1
|
Gutiérrez-Romero SA, Torres-Narváez ES, Zamora-Gómez AC, Castillo-Castillo S, Latorre-Velásquez AL, Betancourt-Villamizar C, Mendivil CO. Effect of a nutraceutical combination on sleep quality among people with impaired sleep: a randomised, placebo-controlled trial. Sci Rep 2024; 14:8062. [PMID: 38580720 PMCID: PMC10997602 DOI: 10.1038/s41598-024-58661-z] [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: 10/06/2023] [Accepted: 04/02/2024] [Indexed: 04/07/2024] Open
Abstract
In this randomised, placebo-controlled trial, adults with impaired sleep (Pittsburgh Sleep Quality Index ≥ 5) were randomly assigned using a minimization algorithm to receive a formulation containing L-theanine plus lemon balm, valerian, and saffron extracts, or placebo, during 6 weeks. Objective sleep quality parameters were measured using an actigraphy device. We enrolled and randomised 64 individuals, 31 from the active group and 27 from the placebo group completed the 6 week follow-up. Mean sleep efficiency remained unmodified in the active group, and increased by 3% in the placebo group, the between-group difference in the change was not statistically significant (p = 0.49). Total sleep time also improved more with placebo (13.0 vs. 1.33 min, p = 0.66). Time wake after sleep onset (WASO) decreased more in the active group (4.6% vs. 2.4%), but the difference was not significant (p = 0.33). Mean PSQI decreased by 3.11 points (32.3%) in the active group, and by 3.86 points (39.5%) in the placebo group (p = 0.41). SF-36 increased more with placebo (+ 18.3 in active, + 32.1 in placebo, p = 0.68). Salivary cortisol remained unchanged in both groups. No serious adverse events were reported. Among adults with impaired sleep, a nutraceutical combination did not improve objective or subjective sleep parameters more than a placebo infusion.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Carlos O Mendivil
- School of Medicine, Universidad de los Andes, Carrera 7 No 116-05, Of 413, 110111, Bogotá, Colombia.
- Section of Endocrinology, Department of Internal Medicine, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| |
Collapse
|
2
|
Pelayo R, Bertisch SM, Morin CM, Winkelman JW, Zee PC, Krystal AD. Should Trazodone Be First-Line Therapy for Insomnia? A Clinical Suitability Appraisal. J Clin Med 2023; 12:jcm12082933. [PMID: 37109268 PMCID: PMC10146758 DOI: 10.3390/jcm12082933] [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: 03/15/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Trazodone is one of the most commonly used prescription medications for insomnia; however, some recent clinical guidelines do not recommend its use for treating insomnia. This clinical appraisal critically reviews the scientific literature on trazodone as a first-line treatment for insomnia, with the focus statement "Trazodone should never be used as a first-line medication for insomnia." In addition, field surveys were sent to practicing physicians, psychiatrists, and sleep specialists to assess general support for this statement. Subsequently, a meeting with a seven-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This paper reports on the evidence review, the panel discussion, and the panel's and healthcare professionals' ratings of the statement's acceptability. While the majority of field survey responders disagreed with the statement, the majority of panel members agreed with the statement based on the limited published evidence supporting trazodone as a first-line agent as they understood the term "first-line agent".
Collapse
Affiliation(s)
- Rafael Pelayo
- Department of Psychiatry and Behavioral Sciences, Stanford University Sleep Medicine Center, Redwood City, CA 94063, USA
| | - Suzanne M Bertisch
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Charles M Morin
- Department of Psychology, Cervo Brain Research Centre, Laval University, Quebec, QC G1E 1T2, Canada
| | - John W Winkelman
- Department of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Phyllis C Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Evanston, IL 60611, USA
| | - Andrew D Krystal
- Departments of Psychiatry and Neurology, UCSF Weill Institute for Neurosciences, San Francisco, CA 94158, USA
| |
Collapse
|
3
|
Jafar NKA, Bennett CJ, Moran LJ, Mansfield DR. Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health. Semin Reprod Med 2023; 41:45-58. [PMID: 38113883 DOI: 10.1055/s-0043-1777724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae that affects 8 to 13% of reproductive-aged women and 3 to 11% of adolescent girls. Sleep is often compromised in women with PCOS due to increased rates of sleep problems, with the most established problem being obstructive sleep apnea (OSA). OSA is highly prevalent in reproductive-aged adult women with PCOS, but not so in adolescence. The international evidence-based PCOS guideline to improve health outcomes in women with PCOS indicated routine screening to identify and alleviate symptoms of OSA. The guidelines, however, did not weigh other multidimensional constructs of sleep health such as sleep disturbances (e.g., sleep quality and quantity), beyond OSA. This is perhaps due to the lack of research and existing mixed findings in the area of PCOS and sleep health. This narrative review summarizes the current knowledge about OSA and expands further to include the limited knowledge about other sleep problems in PCOS among reproductive-aged women and adolescent girls. We broadly cover the prevalence, risk factors, and mechanisms of sleep problems in PCOS and their relationship with cardiometabolic and psychological health. A brief summary on treatment and intervention strategies for sleep problems in PCOS and future recommendations will be deliberated.
