 2013, were retrospectively reviewed. Data were collected on home sleep study findings, sleep-related self-report instrument scores, and active medications. RESULTS A total of 135 medical records were reviewed. One hundred patients (74.07%) had an active prescription for a psychoactive drug. Among all patients, the mean (SD) number of active medications per participant was 2.52 (2.09), with 118 patients (82.96%) having an active medication for depression or insomnia. As the number of prescribed medications increased, the percentage of the sleep cycle in deep sleep decreased (P=.049), the percentage of light sleep increased (P=.016), the percentage of rapid eye movement sleep decreased (P=.083), and the first episode of deep sleep was delayed (P=.056). An increased number of medications had no significant impact on total sleep time (P>.05). CONCLUSION An increasing number of medications did not influence total sleep time but negatively affected the sleep cycle.
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18
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Chung KH, Li CY, Kuo SY, Sithole T, Liu WW, Chung MH. Risk of psychiatric disorders in patients with chronic insomnia and sedative-hypnotic prescription: a nationwide population-based follow-up study. J Clin Sleep Med 2015; 11:543-51. [PMID: 25766696 DOI: 10.5664/jcsm.4700] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 12/18/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Previous epidemiological studies have established insomnia as a major risk factor for mood, anxiety, and substance use disorders. However, the associations between insomnia with sedative-hypnotic prescriptions and various psychiatric disorders have not been thoroughly examined. The current study involved evaluating the risk of psychiatric disorders, namely schizophrenia, mood, anxiety, somatoform, and substance-related disorders, over a 6-y follow-up period in three groups: patients with insomnia and sedative-hypnotic prescriptions (Inso-Hyp), those with insomnia and without sedative-hypnotic prescriptions (Inso-NonHyp), and those with neither insomnia nor sedative-hypnotic prescriptions (NonInso-NonHyp). METHODS We used a historical cohort study design to compare the risk of psychiatric disorders among the three groups. Data regarding these patients were derived from reimbursement claims recorded in Taiwan's National Health Insurance Research Database. Cox proportional hazards regression was used to compare the 6-y risk of subsequent psychiatric disorders among the Inso-Hyp, Inso-NonHyp, and NonInso-NonHyp groups. RESULTS Compared with the Inso-NonHyp and NonInso-NonHyp group patients, the Inso-Hyp group patients exhibited a higher risk of psychiatric disorders, particularly bipolar disorders (adjusted hazard ratio [AHR]: 7.60; 95% confidence interval [CI]: 5.31-10.89 and AHR: 14.69; 95% CI: 11.11-19.43, respectively). Moreover, among the Inso-Hyp patient group, insomnia prescribed with benzodiazepine, a longer duration of sedative-hypnotic action, and higher doses of sedativehypnotics were significantly associated with a higher risk of depressive and anxiety disorders. CONCLUSION The Inso-Hyp group exhibited a higher risk of developing psychiatric disorders than did the Inso-NonHyp and NonInso-NonHyp groups. The results regarding patients with insomnia and sedative-hypnotic prescriptions associated with the risk of psychiatric disorders can serve as a reference for care providers when managing sleep disturbances.
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Affiliation(s)
- Kuo-Hsuan Chung
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Trevor Sithole
- Maternity Department, Emkhuzweni Health Center, Swaziland.,Customer Care Officer, Emkhuzweni Health Center, Swaziland
| | - Wen-Wei Liu
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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19
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Johnson K, Sidani S, Epstein DR. Effects of a Multi-Component Behavioral Intervention (MCI) for Insomnia on Depressive and Insomnia Symptoms in Individuals with High and Low Depression. ACTA ACUST UNITED AC 2015; 12:451-61. [PMID: 25793254 DOI: 10.1080/15433714.2013.873753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Insomnia and depression are prevalent and co-occurring conditions that are associated with significant impairment of life. Previous research indicates that cognitive-behavioral interventions for insomnia (CBT-I) can improve both insomnia and depressive symptoms. The aim of the authors in this study was to determine whether a multi-component behavioral intervention (MCI) improved both insomnia and depressive symptoms in persons presenting with insomnia and high levels of depression. The sample consisted of 321 individuals with insomnia who participated in a trial of insomnia treatments; 106 participants had high levels of depression (score ≥ 16 on CES-D) at baseline. Participants either received the MCI or a control treatment (sleep education and hygiene booklet). At post-test, participants with high and low levels of depressive symptoms showed significant improvement in insomnia symptoms. Those with high depression also had significant reductions in depressive symptoms. It can be concluded that for individuals with depression and insomnia, CBT-I is a viable intervention for managing depressive symptoms, which complements other approaches for treating depression.
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Affiliation(s)
- Kirsten Johnson
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
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20
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Polito L, Davin A, Vaccaro R, Abbondanza S, Govoni S, Racchi M, Guaita A. Serotonin transporter polymorphism modifies the association between depressive symptoms and sleep onset latency complaint in elderly people: results from the ‘InveCe.Ab’ study. J Sleep Res 2014; 24:215-22. [DOI: 10.1111/jsr.12248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Stefano Govoni
- Golgi Cenci Foundation; Abbiategrasso Italy
- Department of Drug Sciences-Pharmacology; University of Pavia; Pavia Italy
| | - Marco Racchi
- Golgi Cenci Foundation; Abbiategrasso Italy
- Department of Drug Sciences-Pharmacology; University of Pavia; Pavia Italy
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21
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Ivan MC, Amspoker AB, Nadorff MR, Kunik ME, Cully JA, Wilson N, Calleo J, Kraus-Schuman C, Stanley MA. Alcohol use, anxiety, and insomnia in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry 2014; 22:875-83. [PMID: 23973253 PMCID: PMC3842378 DOI: 10.1016/j.jagp.2013.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/20/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine alcohol consumption among older primary care patients with generalized anxiety disorder (GAD); its relationship to demographic variables, insomnia, worry, and anxiety; and its moderating role on the anxiety-insomnia relationship. We expected alcohol use to be similar to previous reports, correlate with higher anxiety and insomnia, and worsen the anxiety-insomnia relationship. DESIGN Baseline data from a randomized controlled trial. SETTING Michael E. DeBakey VA Medical Center and Baylor College of Medicine. PARTICIPANTS 223 patients, 60 years and older, with GAD. MEASUREMENTS Frequency of alcohol use, insomnia (Insomnia Severity Index), worry (Penn State Worry Questionnaire - Abbreviated, Generalized Anxiety Disorder Severity Scale), and anxiety (State-Trait Anxiety Inventory - Trait subscale, Structured Interview Guide for the Hamilton Anxiety Rating Scale [SIGH-A]). RESULTS Most patients endorsed alcohol use, but frequency was low. Presence and frequency were greater than in previous reports of primary care samples. Alcohol use was associated with higher education, female gender, less severe insomnia, and lower worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory-Trait subscale; SIGH-A). Whites reported more drinks/week than African-Americans. More drinks/week were associated with higher education and lower anxiety (SIGH-A). Weaker relationships between worry/anxiety and insomnia occurred for those drinking. Drink frequency moderated the positive association between the Penn State Worry Questionnaire-Abbreviated and insomnia, which was lower with higher frequency of drinking. CONCLUSIONS Older adults with GAD use alcohol at an increased rate, but mild to moderate drinkers do not experience sleep difficulties. A modest amount of alcohol may minimize the association between anxiety/worry and insomnia among this group.
