Showing papers in "Sleep in 2001"
TL;DR: This study assessed the extent to which sleep-disordered breathing, difficulty initiating and maintaining sleep (DIMS), and excessive daytime sleepiness (EDS) were associated with impairment of quality of life (QoL) using the SF-36 to suggest mild to moderate SDB is associated with reduced vitality, while severeSDB is more broadly associated with poorer QoL.
Abstract: This study assessed the extent to which sleep-disordered breathing (SDB), difficulty initiating and maintaining sleep (DIMS), and excessive daytime sleepiness (EDS) were associated with impairment of quality of life (QoL) using the SF-36. Participants (n=5,816; mean age=63 years; 52.5% women) were enrolled in the nation-wide population-based Sleep Heart Health Study (SHHS) implemented to investigate sleep-disordered breathing as a risk factor in the development of cardiovascular disease. Each transformed SF-36 scale was analyzed independently using multiple logistic regression analysis with sleep and other potential confounding variables (e.g., age, ethnicity) included as independent variables. Men (11.6%) were significantly more likely to have SDB compared to women (5.6%), while women (42.4%) were significantly more likely to report DIMS than men (32.5%). Vitality was the sole SF-36 scale to have a linear association with the clinical categories of SDB (mild, moderate, severe SDB). However, individuals with severe SDB indicated significantly poorer QoL on several SF-36 scales. Both DIMS and EDS were strongly associated with reduced QoL even after adjusting for confounding variables for both sexes. Findings suggest 1) mild to moderate SDB is associated with reduced vitality, while severe SDB is more broadly associated with poorer QoL, 2) subjective sleep symptoms are comprehensively associated with poorer QoL, and 3) SF-36 mean score profiles for SDB and sleep symptoms are equivalent to other chronic diseases in the U.S. general population.
488 citations
TL;DR: It is suggested that high frequency activity in patients with Primary Insomnia is limited to the Beta/Gamma range (14-45 Hz), and is negatively associated with the perception of sleep.
Abstract: Study Objective: Several studies have shown that patients with insomnia exhibit elevated levels of Beta EEG activity (14-35 Hz) at or around sleep onset and during NREM sleep. In this study, we evaluated 1) the extent to which high frequency EEG activity is limited to the 14-32 Hz domain, 2) whether high frequency EEG activity (HFA) is associated with discrepancies between subjective and PSG measures of sleep continuity, and 3) the extent to which high frequency EEG activity occurs in patients with primary, as opposed to secondary, insomnia. Design: Three groups (n=9 per group) were compared: Primary Insomnia, Insomnia secondary to Major Depression, and Good Sleeper Controls. Groups were matched for age, sex and body mass. Average spectral profiles were created for each NREM cycle after removing waking and movement epochs and epochs containing micro- or mini-arousals. Setting: Sleep Research Laboratory Patients or Participants: Patients with primary and secondary insomnia Interventions: N/A Measurements and Results: Subjects with Primary Insomnia exhibited more average NREM activity for Beta-1 (14-20Hz), Beta-2 (20-35Hz) and Gamma activity (35-45Hz) than the other two groups (p.<.01) Group differences were also suggestive for Omega activity (45.0-125Hz) (p.<.10), with MDD subjects tending to exhibit more activity than the other groups. Correlational analyses revealed that average NREM Beta-1 and Beta-2 activity tended to be negatively correlated with subjective-objective discrepancy measures for total sleep time and sleep latency. Conclusions: Our results confirm that Beta activity is increased in Primary Insomnia. In addition, our data suggest that high frequency activity in oatients with Primary Insomnia is limited to the Beta/Gamma range (14-45 Hz), and is neqativelv associated with the perception of sleep.
397 citations
TL;DR: Insomnia is a prevalent and often chronic problem in breast cancer patients and although it is not always a direct consequence of cancer, pre-existing sleep difficulties are often aggravated by cancer, it is therefore important to better screen breast cancer Patients with insomnia and offer them an appropriate treatment.
Abstract: Study Objectives: To estimate the prevalence of insomnia, describe clinical characteristics of sleep difficulties, assess the influence of cancer on the insomnia course, and identify potential risk factors involved in the development of insomnia among women who had received radiotherapy for non metastatic breast cancer.
Design: A sample of 300 consecutive women who had been treated with radiotherapy for non metastatic breast cancer first completed an insomnia screening questionnaire. Participants who reported sleep difficulties were subsequently interviewed over the phone to evaluate further the nature, severity, duration, and course of their insomnia.
Setting: N/A
Patients or Participants: N/A
Interventions: N/A
Measurements and Results: Nineteen percent (n=56) of the participants met diagnostic criteria for an insomnia syndrome. In most cases (95%), insomnia was chronic. The onset of insomnia followed the breast cancer diagnosis in 33% of the patients and 58% of the patients reported that cancer either caused or aggravated their sleep difficulties. Factors associated with an increased risk for insomnia were sick leave, unemployment, widowhood, lumpectomy, chemotherapy, and a less severe cancer stage at diagnosis. Among women with insomnia symptoms, the risk to meet diagnostic criteria for an insomnia syndrome was higher in those who were separated and had a university degree.
Conclusions: Insomnia is a prevalent and often chronic problem in breast cancer patients. Although it is not always a direct consequence of cancer, pre-existing sleep difficulties are often aggravated by cancer. It is therefore important to better screen breast cancer patients with insomnia and offer them an appropriate treatment.
381 citations
TL;DR: It is suggested that hyperactive behavior is common among children referred for suspected SDB, regardless of the presence or severity of SDB.
