1
|
Curry G, Cheung T, Zhang SD, Logue S, McAnena L, Price R, Sittlington JJ. Repeated electrical vestibular nerve stimulation (VeNS) reduces severity in moderate to severe insomnia; a randomised, sham-controlled trial; the modius sleep study. Brain Stimul 2024; 17:782-793. [PMID: 38797370 DOI: 10.1016/j.brs.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Insomnia is a prevalent health concern in the general population associated with a range of adverse health effects. New, effective, safe and low-cost treatments, suitable for long-term use, are urgently required. Previous studies have shown the potential of electrical vestibular nerve stimulation (VeNS) in improving insomnia symptoms, however only one sham-controlled trial has been conducted on people with chronic insomnia. OBJECTIVES /Hypothesis: Repeated VeNS delivered by the Modius Sleep device prior to sleep onset will show superior improvement in Insomnia Severity Index (ISI) scores over a 4-week period compared to sham stimulation. METHODS In this double-blinded, multi-site, randomised, sham-controlled study, 147 participants with moderate to severe insomnia (ISI≥15) were recruited and allocated a VeNS or a sham device (1:1 ratio) which they were asked to use at home for 30 min daily (minimum 5 days per week) for 4 weeks. RESULTS After 4 weeks, mean ISI score reduction was 2.26 greater in the VeNS treatment group than the sham group (p = 0.002). In the per protocol analysis, the treatment group had a mean ISI score decrease of 5.8 (95 % CI [-6.8, -4.81], approaching the clinically meaningful threshold of a 6-point reduction, with over half achieving a clinically significant decrease. Furthermore, the treatment group showed superior improvement to the sham group in the SF-36 (Quality of Life) energy/fatigue component (PP p = 0.004, effect size 0.26; ITT p = 0.006, effect size 0.22). CONCLUSIONS Modius sleep has the potential to provide a viable, non-invasive and safe clinically meaningful alternative treatment option for insomnia.
Collapse
Affiliation(s)
- Grace Curry
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China; The Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Shu-Dong Zhang
- School of Medicine, Ulster University, Londonderry, BT48 7JL, United Kingdom.
| | - Susan Logue
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Liadhan McAnena
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Ruth Price
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Julie J Sittlington
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| |
Collapse
|
2
|
de Lange MA, Richmond RC, Eastwood SV, Davies NM. Insomnia symptom prevalence in England: a comparison of cross-sectional self-reported data and primary care records in the UK Biobank. BMJ Open 2024; 14:e080479. [PMID: 38719300 PMCID: PMC11086527 DOI: 10.1136/bmjopen-2023-080479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES We aimed to use a large dataset to compare self-reported and primary care measures of insomnia symptom prevalence in England and establish whether they identify participants with similar characteristics. DESIGN Cross-sectional study with linked electronic health records (EHRs). SETTING Primary care in England. PARTICIPANTS 163 748 UK Biobank participants in England (aged 38-71 at baseline) with linked primary care EHRs. OUTCOME MEASURES We compared the percentage of those self-reporting 'usually' having insomnia symptoms at UK Biobank baseline assessment (2006-2010) to those with a Read code for insomnia symptoms in their primary care records prior to baseline. We stratified prevalence in both groups by sociodemographic, lifestyle, sleep and health characteristics. RESULTS We found that 29% of the sample self-reported having insomnia symptoms, while only 6% had a Read code for insomnia symptoms in their primary care records. Only 10% of self-reported cases had an insomnia symptom Read code, while 49% of primary care cases self-reported having insomnia symptoms. In both primary care and self-reported data, prevalence of insomnia symptom cases was highest in females, older participants and those with the lowest household incomes. However, while snorers and risk takers were more likely to be a primary care case, they were less likely to self-report insomnia symptoms than non-snorers and non-risk takers. CONCLUSIONS Only a small proportion of individuals experiencing insomnia symptoms have an insomnia symptom Read code in their primary care record. However, primary care data do provide a clinically meaningful measure of insomnia prevalence. In addition, the sociodemographic characteristics of people attending primary care with insomnia were consistent with those with self-reported insomnia, thus primary care records are a valuable data source for studying risk factors for insomnia. Further studies should replicate our findings in other populations and examine ways to increase discussions about sleep health in primary care.
Collapse
Affiliation(s)
- Melanie A de Lange
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sophie V Eastwood
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Division of Psychiatry & Department of Statistical Sciences, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
3
|
Li SX, Cheung FTW, Chan NY, Chan JWY, Zhang J, Li AM, Espie CA, Gradisar M, Wing YK. Effects of cognitive behavioural therapy and bright light therapy for insomnia in youths with eveningness: study protocol for a randomised controlled trial. Trials 2024; 25:246. [PMID: 38594725 PMCID: PMC11005158 DOI: 10.1186/s13063-024-08090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Insomnia and eveningness are common and often comorbid conditions in youths. While cognitive behavioural therapy for insomnia (CBT-I) has been suggested as a promising intervention, it remains unclear whether it is sufficient to also address circadian issues in youths. In addition, despite that light has been shown to be effective in phase-shifting one's circadian rhythm, there has been limited data on the effects of bright light therapy and its combination with CBT-I on sleep and circadian outcomes in youths. The current protocol outlines a randomised controlled trial that examines the efficacy of CBT-I and CBT-I plus bright light therapy (BLT) in reducing insomnia severity, improving mood symptoms and daytime functioning (e.g. sleepiness, fatigue, cognitive function), and improving subjective and objective sleep and circadian measures compared to a waitlist control group. METHODS We will carry out a randomised controlled trial (RCT) with 150 youths aged 12-24 who meet the criteria of insomnia and eveningness. Participants will be randomised into one of three groups: CBT-I with bright light therapy, CBT-I with placebo light, and waitlist control. Six sessions of CBT-I will be delivered in a group format, while participants will be currently asked to use a portable light device for 30 min daily immediately after awakening throughout the intervention period for bright light therapy. The CBT-I with light therapy group will receive bright constant green light (506 lx) while the CBT-I with placebo light group will receive the modified light device with the LEDs emitting less than 10 lx. All participants will be assessed at baseline and post-treatment, while the two active treatment groups will be additionally followed up at 1 month and 6 months post-intervention. The primary outcome will be insomnia severity, as measured by the Insomnia Severity Index. Secondary outcomes include self-reported mood, circadian, daytime functioning, and quality of life measures, as well as sleep parameters derived from actigraphy and sleep diary and neurocognitive assessments. Objective measures of the circadian phase using dim-light melatonin onset assessment and sleep parameters using polysomnography will also be included as the secondary outcomes. DISCUSSION This study will be the first RCT to directly compare the effects of CBT-I and BLT in youths with insomnia and eveningness. Findings from the study will provide evidence to inform the clinical management of insomnia problems and eveningness in youths. TRIAL REGISTRATION ClinicalTrials.gov NCT04256915. Registered on 5 February 2020.
Collapse
Affiliation(s)
- Shirley Xin Li
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| | - Forrest Tin Wai Cheung
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences and Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
4
|
Mu Y, Luo J, Shi C, Wang H, Tan H, Yang Z, Zhu B. Validity and reliability of the sleep health index among patients with spinal degenerative diseases. Sleep Med 2024; 116:1-6. [PMID: 38394739 DOI: 10.1016/j.sleep.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To test the validity and reliability of the Sleep Health Index (SHI) in a Chinese clinical sample, and thereby provide more evidence for the assessment of sleep health in future research and clinical practice. METHODS This study used a cross-sectional design. A convenient sample of 265 participants with spinal degenerative diseases was recruited from outpatient clinics. The SHI, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), Visual Analogue Scale (VAS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) were administered via REDCap. Structural, concurrent, convergent, known-group validity, internal consistency, and test-retest reliability were evaluated. RESULTS Confirmatory factor analysis confirmed a 3-factor structure (sleep duration, sleep quality, and disordered sleep). The overall SHI score had a high correlation with PSQI and ISI (r = -0.62 and -0.70, respectively) as well as a moderate correlation with PHQ-9 (r = -0.50, p<0.001). The overall SHI was significantly associated with VAS, ESS, and EQ-5D-5L (r = -0.15 to -0.23, p<0.05). Participants with pain had a lower score on the sleep quality sub-index than those without (p<0.001). Those with chronic diseases had a significantly lower score on the sleep duration sub-index than those without (p<0.05). Those with depression, poor sleep quality, and insomnia had lower scores on the overall scale and the three sub-indices than those without (p<0.05). The overall SHI showed acceptable internal consistency (Cronbach's α = 0.74) and test-retest reliability (intraclass correlation coefficient = 0.73). CONCLUSIONS The Chinese version of SHI showed good validity and acceptable reliability and could be used to assess sleep health among clinical populations.
