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Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [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] [Indexed: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
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Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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2
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Langevin R, Pennestri MH, Hershon M, Pirro T, Hébert M. The association between child sexual abuse and self-reported sleep in adolescent girls. J Clin Sleep Med 2023; 19:1933-1939. [PMID: 37469189 PMCID: PMC10620652 DOI: 10.5664/jcsm.10736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
STUDY OBJECTIVES Child sexual abuse is associated with negative consequences on both physical and mental health. It has been found to influence child and adolescent sleep, which is an important developmental factor, which also influences mental and physical health. However, the literature examining this topic is plagued by methodological limitations, such as small sample sizes and unvalidated measures. METHODS Using the Pittsburgh Sleep Quality Index (PSQI), the present study examined 7 self-reported sleep dimensions, including sleep latency, efficiency, duration, disturbances, subjective sleep quality, daytime dysfunction, and use of sleep medication, in a sample of 707 adolescent girls aged 14-18 years old. RESULTS Statistical analyses revealed that child sexual abuse had a significant moderate association with the total PSQI score. Sexually abused adolescent girls, compared with their nonabused counterparts, reported more sleep difficulties. Significant differences also emerged on all sleep dimensions, with abused girls reporting increased difficulties. However, the magnitude of these associations differed from one dimension to another. CONCLUSIONS Our findings support the continued study of sleep in adolescent girls who experienced sexual abuse. They also support the use of a fine-grained perspective when assessing various dimensions of sleep health in girls with a history of child sexual abuse for improved tertiary prevention and intervention. CITATION Langevin R, Pennestri M-H, Hershon M, Pirro T, Hébert M. The association between child sexual abuse and self-reported sleep in adolescent girls. J Clin Sleep Med. 2023;19(11):1933-1939.
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Affiliation(s)
- Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Marie-Hélène Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Montreal, Canada
| | - Malka Hershon
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Montreal, Canada
| | - Teresa Pirro
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Martine Hébert
- Département de Sexologie, Université du Québec à Montréal, Montreal, Canada
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Olatunde K, Patton S. Association Between Insomnia and Healthcare Utilization: A Scoping Review of the Literature. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231164953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Insomnia is a sleep disorder that affects significant portion of the population. It can result in adverse health outcomes and increased healthcare utilization. The purpose of this review was to identify existing research on the association between insomnia and healthcare utilization. A five-stage scoping review process was conducted guided by the Joanna Briggs Institute process. Data sources searched through 2022 were PubMed, HINARI, Google Scholar and Cochrane, with additional studies identified through hand searching. Descriptive and exploratory analyses were conducted from the findings of the selected studies. After reviewing 124 references, 23 studies were selected. A strong and positive association between insomnia and healthcare utilization and healthcare costs was identified. We also found that insomnia was associated with absenteeism from work, lower work performance ratings, disability, difficulties in daily activities, and life dissatisfaction. An unexpected theme that emerged from the included studies is that there is a large population with persistent insomnia who do not seek help that could benefit from improved management. Findings suggest that identifying and managing insomnia could result in a decrease in healthcare utilization and costs. Further research is needed to determine the most effective methods of identifying and managing insomnia.
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Affiliation(s)
- Kolade Olatunde
- Department of Public Policy/Health Policy, University of Arkansas, Fayetteville, AR, USA
| | - Susan Patton
- Department of Nursing, University of Arkansas, Fayetteville, AR, USA
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Hedin G, Garmy P, Norell-Clarke A, Tønnesen H, Hagell P, Westergren A. Measurement properties of the minimal insomnia symptom scale (MISS) in adolescents. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00075-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The Minimal Insomnia Symptom Scale (MISS) is a three-item screening instrument that has been found to be psychometrically sound and capable of screening for insomnia among adults and older people. This study aimed to test the measurement properties of the MISS together with an additional item focusing on daytime functioning among adolescents using the Rasch measurement model.
Methods
A cross-sectional design was used, and data from adolescents (age 13–17 years, n = 3022) were analyzed using the Rasch measurement model.