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Affiliation(s)
- M Cristina Ivan
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Amber B Amspoker
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Michael R Nadorff
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Mark E Kunik
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Jeffrey A Cully
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Nancy Wilson
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Jessica Calleo
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Cynthia Kraus-Schuman
- Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Melinda A Stanley
- Houston VA HSR&D Center of Excellence, Houston, TX; Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX.
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22
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Lande RG. Sleep Problems, Posttraumatic Stress, and Mood Disorders Among Active-Duty Service Members. J Osteopath Med 2014; 114:83-9. [DOI: 10.7556/jaoa.2014.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context: Sleep problems among active-duty service members are pervasive and complicate the recovery from comorbid posttraumatic stress and mood disorders.
Objective: To better understand chronic sleep problems among active-duty service members.
Methods: Medical records for active-duty service members who completed enhanced sleep assessments during an 18-month period beginning in October 2010 at the Walter Reed National Military Medical Centers' Psychiatry Continuity Service were retrospectively reviewed. Sleep assessment measures included the Pittsburgh Insomnia Rating Scale, the Alcohol Use Disorders Identification Test, the Zung Self-Rating Depression Scale, the Zung Self-Rating Anxiety Scale, the Posttraumatic Stress Disorder Checklist – Military Version, the Epworth Sleepiness Scale, the Pre-Sleep Arousal Scale, and a home sleep study.
Results: A total of 76 records met the study criteria. Twenty-two participants (29%) had an apnea/hypopnea index that suggested mild to moderate sleep apnea. Service members with higher self-reported posttraumatic stress scores also reported a higher degree of both somatic and cognitive factors interfering with sleep initiation. Compared with those who had low self-reported posttraumatic stress scores, service members with high posttraumatic stress scores also had less total sleep time (mean difference, 38 minutes) and higher scores on the apnea/hypopnea index, the respiratory disturbance index, and the oxygen saturation index.
Conclusion: Enhanced sleep assessments that include traditional self-report tests and a home sleep study can help identify previously undiscovered behavioral and respiratory problems among service members, particularly those with higher posttraumatic stress scores.
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23
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Polo-Kantola P, Laine A, Aromaa M, Rautava P, Markkula J, Vahlberg T, Sillanpää M. A population-based survey of sleep disturbances in middle-aged women--associations with health, health related quality of life and health behavior. Maturitas 2013; 77:255-62. [PMID: 24378184 DOI: 10.1016/j.maturitas.2013.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/20/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the prevalence of sleep disturbances and the contributing factors in middle-aged women. METHODS In a cross-sectional design of the long-term, prospective follow-up study project of 1278 families from a random population sample, the mothers of 15 year-olds were asked to fill in a questionnaire about sleep, health, health related quality of life, and health behavior. RESULTS Quality of sleep was reported by 32% of women as good, 43% quite good, 12% average, 10% quite poor and 3% as poor. The most frequent sleep disturbance was awakenings in the night, which 60% of the women experienced at least once a week. Difficulty falling asleep and waking too early in the morning were reported as a weekly occurrence by 16% and 20%, respectively. Morning sleepiness was experienced by 42% and daytime sleepiness by 32%. Chronic diseases and use of medications was associated with various sleep disturbances. Both somatic and mental symptoms increased the risk for sleep disturbances. CONCLUSIONS Almost one-quarter of middle-aged women is dissatisfied with their quality of sleep. Women who have chronic disease or use of medications for basic diseases often suffer from sleep disturbance, which is also associated with the health related quality of life. Further analysis of the risk factors is needed to improve the sleep health of middle-aged women.
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Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; Sleep Research Unit, University of Turku, Turku, Finland.
| | - Antti Laine
- Department of Public Health, University of Turku, Turku, Finland
| | - Minna Aromaa
- Department of Public Health, University of Turku, Turku, Finland; Outpatient Clinic for Children and Adolescents, Turku City Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland; Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Juha Markkula
- Department of Public Health, University of Turku, Turku, Finland; Neuropsychiatric outpatient ward, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Institute of Clinical Medicine, Department of Biostatistics, University of Turku, Finland
| | - Matti Sillanpää
- Department of Child Neurology, University of Turku, Turku, Finland
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24
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Walters AB, Hamer JD, Smitherman TA. Sleep Disturbance and Affective Comorbidity Among Episodic Migraineurs. Headache 2013; 54:116-24. [DOI: 10.1111/head.12168] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 01/07/2023]
Affiliation(s)
| | - Joshua D. Hamer
- Department of Psychology; University of Mississippi; Oxford MS USA
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25
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Manglick M, Rajaratnam SM, Taffe J, Tonge B, Melvin G. Persistent sleep disturbance is associated with treatment response in adolescents with depression. Aust N Z J Psychiatry 2013; 47:556-63. [PMID: 23508680 DOI: 10.1177/0004867413481630] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep disturbances are highly prevalent in adolescents with depressive disorders. To date there is limited evidence of the extent to which sleep disturbances are associated with treatment response in adolescents. This study aimed to examine the extent to which self-reported sleep disturbances are associated with treatment response in adolescents with depression. METHOD Sleep data were gathered from a sample of 166 adolescents (aged 12-18 years) with a diagnosis of a DSM-IV depressive disorder who underwent 3 months of treatment (psychosocial and/or pharmacotherapy (sertraline)) in community-based research programs. The subjective report of sleep disturbance within depressive disorders was assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children at three time points: pre-treatment, post-treatment and 6-month follow-up. RESULTS Sixty-nine percent of participants had a sleep disturbance pre-treatment and approximately 75% of these participants had threshold symptoms. Threshold sleep disturbances that persisted from pre- to post-treatment assessments were positively associated with depression at the 6-month follow-up. An ordered logistic regression model controlling for gender, treatment group and comorbid anxiety estimated a 70% risk of depression or partial remission for those with persistent sleep disturbance. Treatment group, anxiety and gender generally had no significant effect on the relationship between sleep and depression. CONCLUSION Sleep disturbances were highly related to depressive state and were associated with poorer treatment response in adolescents with depression. These results provide a rationale for further exploration of sleep-related treatments for adolescents with depression. Knowledge of patient-reported persistent sleep disturbances can help clinicians to predict treatment outcomes and may direct them to augment treatment or focus on sleep-related treatment strategies.
