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Jeon JY, Kim KT, Lee SY, Cho YW. Insomnia during coronavirus disease 2019 pandemic in Korea: a National sleep survey. Sleep Biol Rhythms 2023; 21:431–438. [PMID: 37363639 PMCID: PMC10196317 DOI: 10.1007/s41105-023-00464-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has caused widespread increase in stress and affected sleep quality and quantity, with up to 30% prevalence of sleep disorders being reported after the declaration of the pandemic. This study aimed to assess perceived changes due to the pandemic in the prevalence of insomnia and excessive daytime sleepiness (EDS) in Korea, and identify the associated factors. An online survey was conducted among 4000 participants (2035 men and 1965 women) aged 20-69 years enrolled using stratified multistage random sampling according to age, sex, and residential area, between January, 2021 and February, 2022. The questionnaire included various items, such as socio-demographics, Insomnia Severity Index, and Epworth Sleepiness Scale (ESS). Insomnia was defined as difficulty falling asleep and difficulty maintaining sleep more than twice a week. EDS was classified as an ESS score ≥ 11. Insomnia was reported by 32.9% (n = 1316) of the participants (37.3% among women and 28.6% among men). Multivariate logistic regression revealed that insomnia was associated with female sex [odds ratio (OR) = 1.526, 95% confidence interval (CI) = 1.297-1.796], night workers (OR 1.561, 95% CI 1.160-2.101), and being unmarried (OR 1.256, 95% CI 1.007-1.566). EDS was reported by 12.8% (n = 510) of the participants (14.7% among men and 10.7% among women). EDS was associated with male sex (OR 1.333, 95% CI 1.062-1.674), and being employed (OR 1.292, 95% CI 1.017-1.641). During the COVID-19 pandemic, the prevalence of insomnia increased in Korea, while there was no significant change in EDS compared with pre-pandemic evidence.
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Affiliation(s)
- Ji-Ye Jeon
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seo-Yong Lee
- Department of Neurology, School of Medicine, Kangwon National University, Chuncheon, Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - the Sleep Epidemiology Committee of the Korean Sleep Research Society
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
- Department of Neurology, School of Medicine, Kangwon National University, Chuncheon, Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
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Yang YY, Jun S. The Effects of Cognitive Behavioral Therapy for Insomnia among College Students with Irritable Bowel Syndrome: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14174. [PMID: 36361052 PMCID: PMC9658882 DOI: 10.3390/ijerph192114174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to develop and evaluate cognitive behavioral therapy for insomnia (CBT-I) among college students with irritable bowel syndrome (IBS). We randomly assigned 60 college students with IBS comorbid insomnia to the experimental group who received CBT-I for 90 min once a week for 4 weeks and the control (non-CBT-I) group. Participants completed self-report measures of insomnia severity, pre-sleep arousal, sleep-related dysfunctional cognitions, maladaptive sleep habits, IBS symptom severity and IBS quality of life (QOL) at baseline, after intervention, and at 3-month follow-up. Sleep pattern, GI symptoms during sleep and Interleukin-6 (IL-6) and C-Reaction Protein (CRP) were measured at baseline and after intervention. The experimental group showed significant decreases in insomnia severity, sleep onset latency, total time in bed, pre-sleep arousal, GI symptoms during sleep, sleep-related dysfunctional cognitions, maladaptive sleep habits, and IBS symptom severity, compared with the control group. This group also showed significant increases in sleep efficiency and IBS QOL compared with the control group. No significant differences were observed between the levels of IL-6 and CRP of both groups. CBT-I for college students with comorbid IBS and insomnia was effective in reducing insomnia, IBS symptom severity, and IBS QOL.
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Affiliation(s)
- Yun-Yi Yang
- Department of Nursing, Healthcare Science & Human Ecology, Dong-Eui University, Busan 47340, Korea
| | - Sangeun Jun
- College of Nursing, Keimyung University, Daegu 42601, Korea
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Lin Q, Bonkano O, Wu K, Liu Q, Ali Ibrahim T, Liu L. The Value of Chinese Version GAD-7 and PHQ-9 to Screen Anxiety and Depression in Chinese Outpatients with Atypical Chest Pain. Ther Clin Risk Manag 2021; 17:423-431. [PMID: 34040380 PMCID: PMC8140931 DOI: 10.2147/tcrm.s305623] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Atypical chest pain in some outpatients could derive from mental disorders. It is necessary for them to have a preliminary emotional assessment in the outpatient department of Cardiology before psychiatric outpatient visits. Methods This study included 122 Chinese outpatients with atypical chest pain in the department of Cardiology. They accepted routine examinations, including treadmill test, and were judged by the three-question method as highly likely to have emotional disorders. Then, a standard questionnaire package containing the Chinese version of the seven-item scale for General Anxiety Disorder (GAD-7), Self-rating Anxiety Scale (SAS), the nine-item Patient Health Questionnaire (PHQ-9) and Self-rating Depression Scale (SDS) was administered to evaluate anxiety and depression. Results The percentages of anxiety evaluated by GAD-7 and SAS were 62.3% and 26.2%, respectively. Analogously, the assessment by PHQ-9 showed a significantly higher percentage of depression than that by SDS (61.5% vs 29.5%) (P < 0.05). Kappa analysis showed that the consistency between GAD-7 and SAS, or that between PHQ-9 and SDS was not very good. About 73% outpatients suffered from emotional disorders, presenting as anxiety/depression evaluated by GAD-7 and PHQ-9. Furthermore, sleep disorders accounted for more than 80% of patients with mental disorders. Finally, the suicidal tendency of depression patients was about 17% that should not be ignored. Conclusion Compared with SAS and SDS, GAD-7 and PHQ-9 detected more participants with emotional disorders in the Chinese outpatients with atypical chest pain, indicating that GAD-7 and PHQ-9 could be briefly well-validated tools to screen emotional disorders in the outpatient department of Cardiology before psychiatric visits.
