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Hidaka T, Kakamu T, Endo S, Masuishi Y, Kasuga H, Hata A, Miura R, Funayama Y, Tajimi K, Fukushima T. Associations of endurance, muscle strength, and balanced exercise with subjective sleep quality in sedentary workers: A cross-sectional study. Work 2024; 78:761-770. [PMID: 38160388 DOI: 10.3233/wor-230299] [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: 01/03/2024] Open
Abstract
BACKGROUND The optimal exercise combination for improving sleep quality among sedentary workers is unclear. OBJECTIVE To reveal what combination of exercises contributes to good sleep quality. METHODS In this cross-sectional study, we enrolled 5,201 sedentary workers who underwent health examinations in 2019. Data on sleep quality, basic attributes, energy expenditure, and lifestyle aspects such as exercise and physical activity, supper time close to bedtime, and alcohol intake were obtained. The subjects reported their exercise habits by selecting up to three forms of exercise from a list of 182 options, which were classified into three types: endurance (e.g., jogging), muscle strength (e.g., bench pressing), and balanced types which combined both endurance and muscle strength characteristics. (e.g., walking). These forms were then categorized into eight combination patterns: endurance only; muscle strength only; balanced only; endurance and muscle strength; endurance and balanced; muscle strength and balanced; all types; and absence of any exercise habits. Binary logistic regression analysis was used to examine the associations between the exercise combination patterns and sleep quality. RESULTS Good sleep quality was significantly associated with "endurance" (OR = 1.419; 95% CI 1.110-1.814), "balanced only" (OR = 1.474; 95% CI 1.248-1.741), and "endurance and balance" (OR = 1.782; 95% CI 1.085-2.926) exercise patterns. No significant associations were found between the combinations that included muscle strength exercises and sleep quality. CONCLUSION The endurance or balanced-type exercises, or a combination of both, may help to improve the sleep quality of sedentary workers as part of occupational health management.
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Affiliation(s)
- Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiko Hata
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Rieko Miura
- Koriyama Health Promotion Foundation, Fukushima, Japan
| | | | | | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
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Nistor P, Chang-Kit B, Nicholson K, Anderson KK, Stranges S. The relationship between sleep health and multimorbidity in community dwelling populations: Systematic review and global perspectives. Sleep Med 2023; 109:270-284. [PMID: 37490803 DOI: 10.1016/j.sleep.2023.07.002] [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: 03/02/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
Previous research has identified a relationship between sleep problems and multimorbidity, defined as the co-occurrence of two or more chronic health conditions in the same individual. This systematic review sought to summarize the literature on the association between sleep duration and quality and multimorbidity in adult community-dwelling populations. A comprehensive search of the PubMed, Embase and CINAHL databases identified studies published between January 1990 and January 2023. Studies were included if they focused on community-dwelling populations, used an observational design, measured sleep quality or duration, used multimorbidity as the main study outcome, and explored the relationship between sleep and multimorbidity. Two reviewers independently conducted study screening, data extraction, and bias assessments. Twenty-four cross-sectional and five prospective cohort studies met the inclusion criteria, with studies from 16 countries and two with cross-country comparisons, and a total participant number of 481,862. Overall, poorer sleep quality and sleep duration outside current recommendations were consistently associated with multimorbidity, though with varying strength. This association was present regardless of specific multimorbidity definitions from different studies. Definitions of sleep duration and quality were inconsistent across studies, possibly contributing to mixed evidence on the observed association. Most studies were cross-sectional, limiting the assessment of the temporal direction of association. Our results corroborate relationships between poor sleep and risk of multimorbidity in adult community-dwelling populations around the world. Examining this relationship may help increase public health awareness of sleep as a modifiable risk factor for the prevention of chronic disease and healthy aging.
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Affiliation(s)
- Patricia Nistor
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
| | - Brittany Chang-Kit
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Kathryn Nicholson
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada; Luxembourg Institute of Health, Luxembourg
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Mou H, Xu D, Zhu S, Zhao M, Wang Y, Wang K. The sleep patterns and their associations with mental health among nursing home residents: a latent profile approach. BMC Geriatr 2023; 23:468. [PMID: 37537539 PMCID: PMC10401828 DOI: 10.1186/s12877-023-04124-5] [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: 10/15/2022] [Accepted: 06/21/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Nursing home residents commonly experience poor sleep conditions. However, few studies have explored the potential sleep patterns among nursing home residents. This study aimed to identify the sleep patterns in nursing home residents, compare residents' characteristics across sleep patterns, and examine the relationships between sleep patterns and residents' mental health (i.e., depressive and anxiety symptoms). METHODS This cross-sectional study was conducted in 27 nursing homes in Jinan, China, from March to June 2018. In total, 353 participants were recruited via convenience sampling, and of which, 326 completed the survey. A latent profile analysis was performed to identify sleep patterns based on the seven dimensions of the Pittsburgh Sleep Quality Index. Bivariate analyses were conducted to compare residents' characteristics among the sleep patterns. Mixed-effects logistic regression analyses were adopted to investigate the relationships between sleep patterns and residents' mental health. RESULTS Three sleep patterns were identified, including 'good sleepers', 'poor sleepers without hypnotic use', and 'poor sleepers with hypnotic use'. Residents' gender, education, pain, instrumental activities of daily living, and number of chronic conditions were significantly differentiated across the sleep patterns. Compared with 'good sleepers', 'poor sleepers without hypnotic use' were significantly associated with more depressive symptoms (OR = 3.73, 95% CI = 2.09, 6.65, p < 0.001), but not with anxiety symptoms (OR = 2.04, 95% CI = 0.97, 4.29, p = 0.062); whereas 'poor sleepers with hypnotic use' had significantly more depressive (OR = 5.24, 95% CI = 2.54, 10.79, p < 0.001) and anxiety symptoms (OR = 5.02, 95% CI = 2.13, 11.83, p < 0.001). CONCLUSIONS This study reveals three distinct sleep patterns in nursing home residents and their significant associations with residents' mental health. These findings can inform future research to develop appropriate and tailored intervention strategies for improving sleep and promoting mental health for nursing home residents.