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Affiliation(s)
- Maneesha Manglick
- Centre for Developmental Psychiatry and Psychology, School of Psychology and Psychiatry, Monash University, Notting Hill, Australia.
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26
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Nadorff MR, Fiske A, Sperry JA, Petts R, Gregg JJ. Insomnia symptoms, nightmares, and suicidal ideation in older adults. J Gerontol B Psychol Sci Soc Sci 2013; 68:145-52. [PMID: 22929392 PMCID: PMC3693602 DOI: 10.1093/geronb/gbs061] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 06/13/2012] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Prior research has found that insomnia symptoms and nightmares are associated with suicidal ideation, suicide attempts, and death by suicide. However, to the best of our knowledge, no research has examined the relation between insomnia symptoms, nightmares, and suicidal ideation in older adults. The current project aimed to fill this void by investigating the relation between insomnia symptoms, nightmares, and suicidal ideation in an older adult sample. METHOD The study utilized a cross-sectional design. The sample consisted of 81 older adult patients (age ≥ 65 years) recruited from a family medicine clinic. The participants were asked to complete surveys about their sleep, symptoms of depression, and suicidal ideation. RESULTS Insomnia symptoms, but not nightmares, were significantly related to suicidal ideation. In addition, insomnia symptoms were related to suicidal ideation independent of nightmares. Furthermore, the relation between insomnia symptoms and suicidal ideation was mediated by depressive symptoms. DISCUSSION These findings have implications for the identification and treatment of suicidal ideation in older adults.
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27
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Hartz A, Ross JJ, Noyes R, Williams P. Somatic symptoms and psychological characteristics associated with insomnia in postmenopausal women. Sleep Med 2012; 14:71-8. [PMID: 23041035 DOI: 10.1016/j.sleep.2012.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/05/2012] [Accepted: 08/12/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to assess the association of sleep disturbance with psychological characteristics, somatic symptoms and previously identified risk factors. METHODS Data were from 148,938 postmenopausal women enrolled in The Women's Health Initiative who provided cross-sectional information about psychological characteristics, somatic symptoms and the character of their sleep. Overall sleep quality was based on the Women's Health Initiative Insomnia Rating Scale (WHI IRS), a measure that assessed five types of sleep disturbance. RESULTS Three factors accounted for nearly 20% of the variation in the WHI IRS: a scale for somatic symptoms, daytime restlessness and either depression or emotional well-being. Other independently associated factors were night sweats, pain and worry about expressing anger. Several factors that had been linked to sleep disturbance in other studies were found to have at most a weak independent association in this analysis. These included income, education, marital status, activity level, obesity level, hot flashes, coffee drinking and smoking. CONCLUSION Factors strongly associated with sleep disturbance in this study deserve further evaluation to determine the reasons for the association and whether the associations suggest possible treatments for sleep disturbance.
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Affiliation(s)
- Arthur Hartz
- Department of Medicine, University of Utah, Salt Lake City, UT 84112, USA.
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Krystal AD, McCall WV, Fava M, Joffe H, Soares CN, Huang H, Grinell T, Zummo J, Spalding W, Marshall R. Eszopiclone treatment for insomnia: effect size comparisons in patients with primary insomnia and insomnia with medical and psychiatric comorbidity. Prim Care Companion CNS Disord 2012; 14:11m01296. [PMID: 23251857 DOI: 10.4088/pcc.11m01296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this post hoc analysis was to compare the treatment effect size of eszopiclone 3 mg for insomnia in patients with a diagnosis of primary insomnia and in several of the psychiatric and medical conditions that are most commonly comorbid with insomnia. METHOD Data were analyzed from 5 large, multicenter, randomized, double-blind, placebo-controlled studies of adult outpatients of at least 1 month duration published between 2006 and 2009. Diary-derived indices of sleep and daytime functioning and the Insomnia Severity Index were compared for patients with primary insomnia (DSM-IV-TR criteria, n = 828) and for those with insomnia comorbid with major depressive disorder (MDD, DSM-IV-TR criteria, n = 545), generalized anxiety disorder (GAD, DSM-IV-TR criteria, n = 595), perimenopause/postmenopause (Stages of Reproductive Aging Workshop criteria, n = 410), and rheumatoid arthritis (American College of Rheumatology criteria, n = 153). Cohen d effect sizes were calculated for each individual study as the between-treatment difference score divided by the pooled standard deviation. RESULTS Effect sizes ranged from 0.40 to 0.69 (small-medium) as early as week 1 and were maintained at 0.26-0.63 at week 4 for sleep latency, wake time after sleep onset, and total sleep time. Sleep latency and total sleep time effect sizes increased from week 1 to week 4 in the primary insomnia group. At week 4, effect sizes on all 3 parameters and the Insomnia Severity Index tended to be highest for the primary insomnia patients and tended to be lowest for patients with comorbid GAD and MDD. The effect sizes for daytime functioning were small for all insomnia patient groups. CONCLUSIONS Eszopiclone 3 mg is an effective treatment for insomnia across 5 clinically diverse patient populations; however, magnitude of effect is mediated by underlying comorbidity and their treatments, with largest measures of effect seen in primary insomnia and lowest in MDD and GAD. These consistent results, and the fact that clinical trials were conducted in patients being treated as appropriate for their comorbid clinical conditions, support the results' real-world generalizability and utility to clinical practice.