Abstract: STUDY OBJECTIVES Children with sleep-disordered breathing (SDB) or periodic leg movements during sleep (PLMS) often have hyperactive behavior that improves when the sleep disorder is treated. Some children with SDB also have PLMS. To determine what polysomnographic features of SDB might be associated with hyperactive behavior, we studied behavior, SDB, and PLMS in a series of patients. DESIGN Prospective and observational. SETTING University-based sleep disorders laboratory. SUBJECTS Children (n=113) aged 2 to 18 years, referred for suspected SDB. INTERVENTIONS Parents completed the hyperactivity index of the Connors' Parental Rating Scale, and results were converted to age-adjusted t-scores. Children underwent laboratory-based polysomnography, with esophageal pressure monitoring when requested (n=19) by referring physicians. RESULTS Children with SDB (n=59) showed high hyperactivity scores (mean 59.5+/-18.3 SD, 95% C.I. [54.7, 64.2]) but these scores were no higher than those of children without SDB (59.0+/-15.1, [54.8, 63.1]). Hyperactivity showed no significant associations with the rate of apneas and hypopneas, minimum oxygen saturation, or most negative esophageal pressure (p>0.10), but was associated with the presence of 5 or more PLMS per hour (p=0.02). The rate of PLMS showed a linear association with hyperactivity among those subjects with SDB (p = 0.002), but no association among those subjects without SDB (p = 0.64). CONCLUSIONS These findings suggest that hyperactive behavior is common among children referred for suspected SDB, regardless of the presence or severity of SDB. Current observations cannot prove causality, but they are consistent with the hypothesis that PLMS may contribute to hyperactivity and SDB may act as an effect modifier.
249 citations
TL;DR: In this paper, the authors used wrist actigraphy to predict sleep and wakefulness using simple-threshold and multiple-regression methods and found that act levels correspond to deeper states of psg sleep.
Abstract: Study objectives Because sleep and wakefulness differ from each other by the amount of body movement, it has been claimed that the two states can be accurately distinguished by wrist actigraphy. Our objective was to test this claim in lengthy polysomnographic (psg) and actigraphic (acf) samples that included night and day components. Design Fourteen healthy young (21-35 years) and old (70-72 years) men and women lived in a laboratory without temporal cues for 7 days. Each subject continuously wore sleep-recording electrodes as well as 2 wrist-movement recorders. Act measurements were converted to predictions of sleep and wakefulness by simple-threshold and multiple-regression methods. Psg served as the gold standard for calculation of predictive values (PV, the probability that an act prediction is correct by psg criteria). Setting N/A. Participants N/A. Interventions N/A. Measurements and results The 7-day act recordings showed clear circadian cycles of high and low activity that respectively corresponded to subjective days, when subjects were wakeful, and subjective nights when they slept. Lower act levels corresponded to deeper states of psg sleep. Logistic regression on a 20-minute moving average of act gave the highest overall PV's. Nevertheless, the mean PV for sleep (PVS) was only 62.2% in complete, day + night samples. PVS was 86.6% in night samples. Act successfully predicted wakefulness during subjective nights (PVW = 89.6) and accurately measured circadian period length and the extent of sleep-wake consolidation, but it overestimated sleep rate and sleep efficiency. Act systematically decreased before sleep onset and increased before awakening, but reliable transitions among joint psg/act states (the Markov-1 property) were not demonstrated. Conclusions Low PV's and overestimation of sleep currently disqualify actigraphy as an accurate sleep-wake indicator. Actigraphy may, however, by useful for measuring circadian period and sleep-wake consolidation and has face validity as a measure of rest/activity.
245 citations
TL;DR: It is concluded that in men insomnia is related to lifestyle factors such as obesity, physical inactivity and alcohol dependency but not to aging, and medical disorders such as joint and low back disorders and psychiatric illnesses also increase the risk of reporting insomnia.
Abstract: Study objectives to prospectively analyze changes in the prevalence of insomnia and the relationship between insomnia, aging, lifestyle, and medical disorders Design a longitudinal population survey. Participants a randomly selected population sample of 2,602 men (age 30-69 years) from Uppsala in Sweden. Intervention all participants answered a questionnaire on sleep disturbances, lifestyle factors, and medical disorders in 1984 and again in 1994. Measurements and results The prevalence of INSOMNIA was 10.3% in 1984 and 12.8% in 1994. No significant correlation was found between age and insomnia in any of the two time periods. Insomnia in 1994 was independently related to having insomnia in 1984 (OR=6.45), being over-weight (BMI> 27 kg/m2) (OR=1.35), physical inactivity (OR=1.42), alcohol dependence (OR=1.75), psychiatric disorders (OR=8.27) and joint/low back disorders (OR=2.95). The number of subject with reported insomnia in 1984 but not 1994 was 149. Subjects that quit smoking during the time period had an increased likeliness of remission (OR=2.70) while men who were overweight were less likely to remit (OR=0.43). Conclusions We conclude that in men insomnia is related to lifestyle factors such as obesity, physical inactivity and alcohol dependency but not to aging. Medical disorders such as joint and low back disorders and psychiatric illnesses also increase the risk of reporting insomnia. This study demonstrates the close relationship between quality of sleep and overall health status.
236 citations
225 citations
TL;DR: Insufficient sleep is a common and long-standing condition, most strongly associated with sleep/wake variables, and one third of the liability to it is attributed to genetic influences.
Abstract: STUDY OBJECTIVES Insufficient sleep (sleep deprivation) is a common problem of considerable health, social, and economical impact. We assessed its prevalence and associations, and the role of genetic influences. DESIGN Panel study based on questionnaires administered in 1981 and 1990. SETTING/PATIENTS 12.423 subjects aged 33-60 years included in the Finnish Twin Cohort, representative of the Finnish population. INTERVENTIONS N/A. MEASUREMENTS A difference of 1 hour between the self-reports of the sleep need and the sleep length was considered insufficient sleep. Associations with education, life style, work, psychological characteristics and sleep-wake variables were assessed. Structural equation modelling techniques were used to compare genetic models among monozygotic and dizygotic twin pairs. RESULTS In 1990, the prevalence of insufficient sleep was 20.4% (16.2% in men and 23.9% in women). 44% of those with insufficient sleep in 1981 also had it 9 years later (Spearman correlation for persistence 0.334). In multivariate analyses, the strongest positively associated factors were daytime sleepiness (women: odds ratio 3.87, 95% confidence limits 3.24-4.63/men: 3.77, 2.98-4.75), insomnia (2.48, 1.92-3.19/2.91, 2.17-3.90), not able to sleep without disturbance (1.95, 1.47-2.60/2.54, 1.66-3.89), and evening type (2.10, 1.65-2.69/1.73, 1.25-2.41). Among men, also weekly working hours > or =75 was strongly associated (3.23, 1.54-6.78). "Not working" was negatively associated in both genders (0.68, 0.51-0.89/0.59, 0.42-0.83). Two thirds of the interindividual variability in the liability to insufficient sleep was attributed to non-genetic factors. CONCLUSIONS Insufficient sleep is a common and long-standing condition, most strongly associated with sleep/wake variables. One third of the liability to it is attributed to genetic influences. Sleep sufficiency should be assesssed in health examinations of working adults.
