Assessment of subjective sleep disturbance and related factors during female mid-life with the Jenkins Sleep Scale

Sex-related differential item functioning of the Jenkins Sleep Scale: a cross-sectional study among 77 967 employees in the Finnish public sector

OBJECTIVES

To investigate if the Jenkins Sleep Scale (JSS) demonstrates sex-related differential item functioning (DIF).

DESIGN

Cross-sectional study.

SETTING

Survey data from the Finnish Public Sector study (2015-2017).

PARTICIPANTS

77 967 employees in the Finnish public sector, with a mean age of 51.9 (SD 13.1) years and 82% women.

OUTCOME MEASURES

Item response theory estimates: difficulty and discrimination parameters of the JSS and differences in these parameters between men and women.

RESULTS

The mean JSS total score was 6.4 (4.8) points. For all four items of the JSS, the difficulty parameter demonstrated a slight shift towards underestimation of the severity of sleep difficulties. The discrimination ability of all four items was moderate to high. For the JSS composite score, overall discrimination ability was moderate (0.98, 95% CI 0.97 to 0.99). Mild uniform DIF (p<0.001) was seen: two items showed better discrimination ability among men and two others among women.

CONCLUSIONS

The JSS showed overall good psychometric properties among this healthy population of employees in the Finnish public sector. The JSS was able to discriminate people with different severities of sleep disturbances. However, when using the JSS, the respondents might slightly underestimate the severity of these disturbances. While the JSS may produce slightly different results when answered by men and women, these sex-related differences are probably negligible when applied to clinical situations.

Exploration of Inflammatory Biomarkers and Psychological Cardiovascular Disease Risk Factors Among Community Dwelling Adults: A Gender Comparison Study

Patients with rheumatic disease (RD) are at high risk for cardiovascular disease (CVD), which is the leading non-communicable chronic disease cause of death worldwide. Inflammatory biomarkers and psychological health status are reliable predictors of CVD in patients with RD. The primary aim of this study was to compare the inflammatory biomarkers and psychological CVD risk factors (CRFs) between a group of community-dwelling adults with RD and CRFs and a group of their peers with CRFs only. The secondary aim of this study was to analyze and compare the collected data by gender in the RD group. Data were collected and analyzed from 355 participants, with the 135 participants with physician-diagnosed RD assigned to the RD group and the remainder (n = 220) assigned to the comparison group. The measures used included a demographic datasheet, medical information, serum homocysteine (Hcy) levels, high sensitive C-reactive protein (hs-CRP) levels, and depression and global sleep-quality scale scores. The RD group had higher ratios of hypertension and depression diagnoses than the comparison group. The gender analysis of the RD group found significantly more-severe sleep disturbances in women than men and a significantly higher mean value of Hcy in men than women. The women in the RD group were significantly older, less educated, and less employed than their male counterparts and thus may be presumed to at higher risk of health illiteracy. Gender-tailored interventions to modify the risk factors of CVD identified in this study for patients with RD are recommended.

Post-COVID-19 syndrome in a sample of climacteric women living in Latin America

OBJECTIVE

The aim of this study was to assess resilience, fear of COVID-19, sleep disorders, and menopause-related symptoms after the acute phase of COVID-19 in middle-aged women with positive reverse transcription-polymerase chain reaction and noninfected women.

METHODS

This is a cross-sectional, analytical study of climacteric women from 9 Latin American countries, aged 40-64 years, attending a routine health checkup. We evaluated clinical characteristics and used the Connor-Davidson Resilience Scale, the Fear of COVID-19 Scale, the Jenkins Sleep Scale, and the Menopause Rating Scale to evaluate their health.