Results
The MISS had good measurement properties. When adding the item “daytime disturbance”, the measurement properties deteriorated. When replacing the original MISS item “not rested by sleep” with the item “daytime disturbance”, the measurement properties slightly improved. We label this new scale the MISS-Revised (MISS-R). The reliability was better for the MISS-R (0.55) compared to the MISS (0.50). The optimal cut-off was found to be > 6 points, both for the MISS and the MISS-R.
Conclusions
This study provides general support that both the MISS as well as the MISS-R have good fit to the Rasch model. At this stage, neither the MISS nor the MISS-R can be advocated over the other for use among adolescents, although the MISS-R had slightly better reliability than the MISS. Additional studies are needed to determine the clinically optimal cut-score for identification of insomnia.
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Brown BWJ, Crowther ME, Appleton SL, Melaku YA, Adams RJ, Reynolds AC. Shift work disorder and the prevalence of help seeking behaviors for sleep concerns in Australia: A descriptive study. Chronobiol Int 2022; 39:714-724. [PMID: 35253569 DOI: 10.1080/07420528.2022.2032125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this study was to examine the help seeking behaviours of Australian workers who meet criteria for SWD. Of the 448 (46% of sample, n = 964 total) Australian workers reporting non-standard work hours, 10.5% (n = 41) met the criteria for probable shift work disorder (pSWD). Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD. Of the small proportion of workers with pSWD who sought help, general practitioners were the most common healthcare professionals for sleep problems. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of 'accept it and keep going' as a sleepiness management strategy, highlighting a potential barrier to help seeking behaviour in workers with pSWD. These findings provide novel insight into the help seeking behaviours of those with pSWD. There is a need for further research to understand why individuals at risk for SWD are not actively seeking help, and to develop health promotion and intervention strategies to improve help seeking when needed.
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Affiliation(s)
- Brandon W J Brown
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | | | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
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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.
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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
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Norell-Clarke A, Hagström M, Jansson-Fröjmark M. Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship? Front Psychol 2021; 12:677538. [PMID: 34234716 PMCID: PMC8255681 DOI: 10.3389/fpsyg.2021.677538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: According to the Cognitive Model of Insomnia, engaging in sleep-related cognitive processes may lead to sleep problems over time. The aim was to examine associations between five sleep-related cognitive processes and the incidence of insomnia, and to investigate if baseline anxiety and depression influence the associations. Methods: Two thousand three hundred and thirty-three participants completed surveys on nighttime and daytime symptoms, depression, anxiety, and cognitive processes at baseline and 6 months after the first assessment. Only those without insomnia at baseline were studied. Participants were categorized as having or not having incident insomnia at the next time point. Baseline anxiety and depression were tested as moderators. Results: Three cognitive processes predicted incident insomnia later on. Specifically, more safety behaviors and somatic arousal at Time 1 increased the risk of developing insomnia. When investigating changes in the cognitive processes over time, reporting an increase of worry and safety behaviors also predicted incident insomnia. Depressive symptoms moderated the association between changes in worry and incident insomnia. Conclusion: These findings provide partial support for the hypothesis that cognitive processes are associated with incident insomnia. In particular, safety behaviors, somatic arousal, and worry increase the risk for incident insomnia. Preventative interventions and future research are discussed.
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Affiliation(s)
- Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, The Centre for Psychotherapy, Education & Research, Region Stockholm, Stockholm, Sweden
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Carter SG, Eckert DJ. Effects of hypnotics on obstructive sleep apnea endotypes and severity: Novel insights into pathophysiology and treatment. Sleep Med Rev 2021; 58:101492. [PMID: 33965721 DOI: 10.1016/j.smrv.2021.101492] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023]
Abstract
Impaired upper airway anatomy is the main cause of obstructive sleep apnea (OSA). However, there are other important non-anatomical contributors or "endotypes" including ventilatory control instability, poor pharyngeal dilator muscle responsiveness and waking up too easily to minor respiratory events (low arousal threshold). Recent studies have focused on the potential to target specific OSA causes with novel treatments to reduce OSA severity and improve efficacy with existing non-CPAP therapies which are often suboptimal (e.g., mandibular advancement splints). One novel target is pharmacotherapy with hypnotics to increase the threshold for arousal and reduce OSA severity in the approximately 30% of patients who have a low arousal threshold endotype. This increasing body of work has produced varied and at times unexpected findings which have challenged previous knowledge on the effects of hypnotics on upper airway physiology and breathing during sleep in people with OSA. This review provides a concise overview of the latest research that has investigated the effects of common hypnotics/sedative agents on upper airway physiology and OSA severity and potential implications for OSA pathophysiology, treatment and safety. This includes a summary of the latest knowledge on the effects of hypnotics on OSA endotypes. Priorities for future research are also highlighted.