222 citations
TL;DR: This is the first study to report a direct and graded association between the frequency of nightmares and death from suicide in a general population and the adjusted relative risk of suicide was 57% higher compared with subjects reporting no nightmares at all.
Abstract: Study objectives To examine the relationship between the frequency of nightmares and the risk of suicide. Design and setting A prospective follow-up study in a general population of Finland starting in 1972. Participants A total of 36,211 subjects (17,700 men and 18,511 women) aged 25-64 years at baseline. Interventions N/A. Measurements The study included self-administered questionnaires (mainly questions on socio-economic factors, medical history, health behavior, and psychosocial factors) and health examination at the local primary healthcare center. The frequency of nightmares was estimated. The subjects were followed until Dec. 31, 1995, or death. Information on deaths caused by suicide (n=159) or other self-inflicted injury was obtained from the National Death Register by computerized record linkage using the national personal identification code assigned to every Finnish resident. Using the Cox proportional hazards regression model we controlled for several potential confounding factors. Results The frequency of nightmares was directly related to the risk of suicide. Among subjects having nightmares occasionally the adjusted relative risk of suicide was 57% higher, and among those reporting frequent nightmares 105% higher compared with subjects reporting no nightmares at all. Conclusions This is the first study to report a direct and graded association between the frequency of nightmares and death from suicide in a general population.
213 citations
TL;DR: In this paper, the authors assess various sleep parameters in latency-aged children with ADHD and their normally developing peers through the use of multiple sleep measures and find that many of the sleep problems of children with ADD may be due to challenging behaviours during bedtime routines.
Abstract: Study Objectives: To assess various sleep parameters in latency-aged children with ADHD and their normally developing peers through the use of multiple sleep measures. Design: Six sleep parameters were evaluated for two groups of children, ADHD and normal comparison. Each group consisted of 25 children (20 males, 5 females) who ranged in age from 7 to 11 years. All children underwent rigorous diagnostic procedures and the ADHD subjects were selected only if they displayed pervasiveness in their symptomatology and were medication naive. Parents completed a retrospective questionnaire which evaluated sleep problems over the past six months. Additionally, each child wore an actigraph for seven consecutive nights, and the child's parents completed a sleep diary during this time period. Setting: N/A Patients or Participants: N/A Interventions: N/A Results: Based on the findings from the questionnaire, parents of children with ADHD reported significantly more sleep problems than parents of normally developing children. However, the majority of these sleep differences were not verified through actigraphy or sleep diary data, with the exception of longer sleep duration for children with ADHD and parent reports that describe increased bedtime resistence. It was also found that child-parent interactions during bedtime routines were more challenging in the ADHD group. Conclusions: Despite the possibility of intrinsic sleep problems such as longer sleep duration, results indicate that many of the sleep problems of children with ADHD may be due to challenging behaviours during bedtime routines. The reason for discrepancies among sleep studies employing objective measures as well as between retrospective and prospective measures are discussed.
207 citations
TL;DR: Caffeine was efficacious in overcoming sleep inertia, which suggests a reason for the popularity of caffeine-containing beverages after awakening.
Abstract: Study objectives This study sought to establish the effects of caffeine on sleep inertia, which is the ubiquitous phenomenon of cognitive performance impairment, grogginess and tendency to return to sleep immediately after awakening. Design 28 normal adult volunteers were administered sustained low-dose caffeine or placebo (randomized double-blind) during the last 66 hours of an 88-hour period of extended wakefulness that included seven 2-hour naps during which polysomnographical recordings were made. Every 2 hours of wakefulness, and immediately after abrupt awakening from the naps, psychomotor vigilance performance was tested. Setting N/A. Participants N/A. Interventions N/A. Measurements and results In the placebo condition, sleep inertia was manifested as significantly impaired psychomotor vigilance upon awakening from the naps. This impairment was absent in the caffeine condition. Caffeine had only modest effects on nap sleep. Conclusions Caffeine was efficacious in overcoming sleep inertia. This suggests a reason for the popularity of caffeine-containing beverages after awakening. Caffeine's main mechanism of action on the central nervous system is antagonism of adenosine receptors. Thus, increased adenosine in the brain upon awakening may be the cause of sleep inertia.
TL;DR: Logistic regression analysis performed on the different insomnia symptoms revealed that somatic and psychiatric health were the strongest predictors of insomnia, whereas gender, age, and socioeconomic status showed a more inconsistent relationship.
Abstract: A representative adult sample (18 years and above) of the Norwegian population, comprising 2001 subjects, participated in telephone interviews, focusing on the one-month point prevalence of insomnia and use of prescribed hypnotics. Employment of DSM-IV inclusion criteria of insomnia yielded a prevalence rate of 11.7%. Logistic regression analysis performed on the different insomnia symptoms revealed that somatic and psychiatric health were the strongest predictors of insomnia, whereas gender, age, and socioeconomic status showed a more inconsistent relationship. Use of prescribed hypnotic drugs was reported by 6.9% and was related to being female, elderly, and having somatic and emotional problems. Sleep onset problems and daytime impairment were more common during winter compared to summer. Use of hypnotics was more common in the southern (rather than the northern) regions of Norway. For sleep onset problems a Season x Region interaction was found, indicating that the prevalence of sleep onset problems increased in southern Norway from summer to winter, while the opposite pattern was found in the northern regions. The importance of clinically adequate criteria and seasonal variation in the evaluation of insomnia is briefly discussed.