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Affiliation(s)
- Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, People's Republic of China.,Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, People's Republic of China.,Cardiovascular Disease Research Center of Hunan Province, Changsha, Hunan, 410011, People's Republic of China
| | - Ousseina Bonkano
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, People's Republic of China.,Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, People's Republic of China.,Cardiovascular Disease Research Center of Hunan Province, Changsha, Hunan, 410011, People's Republic of China.,Department of Cardiovascular and Internal Medicine Niger, Niamey Amirou Boubacar Diallo National Hospital, Abdou Moumouni University, Niamey, Niger
| | - Keke Wu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, People's Republic of China.,Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, People's Republic of China.,Cardiovascular Disease Research Center of Hunan Province, Changsha, Hunan, 410011, People's Republic of China
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, People's Republic of China.,Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, People's Republic of China.,Cardiovascular Disease Research Center of Hunan Province, Changsha, Hunan, 410011, People's Republic of China
| | - Toure Ali Ibrahim
- Department of Cardiovascular and Internal Medicine Niger, Niamey Amirou Boubacar Diallo National Hospital, Abdou Moumouni University, Niamey, Niger
| | - Ling Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, People's Republic of China.,Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, People's Republic of China.,Cardiovascular Disease Research Center of Hunan Province, Changsha, Hunan, 410011, People's Republic of China
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Yu C, Li X, Qi G, Yang L, Fu W, Yao Q, Wei L, Zhou D, Zhang X, Zheng H. Prevalence, Risk Factors, and Clinical Correlates of Insomnia in China College Student During the COVID-19. Front Psychiatry 2021; 12:694051. [PMID: 34421678 PMCID: PMC8377355 DOI: 10.3389/fpsyt.2021.694051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/16/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: The 2019 novel coronavirus disease (COVID-19) broke out in Hubei Province and spread rapidly to the whole country, causing huge public health problems. College students are a special group, and there is no survey on insomnia among college students. The purpose of this study was to investigate the incidence and related factors of insomnia in college students during the period of COVID-19. Method: A total of 1,086 college students conducted a cross-sectional study through the questionnaire star platform. The survey time was from February 15 to February 22, 2020. The collected information included demographic informatics and mental health scale, Athens Insomnia Scale (AIS) to assess sleep quality, Self-Reporting Questionnaire-20 (SRQ-20) to assess general psychological symptoms, Chinese perceived stress scale (CPSS) to assess stress. We used logistic regression to analyze the correlation between related factors and insomnia symptoms. Results: The prevalence of insomnia, general psychological symptoms and stress were 16.67, 5.8, and 40.70%, respectively. Multivariate logistic regression analysis showed that gender (OR = 1.55, p = 0.044, 95% CI = 1.00-2.41), general psychological symptoms (OR = 1.49, p < 0.01, 95% CI = 1.40-1.60) and living in an isolation unit (OR = 2.21, p = 0.014, 95% CI = 1.17-4.16) were risk factors for insomnia of college students. Conclusion: Our results show that the insomnia is very common among college students during the outbreak of covid-19, and the related factors include gender, general psychological symptoms and isolation environment. It is necessary to intervene the insomnia of college students and warrants attention for mental well-being of college students.