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Affiliation(s)
- Sophie G Carter
- Neuroscience Research Australia (NeuRA) Barker Street and the University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.
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9
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Hedin G, Norell-Clarke A, Hagell P, Tønnesen H, Westergren A, Garmy P. Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176433. [PMID: 32899407 PMCID: PMC7504459 DOI: 10.3390/ijerph17176433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15–17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS ≥ 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (≤1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.
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Affiliation(s)
- Gita Hedin
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden;
- Correspondence: ; Tel.: +46-44-250-38-45
| | - Annika Norell-Clarke
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Department of Social and Psychological Studies, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Peter Hagell
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden;
| | - Albert Westergren
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Health-Promoting Complex Interventions, Department of Health Sciences, Lund University, SE-221 85 Lund, Sweden
| | - Pernilla Garmy
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (A.N.-C.); (P.H.); (A.W.); (P.G.)
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden;
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Brupbacher G, Gerger H, Wechsler M, Zander-Schellenberg T, Straus D, Porschke H, Gerber M, von Känel R, Schmidt-Trucksäss A. The effects of aerobic, resistance, and meditative movement exercise on sleep in individuals with depression: protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:105. [PMID: 31027509 PMCID: PMC6486698 DOI: 10.1186/s13643-019-1018-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The main objective of this review is to assess the effects of aerobic, resistance, and meditative movement exercise on sleep quality in patients with unipolar depression. A secondary goal is to ascertain the effects on sleep duration, sleepiness, daytime functioning, use of hypnotics, and adverse events. METHODS A systematic computerized search will be performed in the following online databases: PubMed, EMBASE (on Ovid), Cochrane Library, PsycINFO (on Ovid), SPORTDiscus (on EBSCOhost), CINHAL (on EBSCOhost), Clinicaltrials.gov , WHO International Clinical Trials Registry, OpenGrey, and ProQuest Dissertations and Theses. Bibliographies of all included studies as well as any other relevant reviews identified via the search will be screened. Randomized trials using aerobic, resistance, or meditative movement exercise interventions which target sleep as a primary or secondary outcome will be included. The primary outcome will be differences in sleep quality at post-intervention. Secondary outcomes will be adverse events, differences in sleep duration, daytime sleepiness and functioning, and the use of hypnotics at post-intervention. Two authors will independently screen the identified records. Disagreement will be resolved by consensus or if no consensus can be reached by adjudication of a designated third reviewer. Data extraction will be done independently by two authors using a standardized and piloted data extraction sheet. Bias in individual studies will be assessed using the revised Cochrane risk of bias tool. The certainty of evidence across all outcomes will be evaluated using the CINeMA (Confidence in Network Meta-Analysis) framework. A frequentist network meta-analysis will be conducted. The systematic review and network meta-analysis will be presented according to the PRISMA for Network Meta-Analyses (PRISMA-NMA) guideline. DISCUSSION This systematic review and network meta-analysis will provide a synthesis of the currently available evidence concerning the effects of aerobic, resistance, and meditative movement exercises on sleep in patients with unipolar depression. Thereby, we hope to accelerate the consolidation of evidence and inform decision-makers on potential benefits and harms. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019115705).