Collapse
Affiliation(s)
- Nur K Abdul Jafar
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christie J Bennett
- Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Darren R Mansfield
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
4
|
Cowan S, Lim S, Alycia C, Pirotta S, Thomson R, Gibson-Helm M, Blackmore R, Naderpoor N, Bennett C, Ee C, Rao V, Mousa A, Alesi S, Moran L. Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity. BMC Endocr Disord 2023; 23:14. [PMID: 36647089 PMCID: PMC9841505 DOI: 10.1186/s12902-022-01208-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.
Collapse
Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Chelsea Alycia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, Monash University, Clayton, Victoria, Australia
| | - Rebecca Thomson
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Rebecca Blackmore
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Negar Naderpoor
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Simon Alesi
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
5
|
Teo P, Henry BA, Moran LJ, Cowan S, Bennett C. The role of sleep in PCOS: what we know and what to consider in the future. Expert Rev Endocrinol Metab 2022; 17:305-318. [PMID: 35815469 DOI: 10.1080/17446651.2022.2082941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sleep disturbance and clinical sleep conditions disrupt endocrine signals, energy expenditure and nutritional intake. Women with polycystic ovary syndrome (PCOS) are at higher risk of sleep disturbances and clinical conditions. It is possible that sleep may contribute to the exacerbation of PCOS. This review aims to explore the relationship between sleep and chronic disease, particularly in women with PCOS. AREAS COVERED This review narratively explores what sleep is, how to measure sleep and the possible mechanisms that support the link between sleep in adipose tissue deposition, insulin resistance and the presentation of PCOS. EXPERT OPINION Research shows that disturbed sleep and clinical sleep conditions disrupt energy expenditure. This may increase adipose tissue deposition and exacerbate insulin resistance which are known to worsen the presentation of PCOS. Further, sleep disturbance in women with PCOS may ameliorate any positive lifestyle changes made after diagnosis. Cognitive behavioural therapy interventions for sleep are a successful strategy for the management of sleep disturbances in the general population. However, such interventions are yet to be trialled in women with PCOS. Given the proposed implications, interventions to improve sleep could provide additional support for women with PCOS to successfully implement lifestyle strategies and should be further investigated.
Collapse
Affiliation(s)
- Peiseah Teo
- Department of Physiology, Monash University, Melbourne, VIC, Australia
| | - Belinda A Henry
- Department of Physiology, Monash University, Melbourne, VIC, Australia
- Metabolism, Diabetes and Obesity Program, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Christie Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
6
|
Chung KM, Suh YJ, Chin S, Seo D, Yu ES, Lee HJ, Kim JH, Kim SW, Koh SJ. A Pilot Study Testing the Efficacy of dCBT in Patients With Cancer Experiencing Sleep Problems. Front Psychol 2022; 13:699168. [PMID: 35756310 PMCID: PMC9216201 DOI: 10.3389/fpsyg.2022.699168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This pilot study aimed to evaluate the efficacy of a digital cognitive behavioral therapy (dCBT) in patients with cancer experiencing sleep problems. Methods A total of 57 participants aged 25–65 years (6M/51F with a mean of 42.80 years and a standard deviation of 14.15 years) were randomly assigned to three groups—21 participants to a dCBT program (HARUToday Sleep), 20 participants to an app-based attentional control program (HARUCard Sleep), and 16 participants to a waitlist control group—and evaluated offline before and after the program completion. Of the 57 participants, there were a total of 45 study completers, 15 participants in each group. The dependent variables were sleep quality scores, measured by the Pittsburgh Sleep Quality Index (PSQI) and health-related quality of life scores, measured using the Short-Form 36 (SF-36), and attentional bias scores from a dot-probe computer task. Results For both the intention-to-treat (N = 57) and study-completers analyses (N = 45, 15 for each group), a significant increase supported by a large effect size was found in the quality of sleep score of the HARUToday Sleep group compared to both the app-based attentional control and the waitlist control group. However, no significant changes were found in the quality of life and attentional bias scores. Conclusion Our results suggest that the HARUToday Sleep app has the potential to serve as an intervention module to enhance the sleep quality of patients with cancer experiencing sleep problems.
Collapse
Affiliation(s)
- Kyong-Mee Chung
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Yung Jae Suh
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Siyung Chin
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Daesung Seo
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Eun-Seung Yu
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
| | - Hyun Jeong Lee
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea.,Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Jong-Heun Kim
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| |
Collapse
|
7
|
Saradhadevi S, Hemavathy V. Effectiveness of sleep hygiene to reduce insomnia among persons with suffering with obsessive compulsive disorder-pilot analysis. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.462466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Obsessive-compulsive disorder frequently have insomnia, and those with acute insomnia who also have mental comorbidities without therapy, they are more likely to develop persistent insomnia. We present a case of OCD with acute insomnia that was successfully treated with early non-pharmacological sleep psychiatry intervention. Sleep is necessary for brain function and the maintenance of cognitive and emotional processes. Insomnia and anxiety problems are common, and they’re linked to a lot of damage and disability. In addition to being strongly comorbid with major depressive illness, there is evidence that sleeplessness and anxiety disorders frequently co-occur. The majority of insomnia psychological therapies include sleep hygiene. In terms of clinical practice, these instructions are a solid place to start. Obsessive-compulsive disorder is associated with sleep difficulties. Sleep difficulties are also common in people with obsessive-compulsive disorder, with up to 48% reporting them. Obsessive compulsive disorder research reveals a link between specific sleep habits and clinical factors such the severity of obsessive-compulsive symptoms, treatment resistance, and the age at which the disorder.
