Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: the differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia

Mechanisms underlying the associations between different types of nature exposure and sleep duration: An 18-country analysis

Whilst green space has been linked to healthier sleep outcomes, the roles of specific types of nature exposure, potential underlying mechanisms, and between-country variations in nature-sleep associations have received little attention. Drawing on cross-sectional survey data from an 18-country sample of adults (N = 16,077) the current study examined: 1) the relative associations between six different types of nature exposure (streetscape greenery, blue view from home, green space within 1 km, coast within 1 km, green space visits, blue space visits) and insufficient sleep (<6 h vs. 7-10 h per day); 2) whether these relationships were mediated by better mental wellbeing and/or physical activity; and 3) the consistency of these pathways among the different countries. After controlling for covariates, neighbourhood nature measures (green space, coast within 1 km) were not significantly associated with insufficient sleep; but nature visible from home (streetscape greenery, blue views) and recreational visits to green and blue spaces were each associated with less insufficient sleep. Significant nature-sleep associations were mediated, to varying degrees, by better mental wellbeing, but not self-reported physical activity. Country-level heterogeneity in the strength of nature-sleep associations was observed. Increasing nature visible from the home may represent a promising strategy for promoting healthier sleep duration at the population level, whilst nature-based interventions encouraging individuals to spend time in local green/blue spaces may be an appropriate target to assist individuals affected by insufficient sleep.

Move your feet and sleep: A longitudinal dynamic analysis of self-reported exercise, sedentary behavior, and insomnia symptoms

INTRODUCTION

Insomnia symptoms are associated with poor physical and mental health. Exercise is associated with good sleep while sedentary behavior is associated with poor sleep. This study investigated the longitudinal, dynamic associations among exercise, sedentary behavior, and insomnia symptoms.

METHODS

Seven hundred and fifty-six adults (Mage=47.2years, 54.9% female) took part in an online longitudinal study investigating sleep and health across the lifespan. Participants reported duration of moderate-to-strenuous exercise, percentage of day spent sitting, and insomnia symptoms (Insomnia Severity Index [ISI]). The ISI was scored as a total score and two-factor scores: (1) Sleep Disturbance (items 1, 2, 3) and (2) Daytime Dysfunction (items 4, 5, 6, 7). Multilevel modeling was used to examine the typical (i.e., between-persons) and individual (i.e., within-persons) associations among sedentary behavior, exercise, and insomnia symptoms.

RESULTS

Sedentary behavior was significantly associated with total ISI scores at both the between-person and within-person levels (β = 0.036, t = 3.23, p = .001; β = 0.014, t = 1.99, p = .048). Both between-persons and within-person levels of sedentary behavior were associated with Daytime Dysfunction (β = 0.028, t = 3.79, p < .001; β = 0.009, t = 2.08, p = .039). Exercise was associated with total ISI and Daytime Dysfunction scores at the between-persons level but not at the within-persons level (β = 0.028, t = 2.57, p = .01; β = -0.002, t = -3.02, p = .003).

CONCLUSIONS

Sedentary behavior was a more consistent and robust predictor of insomnia symptoms than exercise. The association between sedentary behavior and insomnia symptoms was dynamic in that when an individual reported being more sedentary than their norm, they also reported more insomnia symptoms. Future analyses should examine potential moderator variables and comorbid conditions.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Research progress of plant-derived natural alkaloids in central nervous system diseases

Central nervous system (CNS) disease is one of the most important causes of human death. Because of their complex pathogenesis, more and more attention has been paid to them. At present, drug treatment of the CNS is the main means; however, most drugs only relieve symptoms, and some have certain toxicity and side effects. Natural compounds derived from plants can provide safer and more effective alternatives. Alkaloids are common nitrogenous basic organic compounds found in nature, which exist widely in many kinds of plants and have unique application value in modern medicine. For example, Galantamine and Huperzine A from medicinal plants are widely used drugs on the market to treat Alzheimer's disease. Therefore, the main purpose of this review is to provide the available information on natural alkaloids with the activity of treating central nervous system diseases in order to explore the trends and perspectives for the further study of central nervous system drugs. In this paper, 120 alkaloids with the potential effect of treating central nervous system diseases are summarized from the aspects of sources, structure types, mechanism of action and structure-activity relationship.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study

BACKGROUND

During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel.

