Predictors of perceived sleep quality among men and women with insomnia

Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults

OBJECTIVES

To investigate the objective sleep influencers behind older adult responses to subjective sleep measures, in this case, the Pittsburgh Sleep Quality Index (PSQI). Based on previous literature, we hypothesized that SE would be associated with PSQI reported sleep disruption. Furthermore, because SOL increases progressively with age and it tends to be easily remembered by the patients, we also expected it to be one of the main predictors of the perceived sleep quality in the elderly.

METHODS

We studied 32 cognitively healthy community-dwelling older adults (age 74 ± 0.3 years) who completed an at-home sleep assessment (Zeo, Inc.) and the PSQI. Linear mixed models were used to analyze the association of the objective sleep parameters (measured by the Zeo) with the PSQI total score and sub-scores, adjusting for age, gender, years of education and likelihood of sleep apnea.

RESULTS

Objective sleep parameters did not show any association with the PSQI total score. We found that objective measures of Wake after sleep onset (WASO, % and min) were positively associated with the PSQI sleep disturbance component, while SE and Total Sleep Time (TST) were negatively associated with PSQI sleep disturbance. Lastly, objective SE was positively associated with PSQI SE.

CONCLUSIONS

Our findings showed that WASO, SE and TST, are associated with PSQI sleep disturbance, where the greater WASO, overall lower SE and less TST, were associated with increased subjective report of sleep disturbance. As expected, subjective (PSQI) and objective measures of SE were related. However, PSQI total score did not relate to any of the objective measures. These results suggest that by focusing on the PSQI total score we may miss the insight this easily administered self-report tool can provide. If interpreted in the right way, the PSQI can provide further insight into cognitively healthy older adults that have the likelihood of objective sleep disturbance.

Internalized Weight Stigma, Psychological Well-Being, and Sleep in Women

BACKGROUND

Many women internalize negative attitudes regarding body shape and size because of the societal standards for women's ideal body shapes and sizes. Internalized weight stigma is related to poorer physical and psychological health. A growing body of research has documented the links between other forms of internalized stigma (e.g., HIV-stigma) and poor sleep quality; however, little research examines the links between internalized weight stigma and sleep or the mechanisms that explain this relationship. Internalized weight stigma may be associated with poor sleep through increases in psychological distress. This study hypothesized that the links between internalized weight stigma and sleep would be mediated by higher levels of depression and anxiety.

METHODS

About 257 women were recruited via social media, word of mouth, and an undergraduate participant pool. Participants completed an online survey assessing various aspects of weight stigma and health through self-report questionnaires. Most women were non-Hispanic White (86.8%) and had a mean age of 31.40.

RESULTS

The indirect effects of internalized weight stigma on poorer global sleep quality and daily disturbances through depression and anxiety were significant. In contrast, depressive symptoms but not anxiety explained the links between internalized weight stigma and perceived sleep quality and neither depressive symptoms nor anxiety explained the link between internalized weight stigma and sleep efficiency.

CONCLUSIONS

Internalized weight stigma is linked to poorer sleep quality, and these links may be explained by psychological well-being. Understanding the mechanisms by which internalized weight stigma is associated with sleep quality can inform the psychological interventions employed.

Sex Differences in Insomnia: from Epidemiology and Etiology to Intervention

PURPOSE OF REVIEW

Insomnia is approximately 1.5 times more common in women than in men. To date, research has advanced our knowledge about why women report significantly more sleep problems than men despite not being reflected in objective sleep measures. Precisely understanding the symptomatology and pathological mechanisms underlying sex differences is important for prevention and providing appropriate interventions.

RECENT FINDINGS

Sex differences found in insomnia goes beyond simple explanations and have been proven to be a complicated interplay of biological, psychological, and social factors that play different roles throughout the life span. This paper will review sex differences in insomnia based on risk factors, mechanisms, and consequences, as well as treatment response. In addition, we will also discuss treatment recommendations when working with female populations at different stages in the life span that may be more vulnerable to insomnia. Future studies utilizing prospective, longitudinal designs are needed to understand the interactions of various factors that can explain existing sex differences in insomnia.

Criteria for self-reported quantitative sleep characteristics of individuals who sought medical help for disturbed sleep - a survey of a representative sample of the Swedish population

BACKGROUND

The public often seeks rule-of-thumb criteria for good or poor sleep, with a particular emphasis on sleep duration, sleep latency, and the number of awakenings each night. However, very few criteria are available.

AIM

The present study sought to identify such criteria.

METHODS

Whether or not a person has sought medical help for sleep problems was selected as an indicator of poor sleep. The group that was studied constituted a representative sample of the general Swedish population (N=1,128), with a response rate of 72.8%.

