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Lin J, Song Z, Li Y, Chiang C, Hirakawa Y, Nakano Y, Hong YJ, Matsunaga M, Ota A, Tamakoshi K, Yatsuya H. Nonrestorative Sleep and Type 2 Diabetes Incidence: The Aichi Workers' Cohort Study. J Epidemiol 2024; 34:428-433. [PMID: 38281747 PMCID: PMC11330709 DOI: 10.2188/jea.je20230184] [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] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The term "nonrestorative sleep (NRS)" refers to an unrefreshed feeling at wake-up and is a domain of poor sleep quality. Previous research has demonstrated that NRS is linked to a number of diseases and adverse health outcomes, but less is known regarding the link between NRS and diabetes, particularly in Japanese. METHODS We studied 3,665 middle-aged male participants of the Aichi Workers' Cohort Study who were followed-up from 2002 through 2019. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident type 2 diabetes mellitus (T2DM) in relation to NRS adjusted for potential confounding variables. RESULTS During a median follow-up of 14.6 years, 421 type 2 diabetes cases were identified. Participants with NRS had a higher crude incidence rate of T2DM (11.2/1,000 person-years), compared to participants without NRS (9.3/1,000 person-years). In the fully adjusted model, individuals who reported having NRS had a significantly higher risk of developing T2DM (HR1.36; 95% CI, 1.10-1.67). The association was observed only in participants under 50 years old (HR 1.82; 95% CI, 1.36-2.43), not in the older (50 years or older) participants (P for interaction = 0.025). In contrast, stratified analyses by the presence of shift work, obesity, or sleep duration showed similar associations in all the strata. CONCLUSION NRS was associated with higher risk of T2DM in middle-aged Japanese male workers independent of a variety of lifestyle factors and other sleep problems.
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Affiliation(s)
- Jingyi Lin
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Zean Song
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Yuanying Li
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Chifa Chiang
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Yoshihisa Hirakawa
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Yoshihisa Nakano
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Young-Jae Hong
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
| | - Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine
| | - Hiroshi Yatsuya
- Department of Public Health and Health System, Nagoya University Graduate School of Medicine
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Qin Z, Zhu Y, Shi DD, Chen R, Li S, Wu J. The gap between statistical and clinical significance: time to pay attention to clinical relevance in patient-reported outcome measures of insomnia. BMC Med Res Methodol 2024; 24:177. [PMID: 39118002 PMCID: PMC11308508 DOI: 10.1186/s12874-024-02297-0] [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: 12/29/2023] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Appropriately defining and using the minimal important change (MIC) and the minimal clinically important difference (MCID) are crucial for determining whether the results are clinically significant. The aim of this study is to survey the status of randomized controlled trials (RCTs) for insomnia interventions to assess the inclusion and interpretation of MIC/MCID values. METHODS We conducted a cross-sectional study to survey the status of RCTs for insomnia interventions to assess the inclusion and appropriate interpretation of MIC/MCID values. A literature search was conducted by searching the main sleep medicine journals indexed in PubMed, the Excerpta Medica Database (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify a broad range of search terms. We included RCTs with no restriction on the intervention. The included studies used the Insomnia Severity Index (ISI) or the Pittsburgh Sleep Quality Index (PSQI) questionnaire as the outcome measures. RESULTS 81 eligible studies were identified, and more than one-third of the included studies used MIC/MCID (n = 31, 38.3%). Among them, 21 studies with ISI as the outcome used MIC defined as a relative decrease ranging from 3 to 8 points. The most frequently used MIC value was a 6-point decrease (n = 7), followed by 8-point (n = 6) and 7-point decrease (n = 4), a 4 to 5-points decrease (n = 3), and a 30% reduction from baseline; 6 studies used MCID values, ranging from 2.8 to 4 points. The most frequently used MCID value was a 4-point decrease in the ISI (n = 4). 4 studies with PSQI as the outcome used a 3-point change as the MIC (n = 2) and a 2.5 to 2.7-point difference as MCID (n = 2). 4 non-inferiority design studies considered interval estimation when drawing clinically significant conclusions in their MCID usage. CONCLUSIONS The lack of consistent MIC/MCID interpretation and usage in outcome measures for insomnia highlights the urgent need for further efforts to address this issue and improve reporting practices.
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Affiliation(s)
- Zongshi Qin
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China.
| | - Yidan Zhu
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Dong-Dong Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rumeng Chen
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Jiani Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Iorfino F, Varidel M, Capon W, Richards M, Crouse JJ, LaMonica HM, Park SH, Piper S, Song YJC, Gorban C, Scott EM, Hickie IB. Quantifying the interrelationships between physical, social, and cognitive-emotional components of mental fitness using digital technology. NPJ MENTAL HEALTH RESEARCH 2024; 3:36. [PMID: 38977903 PMCID: PMC11231280 DOI: 10.1038/s44184-024-00078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 06/08/2024] [Indexed: 07/10/2024]
Abstract
Mental fitness is a construct that goes beyond a simple focus on subjective emotional wellbeing to encompass more broadly our ability to think, feel, and act to achieve what we want in our daily lives. The measurement and monitoring of multiple (often interacting) domains is crucial to gain a holistic and complete insight into an individual's mental fitness. We aimed to demonstrate the capability of a new mobile app to characterise the mental fitness of a general population of Australians and to quantify the interrelationships among different domains of mental fitness. Cross-sectional data were collected from 4901 adults from the general population of Australians engaged in work or education who used a mobile app (Innowell) between September 2021 and November 2022. Individuals completed a baseline questionnaire comprised of 26 questions across seven domains of mental fitness (i.e., physical activity, sleep and circadian rhythms, nutrition, substance use, daily activities, social connection, psychological distress). Network analysis was applied at both a domain-level (e.g., 7 nodes representing each cluster of items) and an individual item-level (i.e., 26 nodes representing all questionnaire items). Only 612 people (12%) were functioning well across all domains. One quarter (n = 1204, 25%) had only one problem domain and most (n = 3085, 63%) had multiple problem domains. The two most problematic domains were physical activity (n = 2631, 54%) and social connection (n = 2151, 44%), followed closely by daily activity (n = 1914, 39%). At the domain-level, the strongest association emerged between psychological distress and daily activity (r = 0.301). Psychological distress was the most central node in the network (as measured by strength and expected influence), followed closely by daily activity, sleep and circadian rhythms and then social connection. The item-level network revealed that the nodes with the highest centrality in the network were: hopelessness, depression, functional impairment, effortfulness, subjective energy, worthlessness, and social connectedness. Social connection, sleep and circadian rhythms, and daily activities may be critical targets for intervention due to their widespread associations in the overall network. While psychological distress was not among the most common problems, its centrality may indicate its importance for indicated prevention and early intervention. We showcase the capability of a new mobile app to monitor mental fitness and identify the interrelationships among multiple domains, which may help people develop more personalised insights and approaches.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Matthew Richards
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shin Ho Park
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Sarah Piper
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Sekizuka H, Miyake H. Overtime work is related to nonrestorative sleep independently of short sleep time among a Japanese occupational population. Int Arch Occup Environ Health 2024; 97:75-80. [PMID: 38047958 DOI: 10.1007/s00420-023-02027-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The symptoms of insomnia are defined as difficulty falling asleep, difficulty staying asleep, and early awakening. Although also a symptom of insomnia, nonrestorative sleep (NRS) is clearly more associated with objective indices than other insomnia symptoms. However, the link between NRS and overtime work duration is poorly understood. METHODS The results of a single year's medical examinations were investigated for 26,144 Japanese office workers who were 30 to 59 years old. NRS status and lifestyle were collected through a computer-assisted medical interview. The subjects were asked about the presence or absence of NRS and their lifestyles in the most recent two to three months. The subjects were asked about their sleep times and average overtime durations per month (< 20 h/month, ≥ 20 but < 40 h/month, ≥ 40 but < 60 h/month, and ≥ 60 h/month). The relationships between NRS and overtime work duration adjusted for sleep time were also analyzed. RESULTS The proportion of subjects with NRS showed a stepwise increase as overtime work hours increased. A logistic regression analysis was performed using NRS as an objective variable. The multivariate analysis demonstrated that overtime work duration (OR, 1.13; 95% CI 1.10-1.17; P < 0.001; per one-category increase) was an independent determinant of NRS. CONCLUSION For office workers, long hours of overtime work increased the NRS prevalence at any sleep duration.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, FUJITSU Clinic, 4-1-1 Kamikodanaka, Nakahara-ku, Kawasaki, 211-8588, Kanagawa, Japan.
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa, Japan.