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Affiliation(s)
- Chang Yu
- Ningbo Key Laboratory of Sleep Medicine, Ningbo Kangning Hospital, Ningbo, China
| | - Xingxing Li
- Ningbo Key Laboratory of Sleep Medicine, Ningbo Kangning Hospital, Ningbo, China
| | - Gangqiao Qi
- Taizhou Second People's Hospital, Taizhou, China
| | | | - Wenbo Fu
- Heze Vocational College, Heze, China
| | - Qin Yao
- Ningbo Key Laboratory of Sleep Medicine, Ningbo Kangning Hospital, Ningbo, China
| | - Lei Wei
- Department of Respiratory, Zibo Central Hospital, Zibo, China
| | - Dongsheng Zhou
- Ningbo Key Laboratory of Sleep Medicine, Ningbo Kangning Hospital, Ningbo, China
| | - Xiangyang Zhang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hong Zheng
- Ningbo Key Laboratory of Sleep Medicine, Ningbo Kangning Hospital, Ningbo, China
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Jin R, Wang X, Lv Y, Xu G, Yang C, Guo Y, Li X. The efficacy and safety of auricular point combined with moxibustion for insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22107. [PMID: 33031258 PMCID: PMC7544260 DOI: 10.1097/md.0000000000022107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Insomnia is a common sleep disorder, which seriously affects people's quality of life and work ability. In China, auricular therapy and moxibustion therapy have a long history in treating insomnia. Clinical studies have shown that auricular point and moxibustion can effectively improve insomnia symptoms. At present, auricular point combined with moxibustion in the treatment of insomnia has been widely used in China, but its overall effectiveness and safety are still unclear. There is a lack of systematic evaluation of auricular point combined with moxibustion in the treatment of insomnia. This paper aims to evaluate the efficacy and safety of auricular point combined with moxibustion in the treatment of insomnia. METHODS Retrieve randomized controlled trials of auricular point combined with moxibustion from PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database from their establishment to August 2020. Search Baidu Scholar, Google Scholar, International Clinical Trials Registry Platform, and Chinese Clinical Trials Registry for unpublished gray literature. Two researchers independently applied RevMan 5.3 software for data extraction and risk assessment of bias. RESULTS This study evaluated the efficacy and safety of auricular point combined with moxibustion in the treatment of insomnia from Pittsburgh sleep quality index, Rhone planck sleepiness scale, Traditional Chinese medicine syndrome scores, Hamilton anxiety scale (HAMA), Hamilton Depression, 5-hydroxytryptamine, incidence of adverse reactions, and other aspects. CONCLUSION This study will provide theoretical support for the clinical application of auricular point combined with moxibustion in the treatment of insomnia. ETHICS AND DISSEMINATION The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/8VZRJ.
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Affiliation(s)
- Rui Jin
- Tianjin University of Traditional Chinese Medicine
| | - Xu Wang
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital
| | - Yubing Lv
- Tianjin University of Traditional Chinese Medicine
| | - Guangnan Xu
- Tianjin University of Traditional Chinese Medicine
| | - Chen Yang
- Tianjin University of Traditional Chinese Medicine
| | - Yang Guo
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinju Li
- Tianjin University of Traditional Chinese Medicine
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Karlamangla AS, Lachman ME, Han W, Huang M, Greendale GA. Evidence for Cognitive Aging in Midlife Women: Study of Women's Health Across the Nation. PLoS One 2017; 12:e0169008. [PMID: 28045986 PMCID: PMC5207430 DOI: 10.1371/journal.pone.0169008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022] Open
Abstract
Although cross-sectional studies suggest that cognitive aging starts in midlife, few longitudinal studies have documented within-individual declines in cognitive performance before the seventh decade. Learning from repeat testing, or practice effects, can mask the decline in younger cohorts. In women, the menopause transition also affects test performance and can confound estimates of underlying decline. We designed this study to determine if, after controlling for practice effects, the menopause transition, and the symptoms associated with it, there is evidence of cognitive aging in midlife women. We used data from a longitudinal observational study in 2,124 participants from the Study of Women’s Health Across the Nation. Outcomes examined were scores on annual tests of processing speed, verbal episodic memory (immediate and delayed), and working memory. To reduce the impact of practice effects and of the menopause transition, we used the third cognition testing visit as the baseline. Average age at this baseline was 54 years, and the majority of the women were postmenopausal; half the cohort was 2 or more years beyond the final menstrual period. There were 7,185 cognition assessments with median follow-up time of 6.5 years. In mixed effects regression, adjusted for practice effects, retention, menopause symtoms (depressive, anxiety, vasomotor, and sleep disturbance), and covariates, scores on 2 of 4 cognition tests declined. Mean decline in cognitive speed was 0.28 per year (95% confidence interval [CI] 0.20 to 0.36) or 4.9% in 10 years, and mean decline in verbal episodic memory (delayed testing) was 0.02 per year (95% CI: 0.00 to 0.03) or 2% in 10 years. Our results provide strong, longitudinal evidence of cognitive aging in midlife women, with substantial within-woman declines in processing speed and memory. Further research is needed to identify factors that influence decline rates and to develop interventions that slow cognitive aging.
