Charles P. Pollak

Bio: Charles P. Pollak is an academic researcher from NewYork–Presbyterian Hospital. The author has contributed to research in topics: Sleep disorder & Sleep Stages. The author has an hindex of 12, co-authored 20 publications receiving 1014 citations. Previous affiliations of Charles P. Pollak include The College of New Jersey.

Sleep Problems and Institutionalization of the Elderly

Abstract: This study examined the role of sleep problems in the decisions of families to institutionalize elderly relatives. Previous work on institutionalization of the elderly has given little attention to the contribution of nocturnal, sleep-related problems. Seventy-three primary caregivers of elders recently admitted to a nursing home or psychiatric hospital were asked to identify the problems the elder was having during the night and day and rate the degree to which these influenced their decision to institutionalize the elder. Seventy percent of the caregivers in each sample cited nocturnal problems in their decision to institutionalize, often because their own sleep was disrupted. The most frequent disruptive nocturnal events were micturition, pain, and complaints of sleeplessness. Sleep problems of the elderly contribute heavily to the decision to institutionalize an elder and thus to the social and economic cost of institutional care. They appear to do this largely by interfering with the sleep of caregivers. The nature, prevalence, and treatability of the sleeping problems of both elders and their caregivers need further study.

Sleep problems in the community elderly as predictors of death and nursing home placement.

Abstract: In 1984–85, 1855 elderly residents of an urban community responded to a comprehensive baseline interview that included questions regarding an extensive set of sleep characteristics and problems During the subsequent 3 1/2 years of follow-up, 167% of the respondents died and 35% were placed in nursing homes The predictive significance of each sleep characteristic for mortality and for nursing home placement was determined separately for males and females, using Cox proportional hazards models Selected demographic and psychosocial variables were also entered into the models Age, problems with activities of daily living (ADL), self-assessed health, income, cognitive impairment, depression and whether respondents were living alone were controlled for statistically

Sleep spindle frequency changes during the menstrual cycle

Abstract: SUMMARY Five healthy adult women aged 20 to 28 had 12–15 polysomnographic recordings, as well as daily basal body temperature and multiple LH, FSH, estrogen and progesterone measurements taken during a single menstrual cycle. Sleep stages were scored both visually and with a spindle and delta-wave, real-time, automatic analysing system. A cubic growth-curve model showed that the frequency of sleep spindles changed markedly over the menstrual cycle: spindle frequency was lowest about 18 days before onset of menses and highest 3 days before onset of menses. Slow waves did not change. The percentages of Stage 1 and REM sleep showed small changes during the menstrual cycle, and other parameters of visually scored sleep showed no tendency to change. Spindle frequency may reflect the effects of sex hormones on the reticular thalamic nucleus and may be a quantitative marker of premenstrual sleep disturbances.

High nocturnal body temperature in premenstrual syndrome and late luteal phase dysphoric disorder.

Abstract: Objective: Because women with late luteal phase dysphoric disorder (LLPDD) experience symptomatic affective states predictably, they can be studied to determine whether there are biological findings related solely to the clinically symptomatic state. The authors sought to answer the question, Does body temperature change with affective state? Method: The core body temperature and motor activity patterns of 1 0 women with premenstrual syndrome (PMS), six of whom also met criteria for LLPDD, and no other psychological or medical illness were compared to those of six women with chronic, noncyclic dysphoria and six asymptomatic comparison women at four phases of the menstrual cycle. Results: The nocturnal temperatures of the women with PMS/LLPDD were significantly higher than those of the comparison subjects across the entire menstrual cycle, but there were no differences in nocturnal activity levels. The women with noncyclic dysphoria had a mean nocturnal temperature in the follicular phase as high as that of the women with PMS/LLPDD. The temperatures of all women were higher in the luteal phase than in the follicular phase. Conclusions: These findings suggest that in the future investigators should document menstrual cycle phase in all female subjects and, when studying body temperature, should caref ully monitor symptomatic state in comparison subjects. (Am J Psychiatry 1991; 148:1329-1335)

The role of actigraphy in the study of sleep and circadian rhythms.