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Affiliation(s)
- Huanyu Mou
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, China
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, IN, 47907, USA
| | - Shanshan Zhu
- Geriatrics Department, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450000, China
| | - Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, China
| | - Yaqi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, China.
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Sabatini S, Ukoumunne OC, Ballard C, Collins R, Corbett A, Brooker H, Clare L. Cross-Sectional and Longitudinal Associations between Subjective Sleep Difficulties and Self-Perceptions of Aging. Behav Sleep Med 2022; 20:732-761. [PMID: 34689666 DOI: 10.1080/15402002.2021.1994405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function). PARTICIPANTS/METHODS We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties. RESULTS Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant. CONCLUSIONS Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.
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Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- College of Medicine and Health, University of Exeter, Exeter, UK.,Nihr Applied Research Collaboration South West Peninsula (Penarc), University of Exeter, Exeter, NIHR, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, UK.,Ecog Pro Ltd, Bristol, UK
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK.,Nihr Applied Research Collaboration South West Peninsula (Penarc), University of Exeter, Exeter, NIHR, UK
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Sleep Quality and Insomnia Severity among Italian University Students: A Latent Profile Analysis. J Clin Med 2022; 11:jcm11144069. [PMID: 35887833 PMCID: PMC9318221 DOI: 10.3390/jcm11144069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
Insomnia is a widespread sleep disorder associated with physical and mental health conditions. Although the heterogeneity of insomnia presentations has been acknowledged, research investigating clinically meaningful insomnia subtypes is still ongoing. This study aimed at exploring insomnia subtypes according to widely-used measures of symptoms severity and sleep quality among Italian university students using a latent profile analysis. Data were collected from 490 students reporting relevant insomnia symptoms through an online cross-sectional survey comprising the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the 21-item Depression Anxiety Stress Scale, and the Short Form-12. Latent profile analysis identified five insomnia subtypes. The severe insomnia (8.8%) group showed the highest insomnia severity, with diverse complaints concerning sleep quality and daytime functioning. Moderate insomnia with sleep duration complaints (8.4%) and moderate insomnia with medication use (15.9%) subgroups were characterized by middle range insomnia severity, with problems of sleep continuity and sleep medication use, respectively. Subthreshold insomnia with sleep latency complaints (20.4%) and subthreshold insomnia (46.5%) groups showed attenuated insomnia symptoms. Higher psychological complaints and worse quality of life were associated with greater sleep complaints. Overall, these findings highlight the relevance of sleep quality domains in identifying insomnia subtypes and might help optimize insomnia treatments.
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Aseem A, Chaudhry N, Hussain ME. Effect of moderate intensity aerobic exercise training on electrophysiological and biochemical correlates of sleep. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Depressive and stress symptoms in insomnia patients predict group cognitive-behavioral therapy for insomnia long-term effectiveness: A data-driven analysis. J Affect Disord 2021; 289:117-124. [PMID: 33979721 DOI: 10.1016/j.jad.2021.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Insomnia Disorder is characterized by high degree of phenotypic heterogeneity, that might influence treatment response. METHODS 123 of 294 insomnia patients initially recruited (66.7% females, age=40.59±11.89) were assessed before and after group Cognitive-Behavioral Therapy for Insomnia (CBT-I), as well as at follow-up (7.8±1.6 years after the end-of-treatment). By use of latent class analysis (LCA) we identified insomnia subtypes according with baseline scores of insomnia severity and features, anxiety, depression, stress and sleepiness symptoms, circadian rhythm, and treatment effectiveness (Delta score of Insomnia Severity Index-ISI between baseline and end-of-treatment). RESULTS By LCA we revealed three classes: "PURE INSOMNIA", "INSOMNIA+ANXIETY+DEPRESSION+STRESS", and "INSOMNIA+ANXIETY". The improvements in insomnia severity was maintained up to 10 years after the end-of-treatment, but with differences between classes (p<0.05). Class "INSOMNIA+ANXIETY+DEPRESSION+STRESS" showed at the end-of-treatment the largest percentage of responders (63.5% = Insomnia Severity Index decrease ≥8). However, at follow up the effect was less and 48.1% had a moderate or severe insomnia (Insomnia Severity Index >14). LIMITATIONS The lack of a control group and the absence of a complete clinical assessment at the follow-up limit the interpretability of our results. CONCLUSIONS Our data driven analysis suggest insomnia heterogeneity can be categorized into sub-classes by depression, anxiety, and stress symptoms. In addition, insomnia patients with stress and depression symptoms maintained highest percentage of clinical depression at the end-of-treatment and insomnia at follow-up, in comparison with others classes. Stress and depression symptoms should be considered risk factors that play an important role in the long-term outcome of CBT-I.