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Affiliation(s)
- Arun S. Karlamangla
- Divison of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
| | - Margie E. Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts, United States of America
| | - WeiJuan Han
- Divison of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - MeiHua Huang
- Divison of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Gail A. Greendale
- Divison of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 2016; 26:43-56. [DOI: 10.1016/j.smrv.2015.05.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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Parletta N, Aljeesh Y, Baune BT. Health Behaviors, Knowledge, Life Satisfaction, and Wellbeing in People with Mental Illness across Four Countries and Comparisons with Normative Sample. Front Psychiatry 2016; 7:145. [PMID: 27597833 PMCID: PMC4993073 DOI: 10.3389/fpsyt.2016.00145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/05/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND People with chronic mental illness have poorer physical health and higher mortality than the general population. We investigated lifestyle factors in people with mental illness across four countries and compared with a normative sample. DESIGN AND METHODS Data were collected from N = 672 people (Germany, n = 375; Palestine, n = 192; London, n = 63; Australia, n = 42) with substance abuse disorder (n = 224), schizophrenia (n = 158), mood disorders (n = 227), and somatoform disorders (n = 63). The General Health Behaviour Questionnaire measured behaviors and knowledge related to nutrition, physical activity, alcohol, smoking, sleep, life satisfaction, and wellbeing. The normative samples were derived from a German population (N = 1,019). Data were analyzed using ANOVAs and t-tests. RESULTS The Palestine sample did not differ from the Western samples on reported life satisfaction and wellbeing. However, they reported unhealthier diets, less physical activity, and lower knowledge about the impact of diet, physical activity, smoking, and sleep on health than the Western samples. Comparing the Western and normative samples, people with mental illness reported lower intake of healthy foods/drinks, higher intake of unhealthy foods, higher exercise, higher alcohol consumption, less cigarettes, less sleep, and more sleep problems. Their knowledge was lower for nutrition, physical activity, and smoking. All participants reported lower life satisfaction and wellbeing than the normative sample (P-values <0.001). CONCLUSION Education on health-related lifestyle factors present important targets for primary care, quality of life and prevention of illness in people with mental illness. Further research will clarify specific predictors of health behaviors in each country.
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Affiliation(s)
- Natalie Parletta
- Centre for Population Health Research, School of Health Sciences, University of South Australia , Adelaide, SA , Australia
| | - Yousef Aljeesh
- Faculty of Nursing, Islamic University of Gaza , Gaza , Palestine
| | - Bernhard T Baune
- Department of Psychiatry, University of Adelaide , Adelaide, SA , Australia
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Dubowicz A, Schulz PJ. Medical information on the internet: a tool for measuring consumer perception of quality aspects. Interact J Med Res 2015; 4:e8. [PMID: 25835333 PMCID: PMC4395769 DOI: 10.2196/ijmr.3144] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/27/2014] [Accepted: 01/12/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Most of adult Internet users have searched for health information on the Internet. The Internet has become one of the most important sources for health information and treatment advice. In most cases, the information found is not verified with a medical doctor, but judged by the "online-diagnosers" independently. Facing this situation, public health authorities raise concern over the quality of medical information laypersons can find on the Internet. OBJECTIVE The objective of the study was aimed at developing a measure to evaluate the credibility of websites that offer medical advice and information. The measure was tested in a quasi-experimental study on two sleeping-disorder websites of different quality. METHODS There were 45 survey items for rating the credibility of websites that were tested in a quasi-experimental study with a random assignment of 454 participants to either a high- or a low-quality website exposure. Using principal component analysis, the original items were reduced to 13 and sorted into the factors: trustworthiness, textual deficits of the content, interferences (external links on the Web site), and advertisements. The first two factors focus more on the provided content itself, while the other two describe the embedding of the content into the website. The 45 survey items had been designed previously using exploratory observations and literature research. RESULTS The final scale showed adequate power and reliability for all factors. The loadings of the principal component analysis ranged satisfactorily (.644 to .854). Significant differences at P<.001 were found between the low- and high-quality groups. Advertisements on the website were rated as disturbing in both experimental conditions, meaning that they do not differentiate between good and bad information. CONCLUSIONS The scale reliably distinguished high- and low-quality of medical advice given on websites.
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Affiliation(s)
- Arthur Dubowicz
- Institute of Communication and Health, University of Lugano, Lugano, Switzerland.