Collapse
Affiliation(s)
- Yunping Mu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Luo
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Changgui Shi
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University of China, Shanghai, China
| | - Haotian Wang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University of China, Shanghai, China
| | - Hongsheng Tan
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Yang
- School of Basic Medicine, Chengdu Medical College, Chengdu, China.
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
5
|
Cheung T, Lam JYT, Fong KH, Cheng CPW, Ho A, Sittlington J, Xiang YT, Li TMH. Evaluating the Efficacy of Electrical Vestibular Stimulation (VeNS) on Insomnia Adults: Study Protocol of a Double-Blinded, Randomized, Sham-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3577. [PMID: 36834268 PMCID: PMC9964781 DOI: 10.3390/ijerph20043577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Insomnia is a common health problem in the general population. There are different ways to improve sleeping habits and quality of sleep; however, there is no clinical trial using transdermal neurostimulation to treat individuals with symptoms of insomnia in Asia. This gives us the impetus to execute the first study in Asia which aims to evaluate the efficacy of Electrical Vestibular Stimulation (VeNS) on individuals with insomnia in Hong Kong. This study proposes a two-armed, double-blinded, randomized, sham-controlled trial including the active VeNS and sham VeNS group. Both groups will be measured at baseline (T1), immediately after the intervention (T2), and at the 1-month (T3) and 3-month follow-up (T4). A total of 60 community-dwelling adults aged 18 to 60 years, with insomnia symptoms will be recruited in this study. All subjects will be computer randomized into either the active VeNS group or the sham VeNS group on a 1:1 ratio. All subjects in each group will receive twenty 30-min VeNS sessions during weekdays, which will be completed in a 4-week period. Baseline measurements and post-VeNS evaluation of the psychological outcomes (i.e., insomnia severity, sleep quality and quality of life) will also be conducted on all participants. The 1-month and 3-month follow-up period will be used to assess the short-and long-term sustainability of the VeNS intervention. For statistical analysis, a mixed model will be used to analyze the repeated measures data. Missing data will be managed by multiple imputations. The level of significance will be set to p < 0.05. Significance of the study: The results of this study will be used to determine whether this VeNS device can be considered as a self-help technological device to reduce the severity of insomnia in the community setting. We registered this clinical trial with the Clinical trial government, identifier: NCT04452981.
Collapse
Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joyce Yuen Ting Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kwan Hin Fong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Alex Ho
- Integrated Services for Persons with Disabilities, Christian Family Service Centre, Hong Kong SAR, China
| | - Julie Sittlington
- School of Biomedical Sciences, Ulster University, Coleraine BT52 1SA, UK
| | - Yu-Tao Xiang
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Tim Man Ho Li
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
6
|
Cross-cultural adaptation and validation of the Chinese version of the Sleep Health Index. Sleep Health 2023; 9:117-123. [PMID: 36307320 DOI: 10.1016/j.sleh.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties. METHODS This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity. RESULTS Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p < .05; r = -0.182, p < .01, respectively) and ISI score (r = -0.655, p < .05; r = -0.820, p < .05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p < .05). Students with insomnia (ISI > 9) or poor sleep quality (PSQI > 5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p < .01; 84.1 vs. 86.7, p < .05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82). CONCLUSIONS The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed.
Collapse
|
7
|
The Effect of Zao Ren An Shen Capsule on Insomnia among Patients with Anxiety: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022. [DOI: 10.1155/2022/6520849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background. Zao Ren An Shen capsule (ZRASC) is one of the most widely used Chinese herbal medicine (CHM) in treating insomnia, but its effect on insomnia patients with anxiety remains unclear. We aimed to examine the effect of ZRASC combined with alprazolam in anxiety patients compared with those only with alprazolam prescription. Methods. We conducted a single-blind, parallel-group, randomized trial involving persons from 2 hospitals in China. Participants were randomly assigned in a 1 : 1 ratio to the intervention group, in which the participants were provided with ZRASC and alprazolam, or to the control group, in which the participants were provided with alprazolam. The primary outcomes were insomnia symptoms measured by the insomnia severity index (ISI). The secondary outcomes were anxiety symptoms measured with the Hamilton anxiety rating scale (HAMA). All participants were followed up at 2-week and 4-week after the treatment. The effect was estimated using the mixed-effect models. Results. A total of 334 patients were enrolled in the trial. 167 of them (mean (SD) age, 44.4 (12.8) years; 43.1% female) were assigned to the usual treatment group, while 167 (mean (SD) age, 46.0 (13.4) years; 43.7% female) were assigned to the ZRASC group. From baseline to the 4-weekfollow-up, the mean differences in ISI and HAMA scores between the ZRASC group and the usual care group were −2.542 and −2.563, respectively (both
). Patients in the ZRASC group were more likely to have remission of insomnia and anxiety than those in the control group at the 4-weekfollow-up, with incidence rate ratios of 265% and 213%, respectively (both
). Proportions of remission were 74.93% (
) for insomnia and 85.80% (
) for anxiety at 4-weekfollow-up. Conclusions. This randomized study showed that adjunctive treatment with ZRASC was able to reduce insomnia and anxiety symptoms at the 4-weekfollow-up. Trial Registration. This study was registered in the Chinese Clinical Trial Registry (ChiCTR1800019913).
Collapse
|
8
|
Gender differences in the prevalence of and trends in sleep patterns and prescription medications for insomnia among US adults, 2005 to 2018. Sleep Health 2022; 8:691-700. [PMID: 36117095 DOI: 10.1016/j.sleh.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/05/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evidence indicates that the burden of sleep disorders is increasing, yet recent trends have not been examined. OBJECTIVE To examine the prevalence of and trends in sleep patterns and medications commonly used for insomnia (MCUFI) in US adults from 2005 through 2018. METHODS A total of 39,749 participants aged 20 years or older from 7 consecutive National Health and Nutrition Examination Survey cycles during 2005-2018 were included. RESULTS The age-standardized prevalence of trouble sleeping and using MCUFI was higher in women than men, but men tended to sleep less (sleep duration <7 hours) and were more likely to have sleep disorders. The temporal trends in sleep disorders and MCUFI were similar in men and women, except that trouble sleeping increased more in men (P = 0.024). The prevalence of insufficient sleep decreased from 33.6% in women and 38.1% in men in 2005-2006 to 20.5% in women and 28.6% in men in 2017-2018. The prevalence of MCUFI use was 13.3% in women and 8.9% in men in 2005-2006, peaked at 15.2% for men and 17.0% for women in 2013-2014, and decreased slightly in 2015-2018. CONCLUSION The prevalence of trouble sleeping and MCUFI use was higher in women, while the prevalence of short sleep duration and sleep disorders was higher in men. Sleep disorders, abnormal sleep duration, and MCUFI use increased at a broadly similar pace in men and women, except that trouble sleeping increased more in men.