Collapse
|
8
|
Saradhadevi S, Hemavathy V. Effectiveness of sleep hygiene to reduce insomnia among persons with suffering with obsessive compulsive disorderpilot analysis. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.484488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Obsessive-compulsive disorder frequently have insomnia, and those with acute insomnia who also have mental comorbidities without therapy, they are more likely to develop persistent insomnia. We present a case of OCD with acute insomnia that was successfully treated with early non-pharmacological sleep psychiatry intervention. Sleep is necessary for brain function and the maintenance of cognitive and emotional processes. Insomnia and anxiety problems are common, and they’re linked to a lot of damage and disability. In addition to being strongly comorbid with major depressive illness, there is evidence that sleeplessness and anxiety disorders frequently co-occur. The majority of insomnia psychological therapies include sleep hygiene. In terms of clinical practice, these instructions are a solid place to start. Obsessive-compulsive disorder is associated with sleep difficulties. Sleep difficulties are also common in people with obsessive-compulsive disorder, with up to 48% reporting them. Obsessive compulsive disorder research reveals a link between specific sleep habits and clinical factors such the severity of obsessive-compulsive symptoms, treatment resistance, and the age at which the disorder.
Collapse
|
9
|
Castro R, Ribeiro-Alves M, Oliveira C, Romero CP, Perazzo H, Simjanoski M, Kapciznki F, Balanzá-Martínez V, De Boni RB. What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review. Front Public Health 2022; 9:735624. [PMID: 35047469 PMCID: PMC8761632 DOI: 10.3389/fpubh.2021.735624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.
Collapse
Affiliation(s)
- Rodolfo Castro
- Escola Nacional de Saúde Pública Sergio Arouca, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.,Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Ribeiro-Alves
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Cátia Oliveira
- Centro de Desenvolvimento Tecnológico em Saúde, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Carmen Phang Romero
- Centro de Desenvolvimento Tecnológico em Saúde, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Hugo Perazzo
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Mario Simjanoski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Flavio Kapciznki
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Raquel B De Boni
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
10
|
Hutchinson KA, Amirali Karmali S, Abi-Jaoude J, Edwards T, Homsy C. Sleep Quality Among Burn Survivors And The Importance Of Intervention: A Systematic Review And Meta-Analysis. J Burn Care Res 2022; 43:1358-1379. [PMID: 35349676 DOI: 10.1093/jbcr/irac039] [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: 11/13/2022]
Abstract
Burn survivors undergo a plethora of physiologic disturbances which can greatly affect quality of life (QOL) and healing processes. This review aimed to systematically examine sleep quality among individuals with burns and to explore the effectiveness of interventions using a meta-analytic approach. A systematic review of the literature was conducted by searching for articles using various databases. Titles and abstracts were screened and full texts of retained articles were assessed based on eligibility criteria. Methodological quality was ascertained in all articles using various scales. Overall, 5,323 articles were screened according to titles and abstracts and 25 articles were retained following full-text screening. Of the twenty-five articles, 17 were assessed qualitatively while 8 were included in the meta-analysis. Based on the qualitative analysis, sleep was found to be negatively affected in burn patients. The subsample of 8 articles included in the meta-analysis showed an overall weighted mean effect size (Hedges's g) of 1.04 (SE = 0.4, 95% CI, z = 3.0; p < 0.01), indicating a large, positive effect of intervention on sleep quality for burn patients. This review was able to demonstrate the detrimental effects of burn injury on sleep quality. Several interventions have been examined throughout the literature and have shown to be beneficial for sleep quality. However, there is great heterogeneity between existing interventions. The results from this review suggest that further research is needed before recommendations can be made as to which intervention is most effective at improving sleep in patients suffering from burn injuries.
Collapse
Affiliation(s)
| | | | | | - Thomas Edwards
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Christopher Homsy
- Department of Surgery, Division of Plastic Surgery, Tufts Medical Center, Boston, USA
| |
Collapse
|
11
|
De Fabritiis M, Trisolini F, Bertuletti G, Fagadau ID, Ginelli D, Lalopa KP, Peverelli L, Pirola A, Sala G, Maisto M, Madeddu F, Lopez-Castroman J, Romano D, Gabbiadini A, Preti E, Micucci D, Calati R. An Internet-Based Multi-Approach Intervention Targeting University Students Suffering from Psychological Problems: Design, Implementation, and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052711. [PMID: 35270403 PMCID: PMC8910035 DOI: 10.3390/ijerph19052711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Despite the widespread prevalence of mental health problems, most psychological distress remains untreated. Internet-based psychological interventions can be an essential tool for increasing treatment availability and accessibility. The main objective of the MindBlooming project is to design and implement an innovative Internet-based multi-approach treatment for university students suffering from psychological or physical problems. The intervention will focus on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job- and study-related stress and burnout, and chronic pain. It will be based on different approaches, primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. At the end of the treatment, user satisfaction and usability will be assessed. In addition, two further aims will be evaluating the treatment efficacy through a randomized controlled trial and tuning a predictive model through Machine Learning techniques. The intervention consists of a 7-week treatment on two problematic areas according to each students’ personal needs, identified through an initial assessment. Besides the treatment assigned following the initial screening, participants will also be assigned to a different module to improve their relational skills. The treatment, which can be accessed through a mobile app, consists of psychoeducational videos followed by related exercises. We expect MindBlooming to be a remarkable tool for promoting the mental health of university students.