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5
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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [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: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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6
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Sekizuka H, Miyake H. Relationship between nonrestorative sleep and heartburn among a Japanese occupational population. Indian J Gastroenterol 2023; 42:542-548. [PMID: 37355485 DOI: 10.1007/s12664-023-01366-4] [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: 11/15/2022] [Accepted: 03/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Nonrestorative sleep (NRS) is a symptom of insomnia and is clearly more associated with objective indices than other insomnia symptoms. Gastroesophageal reflux disease (GERD) and insomnia are known to be strongly related. However, the link between NRS and heartburn, a main symptom of GERD, is poorly understood. Therefore, the relationships between them were investigated in addition to sleep duration. METHODS The results of a single year's medical examinations were investigated for 29,475 Japanese active office workers who were 20 to 59 years old. NRS and heartburn were investigated in a medical interview using a personal computer. The relationships between NRS and heartburn in addition to sleep duration were also analyzed. RESULTS The subjects were 46.6 ± 8.7 years old (mean ± SD) and 27% and 13% of them had NRS and heartburn, respectively. The presence of NRS together with a sleep duration of ≤ 5, 6, 7 or ≥ 8 hours was an independent comorbid factor for heartburn compared with the absence of NRS together with a sleep duration of seven hours (reference; odds ratio [OR], 2.38; 95% confidence interval [CI], 2.11-2.69, OR, 2.44; 95% CI, 2.16-2.76, OR, 2.33; 95% CI, 1.94-2.79; and OR, 1.72; 95% CI, 1.14-2.52). The absence of NRS together with a sleep duration of ≤ 5 hours was also an independent comorbid factor for heartburn compared with the reference (OR, 1.20; 95% CI, 1.05-1.37). CONCLUSIONS NRS in active workers may contribute to heartburn comorbidity despite the sleep duration as in other workers without NRS.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, Fujitsu Clinic, Kawasaki City, 4-1-1 Kamikodanaka, Nakahara-Ku, Kanagawa Prefecture, 211-8588, Japan.
- Health Promotion Unit, Fujitsu Limited, Kawasaki, Kanagawa, Japan.
| | - Hitoshi Miyake
- Health Promotion Unit, Fujitsu Limited, Kawasaki, Kanagawa, Japan
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Holbert RC, Carr BR, Bussing R. An open label pilot trial of sequential bifrontal low frequency r-TMS in the treatment of primary insomnia. Psychiatry Res 2023; 324:115194. [PMID: 37054553 DOI: 10.1016/j.psychres.2023.115194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/15/2023]
Abstract
This pilot study examines the therapeutic effects of bifrontal low frequency (LF) TMS on primary insomnia. In this prospective, open-label study 20 patients with primary insomnia and without major depressive disorder received 15 sequential bifrontal LF rTMS stimulation sessions. By week 3, PSQI scores declined from baseline score of 12.57(sd 2.74) to 9.50 (sd 4.27), a large effects size (0.80 (CI 0.29, 1.36)), and CGI-I scores improved for 52.6% of participants. Results of this pilot indicate that the novel bifrontal LF rTMS benefitted this group of patients suffering from primary insomnia, with absence of sham control a significant study limitation.
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Affiliation(s)
- Richard C Holbert
- Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86 Terrace, Gainesville, FL 32606, USA
| | - Brent R Carr
- Department of Psychiatry, University of Florida, College of Medicine, 4037 NW 86th Terrace, Gainesville, FL, USA
| | - Regina Bussing
- Department of Psychiatry, University of Florida College of Medicine, 4197 NW 86 Terrace, Gainesville, FL 32606, USA.
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8
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Sekizuka H, Miyake H. Relationship between nonrestorative sleep with short sleep duration and diabetes mellitus comorbid among a Japanese occupational population. Diabetol Int 2023; 14:199-205. [PMID: 37090133 PMCID: PMC10113405 DOI: 10.1007/s13340-023-00620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/15/2023] [Indexed: 02/19/2023]
Abstract
Objective Nonrestorative sleep (NRS) is one of the symptoms of insomnia and is clearly more associated with objective indices, such as sleep stability, sleep fragmentation, and inflammatory responses, than other insomnia symptoms. However, the link between NRS and diabetes mellitus is poorly understood. Therefore, the prevalence of NRS in workers and the relationships between NRS and diabetes were investigated. Methods The results of a single year's medical examinations were investigated for 26,144 Japanese active office workers who were 30 to 59 years old. NRS was investigated using a personal computer in a medical interview. Furthermore, the relationships between NRS and diabetes comorbidity in addition to sleep duration were also analyzed. Results The mean age of the subjects was 47.9 ± 7.3 years old, and the proportion of subjects with NRS was 26%. The presence of NRS together with a sleep duration ≤ 5 h or a sleep duration of 6 h was an independent comorbid factor for diabetes compared with the absence of NRS together with a sleep duration of 7 h (odds ratio [OR] 1.34; 95% confidence interval [CI] 1.14-1.58; P < 0.001; and OR 1.25; 95% CI 1.04-1.48; P = 0.015). Conclusion NRS in active workers may contribute to the development of diabetes even if the workers have the same short sleep durations as other workers without NRS.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, FUJITSU Clinic, 4-1-1 Kamikodanaka, Nakahara-ku, Kawasaki, Kanagawa 211-8588 Japan
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa, Japan
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Mikulska P, Malinowska M, Ignacyk M, Szustowski P, Nowak J, Pesta K, Szeląg M, Szklanny D, Judasz E, Kaczmarek G, Ejiohuo OP, Paczkowska-Walendowska M, Gościniak A, Cielecka-Piontek J. Ashwagandha (Withania somnifera)—Current Research on the Health-Promoting Activities: A Narrative Review. Pharmaceutics 2023; 15:pharmaceutics15041057. [PMID: 37111543 PMCID: PMC10147008 DOI: 10.3390/pharmaceutics15041057] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023] Open
Abstract
In recent years, there has been a significant surge in reports on the health-promoting benefits of winter cherry (Withania somnifera), also known as Ashwagandha. Its current research covers many aspects of human health, including neuroprotective, sedative and adaptogenic effects and effects on sleep. There are also reports of anti-inflammatory, antimicrobial, cardioprotective and anti-diabetic properties. Furthermore, there are reports of reproductive outcomes and tarcicidal hormone action. This growing body of research on Ashwagandha highlights its potential as a valuable natural remedy for many health concerns. This narrative review delves into the most recent findings and provides a comprehensive overview of the current understanding of ashwagandha’s potential uses and any known safety concerns and contraindications.
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Otsuka Y, Kaneita Y, Tanaka K, Itani O, Kaneko Y, Suzuki M, Matsumoto Y, Kuriyama K. Nonrestorative sleep is a risk factor for metabolic syndrome in the general Japanese population. Diabetol Metab Syndr 2023; 15:26. [PMID: 36803382 PMCID: PMC9942313 DOI: 10.1186/s13098-023-00999-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND This longitudinal study aimed to investigate the effects of nonrestorative sleep on developing metabolic syndrome (MetS) and related diseases in a general Japanese middle-aged population. METHODS Overall, 83,224 adults without MetS (mean age: 51.5 ± 3.5 years) from the Health Insurance Association in Japan were followed up for a maximum of 8 years between 2011 and 2019. The Cox proportional hazard method was used to determine whether nonrestorative sleep, assessed using a single-item question, was significantly associated with the respective development of MetS, obesity, hypertension, diabetes, and dyslipidemia. The MetS criteria were adopted by the Examination Committee for Criteria of Metabolic Syndrome in Japan. RESULTS The mean follow-up duration was 6.0 years. The incidence rate of MetS was 50.1 person-years/1,000 during the study period. Data suggested that nonrestorative sleep was associated with MetS (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.08-1.16) and other disorders, such as obesity (HR: 1.07, 95% CI: 1.02-1.12), hypertension (HR: 1.07, 95% CI: 1.04-1.11), and diabetes (HR: 1.07, 95% CI: 1.01-1.12) but not with dyslipidemia (HR: 1.00, 95% CI: 0.97-1.03). CONCLUSIONS Nonrestorative sleep is associated with the development of MetS and many of its core components in the middle-aged Japanese population. Therefore, assessing nonrestorative sleep may help identify individuals at a risk of MetS development.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan.
| | - Katsutoshi Tanaka
- Department of Occupational Mental Health, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, 252-0374, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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Khot SP, Taylor BL, Longstreth WT, Brown AF. Sleep Health as a Determinant of Disparities in Stroke Risk and Health Outcome. Stroke 2023; 54:595-604. [PMID: 36345822 PMCID: PMC9870956 DOI: 10.1161/strokeaha.122.039524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sleep is essential to human survival and overall vascular health. Sleep health encompasses the objective and subjective qualities associated with one's daily pattern of sleep and wakefulness and has become a growing clinical and public health concern. Impaired sleep duration and quality can increase stroke risk and mediate the relationship between the physical aspects of an individual's environment and disparities in stroke incidence. Here, we review observational studies evaluating the association between sleep health and cerebrovascular disease. We assess the influence on sleep of the physical environment, including the ambient environment with noise levels and the built environment. We also describe the influences on sleep health and stroke risk of social determinants of health, including the chronic stressor of racial discrimination. Finally, we discuss how changes in historical neighborhood characteristics or societal policies can influence the social factors affecting sleep health and stroke risk among socioeconomically disadvantaged groups or ethnic and racial minorities. Given the regional and racial or ethnic differences in stroke risk across the United States, an understanding of novel vascular risk factors, such as the multifaceted role of sleep health, will be critical to develop effective public policies to improve population health.
