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Grodin EN, Baskerville WA, McManus KR, Irwin MR, Ray LA. Elevations in interleukin-8 levels in individuals with alcohol use disorder and clinical insomnia symptoms. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39396879 DOI: 10.1111/acer.15444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/24/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Insomnia commonly co-occurs with alcohol use disorder (AUD) and predicts poorer outcomes for those with AUD. Insomnia and AUD are individually associated with increases in systemic inflammation. Insomnia and inflammation both serve as risk factors for relapse in AUD. However, little is known about the relationship between insomnia and systemic inflammation in individuals with AUD. Therefore, the present study examined the relationship between the severity of insomnia symptoms and plasma levels of inflammatory cytokines in a sample of treatment-seeking individuals with an AUD. METHODS This secondary analysis included 101 (61M/40F) individuals with an AUD. Participants were categorized into groups based on their scores on the Insomnia Severity Index: no insomnia (n = 47), subthreshold insomnia (n = 37), and clinical insomnia (n = 17). Participants provided blood samples to measure plasma levels of four peripheral markers of inflammation (IL-6, IL-8, TNF-α, and CRP). Inflammatory marker levels were compared between groups. Interactive effects of sex and AUD severity were examined. RESULTS There was a significant main effect of insomnia group on log IL-8 levels (F = 6.52, p = 0.002), such that individuals with AUD and clinical insomnia had higher log IL-8 levels compared to both the no insomnia and subthreshold insomnia groups (ps ≤ 0.05). Sex and AUD severity interacted with this relationship, such that men with clinical insomnia and AUD and individuals with severe AUD had higher log IL-8 levels. There were no significant effects of insomnia on IL-6, TNF-α, or CRP levels. CONCLUSION The present study identified a specific elevation in IL-8 levels in individuals with an AUD and clinical insomnia that was not identified in other markers of peripheral inflammation (IL-6, TNF-α, CRP). Sex and AUD severity interacted with insomnia symptoms, indicating that those with clinical insomnia and severe AUD or male sex may be the most vulnerable to the inflammatory consequences associated with AUD and clinical insomnia symptoms.
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Affiliation(s)
- Erica N Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - Wave-Ananda Baskerville
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Kaitlin R McManus
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California, USA
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Lara A Ray
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, California, USA
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
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Hweidi IM, Jebreel OH, Alhawatmeh HN, Jarrah MI, Abu-Awwad AA, Hweidi MI. Nursing-Based Sleep Promotion Intervention Effectiveness for Post Cardiac Surgery Patients: Systematic Review. J Clin Nurs 2024. [PMID: 39370540 DOI: 10.1111/jocn.17442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/17/2024] [Accepted: 09/01/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Sleep is a fundamental prerequisite for physical and mental health. Poor quality of sleep is common among post-cardiac surgery patients and leads to serious health conditions. OBJECTIVE To conduct a systematic review that investigates the effectiveness of eye masks, earplugs and deep-breathing exercise on sleep quality among post-cardiac surgery patients. DESIGN A systematic review of interventional studies was established to meet the PRISMA guidelines. METHODS PRISMA guidelines were used to assess the findings of 11 selected studies that met the inclusion criteria, published between 2007 and 2023 across four databases: CINAHL, JDNR, MEDLINE and PubMed. The search was conducted on 23 November 2023. RESULTS The 11 most eligible studies were analysed. All of them were interventional, encompassing a total of 787 participants. Randomised controlled trials were the most common design. Interventions included eye masks, earplugs and deep-breathing exercises. The Richards-Campbell Sleep Questionnaire was the most used assessment scale. Most of the reviewed studies found that the use of non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) significantly improves the quality of sleep. These interventions were also found to have potentially positive effects on reducing pain and delirium experienced by patients after undergoing cardiac surgery. CONCLUSIONS Non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) were found to be cost-effective interventions that could be easily applied in the clinical setting and are effective in improving the quality of sleep among patients after cardiac surgery.