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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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Hidaka T, Kasuga H, Endo S, Masuishi Y, Kakamu T, Takeda A, Koizumi M, Fukushima T. Are lifestyle pattern changes associated to poor subjective sleep quality?: a cross-sectional study by gender among the general Japanese population underwent specified medical check-ups in 2014 and 2015. BMJ Open 2020; 10:e037613. [PMID: 33328256 PMCID: PMC7745693 DOI: 10.1136/bmjopen-2020-037613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Subjective sleep quality (SSQ) is defined by the satisfaction of one's overall sleep experience and is composed of sleep depth and restfulness. It has not been clarified how poor SSQ is associated to changes in lifestyles. The purpose is to reveal the association of lifestyle pattern changes and poor SSQ. DESIGN A cross-sectional study. SETTING The data on basic attributes, SSQ and lifestyle such as presence/absence of smoking, exercise, physical activity, supper time close to bedtime, drinking habits and alcohol intake amount per day were obtained from database and questionnaire of specified medical check-ups in fiscal year 2014-2015 in Japan. The analysis was conducted in 2019. PARTICIPANTS The subjects comprised 49 483 residents (26 087 men and 23 396 women), aged 40-74 years who had undergone an annual specified medical check-up from 2014 to 2015 in Fukushima Prefecture, Japan. OUTCOME MEASURE Status of SSQ in 2015 was assessed using a question asking whether or not the subjects usually got enough sleep. Poor SSQ in 2015 and lifestyle pattern changes in 2014-2015 were compared between those who were in healthy status both in 2014 and 2015 (referent) and non-referent, using binary logistic regression analysis. RESULTS Unhealthy lifestyle pattern for 2014-2015 was significantly associated to poor SSQ in 2015: 'absent to absent' in exercise for men (OR=1.472; 95% CI 1.316 to 1.647) and women (OR=1.428; 95% CI 1.285 to 1.587), physical activity for men (OR=1.420; 95% CI 1.270 to 1.588) and women (OR=1.471; 95% CI 1.322 to 1.638) and 'present to present' in supper time for men (OR=1.149; 95% CI 1.020 to 1.294) and women (OR=1.288; 95% CI 1.102 to 1.505). CONCLUSIONS Healthcare workers may be able to contribute to the improvement of SSQ, focusing on changeable lifestyles.
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Affiliation(s)
- Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Takeda
- Fukushima National Health Insurance Organization, Fukushima, Japan
| | - Makoto Koizumi
- Fukushima National Health Insurance Organization, Fukushima, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
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Short NA, Allan NP, Saulnier K, Preston TJ, Joiner TE, Schmidt NB. Factor Mixture Modeling of the Insomnia Severity Index among Psychology Clinic Outpatients. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Subgrouping Poor Sleep Quality in Community-Dwelling Older Adults with Latent Class Analysis - The Yilan Study, Taiwan. Sci Rep 2020; 10:5432. [PMID: 32214167 PMCID: PMC7096492 DOI: 10.1038/s41598-020-62374-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/04/2020] [Indexed: 11/08/2022] Open
Abstract
The manifestation of older adults with poor sleep quality is heterogeneous. Using data-driven classifying methods, the study aims to subgroup community-dwelling older adults with poor sleep quality. Adults aged 65 and older participated in the Yilan study. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index. Latent class analysis with the 7 subscores of the Pittsburgh Sleep Quality Index as the indicators was used to generate empirical subgroups. Differences in comorbidity patterns between subgroups were compared. A total of 2622 individuals, of which 1011 (38.6%) had Pittsburgh Sleep Quality Index -defined poor sleep quality, participated. Three groups for poor sleep quality were specified in the latent class analysis: High Insomnia (n = 191, 7.3%), Mild Insomnia (n = 574, 21.9%), and High Hypnotics (n = 246, 9.4%). The High Insomnia and Mild Insomnia groups shared similar profiles but different severities in the 7 domains of the Pittsburgh Sleep Quality Index. In contrast, the High Hypnotics group had the lowest Pittsburgh Sleep Quality Index total scores and insomnia severity but had similar mental and physical comorbid patterns as the High Insomnia group. This finding suggests that poor sleep quality in community-dwelling older adults had various feature-based subgroups. It also implicates the development of group-centered interventions.
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Wallace ML, Lee S, Hall MH, Stone KL, Langsetmo L, Redline S, Schousboe JT, Ensrud K, LeBlanc ES, Buysse DJ. Heightened sleep propensity: a novel and high-risk sleep health phenotype in older adults. Sleep Health 2019; 5:630-638. [PMID: 31678177 PMCID: PMC6993140 DOI: 10.1016/j.sleh.2019.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To reveal sleep health phenotypes in older adults and examine their associations with time to 5-year all-cause and cardiovascular mortality. DESIGN Prospective longitudinal cohorts. SETTING The Study of Osteoporotic Fractures and Outcomes of Sleep Disorders in Older Men Study. PARTICIPANTS N = 1722 men and women aged ≥65 years matched 1:1 on sociodemographic and clinical measures. MEASUREMENTS Self-reported habitual sleep health characteristics (satisfaction, daytime sleepiness, timing, efficiency, and duration) measured at an initial visit and longitudinal follow-up for mortality. RESULTS Latent class analysis revealed 3 sleep health phenotypes: (1) heightened sleep propensity (HSP; medium to long duration, high sleepiness, high efficiency/satisfaction; n = 322), (2) average sleep (AS; medium duration, average efficiency, high satisfaction, low sleepiness; n = 1,109), and (3) insomnia with short sleep (ISS; short to medium duration, low efficiency/satisfaction, moderate sleepiness; n = 291). Phenotype predicted time to all-cause mortality (χ2 = 9.4, P = .01), with HSP conferring greater risk than AS (hazard ratio [95% confidence interval] = 1.48 [1.15-1.92]) or ISS (1.52 [1.07-2.17]), despite ISS reporting the poorest mental and physical health. Although sex did not formally moderate the relationship between phenotype and mortality, subgroup analyses indicated that these findings were driven primarily by women. Phenotype did not predict cardiovascular mortality. CONCLUSIONS These analyses support the utility of examining multidimensional sleep health profiles by suggesting that the combination of long sleep, high efficiency/satisfaction, and daytime sleepiness-previously identified as independent risk factors-may be components of a single high-risk sleep phenotype, HSP. Further investigation of sex differences and the mechanisms underlying mortality risk associated with HSP is warranted.