Collapse
|
9
|
Yu DJ, Yu AP, Li SX, Chan RN, Fong DY, Chan DK, Hui SS, Chung KF, Woo J, Wang C, Irwin MR, Siu PM. Effects of Tai Chi and cognitive behavioral therapy for insomnia on improving sleep in older adults: Study protocol for a non-inferiority trial. J Exerc Sci Fit 2022; 21:67-73. [DOI: 10.1016/j.jesf.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
|
10
|
Ho ECM, Siu AMH. Evaluation of an occupation-based sleep program for people with Insomnia. Hong Kong J Occup Ther 2022; 35:168-179. [DOI: 10.1177/15691861221136261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Sleep problems are a health issue worldwide. Based on the Person-Environment-Occupation-Performance model, we developed an occupation-based sleep programme to promote awareness of sleep hygiene factors, promote an environment conductive to sleep, and restructure participation in daytime activities with a focus on occupational balance. Method This study uses a non-equivalent group design to evaluate the effectiveness of an occupation-based sleep intervention among community-dwelling adults with insomnia, when compared with a treatment-as-usual (TAU) group which focused on sleep hygiene, and relaxation. Results When compared with the TAU group ( n = 20), the intervention group ( n = 22) had significant improvement in sleep duration, occupational balance, and reduction in mood symptoms at both post treatment and 1-month follow up. Conclusion The results demonstrated that an occupation-based programme is an effective treatment for insomnia disorder and demonstrated the role which occupational therapy could play in primary health care service.
Collapse
Affiliation(s)
- Eris C. M. Ho
- Occupational Therapy Department, Tai Po Hospital, Hospital Authority, New Territories, Hong Kong
| | - Andrew M. H. Siu
- Department of Health Sciences, Brunel University London, London, UK
| |
Collapse
|
11
|
Chan SHW, Ng SM, Yu CH, Chan CM, Wang SM, Chan WC. The effects of an integrated mindfulness-based tai chi chuan programme on sleep disturbance among community-dwelling elderly people: protocol for a randomized controlled trial. Trials 2022; 23:808. [PMID: 36153623 PMCID: PMC9509614 DOI: 10.1186/s13063-022-06737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many elderly individuals who experience sleep disturbances would consider complementary and alternative medicine as an alternative therapeutic option in light of the limitations of traditional treatments. Mindfulness-based interventions (MBIs) and Tai Chi Chuan (TCC) are two alternative forms of complementary and alternative medicine. They both share the common feature of a focus on breathing but represent distinct approaches with different mechanisms and philosophical orientations. The trial described in this protocol aims to evaluate the effects of an integrated form of mindfulness-based Tai Chi Chuan (MBTCC) programme and the underlying mechanisms of the beneficial effects over a 12-month follow-up.
Methods
The planned study is a four-armed randomized controlled trial with repeated measures. A total of 256 community-dwelling older adults with sleep problems will be recruited and randomized into four groups: (1) an MBTCC group, (2) an MBI group, (3) a TCC group, and (4) a sleep hygiene education (SHE) control group. The outcome measures in terms of insomnia severity, interoception, sleep-wake pattern, health status, rumination, and hyperarousal level will be collected at four time points: at baseline (T1), after the 8-week intervention (T2), 6 months after the intervention (T3), and 1 year after the intervention (T4). In addition, qualitative evaluation through focus group interviews will be conducted at the end of the 12-month assessment period (T4).
Discussion
This trial will illuminate the synergetic effect of combining both MBIs and TCC on optimizing improvements in sleep disturbance. The findings from this study can provide empirical support for this integrated treatment, which provides an alternative for healthcare professionals in elderly service to select appropriate practices to treat elderly people with sleep disturbance. It can further help to lessen the growing public health burden of sleep disturbances among the elderly living in the community.
Trial registration
ClinicalTrials.gov. NCT05396092. Published on 24 May 2022
Collapse
|
12
|
Bedford LE, Tang EHM, Dong W, Wong CKH, Tse ETY, Ng APP, Cheung BMY, Wu T, Yu EYT, Lam CLK. Who reports insufficient and disturbed sleep? Results from a representative population-based health survey in Hong Kong. BMJ Open 2022; 12:e058169. [PMID: 36115682 PMCID: PMC9486237 DOI: 10.1136/bmjopen-2021-058169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To highlight the prevalence of sleep problems and identify associated risk factors among a representative sample recruited from the general population of Hong Kong. DESIGN, SETTING AND PARTICIPANTS Participants included 12 022 individuals (aged 15 or above) who took part in the Population Health Survey 2014/15, a territory-wide survey conducted by the Department of Health of the Government of the Hong Kong Special Administrative Region. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were the prevalence of (1) insufficient sleep (<6 hours sleep per day) and (2) any sleep disturbance (difficulty initiating sleep, intermittent awakenings, early awakening) ≥3 times per week in the past 30 days. Multivariable logistic regression identified associations between sleep problems and sociodemographic, clinical and lifestyle factors. RESULTS 9.7% of respondents reported insufficient sleep and 10.5% reported sleep disturbances ≥3 times a week. Female gender, monthly household income <$12 250 (Hong Kong dollar), lower education level, mental health condition and physical health condition were significantly associated with both insufficient and disturbed sleep (all p<0.05). Unemployment, homemaker, insufficient physical activity, current/former smoking status and harmful alcohol consumption were associated with sleep disturbances only (all p<0.01). CONCLUSIONS Sleep problems are highly prevalent in Hong Kong. As such problems are associated with a range of health conditions, it is important to facilitate improvements in sleep. Our results show that harmful alcohol consumption, insufficient physical activity and current smoking are modifiable risk factors for sleep disturbances. Public health campaigns should focus on these risk factors in order to promote a healthy lifestyle and ultimately reduce sleep disturbances. Targeted interventions for high-risk groups may also be warranted, particularly for those with doctor-diagnosed physical and mental health conditions.
Collapse
Affiliation(s)
- Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Ho Man Tang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Weinan Dong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Hong Kong
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tingting Wu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
13
|
Zhou ES, Ritterband LM, Bethea TN, Robles YP, Heeren TC, Rosenberg L. Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:538-549. [PMID: 35442432 PMCID: PMC9021979 DOI: 10.1001/jamapsychiatry.2022.0653] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Black women are at risk for insomnia disorder. Despite interest in addressing sleep health disparities, there is limited research investigating the efficacy of criterion-standard treatment (cognitive behavioral therapy for insomnia [CBT-I]) among this racial minority population. OBJECTIVE To compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS In this single-blind, 3-arm randomized clinical trial, participants in a national, longitudinal cohort (Black Women's Health Study [BWHS]) were recruited between October 2019 and June 2020. BWHS participants with elevated insomnia symptoms were enrolled and randomized in the current study. INTERVENTIONS Participants were randomized to receive (1) an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education (PE) about sleep. MAIN OUTCOMES AND MEASURES The primary outcome was insomnia severity (Insomnia Severity Index [ISI]). Index score ranged from 0 to 28 points, with those scoring less than 8 points considered to not have clinically significant insomnia symptoms and a score of 15 points or higher suggesting insomnia disorder. An ISI score reduction of more than 7 points was considered a clinically significant improvement in insomnia symptoms. The SHUTi-BWHS program was hypothesized to be more effective at significantly decreasing insomnia severity compared with the SHUTi program and PE. RESULTS A total of 333 Black women were included in this trial, and their mean (SD) age was 59.5 (8.0) years. Those randomized to receive either SHUTi or SHUTi-BWHS reported significantly greater reductions in ISI score at 6-month follow-up (SHUTi: -10.0 points; 95% CI, -11.2 to -8.7; SHUTi-BWHS: -9.3 points; 95% CI, -10.4 to -8.2) than those randomized to receive PE (-3.6 points; 95% CI, -4.5 to -2.1) (P < .001). Significantly more participants randomized to SHUTi-BWHS completed the intervention compared with those randomized to SHUTi (86 of 110 [78.2%] vs 70 of 108 [64.8%]; P = .008). Participants who completed either intervention showed greater reductions in insomnia severity compared with noncompleters (-10.4 points [95% CI, -11.4 to -9.4] vs -6.2 points [95% CI, -8.6 to -3.7]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, both the SHUTi and SHUTi-BWHS programs decreased insomnia severity and improved sleep outcomes more than PE. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program, as a greater proportion completed the full intervention. Program completion was associated with greater improvements in sleep. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03613519.
