0399 The MSSA: A Novel Instrument to Assess Sleep and Sleep Disturbances in Military Men and Women

Introduction

Military personnel experience unique stressors (e.g., deployments, shift work, family separation) which can cause sleep disturbances. However, little is known regarding the general sleep quality of military personnel and how it changes throughout their service, what types of stressors precipitate sleep disturbances, and how this differs among military men and women. We present findings from a new self-report measure, the Military Service Sleep Assessment (MSSA), which was designed to assess (1) current primary problems with sleep, (2) sleep quality throughout military service (3) life events that may have impacted their sleep and (4) the specific events which most effected sleep.

Methods

A total of 69 military personnel (22 women and 47 men) completed the MSSA and 49 also completed a diagnostic polysomnogram (PSG). Chi-square tests were run to differences in responses between men and women.

Results

No significant differences were found between men and women. In general, sleep quality progressively decreased over a participant’s military career from 3 to 2 on a 5-point Likert scale (1=low, 5=high). For those with at least one deployment (n=52), 73% reported that deployment and 54% reported that a redeployment (return from deployment) negatively impacted sleep quality for 3 months. Women reported that permanent change of station (PCS) negatively impacted their sleep more frequently than men (36% vs. 28%). The reported events that most significantly impacted sleep quality were deployment, military service other than deployment and trauma.

Conclusion

The MSSA is a novel instrument that can be used to increase understanding of sleep disturbances in military men and women which can inform prevention and treatment strategies. This measure is being used to systematically evaluate the factors which may precipitate or perpetuate sleep disturbances in military men and women such as military service-associated factors, training, deployment history, changing stations, and exposure to trauma or other stressful life events.

Support

This study is supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health.

0803 Clinical and Polysomnographic Features of Trauma Associated Sleep Disorder (TASD)

Introduction

Trauma associated sleep disorder (TASD) is an emerging parasomnia that develops after trauma with clinical features of trauma related nightmares (TRN), disruptive nocturnal behaviors (DNB), and autonomic disturbances. The purpose of this study is to characterize the clinical and polysomnographic (PSG) features of TASD.

Methods

Clinical history and detailed video-PSG review, to include post-PSG nightmare reports, of a cohort of patients with TASD.

Results

Patients (n=40, 32 men, 8 women) were active duty service members with a median age of 38.9 yrs (range 24-57 yrs). Dream content typically related to combat (n=37, 92.5%), with 75% (n=30) reporting TRN and 60% (n=24) reporting dream enactment at least weekly. Self-reported DNB included vocalizations, violent limb movements, thrashing, defensive posturing, and jumping from bed. There was a high rate of comorbid insomnia (n=35, 87.5%), PTSD (n=23, 63.9%), anxiety (n=25, 62.5%), depression (n=20, 50%), OSA (n=19, 47.5%), chronic pain (n=12, 30%), and TBI (n=13, 32.5%). Most patients had REM sleep without atonia (RSWA) (n=33, 82.5%), though a minority had purposeful DNB (n=11, 27.5%). Vocalizations were present in seven (17.5%) patients. Patients with PTSD were more likely to have purposeful DNB (n=9, 100%) than those without PTSD (n=13, 50%; p=0.013), whereas patients with purposeful DNB had markedly less N3 sleep (1.0±11.4%) than those without purposeful DNB (13.8±16.2%; p=0.002). There was no significant difference in medications between DNB groups.

Conclusion

TASD is frequently comorbid with other sleep and behavioral health disorders. Characteristics of TASD are often captured on video-PSG during REM sleep, though DNB may be less pronounced than what patients report in their habitual sleeping environment. Clinical and video-PSG correlations are invaluable in assessing patients with TASD. This study, which is the largest cohort to date, provides a further basis for establishing TASD as a unique REM-related parasomnia.

Support

N/A

Self-care agency in two groups of pregnant women

Self-care agency, a multidimensional concept in Orem's self-care deficit nursing theory, includes motivation, decision-making, energy, and knowledge necessary to perform self-care actions. Basic conditioning factors affect individuals' development and exercise of self-care agency. Secondary analysis of Appraisal of Self-Care Agency (ASA) scores in two groups of pregnant women, (1) a childbirth education group (n = 119) and (2) a clinic group (n = 127) was completed. Group 2 had significantly higher ASA scores. Several basic conditioning factors influenced ASA scores. Results offer implications for Orem's theory and maternity nursing practice.

Couples' attitudes toward childbirth participation: relationship to evaluation of labor and delivery

The article reports a correlational, partial replication study investigating the relationship between couples' prenatal attitudes toward childbirth participation and perceptions of their labor and delivery experiences. The Prenatal Attitude toward Childbirth Participation Scale was administered to 119 couples before and after attendance at a childbirth education course. The Labor Delivery Evaluation Scale, the Labor Agency Scale, and the Delivery Agency Scale were administered after delivery. Results showed that childbirth education affected couples' anticipated levels of control during labor and delivery. Anticipated and perceived levels of control were associated, and perceived levels of control correlated with overall evaluations of childbirth experiences. These findings suggest that childbirth educators and health care providers should focus on participants' opportunities to exercise control during childbirth and on identifying emergency situations during which control must be relinquished to the health care team.