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Affiliation(s)
- Sandeep P Khot
- Department of Neurology (S.P.K., B.L.T., W.T.L.), University of Washington, Seattle
| | - Breana L Taylor
- Department of Neurology (S.P.K., B.L.T., W.T.L.), University of Washington, Seattle
| | - W T Longstreth
- Department of Neurology (S.P.K., B.L.T., W.T.L.), University of Washington, Seattle
- Department of Epidemiology (W.T.L.), University of Washington, Seattle
| | - Arleen F Brown
- Department of Medicine, University of California, Los Angeles (A.F.B.)
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12
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Otsuka Y, Kaneita Y, Tanaka K, Itani O, Matsumoto Y, Kuriyama K. Longitudinal assessment of lifestyle factors associated with nonrestorative sleep in Japan. Sleep Med 2023; 101:99-105. [PMID: 36368075 DOI: 10.1016/j.sleep.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/19/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Nonrestorative sleep (NRS) is common in the general global population. This study surveyed the incident/remission rate of NRS and identified related lifestyle factors in a general Japanese adult cohort. METHODS Data from a Japanese health check-based cohort between the fiscal years 2011 and 2018 were obtained. NRS was assessed through a single item question, and socio-demographic and clinical data were assessed through self-reports. To identify potential correlates of NRS incidence/remission, Cox regression analysis (or survival analysis) was performed. RESULTS Among the 135 609 individuals surveyed at baseline, data from 93 548 were considered for analysis. NRS exhibited incidence and remission rates of 11.3% and 15.4%, respectively. New NRS incidence was predicted by eating fast (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.04-1.10), dining close to bedtime (HR: 1.33, 95% CI: 1.27-1.38), midnight snacking (HR: 1.09, 95% CI: 1.04-1.13), skipping breakfast (HR: 1.16, 95% CI: 1.10-1.22), non-regular exercise (HR: 1.12, 95% CI: 1.07-1.17), lower levels of physical activity (HR: 1.19, 95% CI: 1.14-1.24), and slow walking speed (HR: 1.34, 95% CI: 1.29-1.39), while heavy drinking was less predictive of NRS. However, the same factors (except for heavy drinking) were found to predict NRS remission. CONCLUSIONS We found that unhealthy lifestyle behaviors, particularly dining close to bedtime and slow walking speed, were positively associated with NRS incidence, while they were negatively associated with NRS remission. These results can be useful in developing more effective health promotion policies to achieve good sleep.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Katsutoshi Tanaka
- Department of Occupational Mental Health, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, 252-0374, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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13
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Otsuka Y, Takeshima O, Itani O, Matsumoto Y, Kaneita Y. Associations among Alcohol Drinking, Smoking, and Nonrestorative Sleep: A Population-Based Study in Japan. Clocks Sleep 2022; 4:595-606. [PMID: 36412579 PMCID: PMC9680481 DOI: 10.3390/clockssleep4040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022] Open
Abstract
Nonrestorative sleep (NRS) is a common sleep disorder. It is associated with several unhealthy lifestyle factors, such as skipping breakfast and lack of exercise. However, the associations between alcohol drinking, smoking, and NRS are unclear. This study examined the prevalence of NRS within the Japanese general population and the relationships among alcohol drinking, smoking, and NRS. We analyzed an anonymized dataset from a 2013 nationwide population survey (35,717 men and 39,911 women). NRS was assessed through a single-item question, and socio-demographic and lifestyle factors were assessed through self-reports. Multivariable logistic regression analyses were used to examine the associations between alcohol drinking, smoking, and NRS. The total prevalence of NRS was 22.2% (95% CI 21.8-22.7) in men and 23.4% (95% CI 23.0-23.8) in women. Further, we found that sleep duration and prevalence of NRS shared an inverse J-shaped relationship. Heavy alcohol drinking was significantly associated with NRS in both sexes. Short sleep duration and certain socioeconomic factors modified the effect of smoking on NRS in men. These results could be useful in the development of more effective sleep health policies to establish better sleep hygiene.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo 173-8610, Japan
- Correspondence: ; Tel.: +81-3-3972-8111; Fax: +81-3-3972-5878
| | - Ohki Takeshima
- Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo 173-8610, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo 173-8610, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo 173-8610, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-Ku, Tokyo 173-8610, Japan
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14
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Li S, Fong DYT, Xu Y, Wilkinson K, Shapiro C, Wong JYH. Measurement properties of the simplified Chinese version of Nonrestorative Sleep Scale in adolescents. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e299-e307. [PMID: 33756024 DOI: 10.1111/hsc.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/12/2020] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to assess the measurement properties of a simplified Chinese version of the Nonrestorative Sleep Scale (NRSS) among adolescents. We obtained a simplified Chinese NRSS by the standard forward-backward translation procedures and administered it to 486 students who were attending Grade 7-11 in Nanjing, China. Furthermore, Pittsburgh Sleep Quality Index, Athens Insomnia Scale, Centre for Epidemiological Studies Depression Scale, and Toronto Hospital Alertness Test were also self-completed for measuring sleep quality, insomnia, depression and alertness respectively. The sample was randomly split into two halves, with the first half used to explore the scale structure by exploratory factor analysis (EFA), and the second half used to confirm the identified structure by confirmatory factor analysis (CFA). A total of 481 adolescents (49% male) with a mean age of 16 years (range: 13-18) completed this study. In the other half of 250 adolescents, the root mean square error of approximation (RMSEA), standardised root mean square residual, and comparative fit index (CFI) in CFA, which tested the four-factor structure obtained from EFA, were 0.062, 0.051 and 0.975, respectively. Convergent validity was demonstrated from a significant correlation of the simplified Chinese NRSS with sleep quality (r = -0.62), insomnia (r = -0.71), depression (r = -0.60) and alertness (r = 0.54). The internal consistency and test-retest reliability for the global scale were 0.83 and 0.86 respectively. Measurement invariance was established between males and females with the changes of both CFI and RMSEA < 0.01. The simplified Chinese NRSS is valid and reliable for measuring NRS among Chinese adolescents.
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Affiliation(s)
- Sha Li
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | - Yan Xu
- Jiangsu Luhe High School, Nanjing, China
| | - Kate Wilkinson
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Colin Shapiro
- Department of Psychiatry, University of Toronto, Toronto, Canada
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15
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Cabanel N, Schmidt AM, Fockenberg S, Brückmann K, Müller MJ, Kundermann B, Haag A. Circadian preference and sleep quality in healthy controls and psychiatric inpatients with major depressive disorder - An actigraphy study incorporating morning and evening mood assessments. Chronobiol Int 2021; 39:249-260. [PMID: 34724857 DOI: 10.1080/07420528.2021.1994583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Major depressive disorder (MDD) is frequently accompanied by sleep disturbance. Regarding diurnal preference (chronotype), sleep problems and low mood have been associated with evening orientation. Considering diurnal preference, we investigated subjective restorative value of sleep and actigraphy sleep parameters together with mood assessments twice a day, i.e. in the morning and evening, during weekdays and weekends in MDD psychiatric inpatients and healthy controls (HCs). The restorative value of sleep was higher during the weekend in HC, and bedtimes and risetimes were delayed during the weekend compared to weekdays in HC and MDD. Morning mood affected subjective sleep ratings in both groups, while association with symptom severity (BDI) in MDD remained insignificant. In HC, better evening mood was associated with later bedtimes. Regarding the chronotype in HC, evening orientation was associated with relatively low restorative value of sleep during weekdays, and morning orientation was associated with relatively higher actigraphy sleep efficiency during weekdays compared to weekend. In MDD, an association of evening orientation with later rise times could be observed, while no chronotype dependent effect emerged regarding the restorative value of sleep or sleep efficiency. Our results emphasize that research on sleep in MDD should incorporate weekdays as well as weekends, chronotype assessment, and measures of morning and evening mood, as these can be associated with ratings of the subjective restorative value of sleep (i.e. in our study, better morning mood was associated with higher restorative values), but also with behavioral sleep parameters (i.e. in our study, more positive evening mood was associated with later bedtimes). Potentially, the restorative value of sleep in MDD evening types can be improved by maintaining a regular sleep schedule, which needs to be investigated in an experimental design.