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Affiliation(s)
- M L Wallace
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA; Department of Biostatistics, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA.
| | - S Lee
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, USA
| | - M H Hall
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - K L Stone
- California Pacific Medical Center Research Institute, Mission Hall, Second Floor, 550 16th St, San Francisco, CA 94158, USA
| | - L Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55454, USA
| | - S Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - J T Schousboe
- Park Nicollet Clinic and Health Partners Institute, HealthPartners Inc, 3311 Old Shakopee Road, Bloomington, MN 55425, USA
| | - K Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55454, USA; Department of Medicine, University of Minnesota, 401 E River Pkwy, VCRC Suite 131, Minneapolis, MN 55455, USA
| | - E S LeBlanc
- Kaiser Permanente Center for Health Research NW, 3800 N Interstate Ave, Portland, OR 97227-1098, USA
| | - D J Buysse
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
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Abstract
OBJECTIVE To investigate the specific effect of insomnia on neuropsychological functioning in patients with very complex chronic pain. BACKGROUND Individuals with insomnia disorder or chronic pain often experience cognitive deficits, with both conditions appearing to correlate with impairments in neuropsychological functions. As insomnia often occurs comorbid with chronic pain, distinguishing the differential effects of these two syndromes on an individual's neuropsychological functioning can be challenging. Comorbid depressive symptoms in these individuals, which may also affect cognitive function, may further obscure the associations between chronic pain, insomnia, and the neuropsychological profile. METHODS The neuropsychological function of 22 individuals with very complex chronic pain was assessed using specialized tests examining aspects of memory and executive functioning. The severity of insomnia, depression, and anxiety was measured using questionnaires, and pain levels were assessed using a visual analog scale. Pain medications were transformed to the morphine-equivalent daily dose. RESULTS Insomnia severity was found to predict memory function, accounting for 32.4% of the variance: A 1 SD increase in insomnia severity decreased memory function by 0.57 SD. The negative correlation between insomnia and memory was significant even after controlling for pain level, morphine-equivalent daily dose, and comorbid levels of anxiety and depression. CONCLUSIONS Insomnia severity independently predicted memory function in patients with very complex chronic pain, even after controlling for other factors known to impair cognitive function. Insomnia may possibly explain some of the cognitive impairments related to chronic pain; thus, screening for, and treating, sleep disturbances may be a central aspect of chronic pain rehabilitation.
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Chen YL, Tseng WL, Yang LK, Gau SSF. Gender and Age Differences in Sleep Problems in Children: Person-Oriented Approach With Multigroup Analysis. Behav Sleep Med 2019; 17:302-313. [PMID: 28753086 DOI: 10.1080/15402002.2017.1357117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE/BACKGROUND This study aimed to identify subtypes of sleep problems in children and to examine whether these patterns differed between gender and age groups. PARTICIPANTS There were 3,052 children (951 elementary school boys, 943 elementary school girls, 603 junior high school boys, and 555 junior high school girls) aged 7-16 years from two school-based epidemiological samples. METHODS Sleep problems were measured by the Sleep Habit Questionnaire based on parent reports. RESULTS Using the latent class modeling, a person-oriented approach, with a multigroup analysis, we identified four classes of sleep problems: moderate to high sleep problems (1.1%-3.1%), sleep-related breathing problems and parasomnias dominant (14.9%-21.1%), insomnias dominant and parasomnias (1.0%-3.1%), and no or low sleep problems (74.7%-81.4%), with varied prevalence rates of sleep problems across gender and age groups. CONCLUSIONS This study identified four classes of sleep problems across gender and age groups but with different prevalence rates of sleep problems, suggesting the complex interaction of gender and age in the subtypes of sleep problems. The gender- and age-specific interventions for sleep problems are suggested. Future studies are warranted to replicate these classes and to identify associated factors with each class.
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Affiliation(s)
- Yi-Lung Chen
- a Department of Psychiatry , National Taiwan University Hospital and College of Medicine , Taipei , Taiwan.,b Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Wan-Ling Tseng
- c Department of Health and Human Services , Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health , Bethesda , Maryland
| | - Li-Kuang Yang
- a Department of Psychiatry , National Taiwan University Hospital and College of Medicine , Taipei , Taiwan.,d National Defense Medical Center , Tri-Service General Hospital , Beitou Branch , Taiwan
| | - Susan Shur-Fen Gau
- a Department of Psychiatry , National Taiwan University Hospital and College of Medicine , Taipei , Taiwan.,b Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health , National Taiwan University , Taipei , Taiwan.,e Department of Health and Human Services , Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health , Bethesda , Maryland , USA.,f Graduate Institute of Brain and Mind Sciences and Clinical Medicine, College of Medicine , National Taiwan University , Taipei , Taiwan
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Galbiati A, Sforza M, Fasiello E, Castronovo V, Ferini-Strambi L. Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients' Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives. Nat Sci Sleep 2019; 11:367-376. [PMID: 31819690 PMCID: PMC6890191 DOI: 10.2147/nss.s198812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.
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Affiliation(s)
- Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
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Dixon LJ, Lee AA, Gratz KL, Tull MT. Anxiety sensitivity and sleep disturbance: Investigating associations among patients with co-occurring anxiety and substance use disorders. J Anxiety Disord 2018; 53:9-15. [PMID: 29127882 DOI: 10.1016/j.janxdis.2017.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 01/04/2023]
Abstract
Sleep disturbance is a common problem among individuals with anxiety and substance use disorders (SUD). Anxiety sensitivity (AS) is elevated in patients with anxiety disorders and SUD and has been linked to sleep-related problems, including insomnia and somnolence (i.e., daytime sleepiness). We examined the unique roles of AS cognitive, physical, and social concerns in sleep disturbance among a sample of 99 residential SUD patients with anxiety disorders. Clinical levels of insomnia or somnolence were evidenced by 53.5% of the sample. Consistent with predictions, AS physical concerns was significantly associated with insomnia, and AS cognitive concerns was significantly related to insomnia and somnolence. Hierarchical linear regression models were conducted to test the association of AS cognitive and physical concerns with insomnia and somnolence symptoms while controlling for relevant factors. AS cognitive concerns accounted for unique variance, above and beyond withdrawal symptoms, anxiety, and depressive symptoms, in the model examining insomnia symptoms (B=0.30, SE=0.13, p=0.023). Results suggest that AS cognitive concerns may represent an important transdiagnostic mechanism underlying sleep disturbance among individuals with dual diagnosis.