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Functional validity of a judgment skills measure within the concept of health literacy for sleeping disorder patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10868-82. [PMID: 25329537 PMCID: PMC4211011 DOI: 10.3390/ijerph111010868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/25/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
The concept of health literacy has been widened to include higher order aspects such as patient decision-making skills while its measurement continued to rely narrowly on reading and numeracy skills, known as functional health literacy. We developed a Judgment Skills measure, designed to assess patients’ ability to make appropriate decisions with regard to their condition. The measure offers scenarios with answer options ranked for biomedical adequacy. This study aims to examine the psychometric properties and the functional validity of the Judgment Skills measure. A self-administered survey among 87 primary insomnia patients in the Italian-speaking part of Switzerland was conducted. The extensive path model included variables such as functional health literacy, coping with the medical condition, experience of the scenario, sleep quality, duration suffering, education, and age. Correlation analyses were conducted to link the variables. The Judgment Skills measure showed the expected significant correlations. In general, higher Judgment Skills were related to coping strategies leading to better health outcomes. Functional health literacy correlated highly with education, while Judgment Skills did not, which confirmed the conceptual difference of these skills. The findings propose a model for conducting research that does embrace the broader conceptualization of health literacy.
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Wallen GR, Minniti CP, Krumlauf M, Eckes E, Allen D, Oguhebe A, Seamon C, Darbari DS, Hildesheim M, Yang L, Schulden JD, Kato GJ, Taylor VI JG. Sleep disturbance, depression and pain in adults with sickle cell disease. BMC Psychiatry 2014; 14:207. [PMID: 25047658 PMCID: PMC4223647 DOI: 10.1186/1471-244x-14-207] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep disturbance and depression are commonly encountered in primary care. In sickle cell disease, depression is associated with pain, poor treatment compliance, and lower quality of life. The prevalence of sleep disturbance and its effect upon quality of life in adults with sickle cell disease is unknown. The goal of this study was to determine the prevalence of sleep disturbance and if it is associated with pain and depression in sickle cell disease. METHODS Three hundred twenty eight adults with sickle cell disease enrolled on the Bethesda Sickle Cell Cohort Study were assessed using the Pittsburgh Sleep Quality Index and Beck Depression Inventory II screening measures as a cross-sectional survey. Scores greater than 5 (Pittsburgh Sleep Quality Index) and 16 (Beck Depression Inventory II) defined sleep disturbance and depression, respectively. Clinical and laboratory parameters were also assessed. RESULTS The mean Pittsburgh Sleep Quality Index score was 8.4 (SD ± 4.2) indicating a 71.2% prevalence of sleep disturbance. The mean Beck Depression Inventory II score was 8.0 (SD ± 8.9). Sixty five (20.6%) participants had a score indicating depression, and half of these (10.0%) had thoughts of suicide. Both Pittsburgh Sleep Quality Index and Beck Depression Inventory II scores were significantly correlated (p < .001). The number of days with mild/moderate pain (p = .001) and a history of headaches (p = .005) were independently associated with depression by multivariate regression analysis. Patients with sleep disturbance were older (p = .002), had higher body mass index (p = .011), had more days of pain (p = .003) and more frequent severe acute painful events (emergency room visits and hospitalizations) during the previous 12 months (p < .001). CONCLUSIONS More than 70 percent of adults with sickle cell disease had sleep disturbance, while 21 percent showed evidence of clinical depression. Sleep disturbance and depression were correlated, and were most common among those with more frequent pain. Providers caring for adults with sickle cell disease and frequent pain should consider screening for these common co-morbidities. Additional study is needed to confirm these findings and to determine if treatments for pain, depression or sleep disturbances will improve quality of life measures in this patient population. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00011648.
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Affiliation(s)
- Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Caterina P Minniti
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
| | - Michael Krumlauf
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Ellen Eckes
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Darlene Allen
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
| | - Anna Oguhebe
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
| | - Cassie Seamon
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
| | - Deepika S Darbari
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA,Center for Cancer and Blood Diseases, Children’s National Medical Center, Washington, DC, USA
| | - Mariana Hildesheim
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
| | - Li Yang
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Jeffrey D Schulden
- Division of Epidemiology, Services, and Prevention Research, National Institute of Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Gregory J Kato
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
| | - James G Taylor VI
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA
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Hankins JS, Verevkina NI, Smeltzer MP, Wu S, Aygun B, Clarke DF. Assessment of Sleep-Related Disorders in Children With Sickle Cell Disease. Hemoglobin 2014; 38:244-51. [DOI: 10.3109/03630269.2014.919941] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Thase ME, Murck H, Post A. Clinical relevance of disturbances of sleep and vigilance in major depressive disorder: a review. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21494354 DOI: 10.4088/pcc.08m00676gry] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 08/04/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective of this article is to provide a concise review of the clinical relevance of sleep and vigilance in major depressive disorder. DATA SOURCES PubMed was reviewed (1990-2009) and English-language articles were identified using the key words sleep and depression and sleep and antidepressants. Secondary searches included articles cited in sources identified by the primary search. STUDY SELECTION The narrative review provides brief descriptions of the normal physiology of sleep and changes associated with depression, as well as the impact of various treatments on these processes. DATA SYNTHESIS Although it has long been known that sleep disturbances are an important characteristic of depression, relatively few studies have been conducted with the newer-generation antidepressants. Neither of the most widely used classes of antidepressants, the selective serotonin reuptake inhibitors and the serotonin-norepinephrine reuptake inhibitors, have particularly beneficial effects on sleep and, among the medications that reliably improve sleep efficiency, including mirtazapine and the tricyclic antidepressants, problems with daytime sedation can offset therapeutic benefit. Despite relatively widespread use, trazodone has not been demonstrated to be an effective and safe hypnotic in patients taking other antidepressants. For many patients, ongoing concomitant treatment with benzodiazepines and related drugs is the preferred option, again without convincing empirical support of longer-term efficacy. Among newer and investigational antidepressants, agomelatine shows promise with respect to both overall safety and effects on insomnia, although possible negative effects on liver function warrant further study. CONCLUSIONS Sleep disturbances are a significant aspect of depressive syndromes, and relief of insomnia remains an important unmet need in antidepressant therapeutics. Development of a well-tolerated antidepressant medication that rapidly improves sleep maintenance without daytime sedation is a priority for drug development.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine and Philadelphia Veterans Affairs, Medical Center, Philadelphia, Pennsylvania, USA.