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Affiliation(s)
- Nicole Cabanel
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Giessen, Germany.,Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | | | - Konstantin Brückmann
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Giessen, Germany.,Faculty of Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Matthias J Müller
- Faculty of Medicine, Justus-Liebig University Giessen, Giessen, Germany.,Oberberg Group, Berlin, Germany
| | - Bernd Kundermann
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Giessen, Germany.,Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Anja Haag
- Vitos Clinic for Psychiatry and Psychotherapy Marburg, Marburg, Germany
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16
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Gauld C, Lopez R, Morin C, Geoffroy PA, Maquet J, Desvergnes P, McGonigal A, Dauvilliers Y, Philip P, Dumas G, Micoulaud-Franchi JA. Symptom network analysis of the sleep disorders diagnostic criteria based on the clinical text of the ICSD-3. J Sleep Res 2021; 31:e13435. [PMID: 34269498 DOI: 10.1111/jsr.13435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023]
Abstract
The third edition of the International Classification of Sleep Disorders (ICSD-3) is the authoritative clinical text for the diagnosis of sleep disorders. An important issue of sleep nosology is to better understand the relationship between symptoms found in conventional diagnostic manuals and to compare classifications. Nevertheless, to our knowledge, there is no specific exhaustive work on the general structure of the networks of symptoms of sleep disorders as described in diagnostic manuals. The general aim of the present study was to use symptom network analysis to explore the diagnostic criteria in the ICSD-3 manual. The ICSD-3 diagnostic criteria related to clinical manifestations were systematically identified, and the units of analysis (symptoms) were labelled from these clinical manifestation diagnostic criteria using three rules ("Conservation", "Splitting", "Lumping"). A total of 37 of the 43 main sleep disorders with 160 units of analysis from 114 clinical manifestations in the ICSD-3 were analysed. A symptom network representing all individual ICSD-3 criteria and connections between them was constructed graphically (network estimation), quantified with classical metrics (network inference with global and local measures) and tested for robustness. The global measure of the sleep symptoms network shows that it can be considered as a small world, suggesting a strong interconnection between symptoms in the ICSD-3. Local measures show the central role of three kinds of bridge sleep symptoms: daytime sleepiness, insomnia, and behaviour during sleep symptoms. Such a symptom network analysis of the ICSD-3 structure could provide a framework for better systematising and organising symptomatology in sleep medicine.
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Affiliation(s)
- Christophe Gauld
- Department of Psychiatry, University of Grenoble, Grenoble, France.,UMR CNRS 8590 IHPST, Sorbonne University, Paris 1, France
| | - Régis Lopez
- Department of Neurology, Sleep Disorders Center, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,Inserm, Université Montpellier 1, Montpellier, U1061, France
| | - Charles Morin
- École de psychologie, Université Laval, Québec City, Québec, Canada.,Centre d'étude des troubles du sommeil, Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hospital Bichat - Claude Bernard, Paris, France.,GHU Paris - Psychiatry and Neurosciences, Paris, France.,NeuroDiderot, Université de Paris, Paris, Inserm, France.,CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Julien Maquet
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Centre d'investigation clinique 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Desvergnes
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France
| | - Aileen McGonigal
- Epileptology Department, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Aix Marseille University, Marseille, France
| | - Yves Dauvilliers
- Department of Neurology, Sleep Disorders Center, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,Inserm, Université Montpellier 1, Montpellier, U1061, France
| | - Pierre Philip
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France.,USR CNRS 3413 SANPSY, University Hospital of Bordeaux, Bordeaux, France
| | - Guillaume Dumas
- Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, Florida, USA.,Centre de recherche du Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France.,USR CNRS 3413 SANPSY, University Hospital of Bordeaux, Bordeaux, France
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17
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Zhu B, Chen P, Kim MJ, Chen X, Quinn L, Fritschi C. Fluctuations in Self-Reported Symptoms Predict Objective Physical Activity in Adults With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:255-263. [PMID: 34036870 DOI: 10.1177/26350106211015889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine the association between self-reported symptoms including fatigue and sleep disturbance with moderate-intensity physical activity among adults with type 2 diabetes. METHODS This report was a secondary analysis of a cross-sectional study. Data from 53 participants with at least 6 days of repeated measures were used. Daytime physical activity and energy expenditure were assessed using a wrist-worn accelerometer at the free-living setting. Fatigue upon awakening was measured using a 0 to 10 scale. Sleep (eg, restorative sleep, sleep duration, and sleep efficiency) was measured using the Consensus Sleep Diary for Morning. Data were analyzed using linear mixed models by including within- and between-person effects. RESULTS Participants were predominantly females (54.7%) with a mean age of 60.3 years. Controlling for the covariates, at the individual level (within-person), fluctuations in restorative sleep and fatigue upon awakening predicted moderate-intensity PA. Similarly, at the individual level, fluctuations in restorative sleep and fatigue upon awakening predicted average hourly energy expenditure. However, at the group level (between-person), no significant associations were found between fatigue and restorative sleep with moderate-intensity physical activity. CONCLUSIONS The study findings suggest that within-person fluctuations in fatigue and restorative sleep upon awakening predict daytime moderate-intensity physical activity. At the individual level, reducing fluctuations in fatigue and restorative sleep might encourage participation in physical activity. More research is warranted to uncover the underlying causes of fluctuations in fatigue and restorative sleep. Meanwhile, diabetes care and education specialists should pay attention to the within-person fluctuations of fatigue and sleep.
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Pei Chen
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Min Jung Kim
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Xiangfang Chen
- Department of Endocrinology, Shanghai Changzheng Hospital, Shanghai, China (Dr Chen)
| | - Laurie Quinn
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Cynthia Fritschi
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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18
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Poon SH, Quek SY, Lee TS. Insomnia Disorders: Nosology and Classification Past, Present, and Future. J Neuropsychiatry Clin Neurosci 2021; 33:194-200. [PMID: 33985347 DOI: 10.1176/appi.neuropsych.20080206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Insomnia is the most common sleep disorder in the adult population. However, the definition of insomnia disorder has varied across major classification systems and changed over time. In the present study, the investigators traced the evolution of insomnia disorder across classification systems, contemplated the empirical basis for its current definitions, and surveyed ongoing research efforts that may clarify insomnia nosology in the future. Three major classification systems for insomnia are the International Classification of Sleep Disorders, the International Classification of Diseases, and DSM. Despite their divergent origins, these classification systems have converged to nearly identical contemporary insomnia definitions. Over time, the emphasis in classification approaches has shifted from symptomatology to etiology to treatment implications. Additionally, the historical multitude of insomnia subtypes has gradually consolidated into a few core diagnoses, reflecting inadequate evidence with which to support subtyping. Current insomnia definitions include frequency and duration criteria to operationalize these diagnoses, while the diagnostic criterion of nonrestorative sleep has been eliminated (with some controversy). In ongoing research efforts, the quest for insomnia biomarkers has not thus far yielded clinically deployable breakthroughs. Data-driven insomnia subtyping suggests a promising new approach in deriving empirically based subtypes; conversely, the transdiagnostic perspective proposes the elimination of categorical distinctions in favor of finding common processes underlying all psychiatric disorders. The continual evolution of insomnia nosology highlights that much remains to be learned about these conditions; all current diagnostic classification systems are best regarded as "works in progress." Nevertheless, refinement and convergence of classification approaches is essential to standardizing insomnia research, diagnosis, and treatment.
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Affiliation(s)
- Shi-Hui Poon
- Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek)
| | - Shin-Yi Quek
- Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek)
| | - Tih-Shih Lee
- Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek)
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19
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Hülse R, Wenzel A, Dudek B, Losert-Bruggner B, Hölzl M, Hülse M, Häussler D. Influence of craniocervical and craniomandibular dysfunction to nonrestorative sleep and sleep disorders. Cranio 2019; 39:280-286. [PMID: 31195922 DOI: 10.1080/08869634.2019.1630110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Nonrestorative sleep and sleep disorders are commonly reported in patients suffering from craniomandibular (CMD) and craniocervical dysfunctions (CCD). This study aimed to investigate polysomnographic characteristics and the reduction of pain before and after treatment in these patients.Methods: Seventy-four patients with sleep disorders and evident CMD and CCD were included. Manual therapy and an Aqualizer® were used in the therapeutic group. Polysomnographic measurements were conducted pre- and post-therapy.Results: The number of sleep stage alterations and the sleep stage index differed significantly between pre- and post-therapeutic measurements. Between both groups, these parameters were significantly different, as well (p = .001 and p = .012). The subjective perception of sleep quality improved in 81.6% post-therapy (p < .001).Discussion: Manual therapy and the application of an Aqualizer® may improve sleep quality in patients suffering from CMD and CCD. Pain may not be the main cause for the sleep disorders in CMD and CCD.
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Affiliation(s)
- Roland Hülse
- Section of Phoniatrics, Pedaudiology and Neurootology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.,Faculty of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Angela Wenzel
- Section of Phoniatrics, Pedaudiology and Neurootology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Brigitte Dudek
- Outpatient clinic for pneumology and sleep medicine, Heppenheim, Germany
| | | | - Matthias Hölzl
- Department of Otorhinolaryngology, Universitätsklinik Magdeburg, Magdeburg, Germany.,Center of Otorhinolaryngology Traunstein, Traunstein, Germany
| | - Manfred Hülse
- Section of Phoniatrics, Pedaudiology and Neurootology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.,Faculty of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Daniel Häussler
- Section of Phoniatrics, Pedaudiology and Neurootology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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20
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Prevalence of sleep disturbances: Sleep disordered breathing, short sleep duration, and non-restorative sleep. Respir Investig 2019; 57:227-237. [PMID: 30827934 DOI: 10.1016/j.resinv.2019.01.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 01/14/2023]
Abstract
Recently, interest in sleep disturbances, such as sleep disordered breathing (SDB), short sleep duration, and non-restorative sleep (NRS), has been increasing. The potentially large public health implications of sleep disturbances indicate a need to determine their prevalence in a general population. This review describes the characteristics of population-based sleep cohorts from past to present. Unavoidable methodological and baseline characteristic heterogeneity was found between studies. The prevalence of SDB (apnea hypopnea index (AHI), respiratory disturbance index (RDI), or oxygen desaturation index (ODI) ≥5/h) was 24.0-83.8% in men and 9.0-76.6% in women, and that of moderate-to-severe SDB (AHI, RDI, or ODI ≥15/h) was 7.2-67.2% in men and 4.0-50.9% in women. Additionally, the prevalence of SDB in post-menopausal women was 3-6 times higher than in pre-menopausal women. The prevalence of subjective short sleep duration (<6 h) was 7.5-9.6%, while that of objective short sleep duration (<6 h) was 22.1-53.3%. The prevalence of NRS was 19.2-31.0% in men and 26.3-42.1% in women, as determined from studies using a yes-no questionnaire, while a multi-national survey using a telephone-based expert system showed a wide range of prevalence between countries, from 2.4% to 16.1%. An association between SDB, short sleep duration, and NRS has recently been suggested. To gain a better understanding of the burden of sleep disturbances, a consensus on the definition of several sleep disturbances is needed, as methodological heterogeneity exists, including SDB scoring rules, subjective versus objective data collection for short sleep duration, and the definition of NRS itself.