RESULTS

A total of 1,238 women were studied, including 304 who were positive for COVID-19 reverse transcription-polymerase chain reaction. The median (interquartile range) age was 53 (12) years; years of studies, 16 (6); body mass index, 25.6 (5.1) kg/m 2 ; and time since first COVID-19 symptom, 8 (6) months. COVID-19 patients reported fatigability (18.8%), joint and muscular discomfort (14.1%), and anosmia (9.5%). They had a significantly lower resilience score (26.87 ± 8.94 vs 29.94 ± 6.65), higher Fear of COVID-19 score (17.55 ± 7.44 vs 15.61 ± 6.34), and a higher Jenkins Scale score (6.10 ± 5.70 vs 5.09 ± 5.32) compared with control women. A logistic regression model confirmed these results. There was not a significant difference in the total Menopause Rating Scale score, although the odds ratios for both severe menopausal symptoms (1.34; 95% confidence interval, 1.02-1.76) and the use of hypnotics were higher in women with COVID-19 (1.80; 95% confidence interval, 1.29-2.50) compared with those without infection. We found no decrease in studied outcomes between the initial 7 months versus those reported after 8 to 18 months since first COVID-19 symptoms.

CONCLUSIONS

COVID-19 climacteric women have sleep disorders, lower resilience and higher fear of COVID-19.

Spanish version of Jenkins Sleep Scale in physicians and nurses: psychometric properties from a Peruvian nationally representative sample

OBJECTIVE

To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians.

METHODS

We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18-65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles.

RESULTS

We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed.

CONCLUSION

JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians.

Resilience, Perceived Stress, and Depressed Mood in Women Under in Vitro Fertilization Treatment

It has been suggested that women who display higher resilience levels may have less psychological distress during IVF. The aim of this study was to evaluate how infertile women deal with perceived stress, depressed mood, and sleep disturbances at the first IVF attempt and after one or more negative IVF outcomes depending on their level of resilience. An observational, cross-sectional study was carried out in a sample of 207 infertile women undergoing IVF procedures. The participants completed the short version of the Connor-Davidson Resilience Scale (CD-RISC), the short version of the European Spanish Version of Perceived Stress Scale (PSS-10), the Center of Epidemiologic Studies Depression Scale (CESD-10), and the Jenkins Sleep Scale (JSS). The relationship between CD-RISC scores ranked according to percentiles and mean PSS-10 scores revealed that women with strong resilience had lower perceived stress. After splitting the sample according to CD-RISC percentiles, differences were observed only at the first IVF attempt and the observed protective effect of high resilience scores appears to disappear following a negative IVF outcome. Women with high resilience are less likely to suffer from perceived stress or depressed mood during their first IVF attempt, this protective effect appears to be lost after a negative outcome.

Internal consistency and factor structure of Jenkins Sleep Scale: cross-sectional cohort study among 80 000 adults

OBJECTIVES

To assess the internal consistency and construct validity of the Finnish translation of the Jenkins Sleep Scale (JSS) in a large healthy working-age population with diverse work characteristics.

DESIGN

Survey-based cross-sectional cohort study.

SETTING

Survey conducted by an institute of occupational health.

PARTICIPANTS

Employees of 10 towns and 6 hospital districts.

PRIMARY AND SECONDARY OUTCOME MEASURES

The internal consistency defined by a Cronbach's alpha. Exploratory and confirmatory factor analyses to evaluate the construct structure of the JSS.

RESULTS

Of 81 136 respondents, 14 890 (18%) were men and 66 246 (82%) were women. Their average age was 52.1 (13.2) years. Of the respondents, 41 823 (52%) were sleeping 7 or less hours per night. The mean JSS total score was 6.4 (4.8) points. The JSS demonstrated high internal consistency with an alpha of 0.80 (lower 95% confidence limit 0.80). Exploratory factor analysis supported a one-factor solution with eigenvalue of 1.94. Confirmatory factor analysis showed that all four items were positively correlated with a single common factor explaining 44%-61% of common factor's variance.

CONCLUSIONS

The Finnish translation of JSS was found to be a unidimensional scale with good internal consistency. As such, the scale may be recommended as a practicable questionnaire when studying sleep difficulties in a healthy working-age population.