METHODS

We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments.

RESULTS

We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43).

CONCLUSION

We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.

Childhood health conditions and insomnia among adults in mid-life

Background

Little is known regarding the influence of childhood health broadly and childhood health conditions specifically on insomnia throughout adulthood.

Methods

Health and Retirement Study (HRS) Baby Boomers born 1954-1965 were investigated. We fitted regression models predicting self-reported insomnia based on twenty-three retrospectively reported specific childhood health conditions (e.g., measles) and general childhood health measures and adjusted for demographics, childhood socioeconomic status, and adult socioeconomic status.

Results

Nearly all the measures of childhood health significantly increased insomnia symptoms in adulthood. In a model where all measures were included, we found that respiratory disorders, headaches, stomach problems, and concussions were particularly strong predictors of insomnia.

Conclusions

Our findings extend past work illustrating the "long arm" of childhood conditions for health, showing that specific health conditions in childhood may indelibly imprint insomnia risk.

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

STUDY OBJECTIVES

Insomnia, depression, and anxiety show high rates of comorbidity and functional impairment. Transdiagnostic symptom interactions may be implicated in this comorbidity. This network analysis sought to assess how symptoms of insomnia, depression, and anxiety may interact and individually predict impairment across several domains for individuals with insomnia.

METHODS

Baseline psychometric data from a randomised controlled trial were analysed (N = 1711). A regularized partial correlation network was estimated from the symptom data. Centrality (symptom connectivity), community structure (symptom clustering), and bridging (inter-community connectivity) were assessed. The replicability of the network model was assessed via confirmatory analyses in a holdout sample. Separately, Shapley values were estimated to determine the relative importance of each symptom in predicting functioning (i.e., psychological wellbeing, psychosocial functioning, and physical health impairment).

RESULTS

The most connected nodes were uncontrollable worrying; trouble relaxing; and depressed mood/hopelessness. Five communities were identified with trouble relaxing identified as the bridge symptom between communities. The model showed good fit in the holdout sample. Low energy and depressive affect symptoms (feelings of failure/guilt; depressed mood/hopelessness; anhedonia) were key predictors in the relative importance analysis across multiple domains of impairment.

CONCLUSION

Trouble relaxing may be of clinical and transdiagnostic significance in the context of insomnia. In terms of how symptoms relate to functioning, it was clear that, while low energy and feelings of failure/guilt were prominent predictors, a range of symptoms are associated with functional impairment. Consideration of both symptoms and functional impairment across domains may be useful in determining targets for treatment.

CLINICAL TRIAL REGISTRATION

This is a secondary analysis of an original clinical trial.

TRIAL REGISTRATION NUMBER

ISRCTN60530898. Registry URL: https://www.isrctn.com/ISRCTN60530898.

Symptom clusters, associated factors and health-related quality of life in patients with chronic obstructive pulmonary disease: A structural equation modelling analysis

AIMS AND OBJECTIVES

To identify symptom clusters and develop a symptom cluster model among people living with chronic obstructive pulmonary disease (COPD).

BACKGROUND

The examination of symptom clusters in COPD patients is an emerging field of scientific inquiry directed towards symptom management. However, no studies have modelled the relationships among symptom clusters, associated factors and health-related quality of life.

DESIGN

A cross-sectional design with convenience sampling following STROBE guidelines.

METHODS

Data were collected from 450 COPD participants in three university teaching hospitals. Participants were invited to complete a structured questionnaire comprised of a socio-demographic/clinical questionnaire, Integrated Palliative Care Outcome Scale and Clinical Respiratory Questionnaire. Exploratory factor analysis and confirmatory factor analysis were used to identify symptom clusters. Structural equation modelling was used to examine the proposed model.

RESULTS

The respiratory related symptom cluster, psychological symptom cluster and cough-insomnia related symptom cluster were identified. The final model demonstrated a good fit with the data. Gender, stage of disease and monthly income were significant factors associated with symptom clusters. Respiratory related and cough-insomnia related symptom clusters had a direct negative impact on health-related quality of life, while the psychological symptom cluster was found to have a direct and indirect negative effect on health-related quality of life.