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Affiliation(s)
- Issa M Hweidi
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar H Jebreel
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Hossam N Alhawatmeh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad I Jarrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Awwad A Abu-Awwad
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed I Hweidi
- Faculty of Medicine, Medicine Student, Jordan University of Science & Technology, Irbid, Jordan
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3
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Kokkali M, Pinioti E, Lappas AS, Christodoulou N, Samara MT. Effects of Trazodone on Sleep: A Systematic Review and Meta-analysis. CNS Drugs 2024; 38:753-769. [PMID: 39123094 DOI: 10.1007/s40263-024-01110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Sleep problems and insomnia are common, challenging to treat, and transcend specific diagnoses. Although trazodone is a popular choice, robust meta-analytic evidence is lacking. This systematic review and meta-analysis investigates the efficacy and safety of trazodone for sleep disturbances, reflecting recent updates in insomnia diagnosis and treatment. METHODS We searched Medline, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 1 May 2024, for Randomized Controlled Trials (RCTs) comparing trazodone with placebo and reporting sleep-related outcomes. The minimum pharmacotherapy duration was 5 days. Included were all RCTs regardless of blinding (open-label or single- or double-blind), while quasi-randomized studies were excluded. The Cochrane Risk of Bias Tool for Randomized Trials assessed bias. Analyses used a random-effects model on an intention-to-treat (ITT) basis. Risk ratio (RR) was used for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes. When different units or scales were used, Hedge's adjusted g standardized mean difference (SMD) was calculated. Subgroup and preplanned sensitivity analyses explored heterogeneity and evaluated findings' strength and consistency. RESULTS In total, 44 RCTs with 3935 participants were included. Trazodone did not significantly impact subjective total sleep time (TST) [WMD = 0.73 min, 95% confidence interval (CI) - 24.62; 26.07, p = 0.96] but improved sleep quality (SQ) (SMD = - 0.58, 95% CI - 0.87; - 0.28, p < 0.01) and secondary outcomes. These included the number of nocturnal awakenings (SMD = - 0.57, 95% CI - 0.85; - 0.30], p < 0.01), nocturnal time awake after sleep onset (WMD = - 13.47 min, 95% CI - 23.09; - 3.86], p < 0.01), objective TST by polysomnography (WMD = 27.98 min, 95% CI 4.02; 51.95, p = 0.02), and sleep efficiency (WMD = 3.32, 95% CI 0.53; 1.57, p = 0.02). Tolerability issues included more dropouts owing to adverse effects (RR = 2.30, 95% CI 1.45; 3.64, p < 0.01), any sleep-related adverse effects (RR = 3.67, 95% CI 1.07; 12.47, p = 0.04), more adverse effects in general (RR = 1.18, 95% CI 1.03; 1.33, p = 0.02), and more sleep-related adverse effects (RR = 4.31, 95% CI 2.29; 8.13, p < 0.01). CONCLUSION Trazodone extends total sleep time but does not affect perceived sleep duration. It may improve sleep quality and continuity but has minor effects on sleep latency, efficiency, and daytime impairment. Trazodone is associated with adverse effects, necessitating a careful risk-benefit assessment. Limited data restrict generalizability, underscoring the need for more research. REGISTRATION PROSPERO registration number,CRD42022383121.
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Affiliation(s)
- Maria Kokkali
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
| | - Elisavet Pinioti
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
| | - Andreas S Lappas
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
- Aneurin Bevan University Health Board, Wales, UK
| | - Nikolaos Christodoulou
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
- Medical School, University of Nottingham, Nottingham, UK
| | - Myrto T Samara
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece.
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Porcheret K, Hopstock LA, Nilsen KB. Prevalence of insomnia in a general adult population cohort using different diagnostic criteria: The seventh survey of the Tromsø study 2015-2016. Sleep Med 2024; 119:289-295. [PMID: 38718598 DOI: 10.1016/j.sleep.2024.05.002] [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: 11/08/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 06/18/2024]
Abstract
Insomnia disorder is a subjective complaint of sleep dissatisfaction including both night-time and daytime symptoms. Currently there are three commonly used diagnostic manuals each with their own set of criteria, which is often credited for the wide range in insomnia prevalence reported by population-based studies, especially those with self-reported insomnia. However, there are limited studies directly comparing different criteria and little is known about associations with health outcomes. Thus, the aim of this study was to compare the most commonly used diagnostic criteria for insomnia from the literature and to explore the associations with a range of physical and mental health outcomes. We used data from 21,083 women and men from the seventh survey of the population-based Tromsø Study which included adults aged 40-99 years. A revised version of the Bergen Insomnia Scale was used to define insomnia based on the 4th (revised) and 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM5), the 10th edition of the International Classification of Diseases (ICD-10), and the 3rd edition of the International Classification of Sleep Disorders (ICSD-3). We found the following prevalence of insomnia: DSM-IV-TR 23.6 %, DSM5 8.5 %, ICD-10 9.9 % and ICSD-3 20.0 %. When looking at each symptom, we found over half the participants classified as having insomnia using the DSM-IV-TR and ICSD-3 criteria did not report having impaired daytime functioning at least three days per week. Overall, participants with DSM5 and ICD-10 insomnia appeared to have worse health profiles, based on a higher percentage meeting the cut-off for possible anxiety or depression, reporting a psychological problem or chronic pain, and using antidepressants, painkillers or sleeping pills. However logistic regression models showed largely the same health factors had the same association with the odds for being classified as having insomnia disorder from each set of criteria. Overall, this study suggests that insomnia prevalence may be overestimated if daytime symptoms are not adequately included in accordance with current guidelines.