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Affiliation(s)
- Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Sleep America: managing the crisis of adult chronic insomnia and associated conditions. J Affect Disord 2012; 138:192-212. [PMID: 21652083 DOI: 10.1016/j.jad.2011.05.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/22/2011] [Accepted: 05/09/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Chronic insomnia, a public health crisis affecting 10-15% of the U.S. population and costing billions of dollars annually, typically presents with one or more comorbid psychiatric or organic conditions. Historical classification of chronic insomnia as "secondary" to a presenting comorbid condition has resulted in under-recognition and under-treatment of both the insomnia and comorbid condition(s). Though critical in any model of comorbid disease management, chronic insomnia receives little, if any, public policy attention. METHOD We conducted a systematic review of recent empirical studies, review papers, books, government documents, press releases, advertisements, and articles pertaining to the classification, epidemiology, treatment, and physiology of sleep, insomnia, and comorbid conditions. Data were located primarily through MEDLINE, PsycINFO, SCOPUS, and PUBMED databases. OBJECTIVE AND RESULTS Our goal was to provide an overview of the systems for classifying insomnia and available epidemiological data, and to review theoretical models regarding the etiology and maintaining factors of chronic insomnia along with research on the complex, bidirectional associations between chronic insomnia and various affective (and other) conditions. CONCLUSIONS After thorough review of the literature, we propose several public policy measures as an initial step in managing chronic insomnia in the United States. These include introducing a nation-wide multi-modal educational and awareness campaign titled "Sleep America;" increasing the availability and demand for behavioral sleep medicine - the initially preferred treatment approach; and increasing the use of monitoring and enforcement activities by regulatory authorities to curtail false and misleading claims by sponsors of supplements or treatments for insomnia. Through the adoption of such measures, we hope to galvanize a national interest in healthy sleep and the evidence-based treatment of chronic insomnia.
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Abstract
INTRODUCTION The imidazopyridine derivative zolpidem , which acts as a benzodiazepine (BZ) receptor agonist, is the most widely prescribed hypnotic drug in the US. AREAS COVERED This review addresses the neuroreceptor properties of zolpidem; clinical pharmacokinetics, pharmacodynamics and drug interactions; efficacy as a hypnotic; adverse effects; tolerance, dependence and withdrawal; relation to motor vehicle accidents and complex sleep behaviors; and new dosage forms. EXPERT OPINION Approved doses of zolpidem (10 mg for adults, 5 mg for the elderly) are consistently effective in reducing sleep latency and consequently increasing sleep duration in patients with insomnia. However, favorable effects on sleep maintenance are observed less consistently. Residual daytime effects are unlikely with recommended doses, and provided that at least 8 h elapse prior to arising. Hypnotic efficacy is maintained with repeated nightly use, and the risk of rebound insomnia is low. Dependence and abuse of zolpidem are no more likely to occur than with typical benzodiazepines. Newly available novel dosage forms of zolpidem have increased therapeutic options for patients with insomnia variants such as sleep maintenance insomnia and middle-of-the-night awakening.
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Affiliation(s)
- David J Greenblatt
- Tufts University School of Medicine, Department of Molecular Physiology and Pharmacology, 136 Harrison Avenue, Boston, MA 02111, USA.
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Wallace DM, Shafazand S, Ramos AR, Carvalho DZ, Gardener H, Lorenzo D, Wohlgemuth WK. Insomnia characteristics and clinical correlates in Operation Enduring Freedom/Operation Iraqi Freedom veterans with post-traumatic stress disorder and mild traumatic brain injury: an exploratory study. Sleep Med 2011; 12:850-9. [PMID: 21925943 DOI: 10.1016/j.sleep.2011.06.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/20/2011] [Accepted: 06/01/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD-mTBI), and (3) those with insomnia associated with PTSD alone. METHODS Consecutive veterans with insomnia complaints (> 6 months) were recruited over 6 months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires about insomnia, sleepiness, pain, fatigue, depression, PTSD, and health-related quality of life. They underwent polysomnography (PSG) with 2 weeks of actigraphy (ACT) and sleep diaries. RESULTS There were no differences in demographics or most questionnaire responses between PTSD and PTSD-mTBI groups. Subjective daytime sleepiness was significantly greater in PTSD-mTBI subjects compared with HS and PTSD participants. Significant co-morbid sleep disorders were noted in insomnia patients. PSG and ACT wake after sleep onset was significantly shorter in PTSD-mTBI subjects as compared with PTSD participants. CONCLUSION Insomnia patients with PTSD-mTBI were subjectively sleepier despite spending less time awake during the night than PTSD subjects, possibly as a consequence of head trauma.
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Affiliation(s)
- D M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Sarsour K, Kalsekar A, Swindle R, Foley K, Walsh JK. The association between insomnia severity and healthcare and productivity costs in a health plan sample. Sleep 2011; 34:443-50. [PMID: 21461322 DOI: 10.1093/sleep/34.4.443] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is a chronic condition with significant burden on health care and productivity costs. Despite this recognized burden, very few studies have examined associations between insomnia severity and healthcare and productivity costs. DESIGN A retrospective study linking health claims data with a telephone survey of members of a health plan in the Midwestern region of the United States. PARTICIPANTS The total healthcare costs study sample consisted of 2086 health plan members who completed the survey and who had complete health claims data. The productivity costs sample consisted of 1329 health plan members who worked for pay-a subset of the total healthcare costs sample. MEASUREMENTS Subjects' age, gender, demographic variables, comorbidities, and total health care costs were ascertained using health claims. Insomnia severity and lost productivity related variables were assessed using telephone interview. RESULTS Compared with the no insomnia group, mean total healthcare costs were 75% larger in the group with moderate and severe insomnia ($1323 vs. $757, P<0.05). Compared with the no insomnia group, mean lost productivity costs were 72% larger in the moderate and severe insomnia group ($1739 vs. $1013, P<0.001). Chronic medical comorbidities and psychiatric comorbidities were positively associated with health care cost. In contrast, psychiatric comorbidities were associated with lost productivity; while, medical comorbidities were not associated with lost productivity. CONCLUSIONS Health care and lost productivity costs were consistently found to be greater in moderate and severe insomniacs compared with non-insomniacs. Factors associated with lost productivity and health care costs may be fundamentally different and may require different kinds of interventions. Future studies should focus on better understanding mechanisms linking insomnia to healthcare and productivity costs and to understanding whether developing targeted interventions will reduce these costs.