Interaction of polyacrylates with porcine pepsin and the gastric mucus barrier: a mechanism for mucosal protection

1. The mechanism of interaction of the polyacrylates, carbopols with the mucus barrier in vivo has been investigated in vitro. 2. Carbopol caused a dramatic increase in the viscosity of porcine gastric mucin solutions that was up to 19-fold greater than that of the sum of the individual polymers. 3. The mucin-carbopol interaction was stable after an initial 30 min period for up to 36 h at 25 degrees C or 37 degrees C. It was reduced by increasing the temperature from 20 degrees C to 45 degrees C, was unaffected by pH and ionic strength, but was enhanced by Ca2+. 4. The magnitude of the interaction between mucin and carbopol depended on the polymeric structure of the mucin and the molecular size and level of cross-linking of the carbopol. 5. The interactions were reversible and increased with increasing carbopol and mucin concentration. The dramatic increase in viscosity can be explained in terms of space filling by the mucin molecules leading to predominantly carbopol-carbopol interactions. 6. Carbopol 934P inhibits pepsin hydrolysis and therefore has potential as a mucosal protective agent in vivo.

Laparoscopic presacral neurectomy for treatment of midline pelvic pain

STUDY OBJECTIVE

To examine the efficacy and safety of laparoscopic presacral neurectomy (LPSN) as the initial surgical treatment of midline pelvic pain and dysmenorrhea; and to evaluate its effectiveness in conjunction with procedures to relieve lateral pelvic pain, such as excision of endometriosis and lysis of adhesions.

DESIGN

A preoperative and postoperative self-rating with which patients classified pain on an ordinal scale of 0 to 5. A x<SUP>2<SUP> analysis of the data was performed.

SETTING

A private hospital in Savannah, Georgia.

PATIENTS

Twenty-seven women, age 15 to 41 years, who experienced severe midline dysmenorrhea and/or pain; 12 also had significant lateral pain.

INTERVENTIONS

Laparoscopic presacral neurectomy was the primary intervention. Other procedures, including lysis of adhesions, excision and vaporization of endometriosis, and appendectomy were completed as adjuncts to LPSN.

MEASUREMENTS AND MAIN RESULTS

Ratings were completed by patients 5 to 35 months after surgery. Twenty-two women reported no midline pain, three had significant reduction of pain, and two had persistence of severe pain. Two of the 12 women with lateral pain reported that pain persisted.

CONCLUSIONS

The LPSN is safe and effective as an initial surgical intervention for treating midline dysmenorrhea and pelvic pain, and when it is performed by experienced laparoscopic surgeons with adequate training.

Mucolysis of the colonic mucus barrier by faecal proteinases: inhibition by interacting polyacrylate

1. Mucolytic (mucus solubilizing) activity in human faeces has been characterized with both purified human and pig colonic mucin and shown to be mediated by proteolysis. 2. Mucolytic activity was demonstrated by: (i) a drop in mucin viscosity; (ii) a substantial reduction in mucin size, from polymer to degraded subunit, as assessed by Sepharose CL-2B gel filtration; (iii) formation of new N-terminal peptides. 3. Mucolytic activity was also followed in faecal extracts by its proteolytic activity using standard succinyl albumin substrate. Proteolysis extended over the pH range 4.5-11.0. Proteolysis was inhibited at pH 7.5 by soybean trypsin inhibitor and phenylmethanesulphonyl fluoride, suggesting the presence of serine proteinases. 4. The polyacrylate carbomer (934P) inhibited both mucolysis of pig colonic mucin and proteolysis of succinyl albumin. 5. Interaction between the polyacrylate (carbomer 934P) and purified human and pig colonic mucin was demonstrated by a marked synergistic increase in solution viscosity (360% above control). 6. The results demonstrate the presence of a mucolytic activity in the human colonic lumen that has the potential to degrade the mucus barrier, and that polyacrylates inhibit this mucolysis and interact to strengthen the colonic mucus barrier. Polyacrylates may therefore have therapeutic potential in inflammatory bowel disease where luminal proteolytic activity can be raised.

Mucus glycoprotein content of human cholesterol gallstones

Cholesterol gallstones were obtained from patients undergoing cholecystectomy and the mucus glycoprotein extracted. The biliary mucus glycoprotein was separated from other contaminants by Sepharose 4B gel filtration and the PAS staining excluded volume used to estimate mucus glycoprotein content of the gallstones. Hexosamine and sialic acid analysis of the glycoprotein indicated it was compositionally similar to the human mucus glycoprotein from bile. The mucus glycoprotein content of the nine stones analysed individually varied between 0.75 and 2.3 mg (a 3-fold variation) (1.27 +/- 0.16 mg, mean +/- SEM), whereas stone weight varied between 0.076 and 5.885 g (a 77-fold variation) (1.27 +/- 0.63 g, mean +/- SEM). When a pool of smaller stones, average weight 47 mg, was extracted, only 1.73 mg of glycoprotein was isolated, an average of 0.01 mg/stone. Analysis of the mucus glycoprotein by gel filtration on Sepharose 2B showed the majority of the glycoprotein was excluded as is the case with the mucus glycoprotein in bile. These results are consistent with biliary mucus glycoprotein being involved in the initial stages of gallstone formation but not in subsequent growth.