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21
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Li S, Fong DYT, Wong JYH, Wilkinson K, Shapiro C, Choi EPH, McPherson B, Lam CLK, Ip MSM. Nonrestorative sleep scale: reliable and valid for the Chinese population. Qual Life Res 2019; 28:1685-1692. [PMID: 30767089 DOI: 10.1007/s11136-019-02134-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To conduct a linguistic and psychometric evaluation of a Chinese version of the Nonrestorative Sleep Scale (NRSS). METHODS The Chinese NRSS was created from a standard forward-backward translation and trialed on 10 Chinese adults. Telephone interviews were then conducted with 100 adults, who completed the Chinese NRSS, the Pittsburgh Sleep Quality Index (PSQI), the Athens Insomnia Scale (AIS), the Center for Epidemiological Studies Depression Scale (CES-D), and the Toronto Hospital Alertness Test (THAT). A household survey was conducted with 20 subjects, followed by a confirmatory factor analysis (CFA), and a bifactor model was developed to evaluate the reliability and validity of the NRSS. RESULTS The bifactor model had the root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), and comparative fit index (CFI) of 0.06, 0.06, and 0.97, respectively. Convergent validity was shown from the moderate associations with PSQI (r = - 0.66, P < 0.01), AIS (r = - 0.65, P < 0.01), CES-D (r = - 0.54, P < 0.01), and THAT (r = 0.68, P < 0.01). The coefficient omega (0.92), omega hierarchical (0.81), factor determinacy (0.93), H value (0.91), explained common variance (0.63), and percentage of uncontaminated correlations (0.80) derived from the bifactor CFA supported the essential unidimensionality of NRSS. CONCLUSIONS The Chinese NRSS is a valid and reliable essential unidimensional tool for the assessment of nonrestorative sleep in the Chinese population.
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Affiliation(s)
- S Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China
| | - D Y T Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - J Y H Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China
| | - K Wilkinson
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Canada
| | - C Shapiro
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Canada
| | - E P H Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China
| | - B McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - C L K Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China
| | - M S M Ip
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China
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Tinajero R, Williams PG, Cribbet MR, Rau HK, Bride DL, Suchy Y. Nonrestorative sleep in healthy, young adults without insomnia: associations with executive functioning, fatigue, and pre-sleep arousal. Sleep Health 2018; 4:284-291. [DOI: 10.1016/j.sleh.2018.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 02/09/2018] [Accepted: 02/19/2018] [Indexed: 01/05/2023]
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Abstract
OBJECTIVE The aim of this study was to assess the impact of auditory noise tolerance on non-restorative sleep using an objective audiometric test in a representative sample. DESIGN A total of 202 Chinese individuals aged 15 years and above were recruited from a population-based household survey. Their non-restorative sleep was assessed by a single item, the degree of feeling refreshed on waking up, on a 0-10 scale, while noise tolerance was measured by the most comfortable level expressed in A-weighted decibels. RESULTS The 202 individuals (106 women) had a mean degree of feeling refreshed on waking up of 6.5 on the 0-10 scale and a mean maximum comfortable sound level of 69.2 dB. A multivariable analysis showed that a 1 dB increase in noise tolerance was associated with a 0.1-unit increase in the degree of feeling refreshed after adjusting for age, education, marital status, occupation, exercise, smoking, alcohol consumption, household noise level, stress, anxiety and depression. Moreover, housewives, non-smokers and individuals who were less anxious or stressed felt significantly more refreshed on waking up. CONCLUSION People with higher levels of noise tolerance experienced more refreshing sleep. Additional clinical consideration of enhancing noise tolerance in patients with sleep complaints is needed.
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Affiliation(s)
- Daniel Y T Fong
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Janet Y H Wong
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lixi Huang
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong
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Okamoto M, Kobayashi Y, Nakamura F, Musha T. Association Between Nonrestorative Sleep and Risk of Diabetes: A Cross-Sectional Study. Behav Sleep Med 2017; 15:483-490. [PMID: 27152770 DOI: 10.1080/15402002.2016.1163701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although insufficient sleep or poor sleep quality has been reported to be associated with the development of type 2 diabetes, the relation of type 2 diabetes with nonrestorative sleep (NRS), a subjective feeling, has been overlooked. We used a large-scale medical checkup database to investigate whether there is a cross-sectional association between NRS and type 2 diabetes risk in Japanese individuals. We extracted data for 14,476 individuals who were not receiving therapeutic drugs for diabetes. About 36.8% of individuals were identified as having NRS. In a multiple logistic regression analysis, NRS was significantly associated with the risk of developing diabetes. Thus, this line of research may have implications for diabetes prevention.
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Affiliation(s)
- Masaki Okamoto
- a Department of Health Policy/Public Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Yasuki Kobayashi
- a Department of Health Policy/Public Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Fumiaki Nakamura
- a Department of Health Policy/Public Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
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Tutek J, Molzof HE, Lichstein KL. Multilevel modeling of chronotype and weekdays versus weekends to predict nonrestorative sleep. Chronobiol Int 2017; 34:1401-1412. [DOI: 10.1080/07420528.2017.1373118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Joshua Tutek
- The University of Alabama, Department of Psychology, Tuscaloosa, United States of America
| | - Hylton E. Molzof
- The University of Alabama, Department of Psychology, Tuscaloosa, United States of America
| | - Kenneth L. Lichstein
- The University of Alabama, Department of Psychology, Tuscaloosa, United States of America
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Sakamoto I, Igaki M, Ichiba T, Suzuki M, Kuriyama K, Uchiyama M. Effects of Bedtime Periocular Warming on Sleep Status in Adult Female Subjects: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:6419439. [PMID: 29234416 PMCID: PMC5651103 DOI: 10.1155/2017/6419439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022]
Abstract
Several studies have reported that suitable manipulation of human skin or body temperature can lead to improved sleep. To clarify the effect of skin warming on human sleep, 38 female subjects, who occasionally had difficulty with falling asleep, were studied. The participants underwent two experimental sessions, which were carried out in two consecutive follicular phases and randomly crossed over. The participants wore hot or sham eye masks in one 14-day session. The first half of each 14-day session was designated the baseline period (BL) without any interventions and the later half was designated the intervention period (INT), in which they wore either the hot or sham eye mask for 10 minutes at bedtime. All the participants were instructed to keep a sleep diary every morning for the BL and INT. The results showed that the hot eye mask was significantly preferred over the sham one with respect to comfort and that feelings of restfulness and being refreshed upon wakening in the morning were significantly better with the hot eye mask than with the sham. These results suggest that bedtime periocular warming has favorable effects on subjective well-being on awakening, possibly due to the sense of comfort experienced at bedtime.
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Affiliation(s)
- Ichiro Sakamoto
- Personal Health Care Laboratory, Kao Corporation, Tokyo, Japan
| | - Michihito Igaki
- Personal Health Care Laboratory, Kao Corporation, Tokyo, Japan
| | - Tomohisa Ichiba
- Personal Health Care Laboratory, Kao Corporation, Tokyo, Japan
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
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Villarroel N, Artazcoz L. Immigration and Sleep Problems in a Southern European Country: Do Immigrants Get the Best Sleep? Behav Med 2017; 43:233-241. [PMID: 26808618 DOI: 10.1080/08964289.2015.1122568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study analyzes the differences in the prevalence of insomnia symptoms and nonrestorative sleep (NRS) between people born in Spain and immigrants from 7 countries with most immigrants in Spain. Data come from the 2006 Spanish National Health Survey. The sample was composed of all individuals aged 16 to 64 years from Spain and the 7 countries with most immigrants in Spain (N = 22,224). In both sexes, people from Bolivia had a higher prevalence of insomnia symptoms and NRS. Conversely, people from Ecuador, Morocco, and Romania had less insomnia symptoms and NRS than Spanish-born participants. No differences were found between Spanish-born participants and Colombian, Peruvian, and Argentinian women. Poor living conditions in the country of origin and in the host country, discrimination, and culturally related lifestyles could be related to poorer sleep health among Bolivian men. Acculturation may explain the similar sleep health patterns noted between Spanish-born participants and long-term immigrants.