Assessment of the frequency of sleep complaints and menopausal symptoms in climacteric women using the Jenkins Sleep Scale

OBJECTIVE

To identify the frequency of sleep complaints (SC) and associated menopausal symptoms in climacteric women, apparently healthy, residing in three different capital cities of the Colombian Caribbean.

MATERIAL AND METHODS

Cross-sectional study which is part of the investigation project CAVIMEC [Calidad de Vida en la Menopausia y Etnias Colombianas]. Data were collected by interviewers, on a door-to-door visit. Healthy women residing in the Colombian Caribbean, 40-59 years old, were studied. Sociodemographic characteristics form and scales were applied: Menopause Rating Scale, Jenkins Sleep Scale, Perceived Psychological Stress (perceived stress), Goldberg Anxiety and Depression Scale, SCOFF scale (eating disorders), and Loneliness Scale by Hughes. The women were divided into two groups: with SC and without SC, according to the Jenkins scale result. Crude and adjusted logistic regressions were performed: SC (dependent variable) with sociodemographic characteristics and the results of the scales used (independent variables).

RESULTS

Five hundred eighty-five women were studied. 16.5% with SC. No differences were observed in age, BMI, and high blood pressure. Proportionally more women with SC had depression, anxiety, perception of loneliness, severe menopausal symptoms, somatic, psychological, urogenital, and quality of life severe impairment (p<0.05). There were no differences in eating disorders and perceived stress. In the adjusted model, only depression was associated with SC, OR: 9.81 [95% CI: 1.29-74.3], p<0.05.

CONCLUSION

SC were identified in 16.5% of the climacteric women of the Colombian Caribbean. In an adjusted model, probable depression was the only factor associated with SC.

Association of sleep quality with telomere length, a marker of cellular aging: A retrospective cohort study of older adults in the United States

BACKGROUND

Sleep quality is a risk factor for age-related diseases, and although the underlying mechanisms remain unclear, the effects of poor sleep quality on telomere length (TL) may play a role.

OBJECTIVE

The objective of the study was to evaluate the independent association between sleep quality and salivary TL in a large sample of older adults.

DESIGN

We adopted a retrospective cohort design, and participants comprised 5,268 adults drawn from the Health and Retirement Study. We used the 2006 (baseline) and 2008 (follow-up) waves. Baseline sleep quality was assessed using 4 Likert scale questions (trouble falling asleep, waking up during the night, waking up too early and not being able to fall sleep again, and feeling well rested in the morning). The TL was assessed using the T/S ratio, a continuous variable. The associations between sleep quality and T/S were assessed using multivariable ordinary least squares regressions. All analyses were adjusted for demographics, lifestyle characteristics, psychosocial, and other factors.

RESULTS

Overall, 16% reported never feeling well rested in the morning; 25.7% of respondents always had trouble waking during the night; and 12.8% always had trouble waking up too early in the morning. Respondents who never felt rested in the morning had significantly shorter TL than those who always felt rested in the morning (adjusted beta = -0.08, standard error = 0.03, P < .01). The composite sleep measure was not significantly associated with shorter TL.

CONCLUSIONS

In this cohort of older adults, not feeling well rested in the morning was significantly and inversely associated with TL; however, the composite measure of sleep quality was not significantly associated with TL. These findings suggest a potential connection between one of the measures of impaired sleep and reduction in TL, a marker of cellular aging that has been linked to multiple chronic conditions.

Association of socioeconomic and lifestyle-related risk factors with mental health conditions: a cross-sectional study

Background

There is rising public concern over the widening health inequalities in many countries. The aim of this study was to clarify the associations of socioeconomic status (SES)-related variables, such as levels of household disposable income and employment status, and lifestyle factors with mental health conditions among Japanese adults aged 40 to 69.

Methods

A cross-sectional study of 3085 participants (1527 males and 1558 females) was undertaken by using a self-administered questionnaire that included the Japanese version of the 12-item General Health Questionnaire (GHQ-12) and questions related to socioeconomic and lifestyle factors.

Results

The prevalence of poor mental health conditions, represented by a GHQ-12 score of 4 or more, was 33.4% among males and 40.4% among females. Males whose annual household disposable income was less than 2 million yen had significantly higher GHQ-12 scores than those with an annual household disposable income above 2 million yen. As per binary logistic regression analyses, short sleep duration and the absence of physical exercise were significantly related to poor mental health conditions among both males and females. Among females, a household disposable income of less than 2 million yen could be a risk factor for poor mental health conditions. Age and habitual drinking were inversely associated with poor mental health conditions.

Conclusions

Low levels of household disposable income and unhealthy lifestyle factors were significantly associated with mental health conditions. These results suggest the importance of improving unhealthy lifestyle behaviours and developing effective health promotion programmes. In addition, there is a need for social security systems for people from different socioeconomic backgrounds.

Effects of Kefir on Quality of Life and Sleep Disturbances in Postmenopausal Women

The aim of this study is to identify the effects of kefir, an alternative treatment method, on quality of life and sleep disturbances in postmenopausal women. In this study, it is seen that kefir has positive effects on sleep disturbances, depression, and quality of life in postmenopausal women.

Posttraumatic Stress Disorder Severity and Insomnia-Related Sleep Disturbances: Longitudinal Associations in a Large, Gender-Balanced Cohort of Combat-Exposed Veterans

Few studies have investigated the range and severity of insomnia-related sleep complaints among veterans with posttraumatic stress disorder (PTSD), and the temporal association between insomnia and PTSD severity has yet to be examined. To examine these associations, a large, gender-balanced cohort of veterans (N = 1,649) of the Iraq and Afghanistan conflicts participated in longitudinal assessments of PTSD and insomnia-related symptoms over a period of 2.5 years following enrollment (range: 2-4 years). Data were obtained from multiple sources, including interviews, self-report assessments, and electronic medical record data. Three-fourths (74.0%) of veterans with PTSD diagnoses at Time 1 (T1) reported insomnia-related sleep difficulties on at least half the nights during the past 30 days, and one-third of participants had received a prescription for a sedative-hypnotic drug in the past year. Veterans without PTSD had fewer sleep problems overall, although the prevalence of sleep problems was high among all study participants. In longitudinal, cross-lagged panel models, the frequency of sleep problems at T1 independently predicted increases in PTSD severity at Time 2 (T2), B = 0.27, p < .001, after controlling for gender and relevant comorbidities. Conversely, T1 PTSD severity was associated with increasing sleep complaints at T2 but to a lesser degree, B = 0.04, p < .001. Moderately high rates of sedative-hypnotic use were seen in veterans with PTSD, with more frequent use in women compared to men (40.4% vs. 35.0%). Sleep complaints were highly prevalent overall and highlight the need for increased clinical focus on this area.

Child Maltreatment and Polyvictimization as Predictors of Intimate Partner Violence in Women From the General Population of Quebec

This study aimed to (a) evaluate the prevalence of intimate partner violence (IPV) and revictimization among a representative sample of 1,001 women living in Quebec, Canada; (b) examine whether IPV was predicted by experiences of child maltreatment; and (c) explore the role of polyvictimization on IPV beyond the effect of any type of exposure. Results indicate the prevalence rates of lifetime IPV (10.5%), IPV over the last year (2.5%), and revictimization (7.2%). All forms of child maltreatment predicted an increased risk of IPV victimization, yet polyvictimization was related to IPV beyond the effects of specific forms of child maltreatment.

Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women

Importance

Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues.

Objective

To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause symptoms among midlife and older women.

Design, Setting, and Participants

A cross-sectional analysis of data from a multiethnic cohort of 2016 women 40 to 80 years of age in the Kaiser Permanente Northern California health care system was conducted from November 15, 2008, to March 30, 2012. Statistical analysis was conducted from June 8, 2016, to September 6, 2017.