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Affiliation(s)
- Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS 38677, United States.
| | - Aaron A Lee
- VA Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 W. Bancroft, Toledo, OH 43606, United States
| | - Matthew T Tull
- Department of Psychology, University of Toledo, 2801 W. Bancroft, Toledo, OH 43606, United States
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18
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Crawford MR, Chirinos DA, Iurcotta T, Edinger JD, Wyatt JK, Manber R, Ong JC. Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach? J Clin Sleep Med 2017. [PMID: 28633722 DOI: 10.5664/jcsm.6666] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. METHODS Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. RESULTS The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. CONCLUSIONS The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care.
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Affiliation(s)
- Megan R Crawford
- Department of Psychology, Swansea University, Swansea, United Kingdom.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | | | - Toni Iurcotta
- Hofstra Northwell School of Medicine, Hempstead, New York
| | - Jack D Edinger
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - James K Wyatt
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Rachel Manber
- Department of Psychiatry, Stanford University Medical Center, Palo Alto, California
| | - Jason C Ong
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Palagini L, Faraguna U, Mauri M, Gronchi A, Morin CM, Riemann D. Association between stress-related sleep reactivity and cognitive processes in insomnia disorder and insomnia subgroups: preliminary results. Sleep Med 2016; 19:101-7. [DOI: 10.1016/j.sleep.2015.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/06/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
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20
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Abstract
There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients. Insomnia is a major risk factor for mood disturbances such as depression, which may also contribute to lethargy in this at-risk population. The pathophysiology of fatigue and insomnia is discussed in this review, including their differential diagnoses as well as the emerging understanding of the roles of neurotransmitters, branched-chain amino acids, and inflammatory cytokines. Treatment approaches for insomnia and fatigue are also discussed and reviewed, including the role of hypnotics, psychotropics, hormonal agents, and alternative therapies.
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21
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Park M, Buchman AS, Lim AS, Leurgans SE, Bennett DA. Sleep complaints and incident disability in a community-based cohort study of older persons. Am J Geriatr Psychiatry 2014; 22:718-26. [PMID: 23567404 PMCID: PMC3735667 DOI: 10.1016/j.jagp.2012.12.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/16/2012] [Accepted: 10/26/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Sleep complaints are associated with adverse health consequences. We hypothesized that non-disabled older persons with more sleep complaints have an increased risk of developing disability. METHODS Subjects included 908 older clergy participating in the Religious Order Study without clinical dementia, history of stroke, or Parkinson disease. At baseline, participants rated their difficulty falling asleep, frequency of nocturnal awakenings, sleep efficacy, and napping frequency, from which a summary dyssomnia measure was derived. Self-report assessment of disability included instrumental activities of daily living (IADLs), basic activities of daily living (ADLs), and Rosow-Breslau mobility disability at baseline and at annual evaluations. RESULTS Mean follow-up was 9.6 (SD: 4.2) years. At baseline, more than 60% had one or more sleep complaints. In a series of Cox proportional hazards models controlling for age, sex, and education, a one-point higher dyssomnia score at baseline was associated with about 20% increased risk of IADL disability (hazard ratio: 1.20; 95% confidence interval [CI]: 1.04-1.39; χ(2)1 = 7.62; p <0.05), about 27% increased risk of ADL disability (hazard ratio: 1.27; 95% CI: 1.10-1.47; χ(2)1 = 12.15; p <0.01), and about 27% increased risk of mobility disability (hazard ratio: 1.27; 95% CI: 1.09-1.48; χ(2)1 = 11.04; p <0.01). These associations did not vary by age, sex, or education and remained significant after controlling for potential confounders including body mass index, chronic medical conditions, and several common medications. Controlling for depressive symptoms attenuated the association between sleep complaints and incident IADL and ADL disabilities but the association between sleep complaints and incident mobility disability remained significant. CONCLUSION Non-disabled older adults with more sleep complaints have an increased risk of developing disability.
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Affiliation(s)
- Margaret Park
- Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL.
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew S.P. Lim
- Division of Neurology, University of Toronto, 2075 Bayview Avenue – A402, Toronto, ON, M4N 3M5, Canada
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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22
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Ownby RL, Peruyera G, Acevedo A, Loewenstein D, Sevush S. Subtypes of sleep problems in patients with Alzheimer disease. Am J Geriatr Psychiatry 2014; 22:148-56. [PMID: 23567445 DOI: 10.1016/j.jagp.2012.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 07/25/2012] [Accepted: 08/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep disturbances are common in patients with Alzheimer disease (AD) and can contribute to cognitive dysfunction and a negative impact on patients' and caregivers' quality of life. The purpose of this study was to evaluate whether subtypes of sleep disturbance could be identified in patients with AD and to assess the relation of these subtypes to patient characteristics and caregiver mood. METHODS As part of routine clinical assessment, primary caregivers of 344 patients with AD completed a questionnaire that included five items about the patients' sleep. Patients' cognitive and functional status and their mood were assessed as was caregivers' mood. Latent class analysis was used to define subgroups of patients based on their sleep patterns. After identification of groups of sleep disturbance, the relation of group membership to patient and caregiver characteristics was also evaluated. RESULTS Analyses revealed groups with moderate and severe sleep problems as well as a group without problems. Patients with more severe sleep disturbance were older, less well educated, and had poorer cognitive and functional status. Caregiver and patient depression was related to membership in the severe group, suggesting that both may contribute to caregivers' ratings of more severe sleep disturbance, whereas only patient depression was related to membership in the moderate group. CONCLUSION Sleep problems in patients with AD are related to poorer cognitive and functional status and patient and caregiver depression. Caregiver depression was most closely related to more severe patient sleep disturbance.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL.