CONCLUSIONS

Final COPD symptom cluster model should serve as a framework to guide intervention research targeting symptom clusters to improve health-related quality of life of people living with COPD.

RELEVANCE TO CLINICAL PRACTICE

Nurses should be especially attuned to identify those at most risk of facing a higher symptom burden in this case those who are female, have advanced stage COPD and/or lower income. During the clinical symptom assessment, nurses should pay attention to the close relationships among symptoms within a cluster to identify any 'trigger' symptom that could cause the development or exacerbation of other symptoms.

Development and Initial Validation of the Assessment of Sleep Environment (ASE): Describing and Quantifying the Impact of Subjective Environmental Factors on Sleep

The purpose of this study was to develop and test the reliability and validity of a 13-item self-report Assessment of Sleep Environment (ASE). This study investigates the relationship between subjective experiences of environmental factors (light, temperature, safety, noise, comfort, humidity, and smell) and sleep-related parameters (insomnia symptoms, sleep quality, daytime sleepiness, and control over sleep). The ASE was developed using an iterative process, including literature searches for item generation, qualitative feedback, and pilot testing. It was psychometrically assessed using data from the Sleep and Healthy Activity Diet Environment and Socialization (SHADES) study (N = 1007 individuals ages 22-60). Reliability was determined with an internal consistency and factor analysis. Validity was evaluated by comparing ASE to questionnaires of insomnia severity, sleep quality, daytime sleepiness, sleep control, perceived stress, and neighborhood disorder. The ASE demonstrated high internal consistency and likely reflects a single factor. ASE score was associated with insomnia symptoms (B = 0.09, p < 0.0001), sleep quality (B = 0.07, p < 0.0001), and sleep control (B = -0.01, p < 0.0001), but not daytime sleepiness. The ASE was also associated with perceived stress (B = 0.20, p < 0.0001) and neighborhood disorder (B = -0.01, p < 0.0001). Among sleep environment factors, only smell was not associated with sleep quality; warmth and safety were negatively associated with sleepiness; and of the sleep environment factors, only light/dark, noise/quiet, and temperature (warm/cool) were not associated with insomnia symptoms. The ASE is a reliable and valid measure of sleep environment. Physical environment (light, temperature, safety, noise, comfort, humidity, and smell) was associated with insomnia symptoms and sleep quality but not sleepiness.

Sleep as a Major Determinant for Mental Health Outcomes in Elite Australian Football League (AFL) Athletes

PURPOSE

The link between mental health and sleep is well documented in the general population, with the majority of mental health disorders involving some type of sleep disturbance. There is, however, limited research investigating this relationship in elite athlete populations. The aim of this study was to identify whether sleep and mental health outcomes are associated in elite athletes, and if so, what measures of sleep were the most predictive of mental health outcomes.

METHODS

A comprehensive assessment of sleep was conducted using both objective and subjective methods in 68 Australian Football League athletes (male, mean age = 23.3 ± 3.4 years, median = 23 range 18 - 32 years). Rest-activity patterns were recorded using wrist actigraphy for an average of 13.8 ± 3.6 days (total 884 days data). Subjective sleep data were collected using daily sleep diaries and validated questionnaires. Validated mental health questionnaires were used to assess depression, anxiety and stress symptoms. Multiple linear regression modelling was used to investigate the relationship between sleep and mental health.

RESULTS

Using a combination of sleep variables, poor sleep predicted 51% of the variation in clinical depression, 42% of the variation in stress, and 31% in clinical anxiety. Self-reported insomnia symptoms (using the Insomnia Severity Index), were the strongest predictors of poor mental health outcomes, followed by objective sleep monitoring via actigraphy. Sleep diary measures were the weakest predictors of mental health.

CONCLUSION

Our results present poor sleep as a major determinant of impaired mental health outcomes in a population that is constantly under pressure to perform at the highest level and may underreport mental health symptoms. These findings support the inclusion of sleep assessments as an initial screening tool as well as a core component of all routine health and rehabilitation programs.

Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample

Female menstrual health and its relationship with sleep is an understudied subject. The aim of this investigation was to determine the association between the two in a community sample. Data were obtained from n = 579 menstruating females who participated in the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) study, a community-based sample of adults aged 22-60 years. Participants were asked, "How regular is your period?", with response choices of "very regular", "mostly regular", "fairly regular" and "not regular". They were also asked, "How much bleeding do you usually experience during your period?" Response choices were: "very heavy", "heavy", "medium", "light" or "very light". These were evaluated as ordinal outcomes. Sleep-related predictors included sleep duration (in hr; ≤ 6 [short], 7-9 [normal] and ≥ 9 [long]), Insomnia Severity Index score, Pittsburgh Sleep Quality Index score, Epworth Sleepiness Scale score and Fatigue Severity Scale score. Covariates included age, education, income, race/ethnicity and body mass index. Short sleep duration was associated with heavier bleeding (odds ratio = 1.46, p = 0.026) and greater cycle irregularity (odds ratio = 1.44, p = 0.031) as compared with normal sleep. Higher Pittsburgh Sleep Quality Index score was associated with greater cycle irregularity (odds ratio = 1.05, p = 0.022). Higher Fatigue Severity Scale score was associated with heavier bleeding (odds ratio = 1.02, p = 0.003) and greater cycle irregularity (odds ratio = 1.02, p = 0.008). Long sleep, Insomnia Severity Index and Epworth Sleepiness Scale were not associated with either outcome. These results demonstrate an association between short sleep duration, poor sleep quality, fatigue, stress and depression with heavier bleeding and menstrual cycle irregularity, highlighting the need for further studies to improve treatment options.

Why Have Sleep Problems in Later-Midlife Grown Following the Great Recession? A Comparative Cohort Analysis

OBJECTIVES

This research compares three cohorts of individuals in their fifth decade of life and examines whether sleep problems are greater in cohorts following the Great Recession. We argue that these differences will occur because postrecession cohorts are exposed to more economic burdens that harm sleep. We also suggest that postrecession exposure to economic burdens will be amplified among women, leading to greater cross-cohort differences in sleep problems.

METHOD

Data were derived from the Health and Retirement Study, focusing on cohort surveys starting in 2004, 2010, and 2016 (N = 12,129). Structural equation models compared cohorts in latent levels of sleep problems and also examined whether economic burdens mediated cohort differences. Interactions tested whether cohort differences varied between men and women.

RESULTS

The 2010 and 2016 cohorts had higher mean levels of sleep problems than the 2004 cohort. Greater postrecession exposure to economic burdens largely explained inter-cohort change in sleep problems, with this pattern stronger among women.

DISCUSSION

Americans are approaching their senior years increasingly burdened by economic stressors that incur sleep problems. Practitioners and aging researchers should be prepared to address deleterious health consequences created by heightened sleep impairments.

The role of sleep disturbances in cognitive function and depressive symptoms among community-dwelling elderly with sleep complaints

OBJECTIVE

The relationships between sleep problems, cognitive impairments, and depression have been established in the aging population. However, less is known about the role of late-life onset insomnia and sex involved in these dyad or tripartite relationships. This study aimed to consider onset age of insomnia and sex in the relationship between sleep parameters, cognition and depression among older adults with current insomnia complaints.

METHOD

A multistep sampling method was adopted to recruit participants with current insomnia complaints in China in 2018. Sleep measures include onset age of insomnia (64 years old or before vs during/after 65), three factors from insomnia severity index (ISI; nighttime, daytime, and perception), excessive daytime sleepiness, and sleep duration. Outcome measures were mini-mental state examination (MMSE) and center for epidemiologic studies depression scale (CESD).

RESULTS

The average age of older adults was 75 (SD = 7.1). Among them, 62% participants are female. In general, older aged, female, late-life onset insomnia as well as interaction of sex * onset age of insomnia were significantly associated with poorer cognition. Yet, age, sex, and onset age of insomnia were not significant indicators for depression. For female participants, later onset of insomnia, nighttime symptoms of insomnia, excessive daytime sleepiness and depression were risk factors for cognitive decline. Nevertheless, only daytime sleepiness, together with depression, were found positively associated with male participants' cognitive decline.