Collapse
Affiliation(s)
- Eric S. Zhou
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts,Perini Family Survivors’ Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lee M. Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville
| | - Traci N. Bethea
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Yvonne P. Robles
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| |
Collapse
|
14
|
Chan NY, Lam SP, Zhang J, Chan JWY, Yu MMW, Suh S, Yang CM, Okajima I, Li AM, Wing YK, Li SX. Efficacy of Email-delivered Versus Face-to-face Group Cognitive Behavioral Therapy for Insomnia in Youths: A Randomized Controlled Trial. J Adolesc Health 2022; 70:763-773. [PMID: 35125265 DOI: 10.1016/j.jadohealth.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/06/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the study was to compare the efficacy of group-based therapy (GT) and email-delivered self-help (ESH) cognitive behavioral therapy for insomnia (CBT-I) with the wait-list (WL) control group in youths. METHODS The study involved an assessor-blind, parallel group randomized controlled trial in youths meeting the diagnostic criteria for insomnia disorder. Participants were randomized to one of the three groups (8-week GT, 8-week ESH, or WL). Participants in all three groups were assessed at baseline and after treatment (week 9 for the WL group). The two treatment groups were additionally assessed at one month and six months after the intervention. Treatment effects were examined using linear mixed models. RESULTS A total of 135 youths (mean age: 20.0 ± 2.5 years, female: 67.4%) were recruited. After treatment, both active treatment groups showed significant improvements in insomnia symptoms (GT vs. WL: Cohen's d = -1.03, ESH vs. WL: d = -.63), less presleep arousal (d = -.52 to -1.47), less sleep-related dysfunctional belief (d = -.88 to -1.78), better sleep hygiene practice (d = -.79 to -.84), and improved daytime functioning (d = -.56 to -.96) compared with the WL group. In addition, GT outperformed ESH in improving maladaptive sleep-related beliefs and mood symptoms at post-treatment and 6-month follow-up. A reduction of suicidality with moderate effect size favoring GT emerged at 6-month follow-up. DISCUSSION Our findings suggested that both group-based and email-delivered CBT-I were effective in treating youth insomnia, but group-based CBT-I showed superior effects on reducing maladaptive beliefs and mood symptoms.
Collapse
Affiliation(s)
- Ngan Yan Chan
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu Ping Lam
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mandy Man Wai Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Chien-Ming Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
15
|
Chan WS, Cheng C. Elevated Prevalence of Probable Insomnia among Young Men during Social Unrest in Hong Kong: A Population-Based Study. Behav Sleep Med 2022; 20:204-211. [PMID: 33757388 DOI: 10.1080/15402002.2021.1902813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/BACKGROUND Hong Kong has experienced a series of major protests in 2019, leading to deteriorating population mental health. Few studies have documented the impact of social unrest on sleep health. The present study examined the prevalence of probable insomnia and its demographic correlates in a population-based random sample of Hong Kong adults. PARTICIPANTS AND METHODS A population-based cross-sectional telephone survey on lifestyle behaviors was conducted during the period between July and September 2019. Data obtained from 1004 participants who completed the insomnia measure were analyzed. The Chinese version of the Patient-Reported Outcomes Information System (PROMIS) v1.0 Sleep Disturbance Short Form was used to measure insomnia. Logistic regressions were conducted to evaluate if prevalence estimates differed by demographic variables. RESULTS The weighted prevalence of probable insomnia for the population was 20.7%, a nearly twofold increase compared to a prior population-based study in Hong Kong. A novel age by sex interaction was found (p = .046). Men had significantly greater odds of having probable insomnia than women in the 18-39 age group (M = 23.1 vs W = 16.5%), whereas women had greater odds of probable insomnia in the 40-59 (M = 14.8 vs W = 25.6%) and 60+ groups (M = 17.2 vs W = 25.2%). CONCLUSION The present findings documented in a random population-based sample elevated prevalence of probable insomnia among Hong Kong adults, especially young men, during the social unrest in 2019. Easily accessible and scalable intervention is urgently needed to mitigate the potential impact of continued social unrest on deteriorating sleep health facing Hong Kong adults.
Collapse
Affiliation(s)
- Wai Sze Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Cecilia Cheng
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
16
|
Torrens Darder I, Argüelles-Vázquez R, Lorente-Montalvo P, Torrens-Darder MDM, Esteva M. Primary care is the frontline for help-seeking insomnia patients. Eur J Gen Pract 2021; 27:286-293. [PMID: 34633282 PMCID: PMC8510604 DOI: 10.1080/13814788.2021.1960308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Although insomnia is a very common disorder, few people seek medical help. OBJECTIVES To determine the proportion of people who consult a healthcare professional about insomnia and examine reasons for help seeking. METHODS Descriptive study of 99 patients diagnosed with insomnia following a telephone survey of 466 adults assigned to a primary healthcare unit in Majorca (Spain). Data were obtained from interviews and subsequent review of electronic medical records. RESULTS Thirty-nine patients (39.8%) consulted at least once with one health care professional; 36(92.2%) consulted a general practitioner. Only 12.2% had an insomnia diagnosis registered in their medical record. Insomnia consultation was not associated with any sociodemographic variables analysed, anxiety, depression or comorbidities. Also, there was no association with sleep quality, duration, and sleep efficiency. Patients with clinical insomnia (OR, 2.48; 95% CI, 1.03-5.94), those who were more worried (OR, 2.93; 95% CI 1.08-7.95) or felt that others noticed the impact of insomnia on their quality of life (OR, 2.48; 95% CI, 1.02-19.08) are more likely to seek medical help. Patients taking sleep medication were 21.54 (95% CI, 7.34-63.20) times more likely to have asked for medical assistance. CONCLUSION Insomnia is an under-reported problem for both patients and doctors. When patients decide to consult for insomnia problems, they first go to the GP, and the vast majority take medications for their sleep problem. Those who consult most are people with more severe insomnia and those who are more worried.
Collapse
Affiliation(s)
- Isabel Torrens Darder
- Majorca Primary Care Department, Calviá Primary Health Center, Balearic Islands, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain
| | | | | | | | - Magdalena Esteva
- Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain.,Teaching Unit of Family and Community Medicine, Balearic Islands, Spain.,Preventive Activities and Health Promotion Network (RedIAPP), Balearic Islands, Spain
| |
Collapse
|
17
|
Dong M, Lu L, Sha S, Zhang L, Zhang Q, Ungvari GS, Balbuena L, Xiang YT. Sleep Disturbances and the Risk of Incident Suicidality: A Systematic Review and Meta-Analysis of Cohort Studies. Psychosom Med 2021; 83:739-745. [PMID: 34267092 DOI: 10.1097/psy.0000000000000964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between sleep disturbances and suicidality is not well understood partly because of the variability in research results. This meta-analysis aimed to investigate the predictive value of sleep disturbances for incident suicidality. METHODS A systematic search was conducted in PubMed, EMBASE, PsycINFO, and Web of Science databases for studies examining sleep disturbances and incident suicidality. Cohort studies were screened following a registered protocol, and the eligible ones were meta-analyzed. RESULTS Seven studies comprising 1,570,181 individuals at baseline, with 1407 attempting suicide and 1023 completing suicide during follow-up, were included. Individuals with baseline sleep disturbances had a significantly higher incidence of suicidality than did those without (relative risk = 2.17, 95% confidence interval [CI] = 1.45-3.24, I2 = 82.50%, p < .001). The risk of an incident suicide attempt was 3.54-fold higher (95% CI = 3.07-4.09, I2 = 0%, p = .44), whereas the risk of incident completed suicide was 1.80-fold higher (95% CI = 1.32-2.44, I2 = 59.33%, p = .01) in individuals with baseline sleep disturbances. CONCLUSIONS Incident suicide attempts and deaths are higher among people with sleep disturbances. Regular screening and preventive measures should be undertaken for people with sleep disturbances to prevent progression into suicide attempts and deaths.Clinical Trial Registration:CRD42019136397.