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Affiliation(s)
- Nazmy Villarroel
- a Agència de Salut Pública and CIBER en Epidemiología y Salud Pública (CIBERESP) , Spain
| | - Lucía Artazcoz
- b Agència de Salut Pública, Barcelona; CIBER en Epidemiología y Salud Pública (CIBERESP); Universitat Pompeu Fabra; and Institute of Biomedical Research (IIB-Sant Pau) , Spain
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Matsumoto T, Tabara Y, Murase K, Takahashi Y, Setoh K, Kawaguchi T, Muro S, Kadotani H, Kosugi S, Sekine A, Yamada R, Nakayama T, Mishima M, Matsuda F, Chin K. Combined association of clinical and lifestyle factors with non-restorative sleep: The Nagahama Study. PLoS One 2017; 12:e0171849. [PMID: 28278155 PMCID: PMC5344328 DOI: 10.1371/journal.pone.0171849] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/26/2017] [Indexed: 01/13/2023] Open
Abstract
Background Non-restorative sleep (NRS) was suggested to be associated with cardiovascular outcomes. However, causative factors for NRS have not been fully elucidated. This study aimed to clarify factors and their relationships with NRS to better understand the clinical and epidemiological implications of NRS and to develop a score that can objectively evaluate NRS status. Methods Study subjects consisted of 9,788 community residents (age 53.6 ± 13.4 y). Subjective NRS as well as possible clinical and lifestyle factors for NRS were investigated by questionnaires. Other clinical parameters were obtained from personal records of information obtained at the baseline examination. Results A total of 3,261 participants complained of NRS. Factors independently associated with subjective NRS were younger age (odds ratio = 1.43), use of a hypnotic drug (2.04), irregular sleep schedule (2.02), short sleep duration (<5 h, 11.7; 5–6 h, 4.81; 6–7 h, 2.40), frequent sleepiness (2.33), routine stress (4.63), no habitual exercise (1.61), nocturia symptoms (1.43), symptoms of gastroesophageal reflux disease (1.44), and depression (1.46) (all P <0.001). The NRS score comprised of these 10 factors was linearly associated with the frequency of subjective NRS (Ptrend <0.001). Frequency of individuals with a high NRS score was greater in women (52.3%) than in men (42.1%, P<0.001), while no clear association was observed with common risk factors for cardiovascular diseases. Conclusions NRS was a phenomenon representing various clinical and lifestyle features. Careful attention should be paid to individuals with a high NRS score who might be at risk for mental fatigue and have unfavorable lifestyle factors.
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Affiliation(s)
- Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Kadotani
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga, Japan
| | - Shinji Kosugi
- Department of Medical Ethics and Medical Genetics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Akihiro Sekine
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Ryo Yamada
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
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30
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Associations between sleep disturbances, personality, and trait emotional intelligence. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.11.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Araújo T, Jarrin DC, Leanza Y, Vallières A, Morin CM. Qualitative studies of insomnia: Current state of knowledge in the field. Sleep Med Rev 2017; 31:58-69. [PMID: 27090821 PMCID: PMC4945477 DOI: 10.1016/j.smrv.2016.01.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
Despite its high prevalence and burden, insomnia is often trivialized, under-diagnosed, and under-treated in practice. Little information is available on the subjective experience and perceived consequences of insomnia, help-seeking behaviors, and treatment preferences. The use of qualitative approaches (e.g., ethnography, phenomenology, grounded theory) may help gain a better understanding of this sleep disorder. The present paper summarizes the evidence derived from insomnia studies using a qualitative research methodology (e.g., focus group, semi-structured interviews). A systematic review of the literature was conducted using PsycINFO and Medline databases. The review yielded 22 studies and the quality of the methodology of each of them was evaluated systematically using the critical appraisal skills programme (CASP) appraisal tool. Selected articles possess at least a very good methodological rigor and they were categorized according to their main focus: "Experience of insomnia", "Management of insomnia" and "Medicalization of insomnia". The main findings indicate that: 1) insomnia is often experienced as a 24-h problem and is perceived to affect several domains of life, 2) a sense of frustration and misunderstanding is very common among insomnia patients, which is possibly due to a mismatch between patients' and health care professionals' perspectives on insomnia and its treatment, 3) health care professionals pay more attention to sleep hygiene education and medication therapies and less to the patient's subjective experience of insomnia, and 4) health care professionals are often unaware of non-pharmacological interventions other than sleep hygiene education. An important implication of these findings is the need to develop new clinical measures with a broader scope on insomnia and more targeted treatments that take into account the patient's experience of insomnia. Greater use of qualitative approaches in future research may produce novel and more contextualized information leading to a more comprehensive understanding of insomnia.
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Affiliation(s)
- Taís Araújo
- École de psychologie, Université Laval, Québec City, Québec, Canada; Centre d'étude des troubles du sommeil, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada.
| | - Denise C Jarrin
- École de psychologie, Université Laval, Québec City, Québec, Canada; Centre d'étude des troubles du sommeil, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Yvan Leanza
- École de psychologie, Université Laval, Québec City, Québec, Canada; Laboratoire Psychologie et Cultures, Québec, Québec, Canada
| | - Annie Vallières
- École de psychologie, Université Laval, Québec City, Québec, Canada; Laboratoire Psycho|Socio|Culturel du sommeil, Centre de recherche de l'Institut en santé mentale de Québec, Centre de recherche du Centre hospitalier universitaire de Québec, Québec, Canada
| | - Charles M Morin
- École de psychologie, Université Laval, Québec City, Québec, Canada; Centre d'étude des troubles du sommeil, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
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Tutek J, Emert SE, Dautovich ND, Lichstein KL. Association between chronotype and nonrestorative sleep in a college population. Chronobiol Int 2016; 33:1293-1304. [DOI: 10.1080/07420528.2016.1212870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Joshua Tutek
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Sarah E. Emert
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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Abstract
Sleep-wake cycle disturbances are prevalent in patients with medical conditions and frequently present as part of a symptom cluster. Sleep disturbances impair functioning and quality of life, decrease adherence to treatments of the primary medical condition, and increase morbidity and mortality. The pathophysiology of sleep disturbances in these patients involves alterations in immune and neuroendocrine function and shares common pathophysiologic pathways with comorbidities such as fatigue and depression. Emphasis is placed on the evaluation and management of medical and psychiatric comorbidities and other factors contributing to sleep problems. Primary treatments include cognitive-behavioral therapy and pharmacotherapy.
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Affiliation(s)
- Jayesh Kamath
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6415, USA.
| | - Galina Prpich
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6415, USA
| | - Sarah Jillani
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6415, USA
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Wakasugi M, Kazama JJ, Narita I, Iseki K, Moriyama T, Yamagata K, Fujimoto S, Tsuruya K, Asahi K, Konta T, Kimura K, Kondo M, Kurahashi I, Ohashi Y, Watanabe T. Association between combined lifestyle factors and non-restorative sleep in Japan: a cross-sectional study based on a Japanese health database. PLoS One 2014; 9:e108718. [PMID: 25268956 PMCID: PMC4182544 DOI: 10.1371/journal.pone.0108718] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although lifestyle factors such as cigarette smoking, excessive drinking, obesity, low or no exercise, and unhealthy dietary habits have each been associated with inadequate sleep, little is known about their combined effect. The aim of this study was to quantify the overall impact of lifestyle-related factors on non-restorative sleep in the general Japanese population. METHODS AND FINDINGS A cross-sectional study of 243,767 participants (men, 39.8%) was performed using the Specific Health Check and Guidance System in Japan. A healthy lifestyle score was calculated by adding up the number of low-risk lifestyle factors for each participant. Low risk was defined as (1) not smoking, (2) body mass index<25 kg/m², (3) moderate or less alcohol consumption, (4) regular exercise, and (5) better eating patterns. Logistic regression analysis was used to examine the relationship between the score and the prevalence of non-restorative sleep, which was determined from questionnaire responses. Among 97,062 men (mean age, 63.9 years) and 146,705 women (mean age, 63.7 years), 18,678 (19.2%) and 38,539 (26.3%) reported non-restorative sleep, respectively. The prevalence of non-restorative sleep decreased with age for both sexes. Compared to participants with a healthy lifestyle score of 5 (most healthy), those with a score of 0 (least healthy) had a higher prevalence of non-restorative sleep (odds ratio, 1.59 [95% confidence interval, 1.29-1.97] for men and 2.88 [1.74-4.76] for women), independently of hypertension, hypercholesterolemia, diabetes, and chronic kidney disease. The main limitation of the study was the cross-sectional design, which limited causal inferences for the identified associations. CONCLUSIONS A combination of several unhealthy lifestyle factors was associated with non-restorative sleep among the general Japanese population. Further studies are needed to establish whether general lifestyle modification improves restorative sleep.