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Yang AC, Tsai SJ, Yang CH, Kuo CH, Chen TJ, Hong CJ. Reduced physiologic complexity is associated with poor sleep in patients with major depression and primary insomnia. J Affect Disord 2011; 131:179-85. [PMID: 21195485 DOI: 10.1016/j.jad.2010.11.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/29/2010] [Accepted: 11/29/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression is known to be associated with altered cardiovascular variability and increased cardiovascular comorbidity, yet it is unknown whether altered cardiac autonomic function in depression is associated with insomnia, a common symptom comorbid with depression. This study aimed to investigate the long-term diurnal profile of autonomic function as measured by heart rate variability (HRV) in both major depression and primary insomnia patients. METHOD A total of 52 non-medicated patients with major depression, 47 non-medicated patients with primary insomnia, and 88 matched controls without insomnia were recruited. Each subject was assessed by means of sleep and mood questionnaires and underwent twenty-four-hour ambulatory electrocardiogram monitoring. Standard HRV analysis and a well-validated complexity measure, multiscale entropy, were applied to comprehensively assess the diurnal profiles of autonomic function and physiologic complexity in our study sample. RESULTS Compared with the controls, the patients with major depression and those with primary insomnia exhibited significant reductions in parasympathetic-related HRV indices, and this association was mainly driven by the presence of poor sleep. Both groups of patients also exhibited significant reductions in physiologic complexity during the sleep period as compared with the healthy controls. Alterations in HRV indices were correlated with perceived sleep questionnaire scores but not with depression scales. CONCLUSIONS Our findings suggest a pivotal role of sleep disturbance in regulating cardiovascular variability in major depression and primary insomnia patients. These findings could highlight the importance of treating insomnia as an independent disease rather than a symptom.
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Affiliation(s)
- Albert C Yang
- Department of Psychiatry, Chu-Tung Veterans Hospital, Hsin-Chu County, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan.
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Affiliation(s)
- M S Reddy
- Asha Hospital, Hyderabad, Andhra Pradesh, India. E-mail:
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Affiliation(s)
- Markku Partinen
- Helsinki Sleep Clinic, Vital Research Centre, and Department of Neurology, University of Helsinki, Finland.
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Greendale GA, Wight RG, Huang MH, Avis N, Gold EB, Joffe H, Seeman T, Vuge M, Karlamangla AS. Menopause-associated symptoms and cognitive performance: results from the study of women's health across the nation. Am J Epidemiol 2010; 171:1214-24. [PMID: 20442205 DOI: 10.1093/aje/kwq067] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A long-standing, but unproven hypothesis is that menopause symptoms cause cognitive difficulties during the menopause transition. This 6-year longitudinal cohort study of 1,903 midlife US women (2000-2006) asked whether symptoms negatively affect cognitive performance during the menopause transition and whether they are responsible for the negative effect of perimenopause on cognitive processing speed. Major exposures were depressive, anxiety, sleep disturbance, and vasomotor symptoms and menopause transition stages. Outcomes were longitudinal performance in 3 domains: processing speed (Symbol Digit Modalities Test (SDMT)), verbal memory (East Boston Memory Test), and working memory (Digit Span Backward). Adjustment for demographics showed that women with concurrent depressive symptoms scored 1 point lower on the SDMT (P < 0.05). On the East Boston Memory Test, the rate of learning among women with anxiety symptoms tested previously was 0.09 smaller per occasion (P = 0.03), 53% of the mean learning rate. The SDMT learning rate was 1.00 point smaller during late perimenopause than during premenopause (P = 0.04); further adjustment for symptoms did not attenuate this negative effect. Depressive and anxiety symptoms had a small, negative effect on processing speed. The authors found that depressive, anxiety, sleep disturbance, and vasomotor symptoms did not account for the transient decrement in SDMT learning observed during late perimenopause.