Exposures

Lifetime physical or emotional IPV, sexual assault, and current symptoms of posttraumatic stress disorder, assessed with standardized questionnaires.

Main Outcomes and Measures

Difficulty sleeping, vasomotor symptoms, and vaginal symptoms, assessed with standardized questionnaires.

Results

Among the 2016 women enrolled, the mean (SD) age was 60.5 (9.5) years, and 792 of 2011 with race/ethnicity data (39.4)% were non-Latina white (403 [20.0%] Latina, 429 [21.3%] black, and 387 [19.2%] Asian). Lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 women (15.7%), sexual assault was reported by 382 women (18.9%), and 450 of 2000 women (22.5%) had current clinically significant symptoms of posttraumatic stress disorder. In multivariable analyses adjusted for age, race/ethnicity, educational level, body mass index, menopause status, hormone therapy, and parity, symptoms of posttraumatic stress disorder were associated with difficulty sleeping (odds ratio [OR], 3.02; 95% CI, 2.22-4.09), vasomotor symptoms (hot flashes: OR, 1.69; 95% CI, 1.34-2.12; night sweats: OR, 1.72; 95% CI, 1.37-2.15), and vaginal symptoms (vaginal dryness: OR, 1.73; 95% CI, 1.37-2.18; vaginal irritation: OR, 2.20; 95% CI, 1.66-2.93; pain with intercourse: OR, 2.16; 95% CI, 1.57-2.98). Emotional IPV was associated with difficulty sleeping (OR, 1.36; 95% CI, 1.09-1.71), night sweats (OR, 1.50; 95% CI, 1.19-1.89), and pain with intercourse (OR, 1.60; 95% CI, 1.14-2.25). Physical IPV was associated with night sweats (OR, 1.33; 95% CI, 1.03-1.72). Sexual assault was associated with vaginal symptoms (vaginal dryness: OR, 1.41; 95% CI, 1.10-1.82; vaginal irritation: OR, 1.42; 95% CI, 1.04-1.95; pain with intercourse: OR, 1.44; 95% CI, 1.00-2.06).

Conclusions and Relevance

Lifetime history of IPV or sexual assault and current clinically significant symptoms of posttraumatic stress disorder are common and are associated with menopause symptoms. These findings highlight the need for greater recognition of these exposures by clinicians caring for midlife and older women.

The Validity and Reliability of Turkish Version of the Jenkins Sleep Evaluation Scale in Rheumatoid Arthritis

Objectives

This study aims to assess the validity and reliability of the Jenkins Sleep Evaluation Scale (JSS) when applied to a Turkish population with rheumatoid arthritis.

Patients and methods

The Turkish version of JSS (JSS-TR) was obtained after translation from English into Turkish, according to standard guidelines. The study included 61 patients of rheumatoid arthritis (13 males, 48 females; mean age 50.5 years; range 19 to 72 years) as defined by the American College of Rheumatology 2010 criteria. The internal consistency (Cronbach's alpha) was assessed for reliability. Content and construct validity (convergent and divergent validities) were evaluated. The relationships between the JSS-TR and the Pittsburgh Sleep Quality Index, the Multidimensional Assessment of Fatigue scale, subgroups of the Nottingham Health Profile, and the Stanford Health Assessment Questionnaire were assessed for convergent validity. In addition, the relationships between the JSS-TR and age, disease duration, visual analog scale patient global score, and disease activity score 28 were assessed for divergent validity.

Results

The Cronbach's alpha of JSS-TR was 0.80. All questions and the answer choices for the scale were understood well and related to some dimension of sleep demonstrating good content validity. The JSS-TR had good correlations with functional parameters (which are convergent), and poor or insignificant correlations with non-functional parameters (which are divergent). This implies that the JSS-TR had good construct validity in the context of this study. Overall, the JSS-TR had the best correlation with the Pittsburgh Sleep Quality Index (Spearman's rank correlation coefficient=0.76).