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- Oberwaid AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Monika Wechsler
- University Medical Library Basel, Spiegelgasse 5, 4051, Basel, Switzerland
| | - Thea Zander-Schellenberg
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Doris Straus
- Oberwaid AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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Sandlund C, Hetta J, Nilsson GH, Ekstedt M, Westman J. Impact of group treatment for insomnia on daytime symptomatology: Analyses from a randomized controlled trial in primary care. Int J Nurs Stud 2018; 85:126-135. [DOI: 10.1016/j.ijnurstu.2018.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/20/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
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Deshpande A, Irani N, Balakrishnan R. Study protocol and rationale for a prospective, randomized, double-blind, placebo-controlled study to evaluate the effects of Ashwagandha (Withania somnifera) extract on nonrestorative sleep. Medicine (Baltimore) 2018; 97:e11299. [PMID: 29953014 PMCID: PMC6039614 DOI: 10.1097/md.0000000000011299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Nonrestorative sleep (NRS) is one of the cardinal symptoms of insomnia and can occur independent of other components of insomnia. Among the sleep disturbances, NRS has been little studied in the general population, even though this symptom plays an important role in several medical conditions associated with chronic inflammation such as heart disease, fibromyalgia, and chronic fatigue syndrome, as well as various sleep disorders. There is paucity in the literature about effective treatments for NRS. Ashwagandha (Withania somnifera) has been demonstrated to reduce anxiety and stress, allowing the body to settle down and prepare for sleep. This study will be a double-blind, randomized, placebo-controlled interventional study in NRS population.The NRS participants are identified using Restorative Sleep Questionnaire-weekly version (RSQ-W) questionnaire. Actigraphy and polysomnography are used for the objective assessment of sleep. The other assessments used are Hamilton Anxiety Depression Scale (HADS), World Health Organization Quality of Life (WHOQOL) scales, and C-reactive protein. Routine blood and urine analyses will be conducted to assess the safety of treatment. Duration of study for each participant will be 50 days with "day one" for screening followed by randomization for the treatment. The duration for medicine/placebo intake shall be 42 days.Primary outcome will be to evaluate effect of daily supplement of ashwagandha extract compared with placebo in subjects with NRS at 6 weeks from baseline, as assessed by the total score of RSQ-W. CTRI REGISTRATION NUMBER CTRI/2017/02/007801.
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Treatment preferences and help-seeking behaviors for sleep problems among psychiatric outpatients. Gen Hosp Psychiatry 2018; 51:112-117. [PMID: 28865845 DOI: 10.1016/j.genhosppsych.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To understand treatment preferences and help-seeking behaviors among psychiatric patients for their sleep problems, and to examine determinants of problem recognition and help-seeking among patients with sleep difficulties. METHOD A cross-sectional survey was conducted among psychiatric outpatients in Singapore (n=400). Participants completed questionnaires that assessed their sleep quality, daytime fatigue, help-seeking behavior, treatment preferences for sleep problems, and sociodemographic information. Multiple logistic regressions were used to identify correlates of patients who recognized their sleep difficulties and of those who had sought help. RESULTS Mental health professionals were the most preferred choice (60.8%) for consultation on sleep problems. Among patients with poor sleep quality (n=275), 28.4% denied having any problems and 38.9% had not sought help. Patients with chronic physical comorbidity were less likely to recognize their sleep problems (OR=0.432, p-value=0.009), while those with psychiatric comorbidity were twice as likely to perceive the problems (OR=2.094, p-value=0.021) and to seek help (OR=1.957, p-value=0.022). Daytime fatigue was associated with higher odds of problem recognition (OR=1.106, p-value=0.001) and help-seeking (OR=1.064, p-value=0.016). CONCLUSION A considerable number of patients did not perceive their poor sleep as an issue and had not sought help for it. General sleep hygiene education is needed for psychiatric patients.