TL;DR: Results showed CBT produced larger changes on the DBAS-SF than did the other treatments, and these changes endured through the follow-up period, particularly within the CBT group.
Abstract: Study objectives This study was conducted to exam the degree to which cognitive-behavioral insomnia therapy (CBT) reduces dysfunctional beliefs about sleep and to determine if such cognitive changes correlate with sleep improvements. Design The study used a double-blind, placebo-controlled design in which participants were randomized to CBT, progressive muscle relaxation training or a sham behavioral intervention. Each treatment was provided in 6 weekly, 30-60-minute individual therapy sessions. Setting The sleep disorders center of a large university medical center. Participants Seventy-five individuals (ages 40 to 80 years of age) who met strict criteria for persistent primary sleep-maintenance insomnia were enrolled in this trial. Interventions N/A. Measurements and results Participants completed the Dysfunctional Beliefs and Attitudes About Sleep (DBAS) Scale, as well as other assessment procedures before treatment, shortly after treatment, and at a six-month follow-up. Items composing a factor-analytically derived DBAS short form (DBAS-SF) were then used to compare treatment groups across time points. Results showed CBT produced larger changes on the DBAS-SF than did the other treatments, and these changes endured through the follow-up period. Moreover, these cognitive changes were correlated with improvements noted on both objective and subjective measures of insomnia symptoms, particularly within the CBT group. Conclusions CBT is effective for reducing dysfunctional beliefs about sleep and such changes are associated with other positive outcomes in insomnia treatment.
TL;DR: The indirect estimate of sleep influenced accidents approaches data reported by other European countries and highlights the importance of sleepiness as a direct and/or contributing factor in vehicle accident rates.
Abstract: STUDY OBJECTIVE: To evaluate the contributing role of sleepiness in Italian highway vehicle accidents during the time span 1993-1997. DESIGN: We analyzed separately the hourly distribution of accidents ascribed by police officers univocally to sleepiness and the rest. PATIENTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS: Using a polynomial regression, we evaluated the relation between accidents (whether sleep-ascribed or not) and sleepiness as derived from a 24-hour sleep propensity curve. The relation between sleep-influenced and non-sleep influenced accidents was analysed using a linear regression. RESULTS: The rate of non-sleep ascribed accidents is closely related with sleep propensity and bears a strong similarity with the pattern of sleep-ascribed accidents. A close relationship between the curves of non-sleep ascribed accidents and sleep-ascribed accidents is confirmed. The regression coefficient, which can be seen as the ratio between the quota of accidents that can be considered as sleep affected and those actually ascribed to sleepiness, results in a value of 5.83. Considering that the rate of sleep ascribed accidents is 3.2%, we can calculate the quota of sleep influenced accidents out of those not officially ascribed to sleepiness as 18.7% reaching an estimate of accidents related in some way to sleepiness equal to 21.9%. CONCLUSIONS: Our indirect estimate of sleep influenced accidents approaches data reported by other European countries and highlights the importance of sleepiness as a direct and/or contributing factor in vehicle accident rates. Language: en
TL;DR: It is demonstrated that hypertensive patients with sleep apnea whose blood pressure responds beneficially to treatment have less severeSleep apnea than those patients whoseBlood pressure remains elevated despite anti-hypertensive therapy, and resistant hypertension may be caused by frequent intermittent sympathetic stimulation.
Abstract: STUDY OBJECTIVES There is evidence supporting an association between sleep apnea and hypertension. However, it is not clear if sleep apnea interteres with the pharmacotherapy of hypertension. To investigate this question, we studied the relationship between the effectiveness of anti-hypertensive treatment in reducing blood pressure, and severity of sleep apnea in a large group of apneic patients referred to a sleep disorders centre at St. Michael's Hospital at the University of Toronto. DESIGN N/A. SETTING N/A. PARTICIPANTS 1,485 adult patients with sleep apnea, as defined by the apnea/hypopnea index (AHI) >10 events/hr, were analyzed. There were 393 who reported using anti-hypertensive medications on a regular basis for more than 6 months. One hundred and eighty-three patients were treated "effectively" (i.e. blood pressure lower than 140/90 mm Hg in the morning and in the evening). Seventy-four patients were treated "ineffectively," defined as blood pressure >140/90 mm Hg in the morning or in the evening. Both groups were compared with respect to clinical and demographic data using analysis of covariance with gender, age, body mass index (BMI), and neck circumference (NC) as covariates. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Ineffectively and effectively treated patients were similar in age (57 +/- 9) vs. 57 +/- 10 years, respectively), and had similar body mass index (33.8 +/- 7.4 vs. 33.4 +/- 7.3 kg/m2, respectively). However, ineffectively treated patients had significantly higher apnea/hypopnea index (44 +/- 29 vs. 33 +/- 25 events/hr, p<.0005), despite having similar nocturnal oxygenation (percent of total sleep time spent with oxygen desaturation lower than 90% was 36 +/- 34 vs. 29 +/- 30% in the ineffective and effective groups, respectively). The difference in AHI persisted even after adjusting for age, gender, and body mass index. CONCLUSIONS Our results demonstrate that hypertensive patients with sleep apnea whose blood pressure responds beneficially to treatment have less severe sleep apnea than those patients whose blood pressure remains elevated despite anti-hypertensive therapy. Since neither obesity nor nocturnal hypoxemia appear to be important determinants of ineffective treatment, we suggest that resistant hypertension may be caused by frequent intermittent sympathetic stimulation.
TL;DR: Implications of these findings are that patient preference is important to assess prior to treating insomnia and that more work may be needed to increase patients' awareness of the benefits of sleep restriction.