| | - Gloria Peruyera
- Center on Aging, University of Miami Miller School of Medicine, Miami, FL
| | - Amarilis Acevedo
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL; Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL
| | - David Loewenstein
- Center on Aging, University of Miami Miller School of Medicine, Miami, FL
| | - Steven Sevush
- Center on Aging, University of Miami Miller School of Medicine, Miami, FL
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23
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Alfaro E, Dhruva A, Langford DJ, Koetters T, Merriman JD, West C, Dunn LB, Paul SM, Cooper B, Cataldo J, Hamolsky D, Elboim C, Kober K, Aouizerat BE, Miaskowski C. Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery. Eur J Oncol Nurs 2013; 18:85-93. [PMID: 24012192 PMCID: PMC3946647 DOI: 10.1016/j.ejon.2013.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/27/2013] [Accepted: 08/04/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE RESEARCH To attempt to replicate the associations found in our previous study of patients and family caregivers between interleukin 6 (IL6) and nuclear factor kappa beta 2 (NFKB2) and sleep disturbance and to identify additional genetic associations in a larger sample of patients with breast cancer. METHODS AND SAMPLE Patients with breast cancer (n = 398) were recruited prior to surgery and followed for six months. Patients completed a self-report measure of sleep disturbance and provided a blood sample for genomic analyses. Growth mixture modeling was used to identify distinct latent classes of patients with higher and lower levels of sleep disturbance. KEY RESULTS Patients who were younger and who had higher comorbidity and lower functional status were more likely to be in the high sustained sleep disturbance class. Variations in three cytokine genes (i.e., IL1 receptor 2 (IL1R2), IL13, NFKB2) predicted latent class membership. CONCLUSIONS Polymorphisms in cytokine genes may partially explain inter-individual variability in sleep disturbance. Determination of high risk phenotypes and associated molecular markers may allow for earlier identification of patients at higher risk for developing sleep disturbance and lead to the development of more targeted clinical interventions.
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Affiliation(s)
- Emely Alfaro
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - Theresa Koetters
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, CA, USA
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA
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25
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Martin JL, Dzierzewski JM, Mitchell M, Fung CH, Jouldjian S, Alessi CA. Patterns of sleep quality during and after postacute rehabilitation in older adults: a latent class analysis approach. J Sleep Res 2013; 22:640-7. [PMID: 23834036 DOI: 10.1111/jsr.12066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/12/2013] [Indexed: 12/01/2022]
Abstract
Sleep quality is related to emotional, physical, psychological and cognitive functioning and functional independence in later life. After acute health events, older adults are likely to utilize postacute rehabilitation services to improve functioning and facilitate return to independent living. Patterns of how sleep changes with postacute rehabilitation, and predictors of such patterns, are unknown. The current investigation employed latent class analysis (LCA) methods to classify older adults (n = 233) into groups based on patterns of self-reported sleep quality pre-illness, during postacute rehabilitation and up to 1 year following postacute rehabilitation. Using LCA, older adults were grouped into (1) consistently good sleepers (46%), (2) good sleepers who transitioned into poor sleepers (34%), (3) consistently poor sleepers (14%) and (4) poor sleepers who transitioned into good sleepers (6%). In three planned analyses, pain was an independent predictor of membership in classes 1 or 2 (good pre-illness sleep quality) versus classes 3 or 4 (poor pre-illness sleep quality), and of membership in class 1 (consistently good sleep) versus class 2 (good sleep that transitioned to poor sleep). A lower Mini-Mental State Examination score was a predictor of membership in class 1 versus class 2. There were no statistically significant predictors of membership in class 3 versus class 4. Demographics, comorbidities and depressive symptoms were not significant predictors of class membership. These findings have implications for identification of older adults at risk for developing poor sleep associated with changes in health and postacute rehabilitation. The findings also suggest that pain symptoms should be targeted to improve sleep during postacute rehabilitation.
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Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA, USA
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Identification of distinct subgroups of breast cancer patients based on self-reported changes in sleep disturbance. Support Care Cancer 2013; 20:2611-9. [PMID: 22290719 DOI: 10.1007/s00520-012-1381-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The purposes of this study were to identify distinct subgroups of patients based on self-reported sleep disturbance prior to through 6 months after breast cancer surgery and evaluate for differences in demographic, clinical, and symptom characteristics among these latent classes. METHODS Women (n = 398) who underwent unilateral breast cancer surgery were enrolled prior to surgery. Patients completed measures of functional status, sleep disturbance (i.e., General Sleep Disturbance Scale (GSDS); higher scores indicate higher levels of sleep disturbance), fatigue, attentional fatigue, depressive symptoms, and anxiety prior to surgery and monthly for 6 months. RESULTS Three distinct classes of sleep disturbance trajectories were identified using growth mixture modeling. The high sustained class (55.0%) had high and the low sustained class (39.7%) had low GSDS scores prior to surgery that persisted for 6 months. The decreasing class (5.3%) had high GSDS score prior to surgery that decreased over time. Women in the high sustained class were significantly younger, had more comorbidity and poorer function, and were more likely to report hot flashes compared to the low sustained class. More women who underwent mastectomy or breast reconstruction were in the decreasing class. Decreasing and high sustained classes reported higher levels of physical fatigue, attentional fatigue, depressive symptoms, and anxiety compared to the low sustained class. CONCLUSIONS A high percentage of women has significant sleep disturbance prior to surgery that persists during subsequent treatments (i.e., radiation therapy and chemotherapy). Clinicians need to perform routine assessments and initiate appropriate interventions to improve sleep prior to and following surgery.