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Rångtell FH, Karamchedu S, Andersson P, Liethof L, Olaya Búcaro M, Lampola L, Schiöth HB, Cedernaes J, Benedict C. A single night of sleep loss impairs objective but not subjective working memory performance in a sex-dependent manner. J Sleep Res 2018; 28:e12651. [PMID: 29383809 PMCID: PMC7379264 DOI: 10.1111/jsr.12651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/01/2017] [Accepted: 11/16/2017] [Indexed: 12/18/2022]
Abstract
Acute sleep deprivation can lead to judgement errors and thereby increases the risk of accidents, possibly due to an impaired working memory. However, whether the adverse effects of acute sleep loss on working memory are modulated by auditory distraction in women and men are not known. Additionally, it is unknown whether sleep loss alters the way in which men and women perceive their working memory performance. Thus, 24 young adults (12 women using oral contraceptives at the time of investigation) participated in two experimental conditions: nocturnal sleep (scheduled between 22:30 and 06:30 hours) versus one night of total sleep loss. Participants were administered a digital working memory test in which eight‐digit sequences were learned and retrieved in the morning after each condition. Learning of digital sequences was accompanied by either silence or auditory distraction (equal distribution among trials). After sequence retrieval, each trial ended with a question regarding how certain participants were of the correctness of their response, as a self‐estimate of working memory performance. We found that sleep loss impaired objective but not self‐estimated working memory performance in women. In contrast, both measures remained unaffected by sleep loss in men. Auditory distraction impaired working memory performance, without modulation by sleep loss or sex. Being unaware of cognitive limitations when sleep‐deprived, as seen in our study, could lead to undesirable consequences in, for example, an occupational context. Our findings suggest that sleep‐deprived young women are at particular risk for overestimating their working memory performance.
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Affiliation(s)
| | | | - Peter Andersson
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Lisanne Liethof
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Lauri Lampola
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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15
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Miley-Åkerstedt A, Hetta J, Åkerstedt T. Criteria for self-reported quantitative sleep characteristics of individuals who sought medical help for disturbed sleep - a survey of a representative sample of the Swedish population. Nat Sci Sleep 2018; 10:295-301. [PMID: 30288132 PMCID: PMC6163006 DOI: 10.2147/nss.s165158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The public often seeks rule-of-thumb criteria for good or poor sleep, with a particular emphasis on sleep duration, sleep latency, and the number of awakenings each night. However, very few criteria are available. AIM The present study sought to identify such criteria. METHODS Whether or not a person has sought medical help for sleep problems was selected as an indicator of poor sleep. The group that was studied constituted a representative sample of the general Swedish population (N=1,128), with a response rate of 72.8%. RESULTS Logistic regression analysis, with an adjustment for age and gender, showed an increased OR for a weekday sleep duration of ≤6 hour, (OR >2, and for <5 hour: OR >6). For weekend sleep, the value was ≤6 hour (OR >2). For awakenings per night, the critical value was ≥2 (OR >2, and for ≥5 awakenings: OR >9), and for a sleep latency the critical value was ≥30 minutes (OR >2, and for ≥45 minutes: OR >6). Adding difficulties falling asleep and early morning awakening (considered qualitative because of the reflected "difficulty"), led to the elimination of all the quantitative variables, except for the number of awakenings. The addition of "negative effects on daytime functioning" and "sleep being a big problem" resulted in the elimination of all the other predictors except age. CONCLUSION It was concluded that weekday sleep ≤6 hour, ≥2 awakenings/night, and a sleep latency of ≥30 minutes, can function as criteria for poor sleep, but that qualitative sleep variables take over the role of quantitative ones, probably because they represent the integration of quantitative indicators of sleep.