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Affiliation(s)
- Minako Wakasugi
- Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Junichiro James Kazama
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Kunitoshi Iseki
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Shouichi Fujimoto
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Kazuhiko Tsuruya
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Koichi Asahi
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Tsuneo Konta
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Kenjiro Kimura
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | - Masahide Kondo
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
| | | | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Tsuyoshi Watanabe
- Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups,” Fukushima, Japan
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Drake CL, Hays RD, Morlock R, Wang F, Shikiar R, Frank L, Downey R, Roth T. Development and evaluation of a measure to assess restorative sleep. J Clin Sleep Med 2014; 10:733-41, 741A-741E. [PMID: 25024650 PMCID: PMC4067436 DOI: 10.5664/jcsm.3860] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are validated measures assessing insomnia and disturbed sleep, but few psychometrically sound instruments to assess perceptions of the restorative or inadequate properties of sleep are available. STUDY OBJECTIVES To develop and evaluate a new instrument, the Restorative Sleep Questionnaire (RSQ). DESIGN AND SETTING Focus groups were conducted using participants with and without nonrestorative sleep complaints. Questions were designed to elicit the feelings and experiences people have about their sleep and their view of daytime consequences of sleep. Expert panels confirmed the importance of nonrestorative sleep (NRS) as a frequently encountered problem either with or without other sleep complaints. The resulting RSQ was administered in three studies: (1) a telephone interview with healthy controls and individuals with sleep problems; (2) a randomized clinical trial of patients with primary insomnia assessed by polysomnography (PSG); (3) a PSG study of subjects with NRS complaints. MEASUREMENT AND RESULTS Across all studies, the new measures were shown to be significantly correlated with health-related quality of life (HRQL) domains hypothesized to be related to NRS. The RSQ had good psychometric properties (α > 0.90; rtest-retest > 0.80), and factor analysis confirmed the unidimensionality of the measure. The RSQ was able to distinguish between healthy controls, patients with primary insomnia, and insomnia patients with isolated NRS complaints but without PSG defined sleep onset, duration, or maintenance problems. Normal sleepers reported sleep that was about a standard deviation more restorative than that of those with NRS on the RSQ. CONCLUSIONS The results of the study provide support for the reliability and validity of the RSQ as a measure of NRS in subjects with and without self-reported or PSG confirmed sleep initiation and maintenance difficulties. CLINICALTRIALSGOV IDENTIFIERS NCT00655369; NCT00705601.
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Affiliation(s)
| | - Ron D. Hays
- University of California Los Angeles, Los Angeles, CA
| | - Robert Morlock
- Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI
| | | | | | | | - Ralph Downey
- Loma Linda University School of Medicine, Loma Linda, CA
| | - Thomas Roth
- Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI
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Veqar Z, Moiz JA, Hussain ME. Psychometric Analysis of the Pittsburgh Insomnia Rating Scale among University Population of Poor Sleepers in India. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:161-7. [PMID: 24843848 PMCID: PMC4024582 DOI: 10.4103/1947-2714.131238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Pittsburgh insomnia rating scale is a 65 item self administered open source questionnaire. The scale is widely used in clinical practice but its psychometric properties are not well established. Therefore keeping in mind this lacuna the current study was designed for university population of poor sleepers in India. Aims: The purpose of this study was to establish the Pittsburgh sleep Quality Index test- retest reliability, validity and internal consistency of Pittsburgh insomnia rating scale. Materials and Methods: Twenty five subjects were randomly chosen from the screened population of poor sleepers. Pittsburgh insomnia rating scale, Pittsburgh sleep quality index and Insomnia severity index were administered on test day. Retest was administered after one week. Results: Eight males and seventeen females with mean age 24 + 7.04 were recruited. The test retest reliability for Pittsburgh insomnia rating scale total score showed excellent reliability (ICC2,1-0.93). The results also show that the total score is moderately correlated with Pittsburgh sleep Quality Index (r-0.31) and moderately correlated with Insomnia severity index (r-0.49). Internal consistency for the test was excellent (Cronbach's alpha- 0.930) Conclusion: The study findings suggest that Pittsburgh insomnia rating scale has excellent internal consistency, test-retest reliability and good validity for university population of poor sleepers in India. It is an important first line of assessment scale for screening of sleep problems.
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Affiliation(s)
- Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A central university), New Delhi, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A central university), New Delhi, India
| | - Mohammed Ejaz Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A central university), New Delhi, India
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Wilkinson K, Shapiro C. Development and validation of the Nonrestorative Sleep Scale (NRSS). J Clin Sleep Med 2014; 9:929-37. [PMID: 23997705 DOI: 10.5664/jcsm.2996] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nonrestorative sleep (NRS) is defined as the subjective feeling that sleep has been insufficiently refreshing, often despite the appearance of physiologically normal sleep. While NRS has been shown to be associated with a variety of cognitive, affective, and medical complaints, there is currently no valid, reliable instrument available in the public domain for its assessment. The purpose of this study was to develop and validate the nonrestorative sleep scale (NRSS). PARTICIPANTS The scale was administered to a sample of 226 (age: 46.7 ± 14.9 years; gender: 48% female) consecutive sleep clinic patients and to 30 control participants (age: 36.9 ± 12.5; gender: 53% female). RESULTS Data screening led to a final instrument of 12 items, and factor analysis resulted in 4 factors accounting for 73.2% of total variance. The scale demonstrated excellent internal reliability (α = 0.88) and good test-retest reliability (r = 0.72). Preliminary evaluations of construct validity found that certain subscales correlated reasonably well with previously validated sleep, alertness, and affective scales. Comparisons between global NRSS scores and objective polysomnographic variables revealed a few very small but significant correlations. CONCLUSIONS Based on these findings, the NRSS was confirmed to be a valid and reliable tool for the assessment of nonrestorative sleep.
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Howell D, Oliver TK, Keller-Olaman S, Davidson JR, Garland S, Samuels C, Savard J, Harris C, Aubin M, Olson K, Sussman J, MacFarlane J, Taylor C. Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice. Ann Oncol 2014; 25:791-800. [PMID: 24287882 DOI: 10.1093/annonc/mdt506] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.
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Affiliation(s)
- D Howell
- University Health Network & Faculty of Nursing, University of Toronto, Toronto; Canadian Partnership Against Cancer, Toronto.
| | - T K Oliver
- Canadian Partnership Against Cancer, Toronto
| | - S Keller-Olaman
- Dalla Lana School of Public Health, University of Toronto, Toronto
| | - J R Davidson
- Departments of Psychology and Oncology, Queen's University, Kingston; Kingston Family Health Team, Kingston
| | - S Garland
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary; Department of Psychology, University of Calgary, Calgary
| | - C Samuels
- Centre for Sleep and Human Performance in Calgary, Calgary
| | - J Savard
- School of Psychology, Université Laval, Quebec City
| | - C Harris
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa
| | - M Aubin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City
| | - K Olson
- Faculty of Nursing, University of Alberta, Alberta
| | - J Sussman
- Department of Oncology, Juravinski Cancer Centre, Hamilton
| | - J MacFarlane
- Department of Pediatrics & Psychiatry, University of Toronto, Toronto; MedSleep (Network of Clinics), Toronto
| | - C Taylor
- Department of Nursing, Cape Breton University, Sydney, Canada
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Hoey LM, Fulbrook P, Douglas JA. Sleep assessment of hospitalised patients: a literature review. Int J Nurs Stud 2014; 51:1281-8. [PMID: 24636444 DOI: 10.1016/j.ijnurstu.2014.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep is a dynamic and essential part of human life and health. In healthcare settings, nurses are strategically placed to promote sleep and sleep health. In this regard, nursing actions should be based upon effective methods of assessment of patient sleep. Standardised sleep assessment does not currently occur in the care of acute hospitalised patients. Use of an appropriate measurement tool would help evaluate inpatient sleep. An effective, efficient sleep assessment tool is needed to aid clinicians. Such assessment would enable specific nursing intervention to be tailored to individual patients. OBJECTIVE The objective of this paper was to examine the literature on sleep measurement to identify subjective sleep assessment tools that may be suitable for routine use with hospitalised patients, and to evaluate their reliability and validity. METHOD A review of existing literature was undertaken to identify and evaluate subjective sleep measurement tools. RESULTS The initial literature searches identified 402 articles, of which ten met the criteria for review. These reported on three subjective sleep measurement scales: the Richards-Campbell Sleep Questionnaire; the St Mary's Hospital Sleep Questionnaire; and the Verran Snyder-Halpern Sleep Scale. The Richards-Campbell Sleep Questionnaire is brief and easy to use. In specific samples, its items correlate with domains reflecting sleep quality and has shown excellent internal consistency. Equivocal results and scoring challenges were found with the St Mary's Hospital Sleep Questionnaire. The Verran Snyder-Halpern Sleep Scale captured sleep disturbance and total sleep time, but time-to-complete is more burdensome than the Richards-Campbell Sleep Questionnaire. CONCLUSIONS The current use of sleep assessment instruments in the acute hospital setting is restricted mainly to research activities. Of the three tools identified that could be used clinically to measure inpatient sleep, and although it was developed for use in the intensive care setting, the Richards-Campbell Sleep Questionnaire held greatest potential due to its ease and rapidity of use. However, it has yet to be validated for use with general hospital inpatients, and further research is required in this area.