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Affiliation(s)
- Kate Porcheret
- Section for trauma, disasters and forced migration - children and young people, Norwegian Center for Violence and Traumatic Stress Studies, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Laila A Hopstock
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology and Department of Research and Innovation, Neuroscience Clinic, Oslo University Hospital, Norway
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Ma R, Romano E, Ashworth M, Smith TO, Vancampfort D, Scott W, Gaughran F, Stewart R, Stubbs B. The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104421. [PMID: 37952860 DOI: 10.1016/j.jpain.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Chronic pain (CP) and mental illness (MI) are leading causes of years lived with disability and commonly co-occur. However, it remains unclear if available interventions are effective in improving pain outcomes in patients with co-existing CP and MI. This systematic review synthesised evidence for the effectiveness of interventions to improve pain outcomes for people with comorbid CP and clinically diagnosed MI. Ten electronic databases were searched from inception until May 2023. Randomised controlled trials (RCTs) were included if they evaluated interventions for CP-related outcomes among people with comorbid CP and clinically diagnosed MI. Pain-related and mental health outcomes were reported as primary and secondary outcomes, respectively. 26 RCTs (2,311 participants) were included. Four trials evaluated the effectiveness of cognitive-behavioural therapy, 6 mindfulness-based interventions, 1 interpersonal psychotherapy, 5 body-based interventions, 5 multi-component interventions, and 5 examined pharmacological-based interventions. Overall, there was considerable heterogeneity in sample characteristics and interventions, and included studies were generally of poor quality with insufficient trial details being reported. Despite the inconsistency in results, preliminary evidence suggests interventions demonstrating a positive effect on CP may include cognitive-behavioural therapy for patients with depression (with a small to medium effect size) and multi-component intervention for people with substance use disorders (with a small effect size). Despite the high occurrence/burden of CP and MI, there is a relative paucity of RCTs investigating interventions and none in people with severe MI. More rigorously designed RCTs are needed to further support our findings. PERSPECTIVE: This systematic review presents current evidence evaluating interventions for CP-related and MH outcomes for people with comorbid CP and clinically diagnosed MI. Our findings could potentially help clinicians identify the most effective treatments to manage these symptoms for this vulnerable patient group.
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Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Mark Ashworth
- Department of Population Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Toby O Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Physiotherapy and Psychomotor Therapy Unit, University Psychiatric Centre KU Leuven, Kortenberg, Belgium
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; INPUT Pain Management Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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6
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Overton M, Skoog J, Laukka EJ, Bodin TH, Mattsson AD, Sjöberg L, Hofer SM, Johansson L, Kulmala J, Kivipelto M, Solomon A, Skoog I, Kåreholt I, Sindi S. Sleep disturbances and change in multiple cognitive domains among older adults: a multicenter study of five Nordic cohorts. Sleep 2024; 47:zsad244. [PMID: 37708350 PMCID: PMC10925948 DOI: 10.1093/sleep/zsad244] [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: 02/09/2023] [Revised: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
STUDY OBJECTIVES We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years). METHODS Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies. RESULTS While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates. CONCLUSION This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Johan Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Erika J Laukka
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Timothy Hadarsson Bodin
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Scott M Hofer
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lena Johansson
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Shireen Sindi
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
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Maltezos A, Perrault AA, Walsh NA, Phillips EM, Gong K, Tarelli L, Smith D, Cross NE, Pomares FB, Gouin JP, Dang-Vu TT. Methodological approach to sleep state misperception in insomnia disorder: Comparison between multiple nights of actigraphy recordings and a single night of polysomnography recording. Sleep Med 2024; 115:21-29. [PMID: 38325157 DOI: 10.1016/j.sleep.2024.01.027] [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: 09/05/2023] [Revised: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE To provide a comprehensive assessment of sleep state misperception in insomnia disorder (INS) and good sleepers (GS) by comparing recordings performed for one night in-lab (PSG and night review) and during several nights at-home (actigraphy and sleep diaries). METHODS Fifty-seven INS and 29 GS wore an actigraphy device and filled a sleep diary for two weeks at-home. They subsequently completed a PSG recording and filled a night review in-lab. Sleep perception index (subjective/objective × 100) of sleep onset latency (SOL), sleep duration (TST) and wake duration (TST) were computed and compared between methods and groups. RESULTS GS displayed a tendency to overestimate TST and WASO but correctly perceived SOL. The degree of misperception was similar across methods within the GS group. In contrast, INS underestimated their TST and overestimated their SOL both in-lab and at-home, yet the severity of misperception of SOL was larger at-home than in-lab. Finally, INS overestimated WASO only in-lab while correctly perceiving it at-home. While only the degree of TST misperception was stable across methods in INS, misperception of SOL and WASO were dependent on the method used. CONCLUSIONS We found that GS and INS exhibit opposite patterns and severity of sleep misperception. While the degree of misperception in GS was similar across methods, only sleep duration misperception was reliably detected by both in-lab and at-home methods in INS. Our results highlight that, when assessing sleep misperception in insomnia disorder, the environment and method of data collection should be carefully considered.