Collapse
Affiliation(s)
- Min Dong
- From the Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Dong), Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM (Lu), Université de Bordeaux, Bordeaux, France; The National Clinical Research Center for Mental Disorders, the Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection (Sha, L. Zhang, Q. Zhang), Capital Medical University, Beijing, China; Division of Psychiatry, School of Medicine (Ungvari), University of Western Australia/Graylands Hospital, Perth; University of Notre Dame Australia (Ungvari), Fremantle, Australia; Department of Psychiatry, University of Saskatchewan (Balbuena), Saskatoon, Saskatchewan, Canada; Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences (Xiang), Centre for Cognitive and Brain Sciences (Xiang), and Institute of Advanced Studies in Humanities and Social Sciences (Xiang), University of Macau, Macao SAR, China
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Ho KY, Lam KKW, Xia W, Chung JOK, Cheung AT, Ho LLK, Chiu SY, Chan GCF, Li WHC. Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors. Health Qual Life Outcomes 2021; 19:176. [PMID: 34229705 PMCID: PMC8261921 DOI: 10.1186/s12955-021-01803-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/10/2021] [Indexed: 02/23/2023] Open
Abstract
Background Sleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure. Methods A convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis. Results The Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70. Conclusion The Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost. Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.
Collapse
Affiliation(s)
- K Y Ho
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR.
| | - Katherine K W Lam
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR.
| | - W Xia
- School of Nursing, Sun Yan-Sen University of Medical Sciences, Guangzhou, China
| | - J O K Chung
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
| | - Ankie T Cheung
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - Laurie L K Ho
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - S Y Chiu
- Hong Kong Children's Hospital, Kowloon Bay, Hong Kong, SAR
| | | | - William H C Li
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| |
Collapse
|
19
|
Song X, Peng J, Jiang W, Ye M, Jiang L. Effects of aromatherapy on sleep disorders: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25727. [PMID: 33907165 PMCID: PMC8084014 DOI: 10.1097/md.0000000000025727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The progress of modern society and changes in lifestyle have not only increased the proportion of sub-healthy people, but also caused many people to suffer from sleep disorders and mental anxiety. Long-term lack of high-quality sleep will not only cause psychological problems such as anxiety and fatigue, but also cause physical abnormalities, such as abnormal hormone secretion, weakened immunity, neuroendocrine disorders, and high blood pressure. Therefore, the purpose of this study is to systematically evaluate the effectiveness of aromatherapy in improving sleep quality in people with sleep disorders. METHODS Computer search CNKI, SinoMed, Wanfang, PubMed, Web of science, and EMbase collect randomized controlled trials on aromatherapy to improve sleep quality of people with sleep disorders. The search time limit is to build the database until April 5, 2021. RevMan5.3 software is used for meta-analysis. RESULTS This systematic review will provide an assessment of the current state of sleep disorders, aiming to assess the efficacy of aromatherapy for patients with sleep disorders. CONCLUSION This systematic review will provide a credible evidence-based for the clinical treatment of sleep disorders with aromatherapy.
Collapse
Affiliation(s)
- Xin Song
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine
| | - Jiahua Peng
- Institute of Obstetrics and Gynecology of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine Nanchang, Jiangxi Province
| | - Weiyu Jiang
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine
| | - Minghua Ye
- National College of Beijing University of Traditional Chinese Medicine, Beijing
| | - Lisheng Jiang
- Institute of Health Preservation, Jiangxi University of Traditional Chinese Medicine Nanchang 330006, Jiangxi Province, China
| |
Collapse
|
20
|
Chan NY, Li SX, Zhang J, Lam SP, Kwok APL, Yu MWM, Chan JWY, Li AM, Morin CM, Wing YK. A Prevention Program for Insomnia in At-risk Adolescents: A Randomized Controlled Study. Pediatrics 2021; 147:peds.2020-006833. [PMID: 33627370 DOI: 10.1542/peds.2020-006833] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To prevent the future development of insomnia in at-risk adolescents. METHODS A randomized controlled trial comparing 4 weekly insomnia prevention program with a nonactive control group. Subjects were assessed at baseline, postintervention, and 6 and 12 months after intervention. Assessors were blinded to the randomization. Analyses were conducted on the basis of the intention-to-treat principles. RESULTS A total of 242 adolescents with family history of insomnia and subthreshold insomnia symptoms were randomly assigned to an intervention group (n = 121; mean age = 14.7 ± 1.8; female: 51.2%) or control group (n = 121; mean age = 15.0 ± 1.7; female: 62.0%). There was a lower incidence rate of insomnia disorder (both acute and chronic) in the intervention group compared with the control group (5.8% vs 20.7%; P = .002; number needed to treat = 6.7; hazard ratio = 0.29; 95% confidence interval: 0.12-0.66; P = .003) over the 12-month follow-up. The intervention group had decreased insomnia symptoms (P = .03) and reduced vulnerability to stress-related insomnia (P = .03) at postintervention and throughout the 12-month follow-up. Decreased daytime sleepiness (P = .04), better sleep hygiene practices (P = .02), and increased total sleep time (P = .05) were observed at postintervention. The intervention group also reported fewer depressive symptoms at 12-month follow-up (P = .02) compared with the control group. CONCLUSIONS A brief cognitive behavioral program is effective in preventing the onset of insomnia and improving the vulnerability factors and functioning outcomes.
Collapse
Affiliation(s)
- Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry and
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong and.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry and
| | - Siu Ping Lam
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry and
| | - Amy Pui Ling Kwok
- New Territories East Cluster, Hospital Authority, Hong Kong Special Administrative Region, China; and
| | - Mandy Wai Man Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry and
| | | | - Albert Martin Li
- Department of Pediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Charles M Morin
- School of Psychology, Université Laval and Centre de recherche CERVO, Quebec City, Canada
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry and
| |
Collapse
|
21
|
Chan NY, Chan JWY, Li SX, Wing YK. Non-pharmacological Approaches for Management of Insomnia. Neurotherapeutics 2021; 18:32-43. [PMID: 33821446 PMCID: PMC8116473 DOI: 10.1007/s13311-021-01029-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Insomnia is a prevalent sleep problem associated with a constellation of negative health-related outcomes and significant socioeconomic burden. It commonly co-occurs with psychiatric and medical conditions, which may further exacerbate these comorbid conditions and hinder treatment response. There is much empirical evidence to support the clinical efficacy of non-pharmacological treatment for insomnia, especially cognitive behavioral therapy for insomnia (CBT-I), in managing insomnia in a wide range of populations. This article reviews the research on the efficacy of CBT-I for primary insomnia and insomnia comorbid with other psychiatric and medical conditions, the empirical evidence regarding different CBT-I treatment modalities, the implementation of CBT-I across different age groups, and some initial evidence on the sequential combination of insomnia treatments. A brief overview of other non-pharmacological treatment with regard to complementary alternative medicine is also provided.