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27
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Miaskowski C, Cooper BA, Dhruva A, Dunn LB, Langford DJ, Cataldo JK, Baggott CR, Merriman JD, Dodd M, Lee K, West C, Paul SM, Aouizerat BE. Evidence of associations between cytokine genes and subjective reports of sleep disturbance in oncology patients and their family caregivers. PLoS One 2012; 7:e40560. [PMID: 22844404 PMCID: PMC3402493 DOI: 10.1371/journal.pone.0040560] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022] Open
Abstract
The purposes of this study were to identify distinct latent classes of individuals based on subjective reports of sleep disturbance; to examine differences in demographic, clinical, and symptom characteristics between the latent classes; and to evaluate for variations in pro- and anti-inflammatory cytokine genes between the latent classes. Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on General Sleep Disturbance Scale (GSDS) obtained prior to, during, and for four months following completion of radiation therapy. Single nucleotide polymorphisms (SNPs) and haplotypes in candidate cytokine genes were interrogated for differences between the two latent classes. Multiple logistic regression was used to assess the effect of phenotypic and genotypic characteristics on GSDS group membership. Two latent classes were identified: lower sleep disturbance (88.5%) and higher sleep disturbance (11.5%). Participants who were younger and had a lower Karnofsky Performance status score were more likely to be in the higher sleep disturbance class. Variation in two cytokine genes (i.e., IL6, NFKB) predicted latent class membership. Evidence was found for latent classes with distinct sleep disturbance trajectories. Unique genetic markers in cytokine genes may partially explain the interindividual heterogeneity characterizing these trajectories.
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Affiliation(s)
- Christine Miaskowski
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, United States of America.
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Green MJ, Espie CA, Hunt K, Benzeval M. The longitudinal course of insomnia symptoms: inequalities by sex and occupational class among two different age cohorts followed for 20 years in the west of Scotland. Sleep 2012; 35:815-23. [PMID: 22654201 DOI: 10.5665/sleep.1882] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The natural history of insomnia symptomatology is poorly understood. Cross-sectional associations have been demonstrated among socioeconomic disadvantage, female sex, and poor sleep but it is unclear how these social factors predict patterns of insomnia symptoms over time. The aim of this article is to describe longitudinal patterns of insomnia symptoms as people age and investigate how they vary by sex and occupational class. DESIGN A prospective cohort study with 20 yr of follow-up from 1987 to 1988. SETTING West of Scotland. PARTICIPANTS One cohort approximately 36 yr of age at baseline aging to 57 yr (n = 1,444), and another aging from approximately 56 to 76 yr (n = 1,551). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS At approximately 5-yr intervals, respondents self-reported trouble initiating and maintaining sleep. Latent class analysis identified 4 main sleep patterns: a healthy pattern with little sleeping trouble across the 20 yr; an episodic pattern, characterized by trouble maintaining sleep; a chronic pattern with trouble maintaining and initiating sleep throughout the study; and a pattern where symptoms developed during the 20-yr follow-up. Chronic patterns were more likely in the older cohort than the younger one, for women than men in the older cohort, and for those from a manual rather than a nonmanual occupational class in both cohorts. In the middle-aged cohort a developing pattern was more likely for women than men. CONCLUSIONS Chronic symptoms, characterized by both trouble maintaining and initiating sleep, are patterned by social factors.
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Affiliation(s)
- Michael J Green
- Medical Research Council/Chief Scientist Office: Social and Public Health Sciences Unit, Glasgow, UK.
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Sleep America: managing the crisis of adult chronic insomnia and associated conditions. J Affect Disord 2012; 138:192-212. [PMID: 21652083 DOI: 10.1016/j.jad.2011.05.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/22/2011] [Accepted: 05/09/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Chronic insomnia, a public health crisis affecting 10-15% of the U.S. population and costing billions of dollars annually, typically presents with one or more comorbid psychiatric or organic conditions. Historical classification of chronic insomnia as "secondary" to a presenting comorbid condition has resulted in under-recognition and under-treatment of both the insomnia and comorbid condition(s). Though critical in any model of comorbid disease management, chronic insomnia receives little, if any, public policy attention. METHOD We conducted a systematic review of recent empirical studies, review papers, books, government documents, press releases, advertisements, and articles pertaining to the classification, epidemiology, treatment, and physiology of sleep, insomnia, and comorbid conditions. Data were located primarily through MEDLINE, PsycINFO, SCOPUS, and PUBMED databases. OBJECTIVE AND RESULTS Our goal was to provide an overview of the systems for classifying insomnia and available epidemiological data, and to review theoretical models regarding the etiology and maintaining factors of chronic insomnia along with research on the complex, bidirectional associations between chronic insomnia and various affective (and other) conditions. CONCLUSIONS After thorough review of the literature, we propose several public policy measures as an initial step in managing chronic insomnia in the United States. These include introducing a nation-wide multi-modal educational and awareness campaign titled "Sleep America;" increasing the availability and demand for behavioral sleep medicine - the initially preferred treatment approach; and increasing the use of monitoring and enforcement activities by regulatory authorities to curtail false and misleading claims by sponsors of supplements or treatments for insomnia. Through the adoption of such measures, we hope to galvanize a national interest in healthy sleep and the evidence-based treatment of chronic insomnia.
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Shell WE, May LA, Bullias DH, Pavlik SL, Silver DS. Sentra PM (a Medical Food) and Trazodone in the Management of Sleep Disorders. J Cent Nerv Syst Dis 2012; 4:65-72. [PMID: 23650468 PMCID: PMC3619436 DOI: 10.4137/jcnsd.s9381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sleep disorders are a common and poorly treated disease state. This double blind, four arm placebo-controlled, randomized trial compared (1) low dose trazodone, (2) Sentra PM, a neurotransmitter based medical food, (3) the joint administration of trazodone and the medical food Sentra PM and (4) placebo. There were 111 subjects studied in 12 independent sites. Subjects underwent baseline screening, informed consent and an initial sleep questionnaire. After 14 days subjects underwent a second evaluation by questionnaire. At baseline and Day 14 the subjects underwent 24 hour ECG recordings that were analyzed in the frequency domain of heart rate variability. The specific high frequency parasympathetic autonomic nervous system activity was analyzed. The primary endpoints were sleep latency and parasympathetic autonomic nervous system improvement in sleeping hours. The results showed improvement in sleep latency for the Sentra PM and combination of Sentra PM and trazodone (−41 and −56 minutes P < 0.001). There was an improvement in quality of sleep for the amino acid formulation Sentra PM and the combination (3.86 and 6.48 Likert units on a 10 point scale P < 0.001). There was an activation of circadian activity percent at night in the medical food and combination groups while there was no change in parasympathetic activity in either the placebo or trazodone group. These data indicate that Sentra PM can improve the quality of sleep, the response to trazodone as a sleep medication and parasympathetic autonomic nervous system activity.