Abstract: Study Objectives: The purposes of this study were to examine treatment preference and satisfaction with group treatment in individual with chronic insomnia. Design: Correlational. Setting: The study was conducted in an outpatient hospital setting. Patients or Participants: Participants were 43 adult volunteers from the community. Interventions: N/A Measurements and Results: Prior to treatment, participants were presented with descriptions of behavioral and pharmacological treatment for the problem of insomnia and asked to rate the acceptability, presumed effectiveness, and presumed side-effects of treatment. A sub-sample of these individuals (n = 37) participated in a 6-week cognitive behavioral treatment group for insomnia. Sleep diary and questionnaire data were collected prior to and following treatment. Results showed that cognitive-behavioral therapy was significantly preferred over pharmacological therapy at pre-treatment and that more favorable assessments of cognitive-behavioral therapy at pre-treatment were associated with better adherence but not improved outcome. Of treatment techniques, participants least liked sleep restriction and most liked sleep hygiene. Results indicated that more favorable ratings of the usefulness of sleep restriction were associated with improvements in sleep efficiency, sleep-related impairment, and quality of life. Conclusions: Implications of these findings are that patient preference is important to assess prior to treating insomnia and that more work may be needed to increase patients' awareness of the benefits of sleep restriction.
TL;DR: Insomnia was highly prevalent among the non-institutionalized Canadian population age 15 and older and a very stressful life, severe pain and dissatisfaction with one's health demonstrated the highest odds ratios associated with insomnia.
Abstract: Study Objectives: The objective of this study was to determine the prevalence of, and to identify the relative contribution of selected factors associated with insomnia in the Canadian population age 15 and older. Design: Weighted analysis of cross-sectional data from the Canadian General Social Survey, Cycle 6, 1991. Prevalence estimates were calculated for the total and age-specific Canadian population age 15 and older. Multiple logistic regression techniques were employed to study the contribution of an array of sociodemographic, lifestyle, stress, and physical health factors to the experience of insomnia. Setting: N/A Participants: A representative sample of the Canadian household population age 15+ (n=11,924). Interventions: N/A A Measurements and Results: Twenty-four percent of the Canadian population age 15+ report insomnia. The following factors were associated with insomnia in multivariate logistic regression: female gender, being widowed or single, low education, low income, not being in the labor force, ever having smoked, life stress, specific chronic physical health problems (circulatory, digestive and respiratory disease, migraine, allergy and rheumatic disorders), pain, activity limitation and health dissatisfaction. Age was not significantly associated with insomnia. Conclusions: Insomnia was highly prevalent among the non-institutionalized Canadian population age 15 and older. A very stressful life, severe pain and dissatisfaction with one's health demonstrated the highest odds ratios associated with insomnia. Increasing age per se and lifestyle factors were not significantly associated with insomnia.
TL;DR: This study confirms that GSD is a better indicator of an underlying pathology than the classical insomnia symptoms alone: compared to insomniac subjects without GSD, subjects with GSD were two times more likely to report excessive daytime sleepiness, and eight timesMore likely to have a diagnosis of sleep or mental disorder.
Abstract: Study objectives Global sleep dissatisfaction (GSD) is not part of the habitual insomnia symptoms in epidemiological studies Furthermore, none of these studies has examined the relative importance of the various factors correlated to sleep dissatisfaction This study aims to examine the links between GSD and insomnia and to find the factors contributing to GSD Design A cross-sectional telephone survey was conducted in Germany (66 million inhabitants 15 years of age or older) with a representative sample of 4,115 subjects aged 15 years or older Interviewers used the Sleep-EVAL system The questionnaire covered several topics that were grouped into six classes of variables identified as potential factors associated with sleep dissatisfaction: sociodemographic descriptors, environmental factors, life habits, health status, psychological factors, sleep/wake factors Setting N/A Participants A representative sample of 4,115 subjects aged 15 years or older Interventions N/A Measurements and results Overall, 7% of the subjects reported being GSD; 955% of them had at least one insomnia symptom The duration of insomnia symptom(s) was 20 months longer in GSD subjects compared to insomnia subjects without GSD The prevalence of GSD was higher in women than in men and increased with age The most significant predictive factors for GSD were: 1) for sleep/wake schedule variables: night sleep duration less than 6 hours (OR: 40 and over) and sleep latency greater than 30 minutes 2) for sociodemographic variables: age between 65 and 74 (OR: 67) 3) for health variables: Upper airway disease (OR: 71); 4) for mental health variables: anxiety symptoms (OR: 30); 5) for environmental factors: too hot bedroom (OR=25) 6) for life habit factors: the need of a particular object in order to fall asleep (OR: 24) Conclusions This study confirms that GSD is a better indicator of an underlying pathology than the classical insomnia symptoms alone: compared to insomniac subjects without GSD, subjects with GSD were two times more likely to report excessive daytime sleepiness, and eight times more likely to have a diagnosis of sleep or mental disorder Furthermore, in car drivers, road accidents in the previous year were two times more frequent with GSD drivers as compared to insomnia drivers without GSD Subjects with GSD were more than 10 times more likely to seek help for their sleep problems and five times more likely to use a sleep medication than insomnia subjects without GSD
TL;DR: At all circadian phases, the age-related reduction of sleep consolidation is primarily related to a reduction in the consolidation of nonREM sleep.
Abstract: Study objectives (1) To assess the circadian and sleep-dependent regulation of the frequency and duration of awakenings in young and older people; (2) to determine whether age-related deterioration of sleep consolidation is related to an increase in the frequency or duration of awakenings; (3) to determine whether pre-awakening sleep structure is preferentially enriched by REM sleep or nonREM sleep and (4) to determine whether sleep structure prior to awakenings is affected by age. Design Between age-group comparison of sleep consolidation and sleep structure preceding awakenings. Setting Environmental Scheduling Facility, General Clinical Research Center. Participants Eleven healthy young men (21-30 years) and 13 older healthy men (n=9) and women (n=4) (64-74 years). Interventions Forced desynchrony between the sleep-wake cycle and circadian rhythms by scheduling of the rest-activity cycle to 28-h for 21-25 cycles. Measurements and results Circadian and sleep-dependent regulation of the frequency and duration of awakenings and of sleep structure preceding awakenings were assessed in 482 sleep episodes (9h 20 min each). The circadian modulation of wakefulness within sleep episodes was primarily related to a variation in the duration of awakenings. In contrast, the age-related reduction of sleep consolidation was primarily related to an increase in the frequency of awakenings. Whereas in both young and older subjects pre-awakening sleep contained more REM sleep than overall sleep, this enrichment of REM sleep (i.e., the gating of wakefulness by REM sleep) was diminished in older people. In older people, preawakening sleep contained more nonREM sleep and stage two sleep in particular, than in young people. Conclusions At all circadian phases, the age-related reduction of sleep consolidation is primarily related to a reduction in the consolidation of nonREM sleep.