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Affiliation(s)
- Khaled Sarsour
- Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, DC 1833, Indianapolis, IN 46285, USA.
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Holsten F, Pallesen S, Sivertsen B. Søvnforstyrrelser ved psykiske lidelser. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:688-91. [DOI: 10.4045/tidsskr.08.0604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Foley KA, Sarsour K, Kalsekar A, Walsh JK. Subtypes of sleep disturbance: associations among symptoms, comorbidities, treatment, and medical costs. Behav Sleep Med 2010; 8:90-104. [PMID: 20352545 DOI: 10.1080/15402001003622842] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Medical claims and survey data were used to evaluate patients with sleep disturbance lasting 1 year or more, and to identify subtypes of sleep disturbance using latent class analysis. Four subtypes were identified from the 1,374 patients. Subtypes differed on the number of sleep disturbance symptoms, presence of non-restorative sleep and comorbidities, degree of daytime impairment, and insomnia severity. The results from this study suggest that patient-reported symptoms of sleep disturbance, the frequency of symptoms, functional impairment, and comorbid conditions are important elements in distinguishing among groups of patients with varying degrees of sleep problems. These data provide evidence that the Insomnia Severity Index (ISI) varies accordingly with the frequency and resulting impairment of symptoms captured in the 4 clusters.
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Affiliation(s)
- Kathleen A Foley
- Jefferson School of Population Health, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
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Roy AN, Smith M. Prevalence and cost of insomnia in a state Medicaid fee-for-service population based on diagnostic codes and prescription utilization. Sleep Med 2010; 11:462-9. [DOI: 10.1016/j.sleep.2009.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/16/2009] [Accepted: 09/26/2009] [Indexed: 11/30/2022]
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Karabulut N, Karabulu N, Erci B, Ozer N, Ozdemir S. Symptom clusters and experiences of patients with cancer. J Adv Nurs 2010; 66:1011-21. [PMID: 20337795 DOI: 10.1111/j.1365-2648.2009.05254.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study is a report of a study to characterize the prevalence and severity of symptoms in patients with cancer and describing the clustering of symptoms. BACKGROUND Patients with cancer experience multiple symptoms caused by multiple factors, including progression of the cancer, acute physiological changes associated with treatment, delayed side effects of treatment and long-term consequences of the disease. METHODS A convenience sample of 287 patients with cancer at a Turkish university hospital completed a structured questionnaire on demographical characteristics and a symptom inventory for patients with cancer. Cluster analysis, principal components and internal consistency reliability analyses were used to analyse the data. The study was conducted in 2007. FINDINGS The most common symptoms experienced were fatigue, difficulty remembering, sadness, loss of appetite, lack of enjoyment of life, pain, distress, difficulty walking and dry mouth. The least experienced symptoms were shortness of breath and vomiting. Overall, 37.5% of the patients experienced moderate symptoms and 12.5% experienced severe symptoms. Among the severe symptoms were loss of appetite, fatigue, sadness, dry mouth and distress; however, 48% rated these as moderate or severe. CONCLUSIONS Symptom cluster research is still in its early years. Further work is needed to reach a standard definition of a symptom cluster and a consensus of its criteria. Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, comprehensive understanding of the symptom clusters that may be unique to cancer survivors is critical.
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Affiliation(s)
- Neziha Karabulut
- Surgical Nursing Department, School of Nursing, Atatürk University, Erzurum, Turkey
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Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL. Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manage 2010; 39:535-47. [PMID: 20083371 PMCID: PMC2843803 DOI: 10.1016/j.jpainsymman.2009.07.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/15/2009] [Accepted: 07/24/2009] [Indexed: 11/24/2022]
Abstract
CONTEXT Current evidence shows that sleep-wake disturbances are a persistent problem linked to poor quality of life in women surviving breast cancer. Information regarding correlates of sleep-wake disturbances in long-term survivors is sparse. OBJECTIVES The objective of this study was to refine knowledge regarding prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors (BCS) compared with age-matched women without breast cancer (WWC). METHODS The cross-sectional convenience sample included 246 BCS and 246 WWC who completed a quality-of-life study and were matched within +/-5 years of age. RESULTS BCS were a mean of 5.6 years beyond completion of cancer treatment (range = 5.6-10.0 years). Based on Pittsburgh Sleep Quality Index (PSQI) scores, BCS had significantly more prevalent sleep-wake disturbances (65%) compared with WWC (55%) (P < 0.05). BCS also had significantly higher PSQI global scores indicating poorer sleep quality compared with WWC (P < 0.05). Significant correlates of prevalence of poor sleep for BCS included hot flashes, poor physical functioning, depressive symptoms, and distress, and for WWC, these included hot flashes, poor physical functioning, and depressive symptoms. Significant correlates (P < 0.05) of severity of poor sleep for BCS included presence of noncancer comorbidities, hot flashes, depressive symptoms, and residual effects of cancer treatment. For WWC, these included hot flashes, poor physical functioning, depressive symptoms, and impact of a life event. CONCLUSION Knowledge of prevalence, severity, and correlates of sleep-wake disturbances provides useful information to health care providers during clinical evaluations for treatment of sleep-wake disturbances in BCS.
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Affiliation(s)
- Julie L Otte
- Center for Nursing Research, Indiana University School of Nursing, Indianapolis, Indiana 46202, USA.
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Abstract
Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio- and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short-term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long-term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions.