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Affiliation(s)
- Lynn M Hoey
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, Australia.
| | - Paul Fulbrook
- Nursing Research & Practice Development Centre, The Prince Charles Hospital, School of Nursing, Midwifery & Paramedicine and Australia Catholic University, Brisbane
| | - James A Douglas
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, Australia
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Chung KF, Kan KKK, Yeung WF. Insomnia in adolescents: prevalence, help-seeking behaviors, and types of interventions. Child Adolesc Ment Health 2014; 19:57-63. [PMID: 32878360 DOI: 10.1111/camh.12009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the DSM-IV diagnosis of insomnia among adolescents. Their help-seeking behaviors and self-help strategies for insomnia remain largely unclear. METHOD A cross-sectional, interview-based study of 290 Chinese adolescents. RESULTS The prevalence of insomnia symptoms was 40%, among which 9.3% had DSM-IV insomnia. Primary insomnia accounted for 7.9%, whereas insomnia associated with psychiatric disorders constituted 1.4%. Adolescents with DSM-IV insomnia had more severe and frequent insomnia, higher GHQ scores, and were more likely to have a history of sleep paralysis than those with insomnia symptoms alone. About 22% of adolescents with insomnia symptoms sought help and 32% attempted various strategies to improve sleep. CONCLUSIONS Many adolescents were troubled by insomnia, but they seldom sought help from healthcare professionals or received proper treatments.
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Affiliation(s)
- Ka-Fai Chung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | - Wing-Fai Yeung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
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Abstract
Good sleep is essential to good health. Yet for most of its history, sleep medicine has focused on the definition, identification, and treatment of sleep problems. Sleep health is a term that is infrequently used and even less frequently defined. It is time for us to change this. Indeed, pressures in the research, clinical, and regulatory environments require that we do so. The health of populations is increasingly defined by positive attributes such as wellness, performance, and adaptation, and not merely by the absence of disease. Sleep health can be defined in such terms. Empirical data demonstrate several dimensions of sleep that are related to health outcomes, and that can be measured with self-report and objective methods. One suggested definition of sleep health and a description of self-report items for measuring it are provided as examples. The concept of sleep health synergizes with other health care agendas, such as empowering individuals and communities, improving population health, and reducing health care costs. Promoting sleep health also offers the field of sleep medicine new research and clinical opportunities. In this sense, defining sleep health is vital not only to the health of populations and individuals, but also to the health of sleep medicine itself.
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Affiliation(s)
- Daniel J. Buysse
- Sleep Medicine Institute and Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Kawada T. Nonrestorative sleep: a useful indicator of insomnia with a wide range of prevalence. Sleep Med 2013; 14:925. [DOI: 10.1016/j.sleep.2013.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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Mariman AN, Vogelaers DP, Tobback E, Delesie LM, Hanoulle IP, Pevernagie DA. Sleep in the chronic fatigue syndrome. Sleep Med Rev 2013; 17:193-9. [DOI: 10.1016/j.smrv.2012.06.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 01/24/2023]
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Zhang J, Lamers F, Hickie IB, He JP, Feig E, Merikangas KR. Differentiating nonrestorative sleep from nocturnal insomnia symptoms: demographic, clinical, inflammatory, and functional correlates. Sleep 2013; 36:671-9. [PMID: 23633749 DOI: 10.5665/sleep.2624] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
STUDY OBJECTIVES Recent studies have suggested that nonrestorative sleep (NRS) symptoms may be distinct from nocturnal insomnia symptoms (NIS). However, there is limited information on the demographic, medical, and biologic correlates of NRS independent from NIS in the general population. This report presents the sociodemographic correlates, patterns of comorbidity with other sleep and physical disorders, C-reactive protein (CRP) levels, and general productivity associated with NIS and NRS in a nationally representative sample of US adults. DESIGN National Health and Nutrition Examination Survey (NHANES). SETTING The 2005-2008 surveys of the general population in the United States. PARTICIPANTS There were 10,908 individuals (20 years or older). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Respondents were classified by the presence or absence of NIS and NRS. Compared with those without insomnia symptoms, respondents with NIS were older and had lower family income and educational levels than those with NRS. In addition, there was a significant association between NIS and cardiovascular disease, whereas NRS was associated with other primary sleep disorders (including habitual snoring, sleep apnea, and restless legs syndrome), respiratory diseases (emphysema and chronic bronchitis), thyroid disease, and cancer as well as increased CRP levels. In addition, the study participants with NRS only reported poorer scores on the Functional Outcomes of Sleep Questionnaire (FOSQ) than those without insomnia symptoms or those with NIS only. CONCLUSIONS These findings suggest that there are substantial differences between NIS and NRS in terms of sociodemographic factors, comorbidity with other sleep and physical disorders, increased CRP level, and functional impairment. An inflammatory response might play a unique role in the pathogenesis of NRS.
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Affiliation(s)
- Jihui Zhang
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Kotronoulas G, Wengström Y, Kearney N. Sleep and sleep-wake disturbances in care recipient-caregiver dyads in the context of a chronic illness: a critical review of the literature. J Pain Symptom Manage 2013; 45:579-94. [PMID: 22926086 DOI: 10.1016/j.jpainsymman.2012.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/21/2012] [Accepted: 03/09/2012] [Indexed: 11/15/2022]
Abstract
CONTEXT Alterations in sleep-wake patterns of care recipients and their informal caregivers are common in the context of a chronic illness. Given the current notion that sleep may be regulated within and affected by close human relationships, concurrent and interrelated sleep problems may be present in care recipient-caregiver dyads. OBJECTIVES To critically analyze evidence regarding concurrent sleep patterns or changes in care recipient-caregiver dyads in the context of a chronic illness and address methodological and research gaps. METHODS Using a wide range of key terms and synonyms, three electronic databases (Medline, CINAHL, and Embase) were systematically searched for the period between January 1990 and July 2011. RESULTS Ten studies met prespecified selection criteria and were included for analysis. Study quality was fair to good on average. Seven studies were conducted in the context of dementia or Parkinson's disease, two in the context of cancer, and one study included a group of community elders with mixed related comorbidities and their informal caregivers. Bidirectional associations in the sleep of care recipient-caregiver dyads seem to exist. Concurrent and comparable nocturnal sleep disruptions also may be evident. Yet, inconsistencies in the methods implemented, and the samples included, as well as uncertainty regarding factors coaffecting sleep, still preclude safe conclusions to be drawn on. CONCLUSION The dyadic investigation of sleep is a promising approach to the development of truly effective interventions to improve sleep quality of care recipients and their caregivers. Nevertheless, more systematic, longitudinal dyadic research is warranted to augment our understanding of co-occurrence and over time changes of sleep problems in care recipient-caregiver dyads, as well as to clarify covariates/factors that appear to contribute to these problems within the dyad and across time and context of illness.
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Kirsch DB. A Neurologist’s Guide to Common Subjective and Objective Sleep Assessments. Neurol Clin 2012; 30:987-1006. [DOI: 10.1016/j.ncl.2012.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zhang J, Lam SP, Li SX, Li AM, Wing YK. The longitudinal course and impact of non-restorative sleep: A five-year community-based follow-up study. Sleep Med 2012; 13:570-6. [DOI: 10.1016/j.sleep.2011.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 12/28/2011] [Accepted: 12/30/2011] [Indexed: 02/02/2023]
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Wilkinson K, Shapiro C. Nonrestorative sleep: symptom or unique diagnostic entity? Sleep Med 2012; 13:561-9. [PMID: 22560828 DOI: 10.1016/j.sleep.2012.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
Nonrestorative sleep (NRS) refers to the subjective experience of sleep as insufficiently refreshing, often despite the appearance of normal sleep according to traditionally assessed objective parameters. This has led researchers to pursue alternative physiological markers of nonrestorative or unrefreshing sleep, though much of this research remains controversial and inconclusive. This review summarizes the recent findings on NRS in the literature and discusses some of the issues inherent in current efforts to define and measure NRS. We offer a summary of recommended clinical approaches to NRS and discuss a new potential paradigm for the assessment of NRS-an approach modelled on current diagnosis of insomnia.
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Affiliation(s)
- Kate Wilkinson
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, ON M5S 3G5, Canada.
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Hsieh ML, Li YM, Chang ET, Lai HL, Wang WH, Wang SC. Sleep disorder in Taiwanese nurses: a random sample survey. Nurs Health Sci 2011; 13:468-74. [PMID: 22011090 DOI: 10.1111/j.1442-2018.2011.00641.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study determined the prevalence of and factors associated with insomnia in rotating-shift nurses. A two-stage, cross-sectional, hospital-based study was conducted in eastern Taiwan. Participants were randomly-sampled, rotating-shift nurses (n=661), ranging in age from 21 to 62 years, with a mean age of 31.86 (standard deviation=8.09). Insomnia disorder was identified using the Pittsburgh Sleep Quality Index. Nurses completed the self-reported Index, together with other questionnaires designed by the researchers for the purpose of the study. The prevalence of insomnia disorder was 59% (n=390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety, feelings of depression, and a poor working atmosphere. Anxiety, depression, and working atmosphere are independent predictors of insomnia. These results suggest that it is crucial to implement a more appropriate shift system and to develop prevention programs for nurses with insomnia to improve their occupational health.
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Affiliation(s)
- Mei-Lin Hsieh
- Department of Nursing, Tzu Chi University, Buddhist Tzu Chi General Hospital, 707 Section 3 Chung Yang Road, Hualien, Taiwan
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