CONCLUSIONS

There were robust associations between daytime sleepiness, depressive symptoms, and poor cognitive performance. More importantly, late-life onset insomnia was particularly indicative for poor cognitive performance among female older adults. Future study should emphasize the specific mechanism involved in changes of sleep patterns in the development of cognitive impairment among older adults. Sex differences in the relationship between onset age of insomnia and cognition also require further attention.

Anti-depressant effect of cerebrolysin in reserpine-induced depression in rats: Behavioral, biochemical, molecular and immunohistochemical evidence

Depression is a major psychological disorder that contributes to global health problem. This study aimed to evaluate the anti-depressant effect of Cerebrolysin (CBL) in Reserpine-induced depressed rats, its effect on oxidative stress, inflammation, regulatory cyclic AMP-dependent response element binding protein (CREB)/brain derived neurotropic factor (BDNF) signaling pathways, brain monoamines and histopathological changes was assessed. Rats received either the vehicle or Reserpine (0.5 mg/kg, i.p.) for 14 days. The other three groups were pretreated with CBL (2.5, 5 ml/kg; i.p.) or fluoxetine (FLU) (5 mg/kg, p.o.), respectively for 14 days, 30 min before reserpine injection. Then analyses were conducted. CBL reversed Reserpine-induced reduction in latency to immobility and prolongation of immobility time in the forced swimming test (FST), reduced malondialdehyde (MDA), elevated reduced glutathione (GSH), reduced tumor necrosis factor-alpha (TNF-ɑ), and elevated BDNF cortical and hippocampal brain contents. CBL elevated protein kinase A (PKA) and nuclear factor kappa-B (NF-κB) cortical and hippocampal protein expressions. CBL also ameliorated alterations in mRNA expressions of protein kinase B (AKT), CREB and BDNF in the cortical and hippocampal tissues. CBL elevated nor-epinephrine (NE), serotonin (5-HT), and dopamine (DA) and reduced 5-Hydroxyindoleacetic acid (5-HTAA), 3,4-Dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) cortical and hippocampal contents. CBL effects were in parallel to those observed with the standard anti-depressant drug, FLU. This study shows that CBL exerted anti-depressant effect evidenced by attenuation of oxidative stress and inflammation as well as enhancement of neurogenesis, amelioration of monoaminergic system and histopathological changes.

Residual symptoms after natural remission of insomnia: associations with relapse over 4 years

STUDY OBJECTIVES

Chronic insomnia tends to "wax and wane" over lifetime. The presence of residual insomnia symptoms is common, especially among naturally remitted individuals. This study aims to examine the features of these residual symptoms and their potential association with future relapse.

METHODS

A population-based data set on the natural history of insomnia was used for this secondary analysis. Residual insomnia symptoms were investigated in those who had insomnia symptoms/syndrome at baseline and achieved full remission (according to predetermined diagnostic algorithm) within the following 1 year. Cox regressions were used to determine the hazard ratio (HR) of each residual symptom for predicting relapse in the next 4 years. The nature and severity of residual symptoms were examined with an extended version of the Insomnia Severity Index (ISI), which incorporates additional items on sleep quality and specific sleep-related daytime impairments (on daytime fatigue, cognitive functioning, mood, interpersonal relationship, and daily activities). In addition, the presence of depressive symptoms and medical conditions were controlled for in investigating risks of insomnia relapse.

RESULTS

A total of 434 participants were included in this study (age ranges from 18 to 94; 65.9% female); 248 of them had relapsed within 4 years. The response rate ranged from 78% to 83%. The most frequently reported residual symptoms with at least moderate severity (ISI items ≥2 on 0-4 ISI item scale) were poor "Quality of sleep" (39.2 %), followed by "difficulty maintaining sleep" (DMS; 27%). The most common residual daytime impairments related to insomnia were fatigue (24.7 %), mood disturbances (23%) and cognitive disturbances (22.6%). After controlling for baseline insomnia and depression severity and concurrent physical diseases, impairments of cognition (HR = 1.46), poor quality of sleep (HR = 1.43), disturbed mood (HR = 1.39), being female (HR = 1.36), DMS (HR = 1.35), and fatigue (HR = 1.24) were significantly associated with insomnia relapse in the next 4 years. Moreover, residual poor sleep quality and daytime insomnia symptoms were independent of DMS in predicting relapse. Subgroup regressions according to sex showed that for male participants, residual cognition impairments (HR = 1.98) was the most significant predictors of future relapse, whereas residual DMS (HR = 1.46) significantly predicted relapse for women only.