Collapse
Affiliation(s)
- Marlene De Fabritiis
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Federica Trisolini
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Gloria Bertuletti
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Ionut Daniel Fagadau
- Department of Informatics, Systems and Communication (DISCo), University of Milano-Bicocca, 20126 Milan, Italy; (I.D.F.); (D.G.); (D.M.)
| | - Davide Ginelli
- Department of Informatics, Systems and Communication (DISCo), University of Milano-Bicocca, 20126 Milan, Italy; (I.D.F.); (D.G.); (D.M.)
| | - Katiuscia Pia Lalopa
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Lisa Peverelli
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Alessia Pirola
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Gaia Sala
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Marta Maisto
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Fabio Madeddu
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
- BICAPP—Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes, University Hospital, 30900 Nîmes, France;
- IGF, CNRS-INSERM, Université Montpellier, 34094 Montpellier, France
- CIBERSAM, 28029 Madrid, Spain
| | - Daniele Romano
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Alessandro Gabbiadini
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
- BICAPP—Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Daniela Micucci
- Department of Informatics, Systems and Communication (DISCo), University of Milano-Bicocca, 20126 Milan, Italy; (I.D.F.); (D.G.); (D.M.)
| | - Raffaella Calati
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
- BICAPP—Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Adult Psychiatry, Nîmes, University Hospital, 30900 Nîmes, France;
- Correspondence:
| |
Collapse
|
12
|
Management of Insomnia Disorder. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Guida JL, Alfini AJ, Gallicchio L, Spira AP, Caporaso NE, Green PA. Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults. Sleep 2021; 44:6066553. [PMID: 33406254 DOI: 10.1093/sleep/zsab003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults. METHODS We used data from Waves 2 (W2) and 3 (W3) (2010-2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase. RESULTS After controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02-2.84) and mortality (OR = 2.12, 95% CI: 1.09-4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02-1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17-0.97) were associated with mortality. CONCLUSIONS Among community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.
Collapse
Affiliation(s)
- Jennifer L Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alfonso J Alfini
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Gallicchio
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Paige A Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| |
Collapse
|
14
|
Trabelsi K, Masmoudi L, Ammar A, Boukhris O, Khacharem A, Jemal M, Zlitni S, Bragazzi NL, Clark CCT, Lastella M, Chtourou H. The effects of Ramadan intermittent fasting on sleep-wake behaviour and daytime sleepiness in team sport referees. J Sports Sci 2021; 39:2411-2417. [PMID: 34128455 DOI: 10.1080/02640414.2021.1935672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to evaluate the impact of Ramadan fasting on sleep quality and daytime sleepiness in team sport referees. Seventy-eight male amateur team sport referees (age: 31.1 ± 10.8 years) participated in this study. Participants responded to the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth sleepiness scale (ESS) questionnaires before (10-days prior) and during (last 7-days) the month of Ramadan.PSQI and ESS scores increased significantly during Ramadan (both p < .001, ES = 0.56 and 0.54, respectively) with 83.3% of participants scoring ≥5 in the PSQI. The percentage of participants suffering from severe excessive daytime sleepiness (ESS score ≥ 16) was 3.8% before vs. 7.7% during Ramadan (p < 0.001). Sleep duration decreased by ~ 1 h during Ramadan (p < .001, ES = 0.61) and was associated with a delay in bedtime of ~ 2 h (p < 0.001, ES = 0.7) and of wake-up time of ~ 1 h (p < 0.001, ES = 0.5). The score for daytime dysfunction and subjective sleep perception, as components of the PSQI, increased (both p < 0.001; ES = 0.79, ES = 0.57, respectively), whereas the score for the use of sleep medication decreased during vs. before Ramadan (p = 0.041, ES = 0.47). Ramadan fasting impaired sleep quality and increased daytime sleepiness in team sport referees. Future studies, using objective assessment tools, are warranted.