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Suh S, Ong JC, Steidtmann D, Nowakowski S, Dowdle C, Willett E, Siebern A, Manber R. Cognitions and Insomnia Subgroups. COGNITIVE THERAPY AND RESEARCH 2011; 36:120-128. [PMID: 23794767 DOI: 10.1007/s10608-011-9415-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explored cognitive predictors of multiple symptoms of insomnia (difficulty with sleep initiation, maintenance, and early morning awakenings) among a sample of individuals seeking cognitive-behavior therapy for insomnia. METHODS Participants consisted of 146 clinical patients with insomnia of which 67 (45.89%) were classified as Single Symptoms subgroup and 79 (54.11%) as Combined subgroup. A receiver operating curve (ROC) analysis was conducted to identify predictors of Combined versus Single Symptom subgroups. The set of predictor variables included demographics, sleep-related cognitions, circadian preferences, depression symptoms, and self-report sleep parameters with insomnia subgroups (Combined versus Single Symptom only) as the dependent variable. RESULTS The ROC analysis identified two significant predictors: Self Efficacy Scale (SES) < 23 and a 3-item subscale of the Glasgow Content of Thoughts Inventory (GCTI) assessing "thoughts about the environment" with scores ≥ 5. Post-hoc comparisons revealed that individuals with combined symptoms who had SES score < 23 had significantly longer sleep onset latency (SOL) and more number of nights with SOL>30 minutes, poorer sleep quality, higher insomnia severity, less morningness tendency, higher depression symptom severity, and more anxiety about anxiety and about sleep compared to individuals with SES score ≥ 23. CONCLUSIONS These findings indicate that low self-efficacy and increased thoughts about the environment are associated with having multiple symptoms of insomnia. Further research should examine the specific role of self-efficacy and thought content in the etiology of individuals who suffer from multiple symptoms of insomnia.
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Affiliation(s)
- Sooyeon Suh
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Science, Stanford CA 94301
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Walsh JK, Coulouvrat C, Hajak G, Lakoma MD, Petukhova M, Roth T, Sampson NA, Shahly V, Shillington A, Stephenson JJ, Kessler RC. Nighttime insomnia symptoms and perceived health in the America Insomnia Survey (AIS). Sleep 2011; 34:997-1011. [PMID: 21804662 PMCID: PMC3138174 DOI: 10.5665/sleep.1150] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To explore the distribution of the 4 cardinal nighttime symptoms of insomnia-difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS)-in a national sample of health plan members and the associations of these nighttime symptoms with sociodemographics, comorbidity, and perceived health. DESIGN/SETTING/PARTICIPANTS Cross-sectional telephone survey of 6,791 adult respondents. INTERVENTION None. MEASUREMENTS/RESULTS Current insomnia was assessed using the Brief Insomnia Questionnaire (BIQ)-a fully structured validated scale generating diagnoses of insomnia using DSM-IV-TR, ICD-10, and RDC/ICSD-2 inclusion criteria. DMS (61.0%) and EMA (52.2%) were more prevalent than DIS (37.7%) and NRS (25.2%) among respondents with insomnia. Sociodemographic correlates varied significantly across the 4 symptoms. All 4 nighttime symptoms were significantly related to a wide range of comorbid physical and mental conditions. All 4 also significantly predicted decrements in perceived health both in the total sample and among respondents with insomnia after adjusting for comorbid physical and mental conditions. Joint associations of the 4 symptoms predicting perceived health were additive and related to daytime distress/impairment. Individual-level associations were strongest for NRS. At the societal level, though, where both prevalence and strength of individual-level associations were taken into consideration, DMS had the strongest associations. CONCLUSIONS The extent to which nighttime insomnia symptoms are stable over time requires future long-term longitudinal study. Within the context of this limitation, the results suggest that core nighttime symptoms are associated with different patterns of risk and perceived health and that symptom-based subtyping might have value.
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Affiliation(s)
- James K. Walsh
- Sleep Medicine and Research Center, St. Luke's Hospital, St. Louis, MO
| | | | - Goeran Hajak
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Matthew D. Lakoma
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Victoria Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | | | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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Abstract
PURPOSE OF REVIEW Recently published literature indicates that sleep disorders present with medical comorbidities quite frequently. The coexistence of a sleep disorder with a medical disorder has a substantial impact for both the patient and the health system. RECENT FINDINGS Insomnia and hypersomnia are highly comorbid with medical conditions, such as chronic pain and diabetes, as well as with various cardiovascular, respiratory, gastrointestinal, urinary and neurological disorders. Restless legs syndrome and periodic leg movement syndrome have been associated with iron deficiency, kidney disease, diabetes, and neurological, autoimmune, cardiovascular and respiratory disorders. Rapid eye movement behaviour disorder has been described as an early manifestation of serious central nervous system diseases; thus, close neurological monitoring of patients referring with this complaint is indicated. SUMMARY Identification and management of any sleep disorder in medical patients is important for optimizing the course and prognosis. Of equal importance is the search for undetected medical disorder in patients presenting with sleep disorders.
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Sarsour K, Van Brunt DL, Johnston JA, Foley KA, Morin CM, Walsh JK. Associations of nonrestorative sleep with insomnia, depression, and daytime function. Sleep Med 2010; 11:965-72. [DOI: 10.1016/j.sleep.2010.08.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/02/2010] [Accepted: 08/18/2010] [Indexed: 12/22/2022]
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