TL;DR: The Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature, and developed these practice parameters as a guide to the appropriate use of laser-assisted uvulopalatoplasty for treatment of snoring.
Abstract: Laser-assisted uvulopalatoplasty (LAUP) is an outpatient surgical procedure which is in use as a treatment for snoring. LAUP also has been used as a treatment for sleep-related breathing disorders, including obstructive sleep apnea. The Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature, and developed these practice parameters as a guide to the appropriate use of this surgery. Adequate controlled studies on the LAUP procedure for sleep-related breathing disorders were not found in peer-reviewed journals. This is consistent with findings in the original practice parameters on LAUP published in 1994. The following recommendations are based on the review of the literature: LAUP is not recommended for treatment of sleep-related breathing disorders. However, it does appear to be comparable to uvulopalatopharyngoplasty (UPPP) for treatment of snoring. Individuals who are candidates for LAUP as a treatment for snoring should undergo a polysomnographic or cardiorespiratory evaluation for sleep-related breathing disorders prior to LAUP and periodic postoperative evaluations for the development of same. Patients should be informed of the best available information of the risks, benefits, and complications of the procedure.
TL;DR: In this paper, the effects of brief and long daytime naps following nocturnal sleep restriction were compared with subjective alertness and cognitive performance measures and subjective performance measures were taken before, then 5, 35, and 60 minutes after the termination of the nap, and concluded that the detrimental effects of sleep restriction are more rapidly and significantly ameliorated by a 10-minute afternoon nap.
Abstract: STUDY OBJECTIVES: The purpose was to remedy the lack of experimental studies directly comparing the effects of brief and long daytime naps following nocturnal sleep restriction DESIGN: Twelve young adult healthy sleepers participated in a repeated measures design comparing the effects of no nap, a 10-minute nap, and a 30-minute afternoon nap in each case following a night of 47 hours of total sleep time Objective and subjective alertness measures and cognitive performance measures were taken before, then 5, 35, and 60 minutes after the termination of the nap SETTING: N/A PARTICIPANTS: N/A INTERVENTIONS: N/A MEASUREMENTS and RESULTS: In the no nap condition measures showed either no change or a decreases of alertness and performance across the testing period Following the 10-minute nap there was an immediate improvement in subjective alertness and cognitive performance which was sustained for the hour of post nap testing Immediately following the 30 minute nap most measures of alertness and performance declined but showed some recovery by the end of testing CONCLUSIONS: Because the delayed benefits following the 30-minute nap may be due to sleep inertia, longer post-nap testing periods should be investigated However, we conclude that the detrimental effects of sleep restriction were more rapidly and significantly ameliorated, at least within the hour following the nap, by a 10-minute afternoon nap Language: en
TL;DR: The high quality of data collected in TuCASA demonstrates that multi-channel polysomnography data can be successfully obtained in children aged 5-12 years in an unattended setting under a research protocol.
Abstract: Design: A prospective cohort study projected to enroll 500 children between 5 and 12 years of age who will undergo unattended polysomnography, neurocognitive evaluation, and physiological and anatomical measurements thought to be associated with sleep-disordered breathing. Setting: Children are recruited through the Tucson Unified School District. Polysomnograms and anthropometric measurements are completed in the child’s home. Participants: Of the 157 children enrolled in TuCASA, there were 100 children (64%) between 5—8 years old and 57 children (36%) between the ages of 9 to 12. There were 74 (47%) Hispanic children, and 68 (43%) female participants. Interventions: N/A Measurements & Results: Technically acceptable studies were obtained in 157 children (97%). The initial pass rate was 91%, which improved to 97% when 9 children who failed on the first night of recording completed a second study which was acceptable. In 152 studies (97%), greater than 5 hours of interpretable respiratory, electroencephalographic, and oximetry signals were obtained. The poorest signal quality was obtained from the chin electromyogram and from the combination thermister/nasal cannula. Parents reported that 54% of children slept as well as, or better than usual, while 40% reported that their child slept somewhat worse than usual. Only 6% were observed to sleep much worse than usual. Nightto-night variability in key polysomnographic parameters (n=10) showed a high degree of reproducibility on 2 different nights of study using identical protocols in the same child. In 5 children, polysomnograms done in the home were comparable to those recorded in a sleep laboratory. Conclusions: The high quality of data collected in TuCASA demonstrates that multi-channel polysomnography data can be successfully obtained in children aged 5—12 years in an unattended setting under a research protocol.
TL;DR: Sleep loss was found to be associated with having an unhealthy lifestyle and being in poor general health, and the findings suggest that health education and promotion of a healthy lifestyle should be advocated.
Abstract: Study objective To examine the relationship between lifestyle, health status factors and sleep loss. Design A cross-sectional questionnaire survey conducted by the Ministry of Health and Welfare, Japan. Setting N/A. Patients or participants Approximately 30,000 subjects selected from the general population in Japan. Interventions N/A. Measurements and results This study indicated that approximately 28% of the general population sleep less than 6 hours nightly and approximately 65% sleep less than 7 hours. However, approximately 80% of the population reported getting sufficient sleep. Multiple logistic regression analysis showed that being females, being of younger age, living in an urban environment, being unemployed, and having an unhealthy lifestyle (i.e., lack of exercise, poor health status, and irregular eating habits) were associated with sleep loss. Conclusion In this study, sleep loss was found to be associated with having an unhealthy lifestyle and being in poor general health. These findings suggest that health education and promotion of a healthy lifestyle should be advocated.