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Affiliation(s)
- Arne Fetveit
- Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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Lasch K, Joish VN, Zhu Y, Rosa K, Qiu C, Crawford B. Validation of the sleep impact scale in patients with major depressive disorder and insomnia. Curr Med Res Opin 2009; 25:1699-710. [PMID: 19505198 DOI: 10.1185/03007990902973201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Chronic insomnia and depression are often associated. Measuring the impact on quality of life associated with changes in sleep in co-treatment of insomnia and depression requires a valid and reliable patient reported outcome (PRO) instrument. This study aimed to assess the validity of the Sleep Impact Scale (SIS), a sleep-specific PRO instrument, in a population comorbid with Major Depressive Disorder (MDD) and insomnia to support its use in clinical or clinical trial applications. RESEARCH DESIGN AND METHODS Data from 379 subjects enrolled in a 27 week US, multi-center, phase IV, randomized, double-blind, parallel group, placebo-controlled trial of zolpidem tartrate extended-release taken in combination with escitalopram vs. placebo combined with escitalopram were pooled across treatment groups. Results from multi-trait analyses, tests of internal consistency and test-retest reliability, concurrent validity, known-groups validity, responsiveness, and thresholds for minimal important difference (MID) were examined. RESULTS Mean baseline scores on the SIS ranged from 22.85 (+/-13.41) on Satisfaction with Sleep to 43.49 (+/-21.12) on Mental Fatigue, reflecting impairments due to sleep problems. The SIS was found to be internally consistent (alpha > or = 0.70 for all domains) and have good construct validity. The item-domain correlations were > or = 0.52 with no instance of an item correlating more highly with a domain other than its own. There were some floor and no ceiling effects. The test-retest reliability of the SIS domains ranged between 0.68 and 0.83. Clinical validity assessed through known groups methods was supported. The SIS was responsive to changes on all domains. Preliminary estimates of minimum important difference (MID) were obtained to interpret changes in SIS domains. LIMITATIONS Limitations include the need for further qualitative research on content validity and the lack of a patient global assessment of change. CONCLUSIONS This study yielded adequate evidence of the validity of the SIS for use in clinical trials and research on MDD patients with comorbid insomnia.
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Sarsour K, Morin CM, Foley K, Kalsekar A, Walsh JK. Association of insomnia severity and comorbid medical and psychiatric disorders in a health plan-based sample: Insomnia severity and comorbidities. Sleep Med 2009; 11:69-74. [PMID: 19410512 DOI: 10.1016/j.sleep.2009.02.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/26/2009] [Accepted: 02/27/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Insomnia is commonly associated with one or more comorbid illnesses. Data on the relationship between insomnia severity and comorbid disorders are still limited, especially with regard to the use of well-validated measures of insomnia severity. METHODS A total of 2086 health plan enrollees, over-sampling for those with insomnia based on health claims, completed a telephone survey between April and June of 2006. Participants were categorized using four insomnia severity categories and compared on their administrative health claims' psychiatric and medical comorbidities. RESULTS Controlling for age and gender, the odds ratio for having at least one psychiatric diagnosis was 5.04 (CI=3.24-7.84) for severe insomnia, 2.63 (CI=1.97-3.51) for moderate insomnia, and 1.7 (CI=1.30-2.23) for subthreshold insomnia compared with those with no insomnia. Similarly, the odds ratio for having treatment for at least one chronic disease was 2.83 (CI=1.84-4.35) for severe insomnia, 2.34 (CI=1.83-2.99) for moderate insomnia, and 1.55 (CI=1.25-1.92) for subthreshold insomnia compared with the no insomnia group. CONCLUSIONS Increasing insomnia severity is associated with increased chronic medical and psychiatric illnesses. Further research is needed to better understand associations between insomnia severity and individual psychiatric and chronic medical comorbidities.
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Affiliation(s)
- Khaled Sarsour
- Global Health Outcomes, Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, IN 46285, USA.
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Impairment associated with sleep problems in the community: relationship to physical and mental health comorbidity. Psychosom Med 2008; 70:913-9. [PMID: 18842741 DOI: 10.1097/psy.0b013e3181871405] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. Sleep problems are being increasingly recognized as a source of morbidity and role impairment. Little is known, however, about the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. METHODS We utilized data from the German Health Survey (n = 4181; response rate: 87.6%; ages 18-65 years) to examine the relationships between sleep problems (assessed by the Pittsburgh Sleep Quality Inventory (PSQI)), mental and physical health comorbidity, and disability and health-related quality of life (assessed by the Medical Outcomes Scale Short Form-36 (SF-36)). RESULTS A total of 1595 (35.2%) respondents reported current sleep problems (PSQI score of >5). After adjusting for sociodemographic factors, we found the presence of sleep problems was associated with having one or more physical health problems (adjusted odds ratio (AOR) = 1.21, 95% Confidence Interval (CI) = 1.01-1.45) and one or more mental disorders (AOR = 3.58, 95% CI = 2.95-4.35). Among persons with one or more physical health problems, the co-occurrence of a sleep problem was associated with poorer physical component scores on the SF-36 (45.7 versus 48.6, p <.001) and increased odds of >or=1 disability days in the past 30 days due to physical problems (AOR = 1.55, 95% CI = 1.20-1.98), even after adjusting for sociodemographic factors and comorbidity with other mental and physical health conditions. CONCLUSIONS More than one third of adults in the community report sleep problems. These often co-occur with other physical and mental health problems, and when they do they are generally associated with an increased burden of role disability and functional impairment.
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Stoia-Caraballo R, Rye MS, Pan W, Brown Kirschman KJ, Lutz-Zois C, Lyons AM. Negative affect and anger rumination as mediators between forgiveness and sleep quality. J Behav Med 2008; 31:478-88. [PMID: 18787939 DOI: 10.1007/s10865-008-9172-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 08/25/2008] [Indexed: 11/30/2022]
Abstract
Research indicates that forgiveness of interpersonal transgressions relates to better sleep quality, whereas maintaining feelings of anger and hostility relates to poorer sleep quality. However, the mechanisms explaining these relationships have yet to be determined. We examined whether negative affect and anger rumination mediate the relationship between forgiveness of others and sleep quality using a sample of 277 undergraduates from a medium-sized Midwestern Catholic university. Participants completed self-report questionnaires assessing forgiveness of others (situational and dispositional), sleep quality (nocturnal sleep and daytime fatigue), negative affect (depression and anxiety), and anger rumination. Using structural equation modeling, we found that negative affect and anger rumination mediated the relationship between forgiveness and sleep quality through two indirect pathways. In one pathway, negative affect mediated between forgiveness and sleep quality. In the second pathway, both negative affect and anger rumination functioned as mediators. Implications for clinicians and researchers are discussed.