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Affiliation(s)
- Anna Miley-Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, .,Psychology Clinic, Karolinska Hospital, Stockholm, Sweden
| | - Jerker Hetta
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden,
| | - Torbjörn Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, .,Stress Research Institute, Stockholm University, Stockholm, Sweden,
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16
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Orui M, Ueda Y, Suzuki Y, Maeda M, Ohira T, Yabe H, Yasumura S. The Relationship between Starting to Drink and Psychological Distress, Sleep Disturbance after the Great East Japan Earthquake and Nuclear Disaster: The Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101281. [PMID: 29064443 PMCID: PMC5664781 DOI: 10.3390/ijerph14101281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 01/16/2023]
Abstract
This longitudinal study aimed to investigate the prevalence of newly-started drinkers and their continuing drinking behaviors after the Great East Japan earthquake. Moreover, the relationships between newly-started drinking and psychological factor, disaster-related experience, and perceived radiation risk were examined. We used data from 37,687 pre-disaster non-drinkers who participated in the 2012 and 2013 surveys conducted in Fukushima. We defined newly-started drinkers as those who did not drink before the disaster but who began drinking after the disaster, based on information collected retrospectively. In 2012, 9.6% of non-drinkers began drinking, of which the prevalence of heavy drinkers was 18.4%. The prevalence of continued drinking among newly-started drinkers in 2013 was 53.8%. Logistic regression analyses revealed post-disaster newly-started drinking was significantly associated with being male, less than 65 years old, sleep dissatisfaction and psychological distress (Kessler 6 ≤ 13) when this model was adjusted for disaster-related experience and perceived radiation risk. Moreover, psychological distress and heavy drinking were significant risk factors for continued drinking among newly-started drinkers. Newly-started drinkers might use alcohol to cope with disaster-related stress. Thus, they may be targeted for disaster-related health services. Moreover, early intervention should encourage responsible drinking, since post-disaster heavy drinkers were likely to continue heavy drinking.
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Affiliation(s)
- Masatsugu Orui
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Yuka Ueda
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Yuriko Suzuki
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan.
| | - Masaharu Maeda
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
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17
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Carrier J, Semba K, Deurveilher S, Drogos L, Cyr-Cronier J, Lord C, Sekerovick Z. Sex differences in age-related changes in the sleep-wake cycle. Front Neuroendocrinol 2017; 47:66-85. [PMID: 28757114 DOI: 10.1016/j.yfrne.2017.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/09/2017] [Accepted: 07/19/2017] [Indexed: 02/06/2023]
Abstract
Age-related changes in sleep and circadian regulation occur as early as the middle years of life. Research also suggests that sleep and circadian rhythms are regulated differently between women and men. However, does sleep and circadian rhythms regulation age similarly in men and women? In this review, we present the mechanisms underlying age-related differences in sleep and the current state of knowledge on how they interact with sex. We also address how testosterone, estrogens, and progesterone fluctuations across adulthood interact with sleep and circadian regulation. Finally, we will propose research avenues to unravel the mechanisms underlying sex differences in age-related effects on sleep.
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Affiliation(s)
- Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, Québec, Canada; Département de psychologie, Université de Montréal, Montréal, Québec, Canada.
| | - Kazue Semba
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel Deurveilher
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren Drogos
- Departments of Physiology & Pharmacology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Cyr-Cronier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Catherine Lord
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Zoran Sekerovick
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
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18