TL;DR: The results indicate that collapsibility of the upper airways is not mediated by sleep stages but is strongly influenced by body position, and lower nCPAP pressure is needed during lateral positions compared to supine positions.
Abstract: Collapsibility of the upper airways has been identified as an important pathogenic factor in obstructive sleep apnea (OSA) Objective measures of collapsibility are pharyngeal critical pressure (Pcrit) and resistance of the upstream segment (Rus) To systematically determine the effects of sleep stage and body position we investigated 16 male subjects suffering from OSA We compared the measures in light sleep, slow-wave sleep, REM sleep and supine vs lateral positions The pressure-flow relationship of the upper airways has been evaluated by simultaneous readings of maximal inspiratory airflow (Vimax) and nasal pressure (p-nCPAP) With two-factor repeated measures ANOVA on those 7 patients which had all 6 situations we found a significant influence of body position on Pcrit (p<005) whereas there was no significant influence of sleep stage and no significant interaction between body position and sleep stage When comparing the body positions Pcrit was higher in the supine than in the lateral positions During light sleep Pcrit decreased from 06 +/- 08 cm H2O (supine) to -22 +/- 36 cm H2O (lateral) (p<001), during slow-wave sleep Pcrit decreased from 03 +/- 14 cm H2O (supine) to -17 +/- 26 (lateral) (p<005) and during REM sleep it decreased from 12 +/- 15 cm H2O to -20 +/- 22 cm H2O (p<005) Changes in Rus revealed no body position nor sleep-stage dependence Comparing the different body positions Rus was only significantly higher in the lateral position during REM sleep (p<005) The results indicate that collapsibility of the upper airways is not mediated by sleep stages but is strongly influenced by body position As a consequence lower nCPAP pressure is needed during lateral positions compared to supine positions
TL;DR: Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled, and there was no statistically significant association between pain score and any polysomnographically defined stage.
Abstract: Study objectives To test the hypothesis that opioids and pain contribute independently to postoperative sleep disturbance, 10 women undergoing surgery requiring a low abdominal incision for treatment of benign gynecologic conditions were randomized to receive either epidural opioid (fentanyl) (n=6) or epidural local anesthetic (bupivacaine) (n=4) for intraoperative and postoperative analgesia. Design N/A. Setting N/A. Patients or participants N/A. Interventions N/A. Measurements Polysomnography was performed in a standard patient room on the preoperative and first three postoperative nights. Pain at rest and with coughing was evaluated using a visual-analogue pain scale each evening and morning. Results On the first postoperative night, rapid eye movement (REM) sleep was abolished in all patients. On the third postoperative night, the mean +/- SE REM sleep time increased significantly (p=.003) to 9.8% +/- 3.1% in the fentanyl group, and 12.9% +/- 3.8% in the bupivacaine group. Conversely, light non-REM (NREM) sleep (%stage 1 + %stage 2) was higher on the first postoperative night and significantly lower on the third postoperative night (p=0.011). Between group comparison revealed only that the mean % slow-wave sleep (SWS) in the fentanyl group (6.0%, 2.0%, and 14.7%) was different from the bupivacaine group (7.8%, 9.1%, and 10.6%) in the postoperative period after adjusting for the preoperative night % SWS (p=0.021). Pain was well controlled in all patients, but was slightly better controlled in the fentanyl group than in the bupivacaine group on postoperative night 2 (p=0.024). There was no statistically significant association between pain score and any polysomnographically defined stage. Conclusion Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled.
TL;DR: Healthy seniors were able to adopt a napping regimen involving a 90-minute siesta nap each day between 13:30 and 15:00, achieving about one hour of actual sleep per nap, and some negative consequences for nocturnal sleep in terms of reduced sleep efficiency and earlier waketimes, but also some positive consequences for objective evening performance and 24-hour sleep totals.
Abstract: STUDY OBJECTIVES: To determine the effects of a 90-minute afternoon nap regimen on nocturnal sleep, circadian rhythms, and evening alertness and performance levels in the healthy elderly. DESIGN AND SETTING: Nine healthy elderly subjects (4m, 5f, age range 74y-87y) each experienced both nap and no-nap conditions in two studies each lasting 17 days (14 at home, 3 in the laboratory). In the nap condition a 90-minute nap was enforced between 13:30 and 15:00 every day, in the no-nap condition daytime napping was prohibited, and activity encouraged in the 13:30-15:00 interval. The order of the two conditions was counterbalanced. PARTICIPANTS: N/A INTERVENTIONS: N/A MEASUREMENTS: Diary measures, pencil and paper alertness tests, and wrist actigraphy were used at home. In the 72 hour laboratory studies, these measures were augmented by polysomnographic sleep recording, continuous rectal temperature measurement, a daily evening single trial of a Multiple Sleep Latency Test (MSLT), and computerized tests of mood, activation and performance efficiency. RESULTS: By the second week in the "at home" study, an average of 58 minutes of sleep was reported per siesta nap; in the laboratory, polysomnography confirmed an average of 57 minutes of sleep per nap. When nap and no-nap conditions were compared, mixed effects on nocturnal sleep were observed. Diary measures indicated no significant difference in nocturnal sleep duration, but a significant increase (of 38 mins.) in 24-hour Total Sleep Time (TST) when nocturnal sleeps and naps were added together (p<0.025). The laboratory study revealed a decrease of 2.4% in nocturnal sleep efficiency in the nap condition (p<0.025), a reduction of nocturnal Total Sleep Time (TST) by 48 mins. in the nap condition (p<0.001) which resulted primarily from significantly earlier waketimes (p<0.005), but no reliable effects on Wake After Sleep Onset (WASO), delta sleep measures, or percent stages 1 & 2. Unlike the diary study, the laboratory study yielded no overall increase in 24-hour TST consequent upon the siesta nap regimen. The only measure of evening alertness or performance to show an improvement was sleep latency in a single-trial evening MSLT (nap: 15.6 mins., no nap: 11.5 mins., p<0.005). No significant change in circadian rhythm parameters was observed. CONCLUSIONS: Healthy seniors were able to adopt a napping regimen involving a 90-minute siesta nap each day between 13:30 and 15:00, achieving about one hour of actual sleep per nap. There were some negative consequences for nocturnal sleep in terms of reduced sleep efficiency and earlier waketimes, but also some positive consequences for objective evening performance and (in the diary study) 24-hour sleep totals. Subjective alertness measures and performance measures showed no reliable effects and circadian phase parameters appeared unchanged.