Collapse
Affiliation(s)
- Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| |
Collapse
|
22
|
Liu Y, Jiang TT, Shi TY, Liu YN, Liu XM, Xu GJ, Li FL, Wang YL, Wu XY. The effectiveness of diaphragmatic breathing relaxation training for improving sleep quality among nursing staff during the COVID-19 outbreak: a before and after study. Sleep Med 2020; 78:8-14. [PMID: 33383396 PMCID: PMC7724962 DOI: 10.1016/j.sleep.2020.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Recent studies have demonstrated that first-line nurses involved in the coronavirus disease-2019 (COVID-19) crisis may experience sleep disturbances. As breathing relaxation techniques can improve sleep quality, anxiety, and depression, the current study aimed to evaluate the effectiveness of diaphragmatic breathing relaxation training (DBRT) for improving sleep quality among nurses in Wuhan, China during the COVID-19 outbreak. METHODS This study used a quasi-experimental (before and after) intervention strategy, with 151 first-line nurses from four wards in Leishenshan hospital. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) to evaluate the effectiveness of DBRT before and after the intervention. Data were examined using the Shapiro-Wilk test, Levene's test, and paired t-test. RESULTS A total of 140 nurses completed the DBRT sessions. First-line nurses achieved significant reductions in global sleep quality (p < 0.01), subjective sleep quality (p < 0.001), sleep latency (p < 0.01), sleep duration (p < 0.001), sleep disturbances (p < 0.001), habitual sleep efficiency (p = 0.015), daytime dysfunction (p = 0.001), and anxiety (p = 0.001). There were no significant reductions in the use of sleeping medication (p = 0.134) and depression (p = 0.359). CONCLUSION DBRT is a useful non-pharmacological treatment for improving sleep quality and reducing anxiety among first-line nurses involved in the COVID-19 outbreak. The study protocol was clinically registered by the Chinese Clinical Trial Registry. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR2000032743.
Collapse
Affiliation(s)
- Yu Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Tong-Tong Jiang
- The Graduate School of Nursing, Chiba University, Chiba, 263-0043, Japan.
| | - Tie-Ying Shi
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Yong-Ning Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Xiu-Mei Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Guo-Jun Xu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Fang-Lin Li
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Yue-Liang Wang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| | - Xiao-Yu Wu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011 PR China.
| |
Collapse
|
23
|
Liu Y, Jiang TT, Shi TY, Liu YN, Liu XM, Xu GJ, Li FL, Wang YL, Wu XY. WITHDRAWN: The effectiveness of diaphragmatic breathing relaxation training for improving sleep quality among nursing staff during the COVID-19 outbreak: a before and after study. Sleep Med X 2020; 2:100026. [PMID: 33860223 PMCID: PMC7540247 DOI: 10.1016/j.sleepx.2020.100026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yu Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011, PR China
| | - Tong-tong Jiang
- Graduate School of Nursing, Chiba University, Chiba, 263-8672, Japan
| | - Tie-ying Shi
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, No.222 Zhongshan Road, Xigang Distric, Dalian, Liaoning Province, 116011, PR China
- Corresponding author.
| | - Yong-ning Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, No.222 Zhongshan Road, Xigang Distric, Dalian, Liaoning Province, 116011, PR China
- Corresponding author.
| | - Xiu-mei Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011, PR China
| | - Guo-jun Xu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011, PR China
| | - Fang-lin Li
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011, PR China
| | - Yue-liang Wang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011, PR China
| | - Xiao-yu Wu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116011, PR China
| |
Collapse
|
24
|
Naito T, Chin J, Kim TU, Veera S, Jeannette M, Lomiguen CM. Further Reduction in Help-Seeking Behaviors Amidst Additional Barriers to Mental Health Treatment in Asian Populations: A Contemporary Review. Cureus 2020; 12:e11455. [PMID: 33329953 PMCID: PMC7733772 DOI: 10.7759/cureus.11455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Under diagnosis and treatment of mental health illnesses lead to chronic presentations and consequences. Multiple factors contribute to gaps in treatment, including the role culture plays in the development or suppression of help-seeking behaviors (HSBs). In the Asian community, conversation and recognition of mental health and its disorders are considered shameful. This review presents an analysis of literature to identify barriers to mental health treatment pronounced in Asian populations and discusses how culture influences these barriers and treatment-seeking behaviors, particularly in the context of the Asian-origin Coronavirus disease 2019 (COVID-19) global pandemic. It is the purpose of this review to discuss Asian American underutilization of mental health services and understand the factors the contribute to psychiatric care resistance in Asian communities.
Collapse
Affiliation(s)
| | - Justin Chin
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA
- Family Medicine, LifeLong Medical Care, Richmond, USA
| | - Tae Un Kim
- Primary Care, Touro College of Osteopathic Medicine, New York, USA
| | - Simrat Veera
- Pediatrics, Goryeb Children's Hospital - Atlantic Health System, Morristown, USA
| | | | | |
Collapse
|
25
|
Hui VKY, Wong CYF, Ma EKY, Ho FYY, Chan CS. Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: study protocol for a parallel group randomized controlled trial. Trials 2020; 21:843. [PMID: 33036655 PMCID: PMC7545384 DOI: 10.1186/s13063-020-04778-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Depression is a major public health concern. Emerging research has shown that cognitive behavioral therapy for insomnia (CBT-I) is effective in treating individuals with comorbid insomnia and depression. Traditional face-to-face CBT-I encounters many obstacles related to feasibility, accessibility, and help-seeking stigma. CBT-I delivered via smartphone application could be a potential solution. This paper reports a protocol designed to evaluate the efficacy of a self-help smartphone-based CBT-I, using a waitlist group as control, for people with major depression and insomnia. Methods A two-arm parallel randomized controlled trial is conducted in a target sample of 285 non-suicidal Hong Kong Chinese older than 17 years of age with major depression and insomnia. Participants complete an online rapid screening, followed by a telephone diagnostic interview. Those who meet the eligibility criteria are randomized in a ratio of 1:1 to receive either CBT-I immediately or to a waitlist control condition. The CBT-I consists of six weekly modules and is delivered through a smartphone application proACT-S. This smartphone app has been pilot tested and revamped to improve user experience. An online randomized algorithm is used to perform randomization to ensure allocation concealment. The primary outcomes are changes over the measurement points in sleep quality, insomnia severity, and depression severity. The secondary outcomes include changes over the measurement points in anxiety, subjective health, treatment expectancy, and acceptability of treatment. Assessments are administered at baseline, post-intervention, and 6-week follow-up. The recruitment is completed. Important adverse events, if any, are documented. Multilevel linear mixed model based on intention-to-treat principle will be conducted to examine the efficacy of the CBT-I intervention. Discussion It is expected that proACT-S is an efficacious brief sleep-focused self-help treatment for people with major depression and insomnia. If proven efficacious, due to its self-help nature, proACT-S may be applicable as a community-based early intervention, thereby reducing the burden of the public healthcare system in Hong Kong. Trial registration ClinicalTrials.gov NCT04228146. Retrospectively registered on 14 January 2020.
Collapse
Affiliation(s)
- Victoria Ka-Ying Hui
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong
| | - Christy Yim-Fan Wong
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong
| | - Eric Ka-Yiu Ma
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong.
| |
Collapse
|
26
|
Meredith S, Frawley J, Sibbritt D, Adams J. A critical review of self-care for sleep disturbances: prevalence, profile, motivation, perceived effectiveness and medical provider communication. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-019-0039-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Objective
This study aims to undertake the first critical review of self-care use among adults with sleep disturbances by focusing on the prevalence of self-care—the self-determined and self-administered use of products or practices—by adults with sleep disturbances.
Methods
A comprehensive search of 2006–2016 international literature in CINAHL, AMED, Medline and EMBASE databases was conducted. The search was confined to empirical research findings regarding sleep disturbances - as indicated by a validated sleep scale/index or clinician diagnosis.
Results
Of the 21 articles included in this review, only three reported on sleep disturbances other than insomnia disorder (ID) or insomnia symptoms (IS). Overall, a high prevalence of self-care use is reported among adults with sleep disturbances, particularly for ID and IS. Self-care products and practices are more likely to be used by adults with sleep disturbances, than those without sleep disturbances. Commonly used self-care products and practices include OTC hypnotics, antihistamines, diphenhydramine products, diet, exercise, painkillers, herbal medicines, vitamins, minerals and dietary supplements, yoga, tai chi, Qigong, meditation, exercise and relaxation.
Conclusions
Many adults with sleep disturbances–particularly ID or IS–frequently use self-care products and practices. Self-care products are also used concomitantly with conventional prescription medications without disclosure to medical professionals. The current literature is of varied methodological caliber, frequently relies on small sample sizes and low-quality data collection therefore further rigorous health services research is required. There is an especial paucity of data regarding self-care for sleep disturbances such as restless legs syndrome and obstructive sleep apnea. Healthcare providers may find it beneficial to actively ask patients about their use of self-care for sleep disturbances to help avoid harmful drug-drug or drug-herb interactions.