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Sgoifo A, Bignamini A, La Mantia L, Celani MG, Parietti P, Ceriani MA, Marazzi MR, Proserpio P, Nobili L, Protti A, Agostoni EC. Integrated Imaginative Distention Therapy to Cope with Fatigue. DIMMI SI Study: The First Randomized Controlled Trial in Multiple Sclerosis. Neurol Ther 2017; 6:213-223. [PMID: 28795383 PMCID: PMC5700903 DOI: 10.1007/s40120-017-0081-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Fatigue is a frequent, disabling, and difficult to treat symptom in neurological disease and in other stress-related conditions; Integrated Imaginative Distention (IID) is a therapy combining muscular and imaginative relaxation, feasible also in disabled subjects; the DIMMI SI trial was planned to evaluate IID efficacy on fatigue. Methods The design was a parallel, randomised 1:1 (intervention:waiting list), controlled, open-label trial. Participants were persons with multiple sclerosis (pwMS), persons with insomnia (pwINS), and health professionals (HP) as conditions related to fatigue and stress. The primary outcome was the post-intervention change of fatigue; secondary outcomes were changes in insomnia, stress, and quality of life (QoL). Eight IID weekly training group sessions were delivered by a skilled psychotherapist. The study lasted 12 months. Results One hundred and forty-four subjects were enrolled, 48 for each condition. The mean change in Modified Fatigue Impact Scale (MFIS) score among exposed was 7.7 [95% CI 1.1, 14.4] (P = 0.023) in pwMS; 7.1 [1.9, 12.3] (P = 0.007) among pwINS, and 11.3 [4.3, 18.2] among HP (P = 0.002). At the last follow-up, the benefit was confirmed on physical fatigue for pwMS, on total fatigue for pwINS and HP. Conclusions DIMMI SI is the first randomized controlled trial evaluating the efficacy of IID on fatigue. IID resulted a complementary intervention to reduce fatigue in stress-related conditions, in both health and disease status. NCT02290990ClinicalTrials.gov. Electronic supplementary material The online version of this article (doi:10.1007/s40120-017-0081-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annalisa Sgoifo
- Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Angelo Bignamini
- Department of Pharmaceutical Sciences, School of Specialization in Hospital Pharmacy, University of Milan, Milan, Italy
| | - Loredana La Mantia
- Multiple Sclerosis Centre, Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Maria G Celani
- UOC Neurophysiopathology Division, A.O. Perugia, Perugia, Italy
| | | | | | - Maria R Marazzi
- Multiple Sclerosis Centre, Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Paola Proserpio
- Sleep Disorders Center and Claudio Munari Neurosurgery Epilepsy Center, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Lino Nobili
- Sleep Disorders Center and Claudio Munari Neurosurgery Epilepsy Center, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessandra Protti
- Multiple Sclerosis Centre, Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Elio C Agostoni
- Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
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Chen PJ, Huang CLC, Weng SF, Wu MP, Ho CH, Wang JJ, Tsai WC, Hsu YW. Relapse insomnia increases greater risk of anxiety and depression: evidence from a population-based 4-year cohort study. Sleep Med 2017; 38:122-129. [PMID: 29031746 DOI: 10.1016/j.sleep.2017.07.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We investigated the longitudinal impacts of insomnia on the subsequent developments of anxiety and depression during a four-year follow-up. We further categorized individuals with insomnia into different insomnia subgroups to examine whether the risk of anxiety and depression varies by subtype. METHODS Participants were identified from National Health Insurance enrollees in Taiwan during 2002-2009. The study included 19,273 subjects with insomnia and 38,546 matched subjects without insomnia. All subjects did not have previous diagnosis of insomnia, sleep apnea, anxiety, or depression. RESULTS Compared with non-insomniacs, insomniacs had a higher risk of developing anxiety only [adjusted hazard ratio (HR) = 8.83, 95% CI = 7.59-10.27], depression only (adjusted HR = 8.48, 95% CI = 6.92-10.39), and both anxiety and depression (adjusted HR = 17.98, 95% CI = 12.65-25.56). When breaking down the insomnia subgroups, individuals with a relapse of insomnia (adjusted HR = 10.42-26.80) had the highest risk of anxiety only, depression only, and both anxiety and depression, followed by persistent insomnia (adjusted HR = 9.82-18.98), then remitted insomnia (adjusted HR = 4.50-8.27). All three insomnia subgroups had a greater four-year cumulative incidence rate than the non-insomnia group for anxiety only, depression only, and both anxiety and depression (p < 0.0001). CONCLUSION Our findings reinforce the clinical predictor role of insomnia in the future onset of anxiety or/and depression. Awareness of insomnia and treatment of insomnia should be recommended at clinics, and patterns of insomnia should be monitored to help treatment and control of subsequent psychiatric disorders. Future research with comprehensive data collection is needed to identify factors that contribute to different insomnia subtypes.
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Affiliation(s)
- Ping-Jen Chen
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Charles Lung-Cheng Huang
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan; Department of Social Work, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ping Wu
- Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wan-Chi Tsai
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Wen Hsu
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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20
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Sandlund C, Hetta J, Nilsson GH, Ekstedt M, Westman J. Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment. Int J Nurs Stud 2017; 72:30-41. [DOI: 10.1016/j.ijnurstu.2017.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
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