TL;DR: While spontaneous REM reports were longer than those from forced awakenings, the difference was explained by the time within the REM period at which the awakenings occurred, and intersubject differences in REM report lengths were correlated with similar differences in waking report lengths.
Abstract: Study objectives To collect and analyze reports of mental activity across sleep/wake states. Design Mentation reports were collected in a longitudinal design by combining our Nightcap sleep monitor with daytime experience sampling techniques. Reports were collected over 14 days and nights from active and quiet wake, after instrumental awakenings at sleep onset, and after both spontaneous and instrumental awakenings from REM and NREM sleep. Setting All reports were collected in the normal home, work and school environments of the subjects. Participants Subjects included 8 male and 8 female undergraduate students (19-26 years of age). Interventions N/A. Measurements and results A total of 1,748 reports, averaging 109 per subject, were collected from active wake across the day (n=894), from quiet wake in the pre-sleep onset period (n=58), from sleep onset (n=280), and from later REM (n=269) and nonREM (n=247) awakenings. Median report lengths varied more than 2-fold, in the order REM > active wake > quiet wake > NREM = sleep onset. The extended protocol allowed many novel comparisons between conditions. In addition, while spontaneous REM reports were longer than those from forced awakenings, the difference was explained by the time within the REM period at which the awakenings occurred. Finally, intersubject differences in REM report lengths were correlated with similar differences in waking report lengths. Conclusions The use of the Nightcap sleep monitoring system along with waking experience sampling permits a more complete sampling and analysis of mental activity across the sleep/wake cycle than has been previously possible.
TL;DR: The present data suggest both between-group and within-group ethnic differences in sleep complaints among urban community-dwelling older adults, but ethnicity was the most significant predictor.
Abstract: Study Objectives: To date, conflicting observations have been made regarding ethnic differences in sleep patterns. Plausibly, differing sampling strategies and disparity in the cohorts investigated might help explain discrepant findings. To our knowledge population-based studies investigating ethnic differences in sleep complaints have not addressed within-group ethnic heterogeneity, although within-group health disparities have been documented. Design: Volunteers (n =1118) in this study were community-residing older European Americans and African Americans residing in Brooklyn, New York, which were recruited by a stratified, cluster sampling technique. Trained interviewers of the same race as the respondents gathered data during face-to-face interviews conducted either in the respondent's home or another location of their choice. Data included demographic and health risk factors, physical health, social support, and emotional experience. Relationships of demographic and health risk factors to sleep disturbances were examined in multiple linear regression analyses. Within-group differences in sleep complaints were also explored. Setting: N/A Participants: N/A Interventions: N/A Measurements and Results: Of the factors showing significant associations with sleep disturbance, European American ethnicity was the most significant predictor (r 2 = 0.20). Worse sleep and greater reliance on sleep medicine were observed among European Americans. Caribbean Americans reported less sleep complaints than did U.S.-born African Americans, and immigrant European Americans reported greater complaints than did US-born European Americans. Conclusions: As expected several health risk factors were predictive of sleep disturbance among urban community-dwelling older adults, but ethnicity was the most significant predictor. The present data suggest both between-group and within-group ethnic differences in sleep complaints. Understanding of demographic and cultural differences between African Americans and European Americans may be critical in interpreting subjective health-related data.
TL;DR: It was concluded that early morning driving is several times more dangerous than driving during the forenoon, and the effect seems related to sleepiness, but not to darkness.
Abstract: Official accident and traffic density statistics on Swedish highways were used to compute the relative risk (Odds Ratio - OR) of being injured or killed in a traffic accident at different times of day. After removing accidents due to alcohol 10344 accidents remained for computations, and the period 10:00h-11:00h was used as the reference point. The highest total risk was seen at 0400h (OR=5.7, Confidence interval = 5.6-5.8), with an OR of 11.4 (Ci=10.3-12.5) for fatal accidents at the same point. The same pattern was exhibited by single vehicle, head-on, and "other" (e.g., turning off the road) accidents, whereas overtaking and rear-end accidents did not show clear 24 hour patterns. Retaining alcohol-related accidents approximately doubled the nighttime peak for total accidents. During the winter, the peak of total accidents occurred at 03:00h (OR=3.8, Ci=3.5-4.0), five hours before sunrise, whereas the summer peak occurred at 04:00h (OR=11.6, Ci=11.3-11.9), shortly after the early summer sunrise and with consistently higher nighttime risk than for winter driving. It was concluded that early morning driving is several times more dangerous than driving during the forenoon. Apart from alcohol the effect seems related to sleepiness, but not to darkness.
TL;DR: In this paper, the authors present a treatment for narcolepsy using Modafinil, amphetamine, methamphetamine, dextroamphetamine, methylphenidate, selegiline, pemoline, tricyclic antidepressants, and fluoxetine.
Abstract: Successful treatment of narcolepsy requires an accurate diagnosis to exclude patients with other sleep disorders, which have different treatments, and to avoid unnecessary complications of drug treatment. Treatment objectives should be tailored to individual circumstances. Modafinil, amphetamine, methamphetamine, dextroamphetamine, methylphenidate, selegiline, pemoline, tricyclic antidepressants, and fluoxetine are effective treatments for narcolepsy, but the quality of published clinical evidence supporting them varies. Scheduled naps can be beneficial to combat sleepiness, but naps seldom suffice as primary therapy. Regular follow up of patients with narcolepsy is necessary to educate patients and their families, monitor for complications of therapy and emergent of other sleep disorders, and help the patient adapt to the disease.