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Sleep disturbances in an arctic population: the Tromsø Study. BMC Health Serv Res 2008; 8:117. [PMID: 18510767 PMCID: PMC2424044 DOI: 10.1186/1472-6963-8-117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 05/29/2008] [Indexed: 12/22/2022] Open
Abstract
Background Prevalence estimates for insomnia range from 10 to 50% in the adult general population. Sleep disturbances cause great impairment in quality of life, which might even rival or exceed the impairment in other chronic medical disorders. The economic implications and use of health-care services related to chronic insomnia represent a clinical concern as well as a pronounced public health problem. Hypnotics are frequently prescribed for insomnia, but alcohol and over-the-counter sleep aids seem to be more widely used by insomniacs than prescription medications. Despite the complex relationship between insomnia and physical and mental health factors, the condition appears to be underrecognized and undertreated by health care providers, probably due to the generally limited knowledge of the causes and natural development of insomnia. Methods/Design The Tromsø Study is an ongoing population-based cohort study with five previous health studies undertaken between 1974 and 2001. This protocol outlines a planned study within the sixth Tromsø Study (Tromsø VI), aiming at; 1) describing sleep patterns in a community-based sample representative of the general population of northern Norway, and 2) examining outcome variables of sleep disturbances against possible explanatory and confounding variables, both within a cross-sectional approach, as well as retrospectively in a longitudinal study – exploring sleep patterns in subjects who have attended two or more of the previous Tromsø studies between 1974 and 2009. First, we plan to perform a simple screening in order to identify those participants with probable sleep disturbances, and secondly to investigate these sleep disturbances further, using an extensive sleep-questionnaire. We will also collect biological explanatory variables, i.e. blood samples, weight, height and blood pressure. We plan to merge data on an individual level from the Tromsø VI Study with data from the Norwegian Prescription Database (NorPD), which is a national registry including data for all prescription drugs issued at Norwegian pharmacies. Participants with sleep disturbances will be compared with pair-matched controls without sleep disturbances. Discussion Despite ongoing research, many challenges remain in the characterization of sleep disturbances and its correlates. Future mapping of the biological dimensions, natural history, as well as the behavioral and drug-related aspects of sleep disturbances in a representative population samples is clearly needed.
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Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, Vitiello B, Ritz L, Iyengar S, Abebe K, Birmaher B, Ryan N, Kennard B, Hughes C, DeBar L, McCracken J, Strober M, Suddath R, Spirito A, Leonard H, Melhem N, Porta G, Onorato M, Zelazny J. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA 2008; 299:901-913. [PMID: 18314433 PMCID: PMC2277341 DOI: 10.1001/jama.299.8.901] [Citation(s) in RCA: 400] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Only about 60% of adolescents with depression will show an adequate clinical response to an initial treatment trial with a selective serotonin reuptake inhibitor (SSRI). There are no data to guide clinicians on subsequent treatment strategy. OBJECTIVE To evaluate the relative efficacy of 4 treatment strategies in adolescents who continued to have depression despite adequate initial treatment with an SSRI. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial of a clinical sample of 334 patients aged 12 to 18 years with a primary diagnosis of major depressive disorder that had not responded to a 2-month initial treatment with an SSRI, conducted at 6 US academic and community clinics from 2000-2006. INTERVENTIONS Twelve weeks of: (1) switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine, 20-40 mg); (2) switch to a different SSRI plus cognitive behavioral therapy; (3) switch to venlafaxine (150-225 mg); or (4) switch to venlafaxine plus cognitive behavioral therapy. MAIN OUTCOME MEASURES Clinical Global Impressions-Improvement score of 2 or less (much or very much improved) and a decrease of at least 50% in the Children's Depression Rating Scale-Revised (CDRS-R); and change in CDRS-R over time. RESULTS Cognitive behavioral therapy plus a switch to either medication regimen showed a higher response rate (54.8%; 95% confidence interval [CI], 47%-62%) than a medication switch alone (40.5%; 95% CI, 33%-48%; P = .009), but there was no difference in response rate between venlafaxine and a second SSRI (48.2%; 95% CI, 41%-56% vs 47.0%; 95% CI, 40%-55%; P = .83). There were no differential treatment effects on change in the CDRS-R, self-rated depressive symptoms, suicidal ideation, or on the rate of harm-related or any other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of skin problems during venlafaxine than SSRI treatment. CONCLUSIONS For adolescents with depression not responding to an adequate initial treatment with an SSRI, the combination of cognitive behavioral therapy and a switch to another antidepressant resulted in a higher rate of clinical response than did a medication switch alone. However, a switch to another SSRI was just as efficacious as a switch to venlafaxine and resulted in fewer adverse effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00018902.
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Müller MR, Guimarães SS. Impacto dos transtornos do sono sobre o funcionamento diário e a qualidade de vida. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2007. [DOI: 10.1590/s0103-166x2007000400011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os distúrbios do sono provocam conseqüências adversas na vida das pessoas por diminuir seu funcionamento diário, aumentar a propensão a distúrbios psiquiátricos, déficits cognitivos, surgimento e agravamento de problemas de saúde, riscos de acidentes de tráfego, absenteísmo no trabalho, e por comprometer a qualidade de vida. Este estudo foi realizado com o objetivo de revisar a literatura especializada sobre as características dos distúrbios de sono mais freqüentes na população geral e suas implicações sobre os comportamentos, a rotina diária e a qualidade de vida das pessoas portadoras dessa condição. Os estudos revisados mostram que os distúrbios do sono desencadeiam conseqüências adversas à saúde e ao bem-estar dos indivíduos, afetando o trabalho, a cognição, os relacionamentos e o funcionamento diário, com diferentes desdobramentos a curto, médio e longo prazo.
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Abstract
Sleep is an essential part of life with many important roles which include immunologic, cognitive and muscular functions. Of the working population 20% report sleep disturbances and in critically ill patients an incidence of more than 50% has been shown. However, sleep disturbances in the intensive care unit (ICU) population have not been investigated in detail. Sleep disturbances in ICU patients have a variety of reasons: e.g. patient-related pathologies like sepsis, acute or chronic pulmonary diseases, cardiac insufficiency, stroke or epilepsy, surgery, therapeutical interventions like mechanical ventilation, noise of monitors, pain or medication. Numerous scales and questionnaires are used to quantify sleep and the polysomnogramm is used to objectify sleep architecture. To improve sleep in ICU patients concepts are needed which include in addition to pharmacological treatment (pain reduction and sedation) synchronization of ICU activities with daylight, noise reduction and music for relaxation. In order to establish evidence-based guidelines, research activities about sleep and critical illness should be intensified. Questions to be answered are: 1) Which part of sleep disturbances in critically ill patients is directly related to the illness or trauma? 2) Is the grade of sleep disturbance correlated with the severity of the illness or trauma? 3) Which part is related to the medical treatment and can be modified or controlled? In order to define non-pharmacological and pharmacological concepts to improve sleep quality, studies need to be randomized and to include different ICU populations. The rate of nosocomial infections, cognitive function and respiratory muscle function should be considered in these studies as well. This will help to answer the question, whether it is useful to monitor sleep in ICU patients as a parameter to indicate therapeutical success and short-term quality of life. Follow-up needs to be long enough to detect adverse effects of withdrawal symptoms after termination of analgesia and sedation or delirium.