Collapse
Affiliation(s)
- Khaled Trabelsi
- Research Laboratory: Education, Motricité, Sport Et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.,Institut Supérieur Du Sport Et De L'éducation Physique De Sfax, Université De Sfax, Sfax, Tunisie
| | - Liwa Masmoudi
- Research Laboratory: Education, Motricité, Sport Et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.,Institut Supérieur Du Sport Et De L'éducation Physique De Sfax, Université De Sfax, Sfax, Tunisie
| | - Achraf Ammar
- Institute of Sport Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, France
| | - Omar Boukhris
- Physical Activity, Sport and Health, Research Unit, UR18JS01, National Sport Observatory, Tunis, Tunisia
| | - Aïmen Khacharem
- UVHC, DeVisu, Valenciennes; LIRTES-EA 7313, Université Paris Est Créteil Val De Marne, France
| | - Mohamed Jemal
- Research Laboratory: Education, Motricité, Sport Et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sahar Zlitni
- Research Laboratory: Education, Motricité, Sport Et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.,Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Michele Lastella
- The Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Australia
| | - Hamdi Chtourou
- Institut Supérieur Du Sport Et De L'éducation Physique De Sfax, Université De Sfax, Sfax, Tunisie.,Physical Activity, Sport and Health, Research Unit, UR18JS01, National Sport Observatory, Tunis, Tunisia
| |
Collapse
|
15
|
Phillips NL, Moore T, Teng A, Brookes N, Palermo TM, Lah S. Behavioral interventions for sleep disturbances in children with neurological and neurodevelopmental disorders: a systematic review and meta-analysis of randomized controlled trials. Sleep 2021; 43:5804209. [PMID: 32163581 DOI: 10.1093/sleep/zsaa040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
STUDY OBJECTIVES Sleep disturbances are common and associated with negative functional and health consequences in children with neurological and neurodevelopmental disorders (NNDDs) and represent an important potential target for behavioral interventions. This systematic review examined the efficacy of behavioral sleep interventions (BSIs) for children with NNDDs and comorbid sleep disturbances. METHODS A systematic search of MEDLINE, EMBASE, PsychINFO, and CENTRAL was conducted in April 2019. Randomized controlled trials (RCTs) of BSI for children with NNDDS were included. Meta-analysis and GRADE quality ratings were performed on sleep and secondary functional outcomes (cognition, academics, and behavior). RESULTS Nine RCTs were identified (n = 690; Mage = 8.39 ± 2.64years; 71.11% male). The quality of the evidence was predominantly rated as moderate. Posttreatment improvements in sleep were found on self-reported sleep disturbances (total sleep disturbance [standardized mean difference, i.e. SMD = 0.89], night wakings [SMD = 0.52], bedtime resistance [SMD = 0.53], parasomnias [SMD = 0.34], sleep anxiety [SMD = 0.50]) and self-reported sleep patterns (sleep duration [SMD = 0.30], sleep onset duration [SMD = 0.75]) and (2) objectively measured actigraphic sleep patterns (total sleep time [MD = 18.09 min; SMD = 0.32], sleep onset latency [MD = 11.96 min; SMD = 0.41]). Improvements in sleep (self-reported, not actigraphy) were maintained at follow-up, but few studies conducted follow-up assessments resulting in low-quality evidence. Reduction in total behavioral problems (SMD = 0.48) posttreatment and attention/hyperactivity (SMD = 0.28) at follow-up was found. Changes in cognition and academic skills were not examined in any studies. CONCLUSIONS BSIs improve sleep, at least in the short term, in children with NNDDs. Benefits may extend to functional improvements in behavior. More rigorous RCTs involving placebo controls, blinded outcome assessment, longer follow-up durations, and assessment of functional outcomes are required.
Collapse
Affiliation(s)
- Natalie L Phillips
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Teleri Moore
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Arthur Teng
- Department of Sleep Medicine, Sydney Children's Hospital (Randwick), Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Naomi Brookes
- Brain Injury Rehabilitation Program, Sydney Children's Hospital (Randwick), Sydney, New South Wales, Australia
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Minian N, Lingam M, deRuiter WK, Dragonetti R, Selby P. Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings. Front Public Health 2021; 9:555449. [PMID: 33791263 PMCID: PMC8005552 DOI: 10.3389/fpubh.2021.555449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary care organizations are well-suited to help patients change their unhealthy behaviors. Evidence shows that risk communication and self-monitoring of behavior are is an effective strategy practitioners can use to promote health behavior change with their patients. In order for this evidence to be actionable, it is important to understand how patients would like this information to be communicated and to operationalize the self-monitoring resources. The objective of this study was to co-create resources that encourage behavior change based on the scientific evidence and from patients with lived experiences. Materials and Methods: Twenty-seven individuals who participated in a smoking cessation program and engaged in at least one other unhealthy behavior joined one of two engagement events. Each event was 3 h in duration and consisted of two exercises that provided support to participants in reaching a consensus about the types of messages they would like to receive from their practitioner as well as self-monitoring resources they would prefer to use. The first exercise followed an adapted version of the Consensus Methodology developed by the Institute of Cultural Affairs Canada, while the second exercise was in accordance to the Nominal Group Technique. Results: Participants' preference was to have practitioners convey messages to promote health behavior change that include positive affirmation and to monitor all their health behaviors using a single self-reported tracking sheet. Conclusions: This paper features the use of engagement events to reflect upon and identify potential resources that treatment seeking smokers prefer to receive while attempting to modify unhealthy behaviors. These resources can be used by health care providers in primary care settings to support health promotion interventions and assist their patients to increase their likelihood of adopting positive changes to risk behaviors.
Collapse
Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathangee Lingam
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wayne K deRuiter
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Erten Uyumaz B, Feijs L, Hu J. A Review of Digital Cognitive Behavioral Therapy for Insomnia (CBT-I Apps): Are They Designed for Engagement? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062929. [PMID: 33809308 PMCID: PMC7999422 DOI: 10.3390/ijerph18062929] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
Abstract
There are different ways to deliver Cognitive Behavioral Therapy for Insomnia (CBT-I), of which in-person (face to face) is the traditional delivery method. However, the scalability of in-person therapy is low. Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is an alternative and there are tools on the market that are validated in clinical studies. In this paper, we provide a review of the existing evidence-based CBT-I apps and a summary of the published usability-oriented studies of these apps. The goal is to explore the range of interaction methods commonly applied in dCBT-I platforms, the potential impact for the users, and the design elements applied to achieve engagement. Six commercially available CBT-I apps tested by scientifically valid methods were accessed and reviewed. Commonalities were identified and categorized into interactive elements, CBT-I-related components, managerial features, and supportive motivational features. The dCBT-I apps were effectively assisting the users, and the type of interactions promoted engagement. The apps’ features were based on design principles from interactive product design, experience design, online social media, and serious gaming. This study contributes to the field by providing a critical summary of the existing dCBT-I apps that could guide future developers in the field to achieve a high engagement.
Collapse
|
18
|
Agar G, Brown C, Sutherland D, Coulborn S, Oliver C, Richards C. Sleep disorders in rare genetic syndromes: a meta-analysis of prevalence and profile. Mol Autism 2021; 12:18. [PMID: 33632309 PMCID: PMC7908701 DOI: 10.1186/s13229-021-00426-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Sleep disorders are common in people with intellectual disability (ID) and autism, with growing evidence of diverse sleep profiles across ID associated genetic syndromes. Documenting the prevalence and profile of specific sleep disorders in syndromes will quantify syndrome-driven ‘risk’, inform prognosis and enhance understanding of aetiology of sleep disorders. Method Following PRISMA guidelines for meta-analysis, we searched Ovid PsycINFO, Ovid MEDLINE, Ovid Embase, Web of Science and PubMed Central with use of syndrome-specific keywords and 60 sleep-related search terms. We screened and extracted papers that reported sleep disorder prevalence data for five or more individuals within a genetic syndrome, and applied quality criteria to produce a quality-effects prevalence model of six types of sleep disorder across nineteen syndromes. Relative risk estimates were calculated for the prevalence of each sleep disorder in each syndrome. Results Two hundred and seventy three papers were identified, generating 463 prevalence estimates for Angelman, CHARGE, Cornelia de Lange, Down, fragile X, Prader–Willi, Rett, Smith–Magenis and Williams syndromes, mucopolysaccharidoses (MPS disorders), neurofibromatosis and tuberous sclerosis complex. Prevalence estimates were higher in genetic syndromes than published equivalents for typically developing individuals, with few exceptions. Between-syndrome differences for some disorders were evident; sleep-disordered breathing was most prevalent in MPS disorders (72–77%), while excessive daytime sleepiness was highest in Smith–Magenis syndrome (60%). Conversely, insomnia, which was reported at a higher rate than TD estimates in all syndromes except fragile X, was not associated with specific genetic risk. This suggests insomnia could emerge because of the individual’s environment or associated developmental delay, rather than any specific genetic syndromes. Limitations Due to the broad scope of the meta-analysis, only syndromes previously identified as reporting preliminary sleep research were included. Other syndromes may also experience elevated prevalence rates of specific types of sleep disorder. Only English language papers were included. Conclusions Differing prevalence rates between types of sleep disorder suggest differing causal mechanisms, such as cranio-facial morphology in Down and Prader–Willi syndromes and the build-up of mucopolysaccharides in MPS disorders. Priorities for clinical assessment and intervention for sleep disorders are discussed.
Collapse
Affiliation(s)
- Georgie Agar
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Chloe Brown
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.,South West Yorkshire Partnership NHS Foundation Trust, Wakefield, WF1 3SP, UK
| | - Daniel Sutherland
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sean Coulborn
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
19
|
The Effect of an Online Self-Help Cognitive Behavioural Intervention for Insomnia on Negative Affect and Paranoia: A Randomised Controlled Trial. HEALTH PSYCHOLOGY BULLETIN 2020. [DOI: 10.5334/hpb.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Sleep in the Social World of College Students: Bridging Interpersonal Stress and Fear of Missing Out with Mental Health. Behav Sci (Basel) 2020; 10:bs10020054. [PMID: 32041120 PMCID: PMC7071423 DOI: 10.3390/bs10020054] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: The college years are characterized by psychosocial and biological phenomena that may impact mental health, such as heightened sensitivity to social stressors and compromises in sleep quantity and quality. The current study uses a biopsychosocial approach to examine the associations among interpersonal stress, Fear of Missing Out (FoMO), insomnia, and mental health. Methods: Survey data were collected from 283 undergraduate students (90% female) with a mean age of 21.4 years. A path analysis was utilized to test a mediational model linking interpersonal stress and FoMO with mental health through a mediator of insomnia. We hypothesized that higher levels of interpersonal stress and FoMO would be associated with higher levels of insomnia symptoms, which would in turn be associated with poorer mental health. Results: As predicted, insomnia partially mediated significant associations of interpersonal stress and FoMO with mental health. The association of interpersonal stress with insomnia and mental health was more robust than the association of FoMO with these variables. Conclusions: The pathway from interpersonal stress and/or FoMO, through insomnia, to compromises in mental health may be modifiable through behavioral interventions focusing on coping skills, sleep hygiene, and even technology-related habit changes. Recommendations to help disrupt this pathway, particularly among college students, are discussed.
Collapse
|
21
|
Gottfried T, Kamer I, Salant I, Urban D, Lawrence YR, Onn A, Bar J. Self-reported sleep quality as prognostic for survival in lung cancer patients. Cancer Manag Res 2020; 12:313-321. [PMID: 32021445 PMCID: PMC6970259 DOI: 10.2147/cmar.s234523] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/04/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose Sleep is essential for life, as well as having a major impact on quality of life. Not much attention has been given to this important factor in the care of lung cancer patients. Patients and Methods We retrospectively analyzed a cohort of 404 lung cancer patients treated in our institute between 2010 and 2018. Data about sleep quality, distress and pain were self-reported by questionnaires administered to patients at their first clinic visit to the Institute of Oncology. Sex, age, histology, stage, smoking and marital status were extracted from the patients’ charts. Uni- and multi-variate analyses were carried out to evaluate the correlation of these factors with survival. Results Most patients reported some level of distress and pain. Sleep abnormalities were reported by 58.7% of patients. Distress, pain and bad sleep were correlated with shorter survival in univariate analyses; however, only sleep remained associated with survival in multivariate analysis. Patients reporting bad sleep had a median survival of 16 months, compared to 27 months for patients reporting good sleep (hazard ratio 1.83, 95% C.I. 1.27–2.65). Frequent arousals at night were more tightly correlated with survival than difficulty falling asleep. Conclusion Sleep quality, as reported by lung cancer patients, is highly correlated with survival. Further studies are required to comprehend whether poor sleep quality is directly impacting survival or is a result of the cancer aggressiveness and patients’ conditions.
Collapse
Affiliation(s)
- Teodor Gottfried
- Chaim Sheba Medical Center, Institute of Oncology, Ramat Gan 5262000, Israel
| | - Iris Kamer
- Chaim Sheba Medical Center, Institute of Oncology, Ramat Gan 5262000, Israel
| | - Iris Salant
- Chaim Sheba Medical Center, Institute of Oncology, Ramat Gan 5262000, Israel
| | - Damien Urban
- Chaim Sheba Medical Center, Institute of Oncology, Ramat Gan 5262000, Israel
| | - Yaacov R Lawrence
- Department of Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Amir Onn
- Chaim Sheba Medical Center, Pulmonology Institute, Ramat Gan 5262000, Israel
| | - Jair Bar
- Chaim Sheba Medical Center, Institute of Oncology, Ramat Gan 5262000, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| |
Collapse
|
22
|
Murawski B, Plotnikoff RC, Duncan MJ. Development and psychometric testing of an instrument to assess psychosocial determinants of sleep hygiene practice. J Health Psychol 2019; 26:1951-1965. [PMID: 31804153 DOI: 10.1177/1359105319891524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This study examined the psychometric properties of a newly developed instrument to assess psychosocial determinants of sleep hygiene. Baseline data (n = 160) from an m-health physical activity and sleep intervention were analyzed to examine scale validity. Additional participants (n = 20) were recruited to compute test-retest reliability. Four of seven constructs correlated significantly with sleep hygiene practice (r = -0.17 to -0.36). The scales generally displayed unidimensional component structures. Internal consistency was good to excellent (α = 0.76-0.92). Test-retest reliability was good to excellent (ICC = 0.61-0.84). Though satisfactory, these findings warrant replication in larger samples.
Collapse
|
23
|
Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause. Menopause 2019; 26:357-364. [DOI: 10.1097/gme.0000000000001257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Yaya S, Wang R, Shangfeng T, Ghose B. Alcohol consumption and sleep deprivation among Ghanaian adults: Ghana Demographic and Health Survey. PeerJ 2018; 6:e5750. [PMID: 30324025 PMCID: PMC6183558 DOI: 10.7717/peerj.5750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/12/2018] [Indexed: 01/31/2023] Open
Abstract
ABSTRACT Heavy consumption of alcohol has shown to be associated with sleep disturbances among adult and elderly people in high income settings. So far, the relationship between alcohol drinking and sleeping pattern has not been studied in an African setting. Therefore, in this study we investigated whether alcohol consumption has any influence on sleeping hours among adult men and women in Ghana. METHODS Data for this survey were extracted from Ghana Demographic and Health Survey (GDHS 2008). GDHS is the only cross-sectional survey conducted on men and women aged above 15 years that collected information on variables such as sleeping hours and alcohol consumption. The analysis was controlled for various demographic, socioeconomic, household level factors, and smoking. RESULTS Prevalence of sleeping 1-3 h, 4-6 h, and >7 h was respectively 1.5% (1.2-2.0), 14.1% (12-16.5), and 84.4% (82.1-86.4), and that of alcohol use was 26.9% (23.4-30.6). In the multivariable regression analysis, compared with non-drinkers, those reported drinking had significantly lower odds of sleeping for at least 7 h. In the adjusted model, drinkers had 0.8 times (adjusted OR = 0.803, (95% CI [0.690-0.935])) lower odds of sleeping for at least 7 h. The odds for sleeping 4-6 h were not statistically significant. In the stratified analysis, the odds of sleeping for at least seven were comparatively lower among women (adjusted OR = 0.657, (95% CI [0.509-0.849]) then among men (adjusted OR = 0.867, (95% CI [0.740-0.965]). CONCLUSION Men and women who reported consuming alcohol had significantly lower odds of getting adequate sleep (>7 h). The sleep-disrupting effect of alcohol appeared to be more prominent among women than among men. Currently there is not sufficient evidence on alcohol consumption and sleep disorder among Ghanaian population or any other country in the region. Further studies are required to understand sleeping patterns and the burden of alcohol drinking in this population to design intervention programs.
Collapse
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Ruoxi Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Tang Shangfeng
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Bishwajit Ghose
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
25
|
Werner-Seidler A, Johnston L, Christensen H. Digitally-delivered cognitive-behavioural therapy for youth insomnia: A systematic review. Internet Interv 2018; 11:71-78. [PMID: 30135762 PMCID: PMC6084877 DOI: 10.1016/j.invent.2018.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022] Open
Abstract
Sleep disturbance is common among young people, with consequences for academic, emotional and behavioural development. Cognitive-behavioural therapy for insomnia (CBT-I) is efficacious, yet it is costly and not available to many who need it. Digitally-delivered CBT-I (eCBT-I) has the potential to overcome these barriers. The purpose of this systematic review was to identify studies which report on the efficacy or effectiveness of eCBT-I for young people with sleep disturbance. Electronic databases were systematically searched and three studies met inclusion criteria. Two studies used the same online intervention for adolescents with insomnia symptoms, while the other was conducted in a college sample of individuals who opted into a stress-management study. Results showed that eCBT-I improved sleep efficiency, sleep quality, sleep-onset latency and total sleep time with effect sizes ranging from 0.17-1.30 (Cohen's d). This suggests that eCBT-I is a promising intervention for young people, but more studies are needed to verify the conditions under which it is most effective.
Collapse
Key Words
- Adolescence
- BDI-II, Beck Depression Inventory-II
- CBT-I, Cognitive-behavioural therapy for insomnia
- Cognitive-behavioural therapy
- Insomnia
- PSQI, Pittsburgh Sleep Quality Index
- SE, sleep efficiency
- SOL, sleep onset latency
- SQ, sleep quality
- STAI-S, State-Trait Anxiety Inventory State Version
- Sleep disturbance
- TIB, time in bed
- TST, total sleep time
- WASO, wake after sleep onset
- eCBT-I, digitally-delivered CBT-I
Collapse
|
26
|
Abstract
Insomnia, or inadequate or poor sleep leading to significant distress or impairment in functioning, is a prevalent disorder treated by primary care providers (PCPs). With millions of people across the United States suffering from insomnia, PCPs must understand the disorder's pathophysiology, perpetuating factors, and treatment, as well as its effect on patient health and the economy. Although PCPs traditionally treat insomnia with pharmaceuticals, behavioral measures are effective and should be used whenever possible. This article reviews clinically relevant principles of diagnosing and treating insomnia, highlighting nonpharmacologic treatments.
Collapse
|
27
|
Petit A, Karila L, Estellat C, Moisan D, Reynaud M, D’Ortho MP, Lejoyeux M, Levy F. Les troubles du sommeil dans l’addiction à Internet. Presse Med 2016; 45:1170-1177. [DOI: 10.1016/j.lpm.2016.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/19/2016] [Accepted: 04/13/2016] [Indexed: 12/20/2022] Open
|
28
|
Wang ZJ, Liu JF. The Molecular Basis of Insomnia: Implication for Therapeutic Approaches. Drug Dev Res 2016; 77:427-436. [DOI: 10.1002/ddr.21338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Zi-Jun Wang
- Department of Physiology and Biophysics; State University of New York at Buffalo; Buffalo NY
- Department of Pharmacology and Toxicology; State University of New York at Buffalo; Buffalo NY
| | - Jian-Feng Liu
- Department of Pharmacology and Toxicology; State University of New York at Buffalo; Buffalo NY
| |
Collapse
|
29
|
Roscoe JA, Garland SN, Heckler CE, Perlis ML, Peoples AR, Shayne M, Savard J, Daniels NP, Morrow GR. Randomized placebo-controlled trial of cognitive behavioral therapy and armodafinil for insomnia after cancer treatment. J Clin Oncol 2014; 33:165-71. [PMID: 25452447 DOI: 10.1200/jco.2014.57.6769] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone. PATIENTS AND METHODS We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions. RESULTS Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584). CONCLUSION CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality.
Collapse
Affiliation(s)
- Joseph A Roscoe
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada.
| | - Sheila N Garland
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Charles E Heckler
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Michael L Perlis
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Anita R Peoples
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Michelle Shayne
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Josée Savard
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Nina P Daniels
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Gary R Morrow
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| |
Collapse
|
30
|
Andrade C, Suresh Kumar PN. Treating residual insomnia in schizophrenia: examining the options. Acta Psychiatr Scand 2013; 127:11. [PMID: 23240596 DOI: 10.1111/acps.12019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Andrade
- Department of Psychopharmacology; National Institute of Mental Health and Neurosciences; Bangalore; India
| | | |
Collapse
|