Collapse
|
27
|
Lu L, Wang SB, Rao W, Zhang Q, Ungvari GS, Ng CH, Kou C, Jia FJ, Xiang YT. The Prevalence of Sleep Disturbances and Sleep Quality in Older Chinese Adults: A Comprehensive Meta-Analysis. Behav Sleep Med 2019; 17:683-697. [PMID: 29851516 DOI: 10.1080/15402002.2018.1469492] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: This is a meta-analysis of the pooled prevalence of insomnia-specific sleep disturbances (sleep disturbances thereafter) and sleep quality in older Chinese adults. Method: Both English (PubMed, Embase and PsycINFO) and Chinese (Chinese National Knowledge Infrastructure [CNKI], WanFang and SinoMed) databases were systematically searched. Data extraction and quality assessment were independently performed by two investigators. Random-effects model was performed to pool the prevalence of sleep disturbances and sleep quality. Subgroup and meta-regression analyses were performed to explore the source of heterogeneity. Funnel plots, Egger's regression model, and Begg's test were used to assess publication bias. Results: A total of 47 studies were included. The pooled prevalence of sleep disturbances was 35.9% (95% CI: 30.6%-41.2%). Older adults in rural areas had higher prevalence of sleep disturbances than their counterparts in urban areas. Sleep quality was measured by the Pittsburgh Sleep Quality Assessment (PSQI) in all studies with available data. In the 27 studies with available data, the pooled mean PSQI total score was 6.64 (95% CI: 6.14-7.13). There was no significant difference between genders and between rural and urban areas. Compared to men, women had higher mean scores in sleep latency (Q = 23.62, p < 0.001), sleep efficiency (Q = 12.08, p = 0.001), and use of sleep-promoting medications (Q = 4.07, p = 0.044). Conclusion: Sleep disturbances are common in older Chinese adults, particularly in older women.
Collapse
Affiliation(s)
- Li Lu
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau , Macao SAR , China
| | - Shi-Bin Wang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau , Macao SAR , China.,Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences , Guangzhou, China
| | - Wenwang Rao
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau , Macao SAR , China.,Department of Epidemiology and Biostatistics, School of Public Health, Jilin University , Changchun , China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University , Beijing , China
| | - Gabor S Ungvari
- University Notre Dame Australia, Graylands Hospital , Perth , Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne , Melbourne , Australia
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University , Changchun , China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences , Guangzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau , Macao SAR , China
| |
Collapse
|
28
|
Impact of Sleep Disorders and Other Factors on the Quality of Life in General Population: A Cross-Sectional Study. J Nerv Ment Dis 2019; 207:333-339. [PMID: 30907768 DOI: 10.1097/nmd.0000000000000968] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study objective was to assess if insomnia, along with other factors, can impact the physical and mental quality of life (QOL) of the Lebanese general population. This cross-sectional study, conducted between November 2017 and March 2018, enrolled 756 community-dwelling participants. A first linear regression, using the SF-12 PCS score as the dependent variable, showed that having a family history of insomnia problems (β = 1.107, p = 0.026) was significantly associated with higher physical QOL (higher SF-12 PCS score), whereas increased stress (β = 0.048, p = 0.015) was significantly associated with lower physical QOL. A second linear regression, using the SF-12 MCS score as dependent variable, showed that having increased age (β = -0.079, p < 0.001) was significantly associated with lower mental QOL. Despite its cross-sectional design and the modest sample size, this study adds to the evidence that insomnia, along with other factors (including sociodemographic and psychological factors), can have a detrimental impact on both physical and mental QOL of participants.
Collapse
|
29
|
Liu Y, Zhang J, Li SX, Chan NY, Yu MWM, Lam SP, Chan JWY, Li AM, Wing YK. Excessive daytime sleepiness among children and adolescents: prevalence, correlates, and pubertal effects. Sleep Med 2019; 53:1-8. [DOI: 10.1016/j.sleep.2018.08.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
|
30
|
Dennis JA, Alazzeh A, Kumfer AM, McDonald-Thomas R, Peiris AN. The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES. SLEEP DISORDERS 2018; 2018:5987064. [PMID: 30402295 PMCID: PMC6198565 DOI: 10.1155/2018/5987064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVE Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. METHODS Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. RESULTS Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. CONCLUSION Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.
Collapse
Affiliation(s)
- Jeff A. Dennis
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th St., MS 9430, Lubbock, TX 79430, USA
| | - Ahmad Alazzeh
- Department of Pulmonary and Critical Care, East Tennessee State University, Quillen College of Medicine, VA Bldg. 1, Johnson City, TN 37614-0622, USA
| | - Ann Marie Kumfer
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., MS 9410, Lubbock, TX 79430, USA
| | - Rebecca McDonald-Thomas
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., MS 9410, Lubbock, TX 79430, USA
| | - Alan N. Peiris
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., MS 9410, Lubbock, TX 79430, USA
- Clinical Research Institute, Texas Tech University Health Sciences Center, 3601 4th St., MS 8183, Lubbock, TX 79430, USA
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Insomnia is approximately 1.5 times more common in women than in men. To date, research has advanced our knowledge about why women report significantly more sleep problems than men despite not being reflected in objective sleep measures. Precisely understanding the symptomatology and pathological mechanisms underlying sex differences is important for prevention and providing appropriate interventions. RECENT FINDINGS Sex differences found in insomnia goes beyond simple explanations and have been proven to be a complicated interplay of biological, psychological, and social factors that play different roles throughout the life span. This paper will review sex differences in insomnia based on risk factors, mechanisms, and consequences, as well as treatment response. In addition, we will also discuss treatment recommendations when working with female populations at different stages in the life span that may be more vulnerable to insomnia. Future studies utilizing prospective, longitudinal designs are needed to understand the interactions of various factors that can explain existing sex differences in insomnia.
Collapse
Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Nayoung Cho
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
| |
Collapse
|
32
|
Ho ECM, Siu AMH. Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence. Occup Ther Int 2018; 2018:8637498. [PMID: 30150906 PMCID: PMC6087566 DOI: 10.1155/2018/8637498] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/04/2018] [Accepted: 06/25/2018] [Indexed: 11/18/2022] Open
Abstract
The effectiveness of sleep intervention developed by occupational therapists was reviewed, and a conceptual framework for organizing the developing practice of sleep management in occupational therapy was proposed in this paper. Evidence-based articles on sleep management practice in occupational therapy from 2007 to 2017 were retrieved. Four types of effective sleep management intervention were identified from the literature, including the use of assistive devices/equipment, activities, cognitive behavioral therapy for insomnia, and lifestyle intervention, and the use of assistive device was the most popular intervention. Applying the Person-Environment-Occupation Performance (PEOP) framework, we developed a conceptual framework for organizing occupational therapy practice in sleep management. The future development of occupation-based sleep intervention could focus on strategies to (1) minimize the influence of bodily function on sleep, (2) promote environment conducive to sleep, and (3) restructure daytime activity with a focus on occupational balance.