CONCLUSION

A wide range of residual symptoms exists in individuals with naturally remitted insomnia. Notably, residual DMS is the most common residual nighttime symptom and the only nighttime symptom associated with insomnia relapse. Additionally, perceived poor sleep quality and cognitive, mood, and somatic impairments attributed to sleep disturbances are also related to future relapse. Attention to these residual symptoms when initiating insomnia treatment is warranted to minimize future relapse.

Depressive symptoms associated with physical health problems in midlife women: A longitudinal study

BACKGROUND

It is unclear if the relationship between depression and physical health problems in women is related to age, reproductive stage, obesity or socio-demographic risk factors.

METHODS

Longitudinal data were obtained every 6 months for 36 months in 264 midlife African American, Caucasian and Latina women who began the study as healthy regularly menstruating 40 to 50-year-olds; 75 transitioned to peri- or post-menopause by 36 months. Scores of 16 or higher on the Center for Epidemiologic Studies-Depression (CES-D) scale were used to estimate depression risk.

RESULTS

Depression risk was 28% at study initiation and 25% at 36 months. Significantly more women at risk for depression were unemployed, obese, or hypertensive. Women at risk were more likely to become peri- or post-menopausal during the study period. A higher percentage (38%) of overweight and obese women had CES-D scores ≥ 16 compared to normal weight women (23%; p < .001). Over half (58%) of the 73 women at higher depression risk at the initial visit reported a health problem or chronic illness at 36 months, compared to only 36% of the 191 women with CES-D scores <16 (p = .001).

LIMITATIONS

This was a secondary analysis of data from a relatively healthy sample of women in the decade before menopause. Chronic illness was self-reported and the CES-D is a screening tool for depressive symptoms rather than a clinical diagnostic tool.

CONCLUSIONS

Health care providers may be underestimating the impact of unemployment on depressive symptoms, obesity and chronic health problems in midlife women.

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating disorder, which results in additive impairments to patients' sleep, daytime functioning, and quality of life, and complex diagnostic and treatment decisions for clinicians. Although the presence of COMISA was first recognized by Christian Guilleminault and colleagues in 1973, it received very little research attention for almost three decades, until the publication of two articles in 1999 and 2001 which collectively reported a 30%-50% co-morbid prevalence rate, and re-ignited research interest in the field. Since 1999, there has been an exponential increase in research documenting the high prevalence, common characteristics, treatment complexities, and bi-directional relationships of COMISA. Recent trials indicate that co-morbid insomnia symptoms may be treated with cognitive and behavioral therapy for insomnia, to increase acceptance and use of continuous positive airway pressure therapy. Hence, the treatment of COMISA appears to require nuanced diagnostic considerations, and multi-faceted treatment approaches provided by multi-disciplinary teams of psychologists and physicians. In this narrative review, we present a brief overview of the history of COMISA research, describe the importance of measuring and managing insomnia symptoms in the presence of sleep apnea, discuss important methodological and diagnostic considerations for COMISA, and review several recent randomized controlled trials investigating the combination of CBTi and CPAP therapy. We aim to provide clinicians with pragmatic suggestions and tools to identify, and manage this prevalent COMISA disorder in clinical settings, and discuss future avenues of research to progress the field.

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

BACKGROUND

Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults.

AIMS

This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults.

METHODS

This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis.

RESULTS

Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35-0.61), smoking status (B = 1.64, 95% CI = 0.13-3.16), higher pain intensity (B = 0.39, 95% CI = 0.11-0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05-0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12-0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91-1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08-1.24), pain (OR = 2.08, 95% CI = 1.14-3.80), chronic disease (OR = 1.27, 95% CI = 1.07-1.51) and depression (OR = 2.38, 95% CI = 1.22-4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact.

CONCLUSIONS

Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.