RESULTS

Logistic regression analysis, with an adjustment for age and gender, showed an increased OR for a weekday sleep duration of ≤6 hour, (OR >2, and for <5 hour: OR >6). For weekend sleep, the value was ≤6 hour (OR >2). For awakenings per night, the critical value was ≥2 (OR >2, and for ≥5 awakenings: OR >9), and for a sleep latency the critical value was ≥30 minutes (OR >2, and for ≥45 minutes: OR >6). Adding difficulties falling asleep and early morning awakening (considered qualitative because of the reflected "difficulty"), led to the elimination of all the quantitative variables, except for the number of awakenings. The addition of "negative effects on daytime functioning" and "sleep being a big problem" resulted in the elimination of all the other predictors except age.

CONCLUSION

It was concluded that weekday sleep ≤6 hour, ≥2 awakenings/night, and a sleep latency of ≥30 minutes, can function as criteria for poor sleep, but that qualitative sleep variables take over the role of quantitative ones, probably because they represent the integration of quantitative indicators of sleep.

Poor sleep quality in patients with multiple sclerosis: gender differences

OBJECTIVES

Most of the psychological and physical factors associated with poor sleep quality in patients with multiple sclerosis (MS) have a different prevalence in women and men, but whether or not these factors contribute differently to sleep quality in women and men with MS remains unclear. The aim of this study was to identify possible gender differences in factors related to poor sleep quality in MS patients.

MATERIAL AND METHODS

We collected data from 153 patients with MS. Patients filled out the Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety and Depression Scale, and one item of the Short Form-36 regarding pain.

RESULTS

The best model of predictors of poor sleep quality consisting of gender, depression, anxiety, pain, and the interaction between gender and pain showed that the only variable interacting with gender, which was significantly associated with poor sleep quality was pain (odds ratio [OR] for interaction of pain with male gender was 15.4, 95% CI: 2.4; 39.5). Separate models for men and women consisting of pain, depression, anxiety, after adjustment for age, disease duration, and disability showed that pain was the only variable associated with poor sleep quality in men (OR = 12.7, 95% CI: 1.9; 29.6), whereas depression (OR = 4.1, 95% CI: 1.3; 13.2) and anxiety (OR = 6.8, 95% CI: 2.4; 19.1) were in women.

CONCLUSIONS

Factors contributing to poor sleep quality in MS patients differ by gender. Depression and anxiety are associated with poor sleep quality in women, whereas pain is in men. This highlights the need to apply gender-specific approaches to the treatment of sleep disorders.

Remember to do: insomnia versus control groups in a prospective memory task

Primary insomnia is characterized by difficulty in falling asleep and/or remaining asleep, by early morning awakening and/or nonrestorative sleep, and resultant daytime dysfunction in the absence of specific physical, mental, or substance-related causes. However, the studies on daytime cognitive functioning of insomnia patients report inconclusive results. This retrospective study aimed to compare the performance of insomnia patients (N = 54) to that of controls (N = 113) in a naturalistic prospective memory task. Task performance was defined by the percentage of times the event-marker button of an actigraph was pressed, at lights-off time and at wake-up time. The performance pattern in the prospective memory task was similar in both groups. In addition, the task was performed better at lights-off time than at wake-up time regardless of group. Post-hoc subgroup analysis showed that there were more insomnia patients who performed the task perfectly (i.e., 100%) than controls. Performance at wake-up time was significantly correlated to objective sleep quality (i.e., sleep efficiency) only in insomnia patients.

Sleep in mother and child dyads during treatment for pediatric acute lymphoblastic leukemia

PURPOSE/OBJECTIVES

To compare the sleep of children with acute lymphoblastic leukemia (ALL) during maintenance treatment with controls and to measure the effect on maternal sleep.

DESIGN

Comparative, descriptive.

SETTING

Pediatric oncology clinic and communities in Colorado.

SAMPLE

26 dyads of mothers and children with ALL and matched controls.

METHODS

Mothers completed insomnia severity, mood, and stress questionnaires and wore a wrist actigraph, and mothers and children completed a seven-day sleep diary.

MAIN RESEARCH VARIABLES

Mother and child sleep parameters (e.g., total sleep time, sleep latency, sleep efficiency, awakenings); maternal insomnia severity, mood, and stress; child sleep habits.

FINDINGS

Mothers of children with ALL reported greater insomnia compared to controls, which was correlated with anxiety, depressive symptoms, and stress. Maternal groups did not differ on diary- and actigraph-measured sleep outcomes; both groups experienced sleep fragmentation. Children with ALL took longer to fall asleep and had more variable sleep patterns.

CONCLUSIONS

Actigraph and sleep diary data indicated adequate maternal sleep duration and sleep latency. Self-reported insomnia severity in mothers of children with ALL suggested sleep fragmentation that may be undetected by these measures.

IMPLICATIONS FOR NURSING

Oncology nurses are in a unique position to identify sleep problems in mothers and children with ALL, which may lead to recommendations for improved sleep and referrals for treatment.

Can gender difference in prescription drug use be explained by gender-related morbidity?: a study on a Swedish population during 2006

Background

It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity.

Methods

Data was collected on all individuals 20 years and older in the county of Östergötland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses.

Results

The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females.

Conclusion

Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders.