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Liu X, Yang Y, Liu ZZ, Jia CX. Bidirectional associations between sleep problems and suicidal thought/attempt in adolescents: A 3-wave data path analysis. J Affect Disord 2024; 350:983-990. [PMID: 38244795 DOI: 10.1016/j.jad.2024.01.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE This longitudinal data analysis examined the bidirectional relationships between sleep problems and suicidal thought (ST)/attempt (SA) in a large sample of Chinese adolescents. METHODS A total of 6995 adolescents (mean age = 14.86 years and 51.4% males) participated in a 3-wave longitudinal study of behavior and health in Shandong, China. A self-administered questionnaire and standardized scales were used to assess ST, SA, sleep duration, insomnia, daytime sleepiness, and behavioral/emotional problems in 2015 (T1), 1 year later (T2), and 2 years later (T3). Path analyses were performed without and with adjustment for covariates, including gender, grade level, chronic diseases, cigarette smoking, alcohol use, anxiety/depressive symptoms, paternal education, and family economic status. RESULTS The prevalence rates of short sleep (<7 h/night), insomnia symptoms, and daytime sleepiness were 46.9-58.8%, 16.0-19.4%, and 25.1-25.3% at T1, T2, and T3, respectively. The rates of past-year ST and SA were 9.1-12.4% and 1.6-2.4% at T1, T2, and T3, respectively. Path analyses showed that short sleep, insomnia, and daytime sleepiness predicted subsequent ST, and vice versa. Daytime sleepiness and SA predicted each other 1 year later. Sleep problems and ST/SA in the previous year significantly predicted themselves in the follow-up year. STUDY LIMITATION All data were based on self-report. CONCLUSION Short sleep, insomnia, and daytime sleepiness all had bidirectional relationships with ST. Daytime sleepiness and SA were bidirectionally linked. Our findings suggest that interventions should be taken for both night sleep disturbances and daytime sleepiness to prevent suicide. Adverse sleep outcomes in suicidal adolescents should be assessed, which can in turn increase suicide risk.
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Affiliation(s)
- Xianchen Liu
- Department of Epidemiology, School of Public Health, Cheeloo Medical College, Shandong University, Jinan 250012, China; South China Normal University School of Psychology, Guangzhou 510631, China; The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Yanyun Yang
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, FL, USA
| | - Zhen-Zhen Liu
- School of Psychology, Northeast Normal University, Changchun 130024, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo Medical College, Shandong University, Jinan 250012, China
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Kay C, Leonard H, Smith J, Wong K, Downs J. Genotype and sleep independently predict mental health in Rett syndrome: an observational study. J Med Genet 2023; 60:951-959. [PMID: 37055168 DOI: 10.1136/jmg-2022-108905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/26/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Rett syndrome is a genetically caused neurodevelopmental disorder associated with severe impairments and complex comorbidities. This study examined predictors of anxiety and depression in Rett syndrome, including genotype. METHODS The International Rett Syndrome Database, InterRett, was the data source for this observational study. Associations between genotype, functional abilities, comorbidities, anxiety and depression were estimated with univariate and multivariate regression models. An additional regression model for anxiety included use of an anxiety medication as a predictor variable. RESULTS The sample included 210 individuals aged 6-51 years of whom 54 (25.7%) were on psychotropic medication for anxiety or depression. Individuals with the p.Arg294* variant had the highest anxiety scores, as did those with insomnia or excessive daytime sleepiness, irrespective of anxiety medication use. Individuals with the p.Arg306Cys variant had the lowest depression scores, as did those with insomnia or excessive daytime sleepiness. CONCLUSION Findings indicated that genotype and sleep have implications for mental health in Rett syndrome, suggesting that anticipatory guidance and proactive management of poor sleep could improve mental health. More research is needed to understand the effects of psychometric medications, which cannot be inferred from this cross-sectional study.
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Affiliation(s)
- Cayla Kay
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jeremy Smith
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Curtin School of Allied Healt, Curtin University, Perth, Western Australia, Australia
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Karimi M, Hedner J, Grote L. Changes in cognitive function and daytime sleepiness in patients with chronic heart failure and Cheyne-Stokes respiration with adaptive servo ventilation treatment. Sleep Med 2023; 107:157-163. [PMID: 37178547 DOI: 10.1016/j.sleep.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVES Cheyne - Stokes respiration (CSR) is prevalent in patients with chronic heart failure (CHF). Adaptive Servo Ventilation (ASV) alleviates CSR and improves objective sleep quality. We investigated the effects of ASV on neurocognitive function in the symptomatic phenotype of patients with CSR and CHF. METHODS This case series included patients diagnosed with stable CHF (NYHA ≥ II) and CSR (N = 8). Sleep and neurocognitive function were assessed at baseline and after 1- and 6-months following initiation of ASV treatment. RESULTS In CHF patients (n = 8, median age 78.0[64.5-80.8] years and BMI 30.0[27.0-31.5] kg/m2, median ejection fraction 30[24-45]%, Epworth Sleepiness Scale (ESS) score 11.5[9.0-15.0]), ASV markedly improved respiration during sleep (Apnea-Hypopnea Index (AHI) 44.1[39.0-51.5]n/h at baseline, 6.3[2.4-9.7]n/h at 6 months treatment, respectively, p < 0.01). The 6-min-walk test distance increased by treatment from (295.0[178.8-385.0] m to 356.0[203.8-495.0] m (p = 0.05)). Sleep structure was modified, and Stage 3 increased markedly from 6.4[1.7-20.1] % to 20.8[14.2-25.3] %, p < 0.02). Sleep latency in the Maintenance of Wakefulness Test increased from 12.0[6.0-30.0] min to 26.3[12.0-30.0] min, (p = 0.04). In the Attention Network Test, evaluating neurocognition, the number of lapses decreased from 6.0[1.0-44.0] to 2.0[0.3-8.0], (p = 0.05) and the overall number of responses to a preset stimulus increased after treatment (p = 0.04). CONCLUSIONS ASV treatment in CHF patients with CSR may improve sleep quality, neurocognition and daytime performance.
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Affiliation(s)
- Mahssa Karimi
- Centre for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Hedner
- Centre for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ludger Grote
- Centre for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Wescott DL, Franzen PL, Hasler BP, Miller MA, Soehner AM, Smagula SF, Wallace ML, Hall MH, Roecklein KA. Elusive hypersomnolence in seasonal affective disorder: actigraphic and self-reported sleep in and out of depressive episodes. Psychol Med 2023; 53:1313-1322. [PMID: 37010222 PMCID: PMC10071357 DOI: 10.1017/s003329172100283x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hypersomnolence has been considered a prominent feature of seasonal affective disorder (SAD) despite mixed research findings. In the largest multi-season study conducted to date, we aimed to clarify the nature and extent of hypersomnolence in SAD using multiple measurements during winter depressive episodes and summer remission. METHODS Sleep measurements assessed in individuals with SAD and nonseasonal, never-depressed controls included actigraphy, daily sleep diaries, retrospective self-report questionnaires, and self-reported hypersomnia assessed via clinical interviews. To characterize hypersomnolence in SAD we (1) compared sleep between diagnostic groups and seasons, (2) examined correlates of self-reported hypersomnia in SAD, and (3) assessed agreement between commonly used measurement modalities. RESULTS In winter compared to summer, individuals with SAD (n = 64) reported sleeping 72 min longer based on clinical interviews (p < 0.001) and 23 min longer based on actigraphy (p = 0.011). Controls (n = 80) did not differ across seasons. There were no seasonal or group differences on total sleep time when assessed by sleep diaries or retrospective self-reports (p's > 0.05). Endorsement of winter hypersomnia in SAD participants was predicted by greater fatigue, total sleep time, time in bed, naps, and later sleep midpoints (p's < 0.05). CONCLUSION Despite a winter increase in total sleep time and year-round elevated daytime sleepiness, the average total sleep time (7 h) suggest hypersomnolence is a poor characterization of SAD. Importantly, self-reported hypersomnia captures multiple sleep disruptions, not solely lengthened sleep duration. We recommend using a multimodal assessment of hypersomnolence in mood disorders prior to sleep intervention.
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Affiliation(s)
| | - Peter L. Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brant P. Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Megan A. Miller
- Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, WA
| | - Adriane M. Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stephen F. Smagula
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Statistics, University of Pittsburgh, Pittsburgh PA
| | - Martica H. Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathryn A. Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Center for the Neural Basis of Behavior, University of Pittsburgh, Pittsburgh, PA
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Abstract
This study was carried out to evaluate the effect of acupressure applied to hemodialysis patients on the level of daytime sleepiness and sleep quality. The data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. In the study, a total of 12 sessions of acupressure were applied to the Shenmen (HT7), Sanyingjao (Sp6), and Yungquan (KI1) points in the experimental group for 4 weeks. No intervention was applied to the control group. After the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group and that daytime sleepiness was less compared with the control group. After the acupressure, it was determined that the sleep latency of the experimental group was statistically significantly less and their total sleep duration was higher compared with the control group (P < .05). Although there was a decrease in the sleep quality of the experimental group 1 month after the cessation of the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group (P < .05). It was concluded that acupressure was an effective nursing intervention in increasing sleep quality and decreasing daytime sleepiness of hemodialysis patients.
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Affiliation(s)
- Emine Derya Ister
- Nursing Department, Faculty of Health Sciences, Kahramanmaras Sutcu Imam Universıty, Kahramanmaraş, Turkey (Dr Derya Ister); and Department of Internal Medicine Nursing, Nursing Faculty, Inonu University, Malatya, Turkey (Dr Citlik Saritas)
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Abstract
Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.
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Affiliation(s)
- Gerlinde C. Harb
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
- Arctic University of Norway, Tromsø, Norway
- * E-mail:
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Grigg-Damberger M, Andrews N, Wang L, Bena J, Foldvary-Schaefer N. Subjective and objective hypersomnia highly prevalent in adults with epilepsy. Epilepsy Behav 2020; 106:107023. [PMID: 32213453 DOI: 10.1016/j.yebeh.2020.107023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Sleepiness is among the most common complaints of people with epilepsy, but objective documentation is lacking. We systematically investigated subjective and objective sleepiness in an observational cross-sectional cohort of adults with epilepsy (AWE). METHODS This is a prospective study of AWE consecutively recruited without foreknowledge of sleep/wake complaints. Polysomnography (PSG) with 18-channel electroencephalography (EEG) followed by multiple sleep latency testing (MSLT) was performed. Patients completed the Epworth Sleepiness Scale (ESS), a single-item question assessing excessive daytime sleepiness (EDS), and a 7-day sleep and seizure diary. Multivariable linear models were used to assess the association between MSLT mean sleep latency (MSL) and interests with adjustment of covariates of interest. Receiver operating characteristics (ROC) analysis was performed to evaluate the discrimination capability of ESS on MSL < 8 min and <5 min and investigate the optimal cutpoints. RESULTS Among 127 AWE (mean age: 38.7 ± 13.7 years), abnormal MSL (<8 min) was observed in 49.6% and MSL <5 min in 31.5%. While 78% reported feeling sleepy during the day on a single-item question, only 24% had elevated scores on the ESS (>10/24). The ESS score was associated with MSL even after adjusting for seizure frequency, antiseizure medication (ASM) standardized dose and number, age, gender, depression and insomnia symptom severity, and apnea-hypopnea index (HPI) and total sleep time on PSG (coefficients [95% confidence interval (CI)]: -0.26 [-0.48, -0.05], p = 0.018). The area under the curve (AUC) of the ESS ROC predicting MSL < 8 min and MSL < 5 min were similar: 0.62 (95%CI: 0.52-0.72) and 0.62 (95%CI: 0.51-0.74). CONCLUSIONS This is the largest prospective cross-sectional observational study to date using MSLT in AWE. We found subjective and objective daytime sleepiness highly prevalent in AWE and not explained by seizure frequency, ASM burden, symptoms of insomnia/depression, or PSG findings although those with MSL < 5 min were more likely to have obstructive sleep apnea (OSA). Pathologic sleepiness with MSL < 8 min was present in half of AWE. Nearly one-third of AWE unselected for sleep/wake complaints had MSL < 5 min, a range typical of narcolepsy.
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Affiliation(s)
- Madeleine Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - Noah Andrews
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America
| | - Lu Wang
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - James Bena
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - Nancy Foldvary-Schaefer
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America.
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Ng KC, Wu LH, Lam HY, Lam LK, Nip PY, Ng CM, Leung KC, Leung SF. The relationships between mobile phone use and depressive symptoms, bodily pain, and daytime sleepiness in Hong Kong secondary school students. Addict Behav 2020; 101:105975. [PMID: 31076240 DOI: 10.1016/j.addbeh.2019.04.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Studies have found that increased mobile phone use (MPU) is associated with multiple health issues such as depression, disordered sleep and pain. However, the current situation and interrelationships of these problems remain unexplored in the Hong Kong population. OBJECTIVES This study aimed to understand the situation and problematic use of mobile phones by Hong Kong secondary school students and to investigate depressive symptoms, bodily pain and daytime sleepiness and the associations of these factors with MPU in Hong Kong secondary school students. METHODS This quantitative cross-sectional design study was based on self-administered questionnaires completed at five secondary schools. The questionnaire comprised five sections: MPU as measured by the Chinese version of the 10-Item Mobile Phone Problem Use Scale (CMPPUS-10); depressive symptoms according to the Depression Anxiety Stress Scale-21 Chinese Version (DASS-21); bodily pain according to the Brief Pain Inventory Short Form Chinese (BPISF-C); daytime sleepiness as measured using the Chinese version of the Epworth Sleepiness Scale (CESS) and socio-demographic questions. RESULTS A total of 686 students were recruited. The CMPPUS-10 score correlated positively with the average daily duration of MPU and the presence of depression, daytime sleepiness and bodily pain. Problematic mobile phone users received significantly higher scores for depression severity, bodily pain and daytime sleepiness. Health problems were significantly more severe in female than in male students. Bodily pain and daytime sleepiness mediated the relationship of MPU with depression. CONCLUSIONS Problematic MPU was associated with depression, bodily pain and daytime sleepiness. These findings will inform further studies of MPU-related health problems.
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Affiliation(s)
- Ka Chun Ng
- Master of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Lai Har Wu
- The School of Nursing at The Hong Kong Polytechnic University, Hong Kong.
| | - Hoi Yan Lam
- Master of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Lai Kuen Lam
- Master of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Po Yan Nip
- Master of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Cho Man Ng
- Master of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Ka Chun Leung
- Bachelor of Medicine and Bachelor of Surgery, The University of Hong Kong, Hong Kong.
| | - Sau Fong Leung
- The School of Nursing at The Hong Kong Polytechnic University, Hong Kong.
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Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Prevalence and risk factors of excessive daytime sleepiness in major depression: A study with 703 individuals referred for polysomnography. J Affect Disord 2019; 243:23-32. [PMID: 30223136 DOI: 10.1016/j.jad.2018.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/30/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND To date, few studies have investigated the prevalence and risk factors of excessive daytime sleepiness (EDS) in major depression. Thus, the aim of the present study was to examine the prevalence and risk factors of EDS in a large sample of individuals with major depression. METHODS Data from 703 individuals with major depression were retrospectively collected from the sleep laboratory research database of Erasme Hospital for analysis. A score of > 10 on the Epworth Sleepiness Scale was used as the cut-off for EDS. Logistic regression analyses were conducted to examine the clinical and demographic risk factors of EDS in major depression. RESULTS The prevalence of EDS in our sample was 50.8%. Multivariate logistic regression analysis revealed that the following were significant risk factors of EDS in major depression: non-use of short to intermediate half-life benzodiazepine receptor agonists, BMI ≥ 25 kg/m², age < 60 years, C-reactive protein > 7 mg/L, Beck Depression Inventory score ≥ 16, atypical depression, apnea-hypopnea index ≥ 15/h, and use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. LIMITATIONS To evaluate EDS, we used the Epworth Sleepiness Scale, which only allows for a subjective measure of daytime sleepiness. CONCLUSION EDS is a common symptom in individuals with major depression. In this subpopulation, interventions are possible for most risk factors of EDS, which justifies improved management of this symptom to avoid its negative consequences.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Paul Linkowski
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
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Holdaway AS, Becker SP. Children's sleep problems are associated with poorer student-teacher relationship quality. Sleep Med 2017; 47:100-105. [PMID: 29783160 DOI: 10.1016/j.sleep.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Children's sleep problems are associated with poorer student functioning in the school environment, including impairment in peer relationships; yet, no studies have examined sleep functioning in relation to the student-teacher relationship. The objective of this study was to examine whether child-rated total sleep problems or specific sleep problem domains (bedtime problems, nighttime problems, or daytime sleepiness) were associated with teacher-rated student-teacher closeness and conflict after controlling for student mental health symptoms known to be associated with both greater sleep problems and poorer student-teacher relationship quality. The study also examined whether age moderated the relation between sleep problems and student-teacher relationship quality. PARTICIPANTS Participants were 175 children (81 boys and 94 girls) in the first to sixth grades (age = 6-13 years) and their teachers. METHODS Children completed the Sleep Self-Report. Teachers completed a measure of student mental health symptoms (ie, attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and anxiety/depression) and a measure of their relational closeness and conflict with each student. RESULTS Total sleep problems were associated with greater student-teacher conflict, after controlling for child mental health symptoms and demographic factors. This association was moderated by age such that sleep problems were associated with conflict for younger children but not older children. Notably, daytime sleepiness specifically was associated with less student-teacher closeness. CONCLUSIONS This is the first study to demonstrate a relation between student sleep functioning and the student-teacher relationship. Results of the study suggest that sleep may be an important component of school-based screening and evaluation efforts, as sleep is an important malleable factor related to school success.
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Affiliation(s)
- Alex S Holdaway
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Tippin J, Dyken ME. Driving Safety and Fitness to Drive in Sleep Disorders. Continuum (Minneap Minn) 2017; 23:1156-1161. [PMID: 28777182 DOI: 10.1212/con.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Driving an automobile while sleepy increases the risk of crash-related injury and death. Neurologists see patients with sleepiness due to obstructive sleep apnea, narcolepsy, and a wide variety of neurologic disorders. When addressing fitness to drive, the physician must weigh patient and societal health risks and regional legal mandates. The Driver Fitness Medical Guidelines published by the National Highway Traffic Safety Administration (NHTSA) and the American Association of Motor Vehicle Administrators (AAMVA) provide assistance to clinicians. Drivers with obstructive sleep apnea may continue to drive if they have no excessive daytime sleepiness and their apnea-hypopnea index is less than 20 per hour. Those with excessive daytime sleepiness or an apnea-hypopnea index of 20 per hour or more may not drive until their condition is effectively treated. Drivers with sleep disorders amenable to pharmaceutical treatment (eg, narcolepsy) may resume driving as long as the therapy has eliminated excessive daytime sleepiness. Following these guidelines, documenting compliance to recommended therapy, and using the Epworth Sleepiness Scale to assess subjective sleepiness can be helpful in determining patients' fitness to drive.
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Plante DT, Cook JD, Goldstein MR. Objective measures of sleep duration and continuity in major depressive disorder with comorbid hypersomnolence: a primary investigation with contiguous systematic review and meta-analysis. J Sleep Res 2017; 26:255-265. [PMID: 28145043 PMCID: PMC5435536 DOI: 10.1111/jsr.12498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/13/2016] [Indexed: 12/13/2022]
Abstract
Hypersomnolence plays an important role in the presentation, treatment and course of mood disorders. However, there has been relatively little research that examines objective measures of sleep duration and continuity in patients with depression and hypersomnolence, despite the use of these factors in sleep medicine nosological systems. This study compared total sleep time and efficiency measured by naturalistic actigraphic recordings followed by ad libitum polysomnography (PSG; without prescribed wake time) in 22 patients with major depressive disorder and co-occurring hypersomnolence against age- and sex-matched healthy sleeper controls. The major depressive disorder and co-occurring hypersomnolence group demonstrated significantly longer sleep duration compared with healthy sleeper controls quantified by sleep diaries, actigraphy and ad libitum PSG. No between-group differences in sleep efficiency (SE), latency to sleep or wake after sleep onset were observed when assessed using objective measures. To further contextualize these findings within the broader scientific literature, a systematic review was performed to identify other comparable investigations. A meta-analysis of pooled data demonstrated patients with mood disorders and co-occurring hypersomnolence have significantly greater sleep duration and similar SE compared with healthy controls when assessed using ad libitum PSG. These results suggest current sleep medicine nosology that distinguishes hypersomnia associated with psychiatric disorders primarily as a construct characterized by low SE and increased time in bed may not be accurate. Future studies that establish the biological bases hypersomnolence in mood disorders, as well as clarify the accuracy of nosological thresholds to define excessive sleep duration, are needed to refine the diagnosis and treatment of these disorders.
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Affiliation(s)
- David T. Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jesse D. Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Rihmer Z, Gonda X, Rihmer A, Döme P. [Antidepressant-resistant depression and the bipolar spectrum -- diagnostic and therapeutic considerations]. Psychiatr Hung 2016; 31:157-168. [PMID: 27244871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
According to the results of epidemiological studies mood disorders with unipolar (major and minor depressive disorder; dysthymia) or bipolar features are among the most prevalent psychiatric disorders. These disorders with their frequent comorbidities (alcohol and/or drug use disorders, smoking, suicide, cardiovascular disorders) pose great public health challenge and cause substantial individual and familar burdens as well. Since SSRIs and other new antidepressant agents entered the market the possibilities to treat depression improved substantially but 25-35 percent of major depressives do not respond even to the second antidepressant trial but the rate of patients who are resistant after the third and fourth adequate antidepressant trial are around only 15-25 and 10 percent, respectively. Pharmacotherapy-resistant depression is a multicausal phenomenon. Along with its well-known risk-factors investigations of the past decade have revealed that unrecognised or hidden (subsyndromal or subthreshold) bipolarity is one of the most frequent causes of treatment resistance. In the case of bipolar depression (either as a part of syndromal bipolar I or II disorder or a subsyndromal manifestation) antidepressant monotherapy should be avoided and, instead of it, the administration of a mood stabilizer (primarily lithium and lamotrigine) or some atypical antipsychotics (preferably quetiapine) are recommended. If antidepressant is inevitably necessary in bipolar depression, we should use it always in combination with mood stabilizers or atypical antipsychotics.
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Affiliation(s)
- Zoltán Rihmer
- Semmelweis Egyetem Pszichiatriai es Pszichoterapias Klinika, Klinikai es Kutatasi Mentalhigienes Osztaly, Budapest, Hungary, E-mail:
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Pucci SHM, Pereira MDG. The mediator role of psychological morbidity on sleep and health behaviors in adolescents. J Pediatr (Rio J) 2016; 92:53-7. [PMID: 26632248 DOI: 10.1016/j.jped.2015.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/22/2015] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study examined the mediation role of psychological morbidity, defined in this study as depression/anxiety, in the relationship between excessive daytime sleepiness and sleep quality, and between sleep habits and health behaviors, in adolescents. METHODS A total of 272 students, between 12 and 18 years old, underwent a psychological protocol assessing excessive daytime sleepiness, sleep quality, sleep habits, health behavior, and psychological morbidity. RESULTS Psychological morbidity was not associated with the relationship between excessive daytime sleepiness and sleep quality, but was associated, with statistical significance, in the relationship between sleep habits and health behaviors. These results emphasize the role of psychological morbidity in adolescent health behaviors. CONCLUSION Analyzing the symptoms of depression and anxiety in pediatric patients may help in a more accurate diagnosis, especially in relation to sleep problems and health behaviors.
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Avis KT, Shen J, Weaver P, Schwebel DC. Psychosocial Characteristics of Children with Central Disorders of Hypersomnolence Versus Matched Healthy Children. J Clin Sleep Med 2015; 11:1281-8. [PMID: 26285115 PMCID: PMC4623126 DOI: 10.5664/jcsm.5186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 06/12/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypersomnia of central origin from narcolepsy or idiopathic hypersomnia (IHS) is characterized by pathological levels of excessive daytime sleepiness (EDS). Central hypersomnia has historically been underdiagnosed and poorly understood, especially with respect to its impact on daytime functioning and quality of life in children. OBJECTIVE Describe the psychosocial adjustment of children treated for narcolepsy or IHS on school performance, quality of life, and physical/extracurricular activities. METHODS Using a matched case control design, we compared child self- and parent-reported data from thirty-three 8- to 16-year-olds with an established diagnosis of narcolepsy or IHS, according to ICSD-2 criteria, to that of 33 healthy children matched by age, race/ethnicity, gender, and household income. Assessments evaluated academic performance, quality of life and wellness, sleepiness, and participation in extracurricular activities. RESULTS Compared to healthy controls, children with central hypersomnia had poorer daytime functioning in multiple domains. Children with hypersomnia missed more days of school and had lower grades than healthy controls. Children with hypersomnia had poorer quality of life by both parent and child report. Children with hypersomnia were significantly sleepier, had higher BMI, and were more likely to report a history of recent injury. Finally, children with hypersomnia engaged in fewer after-school activities than healthy controls. CONCLUSIONS A range of significant psychosocial consequences are reported in children with hypersomnia even after a diagnosis has been made and treatments initiated. Health care professionals should be mindful of the psychosocial problems that may present in children with hypersomnia over the course of treatment.
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Affiliation(s)
| | - Jiabin Shen
- UAB Department of Psychology, Birmingham, AL
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Abstract
BACKGROUND Though poorly defined, hypersomnia is associated with negative health outcomes and new-onset and recurrence of psychiatric illness. Lack of definition impedes generalizability across studies. The present research clarifies hypersomnia diagnoses in bipolar disorder by exploring possible subgroups and their relationship to prospective sleep data and relapse into mood episodes. METHOD A community sample of 159 adults (aged 18-70 years) with bipolar spectrum diagnoses, euthymic at study entry, was included. Self-report inventories and clinician-administered interviews determined features of hypersomnia. Participants completed sleep diaries and wore wrist actigraphs at home to obtain prospective sleep data. Approximately 7 months later, psychiatric status was reassessed. Factor analysis and latent profile analysis explored empirical groupings within hypersomnia diagnoses. RESULTS Factor analyses confirmed two separate subtypes of hypersomnia ('long sleep' and 'excessive sleepiness') that were uncorrelated. Latent profile analyses suggested a four-class solution, with 'long sleep' and 'excessive sleepiness' again representing two separate classes. Prospective sleep data suggested that the sleep of 'long sleepers' is characterized by a long time in bed, not long sleep duration. Longitudinal assessment suggested that 'excessive sleepiness' at baseline predicted mania/hypomania relapse. CONCLUSIONS This study is the largest of hypersomnia to include objective sleep measurement, and refines our understanding of classification, characterization and associated morbidity. Hypersomnia appears to be comprised of two separate subgroups: long sleep and excessive sleepiness. Long sleep is characterized primarily by long bedrest duration. Excessive sleepiness is not associated with longer sleep or bedrest, but predicts relapse to mania/hypomania. Understanding these entities has important research and treatment implications.
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Affiliation(s)
- Katherine A. Kaplan
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
| | - Eleanor L. McGlinchey
- Division of Child and Adolescent Psychiatry, Columbia University/New York State Psychiatric, New York, NY
| | - Adriane Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Anda Gershon
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
| | - Lisa S. Talbot
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | | | - June Gruber
- Department of Psychology, University of Colorado, Boulder, Boulder, CO
| | - Allison G. Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, CA
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François C, Wertz J, Kirkove M, Verly JG. Evaluation of the performance of an experimental somnolence quantification system in terms of reaction times and lapses. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:5820-3. [PMID: 25571319 DOI: 10.1109/embc.2014.6944951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Somnolence is known to be a major cause of various types of accidents, and ocular parameters are recognized to be reliable physiological indicators of somnolence. We have thus developed an experimental somnolence quantification system that uses images of the eye and that produces a level of somnolence on a continuous numerical scale. The aim of this paper is to show that the level of somnolence produced by our system is well related to the level of performance of subjects accomplishing three reaction-time tests in different sleep conditions. Twenty seven subjects participated in the study and images of their right eye were continuously recorded during the tests. Levels of somnolence, reaction times (RTs), and percentages of lapses were computed for each minute of test. Results show that the values of these three parameters increase significantly with sleep deprivation. We determined the best threshold on our scale of somnolence to predict lapses, and we also shown that correlations exist with some of the ocular parameters. Our somnolence quantification system has thus significant potential to predict performance decrements of subjects accomplishing a task.
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Garbarino S. [24-hour work: the interaction of stress and changes in the sleep-wake cycle in the police force]. G Ital Med Lav Ergon 2014; 36:392-396. [PMID: 25558741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Disruption in police officers. In recent years there has been a widespread growth in services, available regardless of time or day organization (24/7 service) and a diffuse increase in their use, both in work and private lives, generally ignoring the importance of a regular sleep organization. Police officers - often need to work extended shifts and long hours under highly stressful conditions, which results in reduced levels of safety and operational effectiveness. In numerous studies, perceived stress has been found to correlate with both subjective and objective disturbances in sleep. Consequently, excessive daytime sleepiness is one of the most frequent health and safety hazards that police officers have to deal with. Sleep deprivation affects performance outcomes through a wide range of cognitive domains. Sleepiness and fatigue, caused by sleep loss, extended work and wakefulness, circadian misalignment and sleep disorders are major causes of workplace human errors, incidents, and accidents. Therefore, prevention of sleep loss, high levels of stress and fatigue is a key factor to consider when assessing emergency intervention. In order to combat fatigue and sleepiness, a 30-90 minutes nap before night shift could be a viable option.
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Affiliation(s)
- Sergio Garbarino
- Police Health Service Department, Ministry of the Interior, Italy.
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Abstract
STUDY OBJECTIVES Many cognitive factors contribute to unintentional pedestrian injury, including reaction time, impulsivity, risk-taking, attention, and decision-making. These same factors are negatively influenced by excessive daytime sleepiness (EDS), which may place children with EDS at greater risk for pedestrian injury. DESIGN PARTICIPANTS AND METHODS Using a case-control design, 33 children age 8 to 16 y with EDS from an established diagnosis of narcolepsy or idiopathic hypersomnia (IHS) engaged in a virtual reality pedestrian environment while unmedicated. Thirty-three healthy children matched by age, race, sex, and household income served as controls. RESULTS Children with EDS were riskier pedestrians than healthy children. They were twice as likely to be struck by a virtual vehicle in the virtual pedestrian environment than healthy controls. Attentional skills of looking at oncoming traffic were not impaired among children with EDS, but decision-making for when to cross the street safely was significantly impaired. CONCLUSIONS Results suggest excessive daytime sleepiness (EDS) from the clinical sleep disorders known as the hypersomnias of central origin may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Cognitive processes involved in safe pedestrian crossings may be impaired in children with EDS. In the pedestrian simulation, children with EDS appeared to show a pattern consistent with inattentional blindness, in that they "looked but did not process" information in their pedestrian environment. Results highlight the need for heightened awareness of potentially irreversible consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.
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Affiliation(s)
| | | | - David C. Schwebel
- Department of Psychology, University of Alabama Birmingham, Birmingham, AL
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Pikovsky O, Oron M, Shiyovich A, Perry ZH, Nesher L. The impact of sleep deprivation on sleepiness, risk factors and professional performance in medical residents. Isr Med Assoc J 2013; 15:739-744. [PMID: 24449976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Prolonged working hours and sleep deprivation can exert negative effects on professional performance and health. OBJECTIVES To assess the relationship between sleep deprivation, key metabolic markers, and professional performance in medical residents. METHODS We compared 35 residents working the in-house night shift with 35 senior year medical students in a cross-sectional cohort study. The Epworth Sleepiness Scale (ESS) questionnaire was administered and blood tests for complete blood count (CBC), blood chemistry panel, lipid profile and C-reactive protein (CRP) were obtained from all participants. RESULTS Medical students and medical residents were comparable demographically except for age, weekly working hours, reported weight gain, and physical activity. The ESS questionnaires indicated a significantly higher and abnormal mean score and higher risk of falling asleep during five of eight daily activities among medical residents as compared with medical students. Medical residents had lower high density lipoprotein levels, a trend towards higher triglyceride levels and higher monocyte count than did medical students. CRP levels and other laboratory tests were normal and similar in both groups. Among the residents, 5 (15%) were involved in a car accident during residency, and 63% and 49% reported low professional performance and judgment levels after the night shift, respectively. CONCLUSIONS Medical residency service was associated with increased sleepiness, deleterious lifestyle changes, poorer lipid profile, mild CBC changes, and reduced professional performance and judgment after working the night shift. However, no significant changes were observed in CRP or in blood chemistry panel. Larger prospective cohort studies are warranted to evaluate the dynamics in sleepiness and metabolic factors overtime.
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Affiliation(s)
- Oleg Pikovsky
- Division of Internal Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maly Oron
- Division of Internal Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Arthur Shiyovich
- Department of Medicine E, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Zvi H Perry
- Department of Surgery and Soroka University Medical Center, Prywes Center for Medical Education, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Nesher
- Division of Internal Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Karhula K, Härmä M, Sallinen M, Hublin C, Virkkala J, Kivimäki M, Vahtera J, Puttonen S. Association of job strain with working hours, shift-dependent perceived workload, sleepiness and recovery. Ergonomics 2013; 56:1640-1651. [PMID: 24079918 DOI: 10.1080/00140139.2013.837514] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We explored the relationship of job strain with working hours, shift-dependent perceived workload, sleepiness and recovery. Nurses/nursing assistants (n = 95) were recruited from wards that belonged to either the top (high-strain group, HJS) or the bottom (low-strain group, LJS) job strain quartiles of a Job Content Questionnaire survey of employees in five health care districts and four cities in Finland. Three-week field measurements during naturally occurring shift schedules and a subset of pre-selected shift arrangements consisted of the Karolinska Sleepiness Scale, perceived workload and recovery. The HJS group (n = 42) had more single days off and quick returns than the LJS group (n = 53, p < 0.01), and both mental workload and physical workload were rated as higher (p < 0.01). During naturally occurring shift arrangements, severe sleepiness was more common in the HJS group only in quick returns (p = 0.04) and the HJS group recovered on average more poorly from work after all shifts (p = 0.01) and morning shifts (p = 0.02). During pre-selected shift arrangements, the differences between the groups were only minor. In conclusion, job strain-related differences in sleepiness and recovery were mostly attributable to differences in shift arrangements.
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Affiliation(s)
- Kati Karhula
- a Finnish Institute of Occupational Health , Helsinki , Finland
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Eldevik MF, Flo E, Moen BE, Pallesen S, Bjorvatn B. Insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder in nurses having less than 11 hours in-between shifts. PLoS One 2013; 8:e70882. [PMID: 23976964 PMCID: PMC3744484 DOI: 10.1371/journal.pone.0070882] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/24/2013] [Indexed: 12/26/2022] Open
Abstract
Study objective To assess if less than 11 hours off work between work shifts (quick returns) was related to insomnia, sleepiness, fatigue, anxiety, depression and shift work disorder among nurses. Methods A questionnaire including established instruments measuring insomnia (Bergen Insomnia Scale), sleepiness (Epworth Sleepiness Scale), fatigue (Fatigue Questionnaire), anxiety/depression (Hospital Anxiety and Depression Scale) and shift work disorder was administered. Among the 1990 Norwegian nurses who participated in the study; 264 nurses had no quick returns, 724 had 1–30 quick returns and 892 had more than 30 quick returns during the past year. 110 nurses did not report the number of quick returns during the past year. The prevalence of insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder was calculated within the three groups of nurses. Crude and adjusted logistic regression analyses were performed to assess the relation between quick returns and such complaints. Results We found a significant positive association between quick returns and insomnia, excessive sleepiness, excessive fatigue and shift work disorder. Anxiety and depression were not related to working quick returns. Conclusions There is a health hazard associated with quick returns. Further research should aim to investigate if workplace strategies aimed at reducing the number of quick returns may reduce complaints among workers.
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Affiliation(s)
- Maria Fagerbakke Eldevik
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Elisabeth Flo
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Bente Elisabeth Moen
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Nerfeldt P, Aoki F, Friberg D. Polygraphy vs. polysomnography: missing osas in symptomatic snorers--a reminder for clinicians. Sleep Breath 2013; 18:297-303. [PMID: 23942981 DOI: 10.1007/s11325-013-0884-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/18/2013] [Accepted: 07/23/2013] [Indexed: 11/25/2022]
Abstract
PURPOSES The purposes of this study are to investigate the usefulness of polygraphy (PG) in diagnosing obstructive sleep apnea (OSA) in sleepy/tired snorers compared to polysomnography (PSG) and, further, to search for suspected respiratory arousals in the PG. METHODS One hundred eighty-seven adults suffering from sleepiness/tiredness and snoring had undergone ambulant PG and were considered to be normal, using American Academy of Sleep Medicine's 2007 hypopnea criteria A. After approximately 7 months, in-lab PSG was performed using hypopnea criteria B, where arousals are also recognized. Validated questionnaires (Hospital Anxiety and Depression Scale, self-rated general health) were answered. In a subgroup, the sensitivity and specificity were calculated for flow limitation index (FLI) and flattening index (FlatI) in PG compared with the respiratory distress index (RDI) in PSG. RESULTS Despite the normal PG, at PSG, the median RDI was 11.0 (range, 0-89.1). One hundred sixty-eight out of one hundred seventy-eight (90%) were found to have at least mild OSA and 119/187 (64%) with moderate-severe OSA according to the RDI values. The sensitivity and specificity were low (<70%) for FLI and FlatI. Forty-nine percent of the patients rated anxiety at borderline or pathological levels, 35% rated corresponding depression levels, and 45% rated poor or fair general health. CONCLUSIONS PG was insufficient to rule out OSA when the respiratory events were mainly associated with arousals. Almost half of these patients experience low general health and psychiatric problems. We recommend a full-night PSG when PG is "normal", and patients have symptoms of snoring and sleepiness/tiredness.
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Affiliation(s)
- P Nerfeldt
- Department of Oto-Rhino-Laryngology, Karolinska University Hospital, Stockholm, Sweden,
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Samanta J, Dhiman RK, Khatri A, Thumburu KK, Grover S, Duseja A, Chawla Y. Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis. Metab Brain Dis 2013; 28:249-59. [PMID: 23494591 DOI: 10.1007/s11011-013-9393-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/22/2013] [Indexed: 12/11/2022]
Abstract
Sleep disturbances are common in patients of cirrhosis and has a significant effect on their health related quality of life (HRQOL). Thus far, no study has demonstrated a systematically studied significant correlation between the sleep disturbance observed and the neuropsychiatric impairment status of patients of cirrhosis. On the basis of PHES, we divided 100 cirrhotics into those having minimal hepatic encephalopathy (MHE) (PHES≤-5) and those not (NMHE). Now, in these MHE (n=46) and NMHE (n=54) patients, sleep disturbance was measured with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and HRQOL with SF-36(v2) questionnaire. Sixty (60 %) patients were found to be 'poor sleepers' (PSQI>5) while 38 (38 %) patients had excessive daytime sleepiness (ESS≥11). Univariate and multivariate analyses showed MHE has significant effect among 'poor sleepers' (P<0.0001) as well as on those with EDS (P<0.0001). Significant correlation existed between PHES and both the sleep parameters of PSQI (r = -0.518, P <0.0001) as well as ESS (r = -0.383, P <0.0001), implying independently strong correlation between poor cognition and the presence of night time sleep disturbance and excessive daytime sleepiness among cirrhotics. Significant correlation existed between PSQI and ESS and the various scales and component scores of SF-36(v2) signifying the negative impact of sleep disturbance on the HRQOL. In conclusion, both night time sleep disturbance and excessive daytime sleepiness have significant relation with the neuropsychiatric impairment in patients of cirrhosis and are significantly associated with the observed impairment in HRQOL.
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Affiliation(s)
- Jayanta Samanta
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Unalan D, Ozturk A, Ismailogullari S, Akgul N, Aksu M. The effect of sleep duration and quality on academical success of the elementary school children in Kayseri Turkey. J PAK MED ASSOC 2013; 63:576-580. [PMID: 23757983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the sleeping habits of primary school children and establish link between sleeping hours and academic achievement. METHODS The cross-sectional study was conducted between April and June 2007, involving 2422 students of 6-8th grades in 12 primary schools located in Kayseri, Turkey. A questionnaire was presented to the students on the basis of probability sampling method. Academic performance was evaluated with regard to their school grades. SPSS 20 was used for statistical analysis. RESULTS Of the total 2422 questionnaires distributed, 1966 (81.2%) were used for further evaluation. The mean sleeping period of the students during school days was 8.86 +/- 1.10 hours. The number of students having difficulty in waking up in the morning was 940 (47.8%), while 910 (46.3%) were confused when they woke up during the night, and the 886 (45.1%) had nightmares, while 609 (31.0%) were sleepy all day long. As the sleeping period increased, the probability of a mediocre achievement in science lessons increased by 1.33 fold and poor achievement increased by 1.57 fold. Besides, the probability of a mediocre achievement in mathematics lessons increased by 1.36 fold, and poor achievement increased by 1.67 fold. For Turkish language lessons, these increases were found to be 1.40 and 1.60 respectively. Correlation analysis showed a significant negative relationship between sleeping time and successful scores in Turkish (r = -0.65, p < 0.025) and science (r = -0.061, p < 0.036) lessons. CONCLUSION As the sleeping period increased, the academic achievement of the students was negatively affected. The academic success was low in children who felt sleepy throughout the day.
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Affiliation(s)
- Demet Unalan
- Halil Bayrktar Health Services Vocational College, Kayseri, Turkey.
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Motovsky B, Pecenak J. Psychopathological characteristics of bipolar and unipolar depression - potential indicators of bipolarity. Psychiatr Danub 2013; 25:34-39. [PMID: 23470604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Establishing whether a depressive episode is part of a unipolar or bipolar disorder is essential for treatment planning. Over recent years, a growing number of publications have discussed psychopathological characteristics that might serve as indicators of bipolarity in patients with a history of depression dominated by unipolar symptoms. Our primary aim was to verify the adequacy of these indicators in contributing to a precise diagnosis in everyday clinical practice. SUBJECTS AND METHODS We investigated 104 patients diagnosed with major depressive episode at the time of examination. 52 patients had major depressive disorder and 52 patients had bipolar disorder. The patients were then assessed for the presence of potential bipolarity indicators: psychomotor slowing, self-view (self-blaming, feelings of worthlessness), hypersomnia, increased appetite, leaden paralysis/loss of physical energy, weight increase, interpersonal sensitivity, and early morning insomnia, using the Inventory of Depressive Symptomatology. We analysed the correlations between these indicators and the presence of unipolar or bipolar affective disorder. RESULTS Psychomotor slowing, self-blaming/feelings of worthlessness, increased appetite, leaden paralysis/loss of physical energy, and weight increase were significantly more frequent in bipolar depression than in unipolar depression (p<0.05). Early morning insomnia was significantly more frequent in unipolar depression (p<0.05). There was no statistically significant correlation between hypersomnia or interpersonal sensitivity and either of the affective disorders. CONCLUSIONS It would be worthwhile identifying the relative importance of clinical indicators for probable BP in large-scale prospective studies. These would contribute to the better diagnostic assessment of major depressive episodes and therapeutic decision-making.
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Abstract
STUDY OBJECTIVES We aimed to explore the incidence and persistence of insomnia, the associated risk factors, and the potential bidirectional association of insomnia with depression, anxiety, and sleepiness in rural Chinese adolescents. DESIGN School-based prospective study. SETTING Five high schools in rural China. PARTICIPANTS There were 2,787 adolescents studied. INTERVENTIONS N/A. MEASURES AND RESULTS Insomnia was defined as having a score of equal to or higher than nine in the Insomnia Severity Index as validated in Chinese adolescents. Depression, anxiety, and sleepiness were determined by the Beck Depression Inventory (BDI), Zung Self-Rating Anxiety Scale (SAS), and Epworth Sleepiness Scale (ESS), respectively. The incidence and persistence rates of insomnia were 16.0% and 41.0%, respectively. Multivariate analyses in logistic regression models revealed that new incidence of insomnia was significantly associated with age, living in a rural area, habitual daytime napping, high life events, anxiety, and depression at baseline (range adjusted odds ratio = 1.12-1.61), whereas the persistence of insomnia was positively associated with age, female sex, high life events, and depression at baseline (range adjusted odds ratio = 1.26-1.55) but negatively associated with living in a rural area (odds ratio = 0.59). Insomnia at baseline could predict new onsets of both depression (odds ratio = 1.45) and anxiety (odds ratio = 1.98) but not sleepiness at follow-up after adjustment for age, sex, and baseline symptoms. The results in cross-lagged analyses further supported these observations in the bidirectional associations of insomnia with depression, anxiety, and sleepiness. CONCLUSIONS Insomnia has considerable incidence and persistence rates in Chinese adolescents. We have identified several risk factors for the incidence and persistence of insomnia. There are bidirectional associations of insomnia with depression and anxiety but not sleepiness. CITATION Luo C; Zhang J; Pan J. One-year course and effects of insomnia in rural Chinese adolescents. SLEEP 2013;36(3):377-384.
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Affiliation(s)
- Chunliu Luo
- Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
- Department of Nursing, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Jihui Zhang
- Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jiyang Pan
- Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
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Verwimp J, Ameye L, Bruyneel M. Correlation between sleep parameters, physical activity and quality of life in somnolent moderate to severe obstructive sleep apnea adult patients. Sleep Breath 2013; 17:1039-46. [PMID: 23354507 DOI: 10.1007/s11325-012-0796-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/05/2012] [Accepted: 12/24/2012] [Indexed: 01/22/2023]
Abstract
PURPOSE Several symptoms are described in obstructive sleep apnea (OSA), including excessive daytime sleepiness, depressive mood and neurocognitive dysfunction. However, few studies examined the relationship between objective physical activity, quality of life and sleep parameters. The purpose of this study was to determine sleep parameters (evaluated by actigraphy and polysomnography) implied in the occurrence of impaired physical activity and reduced quality of life in somnolent moderate to severe OSA patients. METHODS We reviewed retrospectively data of 75 somnolent moderate to severe (Apnea-Hypopnea Index > 20) OSA patients. Data of 5-days actigraphy and polysomnography were analysed. They all completed the Nottingham Health Profile questionnaire (NHP). Sleep parameters associated with physical activity and quality of life were assessed. RESULTS Patients were mainly obese (mean BMI 36) and males (53 %). Controlling for age and BMI, physical activity, expressed as number of steps walked/day, is associated with OSA severity in REM sleep (p = 0.05). Subjective somnolence was not associated with reduced physical activity. Regarding quality of life, "sleep", "energy" and "emotional reactions" scored highest; and patients evaluated correctly their activity impairment through the "mobility" item of NHP questionnaire. CONCLUSIONS Low level of physical activity is associated with increasing OSA severity in somnolent moderate to severe OSA patients but is not linked to subjective somnolence. These patients describe concomitantly a severely impaired quality of life in several domains, and the negative perception in the "mobility" domain is effectively related to an objective low level of physical activity.
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Affiliation(s)
- Jelke Verwimp
- Chest Service, Saint-Pierre University Hospital, Rue Haute 322, 1000 Brussels, Belgium
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Kyle SD, Crawford MR, Morgan K, Spiegelhalder K, Clark AA, Espie CA. The Glasgow Sleep Impact Index (GSII): a novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. Sleep Med 2013; 14:493-501. [PMID: 23347908 DOI: 10.1016/j.sleep.2012.10.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/13/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Daytime dysfunction and quality of life impairment are important and salient consequences of poor sleep in those with insomnia. Existing measurement approaches to functional impact tend to rely on non-specific generic tools, non-validated scales, or ad hoc single scale items. Here we report the development and validation of the Glasgow Sleep Impact Index (GSII), a novel self-report measure which asks patients to generate, and assess, three domains of impairment unique to their own individual context. These three patient-generated areas of impairment are ranked in order of concern (1-3; i.e. 1=the most concerning impairment), and then rated on a visual analogue scale with respect to impact in the past two weeks. Patients re-rate these specified areas of impairment, post-intervention, permitting both individual and group-level analyses. METHODS One-hundred and eight patients (71% female; Mean age=45 yrs) meeting Research Diagnostic Criteria for Insomnia Disorder completed the GSII, resulting in the generation of 324 areas (ranks) of sleep-related daytime and quality of life impairment. Fifty-five patients also completed the GSII pre- and post-sleep restriction therapy. The following psychometric properties were assessed: content validity of generated domains; relationship between ranks of impairment; and sensitivity to change post-behavioural intervention. RESULTS Content analysis of generated domains support recent DSM-5 proposals for specification of daytime consequences of insomnia; with the most commonly cited areas reflecting impairments in energy/motivation, work performance, cognitive functioning, emotional regulation, health/well-being, social functioning and relationship/family functioning. Preliminary results with 108 patients indicate the GSII to have excellent face and construct validity. The GSII was found to be sensitive to change, post-behavioural treatment (p<0.001; Cohen's d≥0.85 for all three ranks of impairment), and improvements were associated with reductions in insomnia severity in both correlational (range of r=0.28-0.56) and responder versus non-responder analyses (all p<0.05). CONCLUSIONS The development of the GSII represents a novel attempt to capture and measure sleep-related quality of life impairment in a valid and meaningful way. Further psychometric and clinical evaluation is suggested.
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Affiliation(s)
- Simon D Kyle
- University of Glasgow Sleep Centre, Institute of Neuroscience & Psychology, University of Glasgow, Scotland, United Kingdom.
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30
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Suzuki K, Miyamoto M, Miyamoto T, Suzuki S, Watanabe Y, Numao A, Iwanami M, Tatsumoto M, Sada T, Kadowaki T, Hashimoto K, Sakuta H, Hirata K. Snoring is associated with an impaired motor function, disease severity and the quality of life but not with excessive daytime sleepiness in patients with Parkinson's disease. Intern Med 2013; 52:863-9. [PMID: 23583989 DOI: 10.2169/internalmedicine.52.9083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE There are conflicting results regarding the frequency and clinical significance of sleep related breathing disorders in patients with Parkinson's disease (PD). The aim of this study was to investigate the relationship between snoring and its clinical correlates in patients with PD. METHODS A total of 93 PD patients and 93 controls were analyzed from a previously conducted cross-sectional study. Snoring was defined as a snoring frequency of ≥ 2 days/week (a score of 2 or higher on the PD Sleep Scale-2 subitem 15). Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of ≥ 10. RESULTS Snoring was more prevalent in the patients with PD than in the controls (14.0% vs. 1.1%). The PD patients who snored exhibited greater disease severity, worse scores on the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson fatigue scale and more impaired scores in several domains of the Parkinson's Disease Questionnaire, including the domains of mobility, activities of daily living, emotional well-being, communication and bodily discomfort, when compared to those who did not snore. No between-group differences were found in EDS. A higher proportion of the UPDRS motor scores for bradykinesia was seen in the PD patients who snored compared to that observed in the PD patients who did not snore. CONCLUSION We found that snoring was more frequent in PD patients than in controls. Furthermore, snoring in PD patients was associated with disease severity, an impaired motor function and a decreased quality of life, although it was not associated with EDS.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Japan.
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31
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Fredericks EM, Dore-Stites D, Calderon SY, Well A, Eder SJ, Magee JC, Lopez MJ. Relationship between sleep problems and health-related quality of life among pediatric liver transplant recipients. Liver Transpl 2012; 18:707-15. [PMID: 22344942 PMCID: PMC3365624 DOI: 10.1002/lt.23415] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Among adult liver transplant recipients (LTRs), sleep disturbances and fatigue are common. Sleep problems following pediatric liver transplantation may contribute to daytime fatigue and lower health-related quality of life (HRQOL). The aim of this cross-sectional study was to determine the impact of sleep problems on the HRQOL of pediatric LTRs using validated measures. Participants included 47 LTRs. Mean age of the LTRs was 10.9 ± 4.6 years, and mean time since transplantation was 6.2 ± 3.9 years. The primary indication for transplantation was biliary atresia (51%). According to parent reports, pediatric transplant recipients had symptoms of sleep-disordered breathing, excessive daytime sleepiness, daytime behavior problems, and restless legs; 40.4% of parents and 43.8% of children reported significantly lower total HRQOL for the recipients. Age, time since transplantation, and health status were not significantly related to the quality of life. Hierarchical regression analyses revealed that the sleep-disordered breathing subscale of the Pediatric Sleep Questionnaire accounted for significant variance in parent-proxy reports on the Pediatric Quality of Life (PedsQL) summary scales measuring children's psychosocial health (R(2) = 0.36, P < 0.001), physical health (R(2) = 0.19, P = 0.004), and total HRQOL (R(2) = 0.35, P < 0.001). Also, the sleep-disordered breathing subscale accounted for significant variance in the child self-reported school functioning scale (R(2) = 0.18, P = 0.03). Clinically significant sleep problems were more common among children with low total HRQOL. In conclusion, sleep problems were common in this cohort of pediatric LTRs and predicted significant variance in HRQOL. Prospective larger scale studies are needed to assess factors that contribute to sleep difficulties and low HRQOL in this population. The detection and treatment of significant sleep problems may benefit the HRQOL of pediatric LTRs.
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Affiliation(s)
- Emily M Fredericks
- Department of Pediatrics and Communicable Diseases, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5318, USA.
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Settineri S, Gitto L, Conte F, Fanara G, Mallamace D, Mento C, Silvestri R, Tati F, Zoccali R, Cordici F, Grugno R, Polimeni G, Vitetta A, Bramanti P. Mood and sleep problems in adolescents and young adults: an econometric analysis. J Ment Health Policy Econ 2012; 15:33-41. [PMID: 22611091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/18/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Sleep related problems affect approximately 25-40% of children and adolescents. The acquisition of sleep patterns characterised by later bedtimes, insomnia and excessive daytime sleepiness is related to poorer school performance, daytime drowsiness, physical tiredness and a higher rate of psychiatric illnesses. Many studies have investigated the correlation between sleep and mood in children and adolescents and overall, show a positive association between sleep problems and psychiatric disorders. However, little is known about adolescents' personal perception of their psychological status as it is linked with the occurrence of mood changes and sleep-related problems. AIMS OF THE STUDY The aim of the study is to explore the impact of variables such as age, gender, education and the perception of their own psychological status (evaluated through suitable questionnaires) on the simultaneous presence of sleep disturbances and affective symptoms in a sample of adolescents. A positive correlation between these two dependent variables signals the need to intervene with proper support programs. METHODS A recursive bivariate probit model has been employed. This method allows us to take into account two dependent dummy variables and to consider the relationship between the two, presuming that one may also influence the other. The analysis has been carried out on a sample of 2,005 adolescents out of a total of 4,000 who declared their willingness to be telephonically interviewed using a questionnaire in two parts designed to obtain information about the participants sleep habits and affective symptoms. RESULTS There is a positive correlation between sadness and daytime drowsiness. The estimated joint probability ranging from 5.5% to 9% in girls demonstrates a greater tendency for girls to experience both depression and altered sleep patterns. DISCUSSION AND LIMITATIONS OF THE STUDY: Just as sadness is a key symptom of affective disorders, daytime drowsiness indicates the presence of sleep disorders caused by sleep habits that are likely to evolve into affective symptoms. This assumption is confirmed by the results of this analysis. However, since the interviews were conducted during the years 2003 and 2004, a replication of the analysis would outline whether this evidence is still the same or whether changes in habits and behaviours have intervened to modify substantially this pattern in recent years. As the analysis considers a sample of adolescents living in two southern Italian regions, the study should be replicated in other geographical areas. IMPLICATIONS FOR HEALTH CARE PROVISIONS AND USE: The early detection of affective symptoms in adolescents may presumably lead to a diminished use of antidepressants and an improvement in learning abilities and school results along with strengthening of personal motivations. IMPLICATIONS FOR HEALTH POLICIES Counselling and educational programs directed towards those adolescents demonstrating poor sleep habits should be planned and implemented to avoid further complications and impact on their mental health.
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Semionov V, Singer Y, Shvartzman P. Prevalence and management of symptoms during the last month of life. Isr Med Assoc J 2012; 14:96-99. [PMID: 22693789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The prevalence and severity of the "most troublesome" symptoms in terminally ill patients are well known and have been studied in many settings. However, these symptoms change during the course of advanced disease. OBJECTIVES To evaluate the range and trajectory of symptoms in the final stage of life as measured a month prior to death. METHODS Patients with an expected prognosis of less than 6 months were recruited forthe study. Excluded were non-Hebrew or Russian speakers, and patients with cognitive impairment or a diagnosis of brain tumor. A structured questionnaire was used to interview patients and their caregivers at home every 2 weeks until death. We present a comparison analysis of 45 patients who completed both interviews 2 and 4 weeks before death. RESULTS There were five symptoms (fatigue, pain, reduced wellbeing, lack of appetite, somnolence) that were reported most frequently, occurring in more than 70% of the patients. Most of the symptoms showed a worsening trend towards death. CONCLUSIONS Assessing the presence and severity of symptoms as a guide to start or modify treatment is recommended. Knowledge of how symptoms change in the final stage of life could better assist in the management of resources and could help patients and their families in their final preparations.
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Affiliation(s)
- Valentina Semionov
- Pain and Palliative Care Unit, Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Favrat B, Pasche C. [Aptitude to drive: what road to take?]. Rev Med Suisse 2012; 8:176-177. [PMID: 22338503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- B Favrat
- Unité de médecine et psychologie du trafic, Centre universitaire romand de médecine légale (HUG/CHUV), CMU, 1211 Genève 4.
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Basoglu OK, Midilli M, Midilli R, Bilgen C. Adherence to continuous positive airway pressure therapy in obstructive sleep apnea syndrome: effect of visual education. Sleep Breath 2011; 16:1193-200. [PMID: 22167633 DOI: 10.1007/s11325-011-0631-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is the most effective treatment in obstructive sleep apnea syndrome (OSAS) although it is known that adherence to therapy is limited. The aims of this study were to evaluate the effect of visual education on CPAP adherence and to identify the factors affecting adherence. METHODS Out of 133 consecutive newly diagnosed moderate-to-severe OSAS patients, 66 were informed about OSAS and CPAP therapy and received visual education by videotape (video group), whereas only information was given to 67 of them (control group). The patients were followed up in the 1st, 3rd, and 6th months. RESULTS After 6-month follow-up, adherence rate to CPAP therapy was 71.2% in the video group and 56.7% in the control group (p = 0.08). OSAS symptoms, such as witnessed apnea, morning headache, night sweating, dry mouth, and Epworth sleepiness score (ESS), were ameliorated more significantly in the video group (p < 0.05). In order to assess predictors of adherence, 85 patients using CPAP effectively were compared to 48 nonadherent patients; significant improvement in OSAS symptoms and ESS was observed in the adherent patients (p < 0.05). ESS was negatively correlated with the duration of CPAP use (r = -0.524, p < 0.0001). Adverse effects such as mask intolerance, choking, noise, and nasal congestion were related to poorer adherence (p < 0.01). CONCLUSIONS It is shown that adherence rate to CPAP therapy might be improved by visual education although the difference was not significant. Besides, patients with better adherence to CPAP treatment report the greatest improvement in OSAS symptoms and daytime sleepiness, and adverse effects are significantly related to poorer adherence.
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Affiliation(s)
- Ozen K Basoglu
- Department of Chest Diseases, Ege University Medical School, 35100, Bornova, Izmir, Turkey.
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Billiard M, Jaussent I, Dauvilliers Y, Besset A. Recurrent hypersomnia: A review of 339 cases. Sleep Med Rev 2011; 15:247-57. [PMID: 20970360 DOI: 10.1016/j.smrv.2010.08.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/06/2010] [Accepted: 08/06/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Michel Billiard
- Department of Neurology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier cedex 5, France.
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Koić E, Strkalj-Ivezić S, Venus M, John N. [Excessive daytime sleepiness--as possible suicidal equivalent in people with depressive disorder]. Lijec Vjesn 2011; 133:263-268. [PMID: 22165194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper presents the case of a patient suffering from atypical depression, with excessive daytime sleepiness, which was a suicidal equivalent. Patients who suffer from depression and sleep disorders can have an increased risk of suicidality, and to them should pay increased attention. Field of suicide as a means of resolving conflicts and unconscious mental escape from the reality of the obstacles, including sleep and daytime sleepiness, which may represent a form of "temporary suicide". The authors recommend that hypersomnia, daytime sleepiness in depressed patients and other sleep disorders should be treated as a potential risk factor for suicidal behavior.
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Mesas AE, López-García E, León-Muñoz LM, Graciani A, Guallar-Castillón P, Rodríguez-Artalejo F. The association between habitual sleep duration and sleep quality in older adults according to health status. Age Ageing 2011; 40:318-23. [PMID: 21330338 DOI: 10.1093/ageing/afr004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND research on the association between habitual sleep duration and quality in older adults is scarce and has shown conflicting results. Moreover, no previous study has assessed the influence of health status on this association. OBJECTIVES to examine the association between habitual duration and quality of sleep in older adults, and to test if this association varies with health status, as approximated by self-rated health, quality-of-life and functional limitation. DESIGN cross-sectional study with data collected by telephone interview. SETTING community-based study. SUBJECTS a total of 1,567 community-dwelling individuals aged ≥68 years in Spain. METHODS poor sleep quality was ascertained through nighttime complaints (sleeping-pill consumption, difficulty falling asleep, awakening during the night and early awakening), and daytime complaints (feeling unrested in the morning and daytime sleepiness). The analyses were adjusted for the main confounders, and were stratified by health status (self-rated health, health-related quality-of-life and functional limitation). RESULTS when compared with those sleeping 7-8 h, those who slept ≤6 h were more likely to report difficulty falling asleep [odds ratio (OR) 3.51; 95% confidence interval (CI) 2.37-5.20], frequent awakening during the night (OR 1.97; 95% CI 1.42-2.75), early awakening in the morning (OR 2.78; 95% CI 2.02-3.82) and feeling unrested in the morning (OR 1.73; 95% CI 1.18-2.54). Moreover, those who slept ≥9 h were more likely to report daytime sleepiness (OR 1.68; 95% CI 1.17-2.42). In stratified analyses, these associations generally did not vary with health status. CONCLUSIONS in older adults, short sleep is associated with nighttime sleep complaints and feeling unrested in the morning, while long sleep is associated with daytime sleepiness.
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Affiliation(s)
- Arthur Eumann Mesas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo, 2, 28029 Madrid, Spain
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Riegel B, Moelter ST, Ratcliffe SJ, Pressler SJ, De Geest S, Potashnik S, Fleck D, Sha D, Sayers SL, Weintraub WS, Weaver TE, Goldberg LR. Excessive daytime sleepiness is associated with poor medication adherence in adults with heart failure. J Card Fail 2010; 17:340-8. [PMID: 21440873 DOI: 10.1016/j.cardfail.2010.11.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/30/2010] [Accepted: 11/02/2010] [Indexed: 01/03/2023]
Abstract
BACKGROUND A relationship between excessive daytime sleepiness (EDS) and poor treatment adherence has been suspected but not confirmed. We hypothesized that medication adherence would be poorer in adults with heart failure (HF) and EDS and that cognitive status would be the mechanism of effect. METHODS AND RESULTS A sample of 280 adults with chronic HF were enrolled into a prospective cohort comparison study. We identified a cohort with EDS and a control group without EDS and further divided both groups into those with and without mild cognitive decline. Data on medication adherence were obtained at baseline and 3 and 6 months by using the Basel Assessment of Adherence Scale. Regression analysis was used to clarify the contribution of EDS and cognition to medication adherence and to assess relationships over 6 months after adjusting for age, enrollment site, gender, race, functional class, depression, and premorbid intellect. At baseline, 62% of subjects were nonadherent to their medication regime. Nonadherence was significantly more common in those with EDS, regardless of cognitive status (P = .035). The odds of nonadherence increased by 11% for each unit increase in EDS (adjusted odds ratio 1.11; 95% confidence interval 1.05-1.19; P = .001). In longitudinal models, there was a 10% increase in the odds of nonadherence for each unit increase in EDS (P = .008). The only cognition measure significantly associated with medication adherence was attention (P = .047). CONCLUSIONS Adults with HF and EDS are more likely to have problems adhering to their medication regimen than those without EDS, regardless of their cognitive status. Identifying and correcting factors that interfere with sleep may improve medication adherence.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
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40
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Singareddy R, Bixler EO, Vgontzas AN. Fatigue or daytime sleepiness? J Clin Sleep Med 2010; 6:405. [PMID: 20726292 PMCID: PMC2919674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ravi Singareddy
- Sleep Research & Treatment Center, Department of Psychiatry, Penn State College of Medicine, Hershey, PA 17033, USA.
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Parish JM. The pursuit of happiness: sleep apnea, sex, and sleepiness. J Clin Sleep Med 2010; 6:227-228. [PMID: 20572414 PMCID: PMC2883032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- James M Parish
- Center for Sleep Medicine, Division of Pulmonary Medicine, Mayo Clinic, Phoenix, AZ, USA.
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Ownby RL, Saeed M, Wohlgemuth W, Capasso R, Acevedo A, Peruyera G, Sevush S. Caregiver reports of sleep problems in non-Hispanic white, Hispanic, and African American patients with Alzheimer dementia. J Clin Sleep Med 2010; 6:281-289. [PMID: 20572423 PMCID: PMC2883041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
STUDY OBJECTIVES Sleep problems are common in persons with dementing illnesses and among the most stressful patient behaviors for caregivers. Although studies have shown differences in sleep across ethnic groups, little information is available on ethnic differences among persons with dementia. The purpose of this study was to investigate possible ethnic differences in sleep problems among patients with Alzheimer dementia. METHOD Caregiver reports of 5 sleep- or circadian rhythm-related behavioral problems (behavior disturbance worse in the evening, difficulties falling asleep, frequent awakenings, early awakenings, and excessive daytime sleep) were evaluated in 395 patients who had received a diagnosis of Alzheimer disease after diagnostic evaluation. The average cognitive score of the groups suggested that they could be characterized as having moderately severe impairment. The frequency of sleep problems was then evaluated across subgroups defined by self-reported ethnicity (African American, Hispanic, and non-Hispanic white). As patient and caregiver characteristics may affect caregivers' reports of patients' behaviors, mixed effects regression models were used to adjust for patient and caregiver variables that might affect caregiver reports. RESULTS Analyses revealed ethnic differences in sleep or circadian rhythm disturbances. African American and Hispanic patients were reported to have more severe sleep disturbances than non-Hispanic whites. After correction for patient and caregiver variables that might have affected caregiver reports, differences between African Americans and others remained. CONCLUSIONS Sleep problems in patients with dementing illnesses are reported by caregivers with differing frequencies across groups of African Americans, Hispanics, and non-Hispanic whites. Clinicians should be aware of these differences in assessing sleep disturbance in patients with dementia as well as the potential effects of patient and caregiver variables on reports of these problems.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Public Health, Nova Southeastern University, Fort Lauderdale, FL, USA.
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Jackson ML, Stough C, Howard ME, Spong J, Downey LA, Thompson B. The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea. Sleep Breath 2010; 15:439-45. [PMID: 20446116 DOI: 10.1007/s11325-010-0355-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 04/14/2010] [Accepted: 04/16/2010] [Indexed: 01/27/2023]
Abstract
PURPOSE A high prevalence of depressive symptomatology has been reported amongst sufferers of obstructive sleep apnea (OSA), but it remains unclear as to whether this is due to their OSA or other factors associated with the disorder. The current study aimed to assess the incidence and aetiology of depression in a community sample of individuals presenting to the sleep laboratory for diagnostic assessment of OSA. METHODS Forty-five consecutive individuals who presented to the sleep laboratory were recruited; of those, 34 were diagnosed with OSA, and 11 were primary snorers with no clinical or laboratory features of OSA. Nineteen control subjects were also recruited. Patients and controls completed the Beck Depression Inventory, the Profile of Mood States (POMS), and the Epworth Sleepiness Scale to assess their mood and sleepiness, prior to their polysomnography. RESULTS All patients reported significantly more depressive symptoms compared with healthy controls, regardless of their degree of OSA. There were no significant differences between OSA patients and primary snorers on any of the mood and self-rated sleepiness measures. Depression scores were not significantly associated with any of the nocturnal variables. Regression analysis revealed that the POMS fatigue subscale explained the majority of the variance in subjects' depression scores. CONCLUSIONS Fatigue was the primary predictor of the level of depressive symptoms in patients who attended the sleep laboratory, regardless of the level of severity of sleep-disordered breathing. When considering treatment options, practitioners should be aware of the concomitant occurrence of depressive symptoms and fatigue in patients presenting with sleep complaints, which may not be due to a sleep disorder.
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Affiliation(s)
- Melinda L Jackson
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99210, USA.
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Ustinov Y, Lichstein KL, Wal GSV, Taylor DJ, Riedel BW, Bush AJ. Association between report of insomnia and daytime functioning. Sleep Med 2010; 11:65-8. [PMID: 19783473 DOI: 10.1016/j.sleep.2009.07.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 07/20/2009] [Accepted: 07/27/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Yuriy Ustinov
- The University of Alabama, Tuscaloosa, AL 35487-0348, USA.
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45
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Abstract
Patients being evaluated in child psychiatry clinics for behavior and mood disturbances frequently exhibit daytime sleepiness. Conversely, patients being evaluated for hypersomnia by sleep specialists may have depressed mood or hyperactive and aggressive behavior. The etiology of daytime sleepiness in children and adolescents is diverse and includes inadequate sleep hygiene, obstructive sleep apnea, delayed sleep phase syndrome, idiopathic hypersomnia, periodic hypersomnia, narcolepsy, and mood disorders per se. Treatment of a sleep disorder can have a favorable impact on alertness and quality of life. A high index of suspicion for sleep problems should be maintained in children and adolescents with psychiatric disorders.
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MESH Headings
- Adolescent
- Child
- Comorbidity
- Cross-Cultural Comparison
- Cross-Sectional Studies
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/psychology
- Diagnosis, Differential
- Disorders of Excessive Somnolence/diagnosis
- Disorders of Excessive Somnolence/epidemiology
- Disorders of Excessive Somnolence/etiology
- Disorders of Excessive Somnolence/psychology
- Health Surveys
- Humans
- Idiopathic Hypersomnia/diagnosis
- Idiopathic Hypersomnia/epidemiology
- Idiopathic Hypersomnia/psychology
- Mental Disorders/diagnosis
- Mental Disorders/epidemiology
- Mental Disorders/psychology
- Narcolepsy/diagnosis
- Narcolepsy/epidemiology
- Narcolepsy/psychology
- Patient Care Team
- Referral and Consultation
- Risk Factors
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/epidemiology
- Sleep Apnea, Obstructive/psychology
- Sleep Disorders, Circadian Rhythm/diagnosis
- Sleep Disorders, Circadian Rhythm/epidemiology
- Sleep Disorders, Circadian Rhythm/psychology
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Affiliation(s)
- Suresh Kotagal
- Department of Neurology, Division of Child Neurology, The Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Silva GE, An MW, Goodwin JL, Shahar E, Redline S, Resnick H, Baldwin CM, Quan SF. Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). Sleep 2009; 32:1049-57. [PMID: 19725256 PMCID: PMC2717195 DOI: 10.1093/sleep/32.8.1049] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY OBJECTIVES Findings from population studies evaluating the progression and incidence of sleep disordered breathing have shown evidence of a longitudinal increase in the severity of sleep disordered breathing. The present study evaluates the association among changes in sleep disordered breathing, sleep symptoms, and quality of life over time. DESIGN Prospective cohort study. Data were from the Sleep Heart Health Study. SETTING Multicenter study. PARTICIPANTS Three thousand seventy-eight subjects aged 40 years and older from the baseline and follow-up examination cycles were included. MEASUREMENTS The primary outcomes were changes in the Physical Component Summary and Mental Component Summary scales obtained from the Medical Outcomes Study Short-Form Health Survey. The primary exposure was change in the respiratory disturbance index obtained from unattended overnight polysomnograms performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness and difficulty initiating and maintaining sleep. RESULTS Mean respiratory disturbance index increased from 8.1 +/- 11 SD at baseline to 10.9 +/- 14 (P < 0.0001) at follow-up. The mean Physical Component Summary and Mental Component Summary scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up. No associations between change in respiratory disturbance index and changes in Physical Component Summary or Mental Component Summary scores were seen. However, worsening of difficulty initiating and maintaining sleep and excessive daytime sleepiness were significantly associated with lower quality of life. CONCLUSIONS A slight increase in severity of sleep disordered breathing was seen over 5 years; this was not associated with worsening of quality of life. However, subjective symptoms of quality of sleep and daytime sleepiness were associated with declining quality of life.
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Affiliation(s)
- Graciela E Silva
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004-0698, USA.
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Faubel R, Lopez-Garcia E, Guallar-Castillón P, Balboa-Castillo T, Gutiérrez-Fisac JL, Banegas JR, Rodríguez-Artalejo F. Sleep duration and health-related quality of life among older adults: a population-based cohort in Spain. Sleep 2009; 32:1059-1068. [PMID: 19725257 PMCID: PMC2717196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
STUDY OBJECTIVES The few studies that have addressed the association between sleep duration and health-related quality of life (HRQL) were cross-sectional and small-sized, targeted young and middle-aged persons, and did not adjust for the main confounders. This study sought to examine the cross-sectional and longitudinal relationship between habitual sleep duration and HRQL in older adults. DESIGN Prospective study conducted from 2001 through 2003. Sleep duration was self-reported in 2001, and HRQL was measured using the SF-36 questionnaire in 2001 and 2003. Analyses were adjusted for the main confounders. SETTING Community-based study. PARTICIPANTS A cohort of 3834 persons representative of the non-institutionalized Spanish population aged 60 years and over. INTERVENTION None. MEASUREMENT AND RESULTS In comparison with women who slept 7 hours, those with extreme sleep durations (< or = 5 or > or = 10 h) reported worse scores on the SF-36 physical and mental scales in 2001. Among men, sleeping < or = 5 h was associated with a worse score in the role-physical scale in 2001. The magnitude of most of these associations was comparable with the reduction in HRQL associated with aging 10 years. Sleep duration in 2001 failed to predict changes in HRQL between 2001 and 2003. CONCLUSION Extreme sleep durations are a marker of worse HRQL in the elderly.
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Affiliation(s)
- Raquel Faubel
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
| | - Teresa Balboa-Castillo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
| | - Juan Luis Gutiérrez-Fisac
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
| | - José R. Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid – CIBER in Epidemiology and Public Health ( CIBERESP), Madrid, Spain
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Moore M, Kirchner HL, Drotar D, Johnson N, Rosen C, Ancoli-Israel S, Redline S. Relationships among sleepiness, sleep time, and psychological functioning in adolescents. J Pediatr Psychol 2009; 34:1175-83. [PMID: 19494088 DOI: 10.1093/jpepsy/jsp039] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examined associations among adolescent sleepiness, sleep duration, variability in sleep duration, and psychological functioning (symptoms of anxiety, depression, externalizing behaviors, and perceived health). METHODS This was a cross-sectional analysis of data from a community-based cohort study of sleep and health. Participants were 247 adolescents (48.6% female, 54.3% ethnic minority, mean age of 13.7 years). Sleep duration and variability in sleep duration were measured by actigraphy and sleepiness was measured by adolescent questionnaire. Primary outcomes were measured by parent, teacher, and adolescent questionnaires. RESULTS Sleepiness was associated with higher scores on measures of anxiety (Adjusted partial r(2) = .28, p < .001), depression (Adjusted partial r(2) = .23, p < .001), and perceived health (indicating more negative outcomes) (Adjusted partial r(2) = .19, p < .01). Significant associations between sleep duration or variability in sleep duration with psychological variables were not found. CONCLUSIONS Findings highlight the inter-relationships between sleepiness and psychological functioning and the potential importance of addressing sleepiness in health and psychological evaluations of adolescents.
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Affiliation(s)
- Melisa Moore
- Center for Sleep and Respiratory Neurobiology, University of Pennsylvania School of Medicine, USA.
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Gruber R, Xi T, Frenette S, Robert M, Vannasinh P, Carrier J. Sleep disturbances in prepubertal children with attention deficit hyperactivity disorder: a home polysomnography study. Sleep 2009; 32:343-50. [PMID: 19294954 DOI: 10.1093/sleep/32.3.343] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVE To examine sleep architecture and reported sleep problems in children with ADHD and normal controls, while considering the roles of pertinent moderating factors. DESIGN Overnight sleep recordings were conducted in 15 children diagnosed with ADHD (DSM-IV) without comorbid psychiatric problems and in 23 healthy controls aged 7 to 11 years. Children were on no medication, in good health and did not consume products containing caffeine > or = 7 days prior to the polysomnography (PSG) study. PSG evaluation was performed at each child's home; children slept in their regular beds and went to bed at their habitual bedtimes. MEASUREMENTS Standard overnight multichannel PSG evaluation was performed using a portable polysomnography device. In addition, parents were asked to complete a sleep questionnaire. RESULTS Compared to controls, children in the ADHD group had significantly shorter duration of REM sleep, smaller percentage of total sleep time spent in REM sleep, and shorter sleep duration. In addition, the ADHD group had higher scores on the insufficient sleep and sleep anxiety factors than children in the control group. CONCLUSION The present findings support the hypothesis that children with ADHD present sleep disturbances.
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Affiliation(s)
- Reut Gruber
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun (Quebec), Canada H4H 1R3.
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50
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Abstract
STUDY OBJECTIVES The present study investigated the effectiveness of a school-based intervention in increasing sleep knowledge and improving adolescent sleep problems. DESIGN A randomized, controlled trial using 2 groups (program class, classes-as-usual: [CAU]) assessed over 3 time points (pre-program, post-program, 6-week follow-up). PARTICIPANTS/SETTING Eighty-one students (mean age = 15.6 +/- 0.6 y; 33% male) from 2 schools in South Australia. Schools provided one class to participate in the sleep intervention program (N = 41) and a second class to act as a control class (N = 40). INTERVENTION Four 50-minute classes across a 4-week period. Classes consisted of educating adolescents on promoting and maintaining a healthy lifestyle based on a cognitive-behavior therapy framework. MEASUREMENTS AND RESULTS Data were collected pre-program, post-program, and at 6-week follow-up using an online questionnaire. Qualitative student and teacher data were collected at post-program. Baseline data indicated sleep problems were prevalent (53.1% insufficient sleep on school nights [< 8 h] and 77.8% discrepant school/weekend rise times [> 2 h]). These 2 criteria identified 36 adolescents with a delayed sleep timing (DST; Program, N = 21; CAU, N = 15). The program increased sleep knowledge (P = 0.001); however, analyses revealed no significant effects on target sleep variables as compared with the CAU class for the entire group (all P > 0.05). For DST adolescents, there was a significant interaction for reducing the discrepancy between school and weekend out of bed times (P = 0.002). There was no impact on other sleep parameters or depressed mood. CONCLUSIONS School-based sleep interventions for adolescents are a novel method for addressing a prevalent problem. Future programs should develop ways to motivate adolescents to change sleep practices.
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Affiliation(s)
- Lynette Moseley
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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