Collapse
Affiliation(s)
- Eris C. M. Ho
- Occupational Therapy Department, Queen Elizabeth Hospital, Hospital Authority, Kowloon, Hong Kong
| | - Andrew M. H. Siu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
33
|
Chang LY, Chang HY, Wu WC, Lin LN, Wu CC, Yen LL. Dual Trajectories of Sleep Duration and Cigarette Smoking during Adolescence: Relation to Subsequent Internalizing Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018. [DOI: 10.1007/s10802-018-0414-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
34
|
Zhu B, Xie M, Park CG, Kapella MC. Adaptation of the Pittsburgh Sleep Quality Index in Chinese adults with type 2 diabetes. J Chin Med Assoc 2018; 81:242-247. [PMID: 29258729 PMCID: PMC6873698 DOI: 10.1016/j.jcma.2017.06.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Sleep disturbance is a major health issue in people with type 2 diabetes (T2DM). The Pittsburgh Sleep Quality Index (PSQI) has been the most widely used instrument to measure subjective sleep disturbance. Nevertheless, its factor structure in the context of T2DM has not been examined. The purpose of the study is to evaluate the factor structure of the PSQI in Chinese adults with T2DM and thereby to facilitate its use in clinical practice and research. METHODS The PSQI (Chinese version) was administered to 240 patients with T2DM. Confirmatory factor analysis was conducted to examine the one-factor, adapted one-factor by removing the component "use of sleep medication", and the three-factor structure of the PSQI. Goodness-of-fit indices were used to evaluate the fit of the model. Construct validity of the resultant model was further examined using contrasted groups. Cronbach's α of the resultant model was obtained to evaluate its internal consistency. RESULTS The three-factor model proposed by Cole et al. did not fit the sleep data. Confirmatory factor analysis supported the adapted one-factor model with the PSQI global score as an indicator of overall sleep quality, and the goodness-of-fit indices for the adapted model were better compared to the original one-factor model. As expected, women, older adults, and patients with poor glycemic control had higher adapted PSQI global score (p < 0.01). Cronbach's α of the adapted PSQI was 0.78. CONCLUSION The adapted PSQI was similar to the original PSQI in that only the component "use of sleep medication" was removed from the original scale and the one-factor scoring worked better. In contrast, the three-factor model has limited usefulness in this population.
Collapse
Affiliation(s)
- Bingqian Zhu
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA.
| | - Meng Xie
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University of China, Shanghai, China
| | - Chang G Park
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Mary C Kapella
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
35
|
Abstract
OBJECTIVES This study aimed to assess patients' healthcare-seeking preferences in mild, chronic, and serious illness; identify influential factors; and examine the reasons underlying patients' healthcare-seeking preference. DESIGN A retrospective study. SETTING The study was conducted in 14 tertiary hospitals in Shanghai, China. PARTICIPANTS Questionnaires were distributed to 1519 patients, and 1114 were completed and returned. All patients participated in the study voluntarily, provided written informed consent, and possessed the ability to complete the questionnaire. MAIN OUTCOME MEASURES We measured and compared preferences and choice of healthcare providers in patients if they had experienced mild, chronic, or serious illness. RESULTS More than 50% of participants, including those who were >60 years of age, had consulted a doctor more than three times during the preceding year, were single, and were most likely to decide not to seek medical treatment. Community health facilities were the most frequently selected healthcare provider in mild illness. In addition, patients who had no personal preference, did not express a preference for a good environment or first-class medical technology, were concerned about close proximity and short waiting times, and pursued low medical costs were most likely to choose a community health facility. General hospitals were the most frequently selected healthcare provider in chronic and serious illness. In addition, patients who earned higher monthly incomes, did not pursue low medical costs, were not concerned about short waiting times or close proximity, and expressed a preference for first-class medical technology, were most likely to choose general hospitals. CONCLUSION Patients' healthcare-seeking preference was influenced mainly by healthcare providers' characteristics, illness severity, and sociodemographic characteristics. These findings indicate that patients' current healthcare-seeking preference was not ideal and requires optimisation.
Collapse
Affiliation(s)
- Wenya Yu
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Meina Li
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Feng Ye
- Department of Medical Affairs, No. 187th hospital of PLA, Haikou, China
| | - Chen Xue
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Lulu Zhang
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| |
Collapse
|
36
|
Chung KF, Yeung WF, Yu YM, Ho FYY. A population-based 2-year longitudinal study of insomnia disorder in a Chinese population in Hong Kong. PSYCHOL HEALTH MED 2017; 23:505-510. [PMID: 28786296 DOI: 10.1080/13548506.2017.1363397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a paucity of literature examining the longitudinal course of insomnia using standardized diagnostic criteria. This study aims to evaluate the persistence, remission, relapse, and incidence rates of insomnia symptoms and insomnia disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th edition (DSM-IV and DSM-5). A total of 398 community dwellers were interviewed annually over two years using the Brief Insomnia Questionnaire, a validated questionnaire for deriving insomnia diagnoses. Normal sleepers were defined according to the DSM-5 quantitative criteria as having insomnia symptoms at most twice per week. Estimates were weighted against population age and sex distribution. Persistence for two consecutive years was 26.3, 26.4, and 23.0% for insomnia symptoms, DSM-IV, and DSM-5 insomnia disorders; remission rate was 55.8, 22.9, and 26.1%, relapse rate was 21.8, 1.3, and 0%, while incidence rate was 62.4, 19.6, and 4.5%. The common trajectories for DSM-IV insomnia disorder were to remain the same (26.4%), followed by a change to insomnia symptoms at the second year (25.7%), and at the third year (17.3%). For DSM-5 insomnia disorder, a change to insomnia symptoms at the second year was the commonest (28.3%), followed by continuing the same (23.0%), and a change to insomnia symptoms at the third year (14.0%). Over a two-year naturalistic follow-up, persistence of insomnia disorder was roughly 25%. Changes from insomnia disorder to insomnia symptoms were common; however, remission only occurred in about 25%, highlighting the chronic course of insomnia, perhaps due to a lack of treatment, under-treatment, or resistance to treatment. Incidence of insomnia symptoms was 62.4%, suggesting a high risk of developing insomnia in the general population.
Collapse
Affiliation(s)
- Ka-Fai Chung
- a Department of Psychiatry , University of Hong Kong , Hong Kong SAR , China
| | - Wing-Fai Yeung
- b School of Nursing , Hong Kong Polytechnic University , Hong Kong SAR , China
| | - Yee-Man Yu
- b School of Nursing , Hong Kong Polytechnic University , Hong Kong SAR , China
| | - Fiona Yan-Yee Ho
- c Department of Psychology and Centre for Psychosocial Health , Education University of Hong Kong , Hong Kong SAR , China
| |
Collapse
|
37
|
Zhang J, Chan NY, Lam SP, Li SX, Liu Y, Chan JWY, Kong APS, Ma RCW, Chan KCC, Li AM, Wing YK. Emergence of Sex Differences in Insomnia Symptoms in Adolescents: A Large-Scale School-Based Study. Sleep 2016; 39:1563-70. [PMID: 27091537 DOI: 10.5665/sleep.6022] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/24/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES This study aimed to explore the moderation of pubertal status on the onset of sex differences in the prevalence of insomnia symptoms and their health correlates. METHODS A total of 7,507 children and adolescents (weighted percentage of female: 48.5%) aged between 6-17 y were recruited from thirty-one primary and secondary schools. Participants with difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and/or early morning awakening (EMA) ≥ 3 times/week in the past month were considered as having insomnia symptoms. The severity of insomnia was measured by the Insomnia Severity Index (ISI). RESULTS The prevalence of insomnia symptoms increased from 3.4% to 12.2% in girls (3.6-fold) and from 4.3% to 9.1% in boys (2.1-fold) from Tanner stage 1 to 5. There was a significant interaction between sex and Tanner stage in the prevalence of insomnia (P < 0.001) with an emergence of female preponderance at Tanner stage 4 even after controlling for age, family income, and school start time. Similar sex-Tanner stage interactions were found in DIS, DMS, and ISI total score but not EMA. Insomnia symptoms were strongly associated with behavioral problems, poor mental health, and poor general health in both sexes. Boys with insomnia would report more maladaptive lifestyles (smoking, alcohol, and energy drinks) whereas girls with insomnia were more susceptible to emotional and relationship difficulties. CONCLUSIONS Pubertal maturation was associated with a progressive increase in the prevalence of insomnia symptoms with the emergence of female preponderance in both the prevalence and severity of insomnia symptoms at late puberty. CLINICAL TRIALS REGISTRATION Chinese Clinical Trial Register, http://www.chictr.org.cn, ID: ChiCTR-TRC-12002798.
Collapse
Affiliation(s)
- Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan Yin Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu Ping Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey W Y Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate C C Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|