Abstract: In summary, although actigraphy is not as accurate as PSG for determining some sleep measurements, studies are in general agreement that actigraphy, with its ability to record continuously for long time periods, is more reliable than sleep logs which rely on the patients' recall of how many times they woke up or how long they slept during the night and is more reliable than observations which only capture short time periods Actigraphy can provide information obtainable in no other practical way It can also have a role in the medical care of patients with sleep disorders However, it should not be held to the same expectations as polysomnography Actigraphy is one-dimensional, whereas polysomnography comprises at least 3 distinct types of data (EEG, EOG, EMG), which jointly determine whether a person is asleep or awake It is therefore doubtful whether actigraphic data will ever be informationally equivalent to the PSG, although progress on hardware and data processing software is continuously being made Although the 1995 practice parameters paper determined that actigraphy was not appropriate for the diagnosis of sleep disorders, more recent studies suggest that for some disorders, actigraphy may be more practical than PSG While actigraphy is still not appropriate for the diagnosis of sleep disordered breathing or of periodic limb movements in sleep, it is highly appropriate for examining the sleep variability (ie, night-to-night variability) in patients with insomnia Actigraphy is also appropriate for the assessment of and stability of treatment effects of anything from hypnotic drugs to light treatment to CPAP, particularly if assessments are done before and after the start of treatment A recent independent review of the actigraphy literature by Sadeh and Acebo reached many of these same conclusions Some of the research studies failed to find relationships between sleep measures and health-related symptoms The interpretation of these data is also not clear-cut Is it that the actigraph is not reliable enough to the access the relationship between sleep changes and quality of life measures, or, is it that, in fact, there is no relationship between sleep in that population and quality of life measures? Other studies of sleep disordered breathing, where actigraphy was not used and was not an outcome measure also failed to find any relationship with quality of life Is it then the actigraph that is not reliable or that the associations just do not exist? The one area where actigraphy can be used for clinical diagnosis is in the evaluation of circadian rhythm disorders Actigraphy has been shown to be very good for identifying rhythms Results of actigraphic recordings correlate well with measurements of melatonin and of core body temperature rhythms Activity records also show sleep disturbance when sleep is attempted at an unfavorable phase of the circadian cycle Actigraphy therefore would be particularly good for aiding in the diagnosis of delayed or advanced sleep phase syndrome, non-24-hour-sleep syndrome and in the evaluation of sleep disturbances in shift workers It must be remembered, however, that overt rest-activity rhythms are susceptible to various masking effects, so they may not always show the underlying rhythm of the endogenous circadian pacemaker In conclusion, the latest set of research articles suggest that in the clinical setting, actigraphy is reliable for evaluating sleep patterns in patients with insomnia, for studying the effect of treatments designed to improve sleep, in the diagnosis of circadian rhythm disorders (including shift work), and in evaluating sleep in individuals who are less likely to tolerate PSG, such as infants and demented elderly While actigraphy has been used in research studies for many years, up to now, methodological issues had not been systematically addressed in clinical research and practice Those issues have now been addressed and actigraphy may now be reaching the maturity needed for application in the clinical arena

The Role of Actigraphy in the Study of Sleep and Circadian Rhythms AMERICAN ACADEMY OF SLEEP MEDICINE REVIEW PAPER

Abstract: 1.0 BACKGROUND ACTIGRAPHY HAS BEEN USED TO STUDY SLEEP/WAKE PATTERNS FOR OVER 20 YEARS. The advantage of actigraphy over traditional polysomnography (PSG) is that actigraphy can conveniently record continuously for 24-hours a day for days, weeks or even longer. In 1995, Sadeh et al.,1 under the auspices of the American Sleep Disorders Association (now called the American Academy of Sleep Medicine, AASM), reviewed the current knowledge about the role of actigraphy in the evaluation of sleep disorders. They concluded that actigraphy does provide useful information and that it may be a “cost-effective method for assessing specific sleep disorders...[but that] methodological issues have not been systematically addressed in clinical research and practice.” Based on that task force’s report, the AASM Standards of Practice Committee concluded that actigraphy was not indicated for routine diagnosis or for assessment of severity or management of sleep disorders, but might be a useful adjunct for diagnosing insomnia, circadian rhythm disorders or excessive sleepiness.2 Since that time, actigraph technology has improved, and many more studies have been conducted. Several review papers have concluded that wrist actigraphy can usefully approximate sleep versus wake state during 24 hours and have noted that actigraphy has been used for monitoring insomnia, circadian sleep/wake disturbances, and periodic limb movement disorder.3,4 This paper begins where the 1995 paper left off. Under the auspices of the AASM, a new task force was established to review the current state of the art of this technology.

Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.

Abstract: ContextInsomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia.ObjectiveTo evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia.Design and SettingRandomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months.SubjectsSeventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia.InterventionsCognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n=18), pharmacotherapy (temazepam) (n=20), or both (n=20) compared with placebo (n=20).Main Outcome MeasuresTime awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians.ResultsThe 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach.ConclusionsBehavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.

Sex differences in insomnia: a meta-analysis.

Abstract: Study objective Most but not all epidemiologic evidence suggests a female predisposition of insomnia. We applied meta-analytic methods to investigate sex differences in the risk of insomnia among the published epidemiologic studies. Design Meta-analysis with Comprehensive Meta-Analysis (Englewood, NJ); 9 different analyses were performed to investigate the sex difference of insomnia among different conditions. Setting A comprehensive search of the medical literature databases was performed to identify epidemiologic studies of insomnia. A rolling snowball method was also used. Participants General population. Interventions N/A. Result Thirty-one related papers were found, but 2 studies only reported the subtype prevalence of insomnia. All other studies (1,265,015 participants, female/male: 718,828/546,187) were included in the overall analysis of insomnia. A risk ratio of 1.41 [95% confidence interval: 1.28-1.55] for female versus male was found. The female excess in the risk of insomnia in large and quality studies was much higher than that of small and nonquality studies. The trend of female predisposition was consistent and progressive across age, with more significance in the elderly. The use of various criteria and frequency and duration of insomnia did not influence the predisposition of female in the risk of developing insomnia. Although obvious female excess in the risk of insomnia exists among different regions, there was a relatively lower female excess in East Asia. Conclusion This meta-analysis confirmed a female predisposition of insomnia. Further studies will be needed to examine the roles of different factors in leading to the sex difference of insomnia.

Sleep duration and mortality: a systematic review and meta‐analysis

Abstract: Summary Epidemiologic studies have shown that sleep duration is associated with overall mortality. We conducted a systematic review of the associations between sleep duration and all-cause and cause-specific mortality. PubMed was systematically searched up to January, 2008 to identify studies examining the association between sleep duration and mortality (both all-cause and cause-specific) among adults. Data were abstracted serially in a standardized manner by two reviewers and analyzed using random-effects meta-analysis. Twenty-three studies assessing the associations between sleep duration and mortality were identified. All examined sleep duration measured using participant self-report. Among the 16 studies which had similar reference categories and reported sufficient data on short sleep and mortality for meta-analyses, the pooled relative risk (RR) for all-cause mortality for short sleep duration was 1.10 [95% confidence interval (CI): 1.06, 1.15]. For cardiovascular-related and cancer-related mortality, the RRs associated with short sleep were 1.06 (95% CI: 0.94, 1.18) and 0.99 (95% CI: 0.88, 1.13), respectively. Similarly, among the 17 studies reporting data on long sleep duration and mortality, the pooled RRs comparing the long sleepers with medium sleepers were 1.23 (95% CI: 1.17, 1.30) for all-cause mortality, 1.38 (95% CI: 1.13, 1.69) for cardiovascular-related mortality, and 1.21 (95% CI: 1.11, 1.32) for cancer-related mortality. Our findings indicate that both short sleepers and long sleepers are at increased risk of all-cause mortality. Further research using objective measures of sleep duration is needed to fully characterize these associations.