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Affiliation(s)
- Antonia Maltezos
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada
| | - Aurore A Perrault
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada.
| | - Nyissa A Walsh
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Emma-Maria Phillips
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada
| | - Kirsten Gong
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Lukia Tarelli
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Dylan Smith
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
| | - Nathan E Cross
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada
| | - Florence B Pomares
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada
| | - Jean-Philippe Gouin
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Thien Thanh Dang-Vu
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada.
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8
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Bjelkarøy MT, Simonsen TB, Siddiqui TG, Halset S, Cheng S, Grambaite R, Benth JŠ, Gerwing J, Kristoffersen ES, Lundqvist C. Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series. JMIR Form Res 2024; 8:e51862. [PMID: 38329779 PMCID: PMC10884901 DOI: 10.2196/51862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/06/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. OBJECTIVE Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. METHODS This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. RESULTS Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. CONCLUSIONS We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.
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Affiliation(s)
- Maria Torheim Bjelkarøy
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Tone Breines Simonsen
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Sigrid Halset
- Department of Geriatrics, Akershus University Hospital, Lørenskog, Norway
| | - Socheat Cheng
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Ramune Grambaite
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Jennifer Gerwing
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit Helsetjenesteforskning, Akershus University Hosptial, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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Ren W, Zhang N, Sun Y, Pan L, Hou Y, Li D, Huang X, Liu K, Sun H, Sun Y, Lv C, Yu Y, Han F. The REM microarousal and REM duration as the potential indicator in paradoxical insomnia. Sleep Med 2023; 109:110-117. [PMID: 37429109 DOI: 10.1016/j.sleep.2023.06.011] [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: 03/22/2023] [Revised: 06/10/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Although paradoxical insomnia is a prevalent subtype of chronic insomnia, the etiology of it is unclear. Contrary to complaints of little or no sleep, polysomnography (PSG) findings show that paradoxical insomnia patients have near normal sleep macrostructure. The purpose of this study is to determine the changes of microstructure and explore the etiology of paradoxical insomnia. METHODS The PSG findings of 89 paradoxical insomnia patients were compared with those of 41 gender balanced healthy controls without sleep complaints. All subjects underwent nocturnal PSG recordings. Conventional PSG measures and microarousals were quantified and statistically analyzed. Receiver operating characteristic curve and correlation analysis were used to evaluate the potential of REM sleep microarousals and REM duration as indicators of paradoxical insomnia. RESULTS Compared with the controls, paradoxical insomnia patients had no significant differences in sleep macrostructures. Statistical analysis showed that non-rapid eye movement (NREM) microarousals revealed no significant differences between paradoxical insomnia patients and controls. Noticeably, more spontaneous microarousals appeared in rapid eye movement (REM) stage for paradoxical insomnia patients. Based on receiver operating characteristic curve (ROC), the optimal cutoff value of REM sleep microarousals could predict paradoxical insomnia. Furthermore, a positive correlation between microarousals in REM sleep and the duration of REM sleep was presented in paradoxical insomnia patients. CONCLUSIONS The frequency of REM microarousals and the duration of REM sleep could reflect the real sleep state of paradoxical insomnia patients. That suggested PSG investigation extended to microarousal could be helpful to understand the etiology in paradoxical insomnia.
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Affiliation(s)
- Wenjing Ren
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Na Zhang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Yunliang Sun
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Yanyan Hou
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Dongze Li
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Xiao Huang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Kuikui Liu
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Hongliu Sun
- Department of Pharmaceutical Sciences, Binzhou Medical University, Yantai, China
| | - Yeying Sun
- Department of Pharmaceutical Sciences, Binzhou Medical University, Yantai, China
| | - Changjun Lv
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Yan Yu
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China.
| | - Fang Han
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China.
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10
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Mendelevich VD, Mendelevich EG. [Insomnia in the context of affective disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:43-48. [PMID: 37275997 DOI: 10.17116/jnevro202312305243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.
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