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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: 74] [Impact Index Per Article: 4.9] [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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Jurysta F, Lanquart JP, Sputaels V, Dumont M, Migeotte PF, Leistedt S, Linkowski P, van de Borne P. The impact of chronic primary insomnia on the heart rate--EEG variability link. Clin Neurophysiol 2009; 120:1054-60. [PMID: 19403330 DOI: 10.1016/j.clinph.2009.03.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 01/21/2009] [Accepted: 03/30/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if chronic insomnia alters the relationship between heart rate variability and delta sleep determined at the EEG. METHODS After one night of accommodation, polysomnography was performed in 14 male patients with chronic primary insomnia matched with 14 healthy men. ECG and EEG recordings allowed the determination of High Frequency (HF) power of RR-interval and delta sleep EEG power across the first three Non Rapid Eye Movement (NREM)-REM cycles. Interaction between normalized HF RR-interval variability and normalized delta sleep EEG power was studied by coherency analysis. RESULTS Patients showed increased total number of awakenings, longer sleep latency and wake durations and shorter sleep efficiency and REM duration than controls (p<.01). Heart rate variability across first three NREM-REM cycles and sleep stages (NREM, REM and awake) were similar between both groups. In each group, normalized HF variability of RR-interval decreased from NREM to both REM and awake. Patients showed decreased linear relationship between normalized HF RR-interval variability and delta EEG power, expressed by decreased coherence, in comparison to controls (p<.05). Gain and phase shift between these signals were similar between both groups. CONCLUSIONS Interaction between changes in cardiac autonomic activity and delta power is altered in chronic primary insomniac patients, even in the absence of modifications in heart rate variability and cardiovascular diseases. SIGNIFICANCE This altered interaction could reflect the first step to cardiovascular disorders.
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Affiliation(s)
- F Jurysta
- Sleep Laboratory, Department of Psychiatry, Erasmus Academic Hospital, Free University of Brussels, 1070 Brussels, Belgium.
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Cho YW, Shin WC, Yun CH, Hong SB, Kim J, Earley CJ. Epidemiology of insomnia in korean adults: prevalence and associated factors. J Clin Neurol 2009; 5:20-3. [PMID: 19513329 PMCID: PMC2686894 DOI: 10.3988/jcn.2009.5.1.20] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 02/04/2009] [Accepted: 02/09/2009] [Indexed: 11/21/2022] Open
Abstract
Background and purpose Insomnia is a common complaint in adults. However, large epidemiologic studies of insomnia involving Asian populations are rarely reported. We performed an epidemiologic study of insomnia in a large Korean adult population. Methods A total of 5,000 subjects (2,470 men and 2,530 women) were interviewed by telephone. A representative sample of subjects aged 20 to 69 years was constituted according to a stratified, multistage random sampling method. Insomnia was defined as either any difficulty getting to sleep or getting back to sleep after waking in the night. Results More than one fifth (n=1,141, 22.8%) of the 5,000 subjects complained of insomnia, with the prevalence being significantly higher in women (25.3%) than in men (20.2%, p<0.001). Logistic regression revealed that the prevalence of insomnia increased significantly with age (p<0.001), being higher in those aged 60-69 years than in those aged 20-29 years (OR=2.368, 95% CI=1.762-3.182, p<0.001), and was lower in those with a monthly income of >4.5 million Korean won than in those with an income of <1.5 million Korean won (OR=0.689, 95% CI=0.523-0.906, p<0.01). Conclusions Insomnia is a common complaint in Korean adults, and its prevalence is similar to that in adults in Western countries.
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Affiliation(s)
- Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea
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Balkrishnan R, Pollack M, Joish VN, Asche CV, Pawaskar MD, Cziraky MJ. An economic evaluation of therapeutic alteration in the management of insomnia. Curr Med Res Opin 2009; 25:663-9. [PMID: 19196222 DOI: 10.1185/03007990802714713] [Citation(s) in RCA: 4] [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 The economic impact of switching patterns from older drug treatment for the management of insomnia has not been thoroughly investigated. The objective of this study was to examine the economic burden of therapeutic alterations for the treatment of insomnia. METHODS Treated insomnia patients were identified from the Medstat Marketscan claims database who had at least one prescription for insomnia agents during the study period (05/01/01 to 11/30/03). A change in therapy was defined as having a recorded prescription for an insomnia treatment other than the index study medication during the post-index period, which included overlapping augmentation or complete therapy switch. Economic costs included direct medical and pharmacy expenditures. One-year follow-up costs were compared using Wilcoxon tests for bivariate analyses and generalized linear models with gamma functions for multivariate comparisons. RESULTS Approximately 88% of the sample had no change in insomnia treatment. Patients on monotherapy (n = 24540) differed from patients altering therapy (n = 3267) with respect to age, gender and baseline Deyo-Charlson score. Patients altering therapy had a higher frequency of insomnia diagnoses (22 vs. 11%; p < 0.001) and comorbid depression or anxiety (21-45 vs. 12-25%; p < 0.001) than patients who did not alter therapy. Patients who changed therapy had approximately 67% higher (p < 0.001) direct medical costs compared to those who did not. Limitations of the study include observational study design, and lack of complete availability of all possible risk adjusters for clinical severity. CONCLUSION Total direct medical costs were significantly higher in patients who altered therapy in a year compared to maintainers after controlling for baseline differences.