Conclusion

The JSS-TR is a valid and reliable instrument. It is a simple and effective tool which can be used to evaluate sleep disturbances in rheumatoid arthritis patients in both daily practice and clinical research.

Effects of programmed exercise on depressive symptoms in midlife and older women: A meta-analysis of randomized controlled trials

OBJECTIVE

To perform a systematic review and meta-analysis to clarify the effect of programmed exercise on depressive symptoms (DSs) in midlife and older women.

METHODS

We carried out a structured search of PubMed-Medline, Web of Science, Scopus, Embase, Cochrane Library and Scielo, from database inception through June 29, 2017, without language restriction. The search included the following terms: "depression", "depressive symptoms", "exercise", "physical activity", "menopause", and "randomized controlled trial" (RCTs) in midlife and older women. The US, UK and Australian Clinical Trials databases were also searched. We assessed randomized controlled trials (RCTs) that compared the effect of exercise for at least 6 weeks versus no intervention on DSs as the outcome (as defined by trial authors). Exercise was classified according to duration as "mid-term exercise intervention" (MTEI; lasting for 12 weeks to 4 months), and "long-term exercise intervention" (LTEI; lasting for 6-12 months). Mean changes (±standard deviations) in DSs, as assessed with different questionnaires, were extracted to calculate Hedges' g and then used as the effect size for meta-analysis. Standardized mean differences (SMDs) of DSs after intervention were pooled using a random-effects model.

RESULTS

Eleven publications were included for analysis related to 1943 midlife and older women (age range 44-55 years minimum to 65.5±4.0 maximum), none of whom was using a hormone therapy. Seven MTEIs were associated with a significant reduction in DSs (SMD=-0.44; 95% CI -0.69, -0.18; p=0.0008) compared with controls. The reduction in DSs was also significant in six LTEIs (SMD=- 0.29; 95% CI -0.49; -0.09; p=0.005). Heterogeneity of effects among studies was moderate to high. Less perceived stress and insomnia (after exercise) were also found as secondary outcomes.

CONCLUSION

Exercise of low to moderate intensity reduces depressive symptoms in midlife and older women.

Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

We assessed the effects of programmed exercise (PE) on sleep quality and insomnia in middle-aged women (MAW).

METHODS

Searches were conducted in five databases from inception through December 15, 2016 for randomized controlled trials (RCTs) evaluating the effects of PE versus a non-exercising control condition on sleep quality, sleep disturbance and/or insomnia in MAW. Interventions had to last at least 8 weeks. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and insomnia with the Insomnia Severity Index (ISI). Random effects models were used for meta-analyses. The effects on outcomes were expressed as mean differences (MDs) and their 95% confidence intervals (CI).

RESULTS

Five publications reported data from four RCTs on PE effects during 12-16 weeks on sleep quality (n=4 studies reporting PSQI results) and/or insomnia (n=3 studies reporting ISI results), including 660 MAW. Low-moderate levels of exercise significantly lowered the PSQI score (MD=-1.34; 95% CI -2.67, 0.00; p=0.05) compared with controls. In a subgroup analysis, moderate PE (aerobic exercise) had a positive effect on sleep quality (PSQI score MD=-1.85; 95% CI -3.62, -0.07; p=0.04), while low levels of physical activity (yoga) did not have a significant effect (MD-0.46, 95% CI -1.79, 0.88, p=0.50). In three studies (two studies of yoga, one study of aerobic exercise), there was a non-significant reduction in the severity of insomnia measured with the ISI score (MD -1.44, 95% CI -3.28, 0. 44, p=0.13) compared with controls. Heterogeneity of effects among studies was moderate to high.

CONCLUSION

In middle-aged women, programmed exercise improved sleep quality but had no significant effect on the severity of insomnia.