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Affiliation(s)
- B Walder
- Service d'Anesthésiologie, Hôpitaux Universitaires, Rue Micheli-du-Crest 24, 1211 Genève 14.
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Gusbeth-Tatomir P, Boisteanu D, Seica A, Buga C, Covic A. Sleep disorders: a systematic review of an emerging major clinical issue in renal patients. Int Urol Nephrol 2007; 39:1217-26. [PMID: 17914660 DOI: 10.1007/s11255-007-9262-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 07/17/2007] [Indexed: 11/26/2022]
Abstract
The prevalence of sleep disorders is significantly higher (up to 80%) in patients with chronic uremia compared to the general population. Sleep disorders appear even in the early stages of chronic kidney disease. These disturbances are complex, including difficulties in falling asleep and awakening, interrupted sleep, nightmares, restless legs syndrome, sleep apnea syndrome, etc. There are still disagreements on the major etiological factors of sleep disorders in the uremic patient. Older age, long dialysis vintage, alcohol and tobacco abuse and, particularly, the presence of significant comorbidities are major determinants of sleep disorders in dialysis patients. Proper assessment of sleep disorders in the renal population is still under investigation; recent studies have mostly addressed patients' perception based on questionnaires. More precise polysomnographic assessments are less studied in renal patients. Sleep disorders significantly affect quality of life in dialysis patients. An accurate and early identification of such disturbances would lead to a significant improvement in quality of life, and probably also in outcome, in uremic patients. Sleep apnea syndrome is extremely frequent in dialysis patients, with obvious consequences for cardiovascular morbidity and mortality. Proper diagnosis and therapy of sleep apnea syndrome could significantly reduce cardiovascular risk. Although sleep quality improves after renal transplantation, allograft recipients still have significantly more sleep disorders than healthy individuals. Here, we review recent data on sleep disturbances in renal patients, focusing on the end-stage renal disease patient treated by dialysis.
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Affiliation(s)
- Paul Gusbeth-Tatomir
- Dialysis and Renal Transplant Center, Dr. C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Carol 1st Blvd Nr. 50, 700503, Iasi, Romania.
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Kalavapalli R, Singareddy R. Role of acupuncture in the treatment of insomnia: A comprehensive review. Complement Ther Clin Pract 2007; 13:184-93. [PMID: 17631261 DOI: 10.1016/j.ctcp.2007.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 01/16/2007] [Indexed: 11/21/2022]
Abstract
Insomnia is a common sleep disorder with devastating socioeconomic consequences. Even though there are pharmacological and behavioral treatments for insomnia, most of the patients are treated with medications. However, the long-term use of medications to treat insomnia is questioned and has potential side effects. More and more Americans are seeking complementary/alternative treatments for many conditions including insomnia and there are anecdotal reports/case series of use of acupuncture in treating insomnia. To examine critically the role of acupuncture in treatment of insomnia, we performed a systematic review of published literature. Among the selected studies for review many were clinical case series and few open or randomized clinical trails. Even though several of these studies did not clarify the nature of insomnia (primary vs. secondary), it seemed that many of the subjects enrolled in these studies had co-morbid other psychiatric (depression or anxiety disorders) and/or medical conditions (Hemodialysis, Stroke, Pregnancy). Except for few, several of these studies had methodological limitations. Despite the limitations of the reviewed studies, all of them consistently indicate significant improvement in insomnia with acupuncture. Further methodologically strong, randomized controlled studies with large sample size are needed to assess the usefulness of acupuncture in treatment of insomnia and explore the possible mechanisms underlying the effects of acupuncture on sleep and sleep disorders.
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Affiliation(s)
- Ramprasad Kalavapalli
- Department of Psychiatry-H073, Penn State University College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA 17033, USA
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Carter LP, Griffiths RR, Suess PE, Casada JH, Wallace CL, Roache JD. Relative abuse liability of indiplon and triazolam in humans: a comparison of psychomotor, subjective, and cognitive effects. J Pharmacol Exp Ther 2007; 322:749-59. [PMID: 17502431 DOI: 10.1124/jpet.107.119693] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Indiplon [N-methyl-N-[3-[3-(2-thienylcarbonyl)-pyrazolo[1,5-alpha]pyrimidin-7-yl]phenyl]acetamide; NBI 34060] is a positive allosteric GABA(A) receptor modulator that is under development for the treatment of insomnia. This study compared the abuse potential of indiplon, a compound with preferential affinity for GABA(A) receptors containing an alpha(1) subunit, with triazolam in 21 volunteers with histories of drug abuse. Placebo, triazolam (0.25, 0.5, and 0.75 mg), and indiplon (30, 50, and 80 mg) were studied in counterbalanced order under double-blind conditions at two different residential research facilities. Both drugs impaired psychomotor and cognitive performance and produced similar dose-related increases in participant and observer ratings of drug strength. The onset of action of both drugs was rapid (30 min); however, the duration of action of indiplon (3-4 h) was shorter than that of triazolam (4-6 h). The profiles of subjective effects of triazolam and indiplon were similar; however, a maximum of 52% of participants identified indiplon as a benzodiazepine or barbiturate, compared with 81% of participants after 0.75 mg of triazolam. On participantrated subjective effects relevant to sedation, the slope of the triazolam dose-effect curve was significantly steeper than that of indiplon. Neither the largest doses of indiplon and triazolam nor the slope of the indiplon and triazolam dose-effect curves were significantly different from each other on any of the same-day or next-day measures of positive drug effects or next-day measures of reinforcing effects. Together, these data suggest that although the abuse potential of indiplon is not different from that of triazolam at these doses, psychomotor and cognitive impairment after large doses of indiplon might be less.
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Affiliation(s)
- Lawrence P Carter
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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