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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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Basner M, Fomberstein KM, Razavi FM, Banks S, William JH, Rosa RR, Dinges DF. American time use survey: sleep time and its relationship to waking activities. Sleep 2008; 30:1085-95. [PMID: 17910380 PMCID: PMC1978395 DOI: 10.1093/sleep/30.9.1085] [Citation(s) in RCA: 338] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To gain some insight into how various behavioral (lifestyle) factors influence sleep duration, by investigation of the relationship of sleep time to waking activities using the American Time Use Survey (ATUS). DESIGN Cross-sectional data from ATUS, an annual telephone survey of a population sample of US citizens who are interviewed regarding how they spent their time during a 24-hour period between 04:00 on the previous day and 04:00 on the interview day. PARTICIPANTS Data were pooled from the 2003, 2004, and 2005 ATUS databases involving N=47,731 respondents older than 14 years of age. INTERVENTIONS N/A. RESULTS Adjusted multiple linear regression models showed that the largest reciprocal relationship to sleep was found for work time, followed by travel time, which included commute time. Only shorter than average sleepers (<7.5 h) spent more time socializing, relaxing, and engaging in leisure activities, while both short (<5.5 h) and long sleepers (> or =8.5 h) watched more TV than the average sleeper. The extent to which sleep time was exchanged for waking activities was also shown to depend on age and gender. Sleep time was minimal while work time was maximal in the age group 45-54 yr, and sleep time increased both with lower and higher age. CONCLUSIONS Work time, travel time, and time for socializing, relaxing, and leisure are the primary activities reciprocally related to sleep time among Americans. These activities may be confounding the frequently observed association between short and long sleep on one hand and morbidity and mortality on the other hand and should be controlled for in future studies.
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Affiliation(s)
- Mathias Basner
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
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Pawaskar MD, Joish VN, Camacho FT, Rasu RS, Balkrishnan R. The influence of co-morbidities on prescribing pharmacotherapy for insomnia: evidence from US national outpatient data 1995-2004. J Med Econ 2008; 11:41-56. [PMID: 19450109 DOI: 10.3111/13696990701817491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Patients with insomnia are likely to have other co-morbidities that could affect pharmacotherapeutic choices. This study examined the prevalence and impact of co-morbidities on the pharmacological treatment of insomnia. STUDY DESIGN A retrospective data analysis of the National Ambulatory Medical Care Survey from 1995 to 2004, comprising patients with a diagnosis of insomnia, was conducted. Multivariate logistic regression models were used to predict the impact of co-morbidities on pharmacotherapy for insomnia. RESULTS A total of 5,487 unweighted patient visits with insomnia were identified, representing 161.4 million patients in the US. Approximately 38% of these patients had at least one co-morbid condition. Patients with mental co-morbidities, especially anxiety, had decreased likelihood of receiving pharmacotherapy for insomnia. CONCLUSIONS Mental co-morbidities such as episodic mood disorder, anxiety and depression are prevalent in patients with insomnia. However, many co-morbid patients do not receive pharmacological therapy specific for insomnia.
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Affiliation(s)
- Manjiri D Pawaskar
- Department of Pharmacy Practice and Administration, Ohio State University College of Pharmacy, Columbus, OH, USA
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Abstract
Low-dose doxepin hydrochloride (1, 3 and 6 mg) is a tricyclic antidepressant currently being investigated for the treatment of primary insomnia in adult and geriatric patients. Although it has been used at much higher doses to treat depression effectively for a number of decades, it offers a unique potency and selectivity for antagonizing the H1 (histamine) receptor at low doses. This mechanism of action may prove to be advantageous compared with other medications currently approved for the treatment of insomnia. This article reviews previous clinical studies using doxepin for insomnia and the recent clinical trial data, and briefly discusses other potential roles of this compound in clinical practice.
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Affiliation(s)
- Haramandeep Singh
- The University of Texas, Southwestern Department of Psychiatry, Sleep Medicine Fellowship Program, Dallas, TX 75390, USA.
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