Instruments to study sleep disorders in climacteric women

To identify the scales to assess sleep disorders applied to women with climacteric stage. Bibliographical research without intervention, the available information in scientific databases. Performed in PubMed, ScienceDirect, Scopus, Ebscohos OvidSP and Health Library. The words used in this article: insomnia, adjustment sleep disorder, questionnaires, studies and menopause. Publications of all types were included. Seven scales were identified: Insomnia Severity Index, Athens Insomnia Scale, Pittsburgh Quality of sleep Index, Epworth Sleepiness Scale, Jenkins Sleep Scale, Basic Nordic Sleep Questionnaire and The St Mary's Hospital Sleep Questionnaire. There are validated scales in multiple languages and considered appropriate for studying sleep disorders.

A Novel, Open Access Method to Assess Sleep Duration Using a Wrist-Worn Accelerometer

Wrist-worn accelerometers are increasingly being used for the assessment of physical activity in population studies, but little is known about their value for sleep assessment. We developed a novel method of assessing sleep duration using data from 4,094 Whitehall II Study (United Kingdom, 2012-2013) participants aged 60-83 who wore the accelerometer for 9 consecutive days, filled in a sleep log and reported sleep duration via questionnaire. Our sleep detection algorithm defined (nocturnal) sleep as a period of sustained inactivity, itself detected as the absence of change in arm angle greater than 5 degrees for 5 minutes or more, during a period recorded as sleep by the participant in their sleep log. The resulting estimate of sleep duration had a moderate (but similar to previous findings) agreement with questionnaire based measures for time in bed, defined as the difference between sleep onset and waking time (kappa = 0.32, 95%CI:0.29,0.34) and total sleep duration (kappa = 0.39, 0.36,0.42). This estimate was lower for time in bed for women, depressed participants, those reporting more insomnia symptoms, and on weekend days. No such group differences were found for total sleep duration. Our algorithm was validated against data from a polysomnography study on 28 persons which found a longer time window and lower angle threshold to have better sensitivity to wakefulness, while the reverse was true for sensitivity to sleep. The novelty of our method is the use of a generic algorithm that will allow comparison between studies rather than a "count" based, device specific method.

Evaluation of the presence and severity of menopausal symptoms among postmenopausal women screened for the metabolic syndrome

BACKGROUND

The prevalence of the metabolic syndrome (METS) increases after the menopause. Reports indicate that the METS and its components, especially obesity, enhance the intensity of menopausal symptoms.

OBJECTIVE

Assess the frequency and severity of menopausal symptoms in postmenopausal women. Factors related to the symptom severity were also analyzed including depressive and metabolic status.

METHODS

A total of 204 natural postmenopausal women (40-65 years) participating in a METS screening program were asked to fill out the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), and a general socio-demographic questionnaire containing personal and partner data. Criteria of the American Heart Association were used to define the METS.

RESULTS

Median age of the whole sample was 56 years. A 52.9% presented the METS, with 37.3% presenting hyperglycemia, 51.5% hypertension, 58.3% abdominal obesity, 45.6% high triglyceride and 56.4% low HDL-C levels. Total and subscale MRS scores did not differ in accordance to the presence or not of the METS. The three top prevalent menopausal symptoms were muscle and joint problems (87.2%), physical and mental exhaustion (72%) and depressive mood (64.7%). A 19.6% of women presented total MRS scores above 16 defined as severe. Multivariate linear regression analysis determined that anxiety (higher HADS anxiety subscale scores) was significantly and positively correlated with all components of the MRS (Total and subscale scores). Higher total MRS scores correlated positively with abdominal perimeter and higher parity. Somatic scores correlated inversely with female education and positively with psychotropic drug use; and psychological MRS scores positively correlated depressed mood (higher HADS depressive subscale scores) and abdominal perimeter.

CONCLUSION

In this postmenopausal sample, severity of menopausal symptoms correlated to abdominal obesity, mood and other personal aspects.