Showing papers on "Sleep disorder published in 2000"

The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children.

Abstract: Study objectives To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group. Design Cross-sectional survey. Setting Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital. Participants Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ. Interventions N/A. Measurements and results The CSHQ showed adequate internal consistency for both the community sample (p=0.68) and the clinical sample (p=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72. Conclusions The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.

Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases.

Abstract: We describe demographic, clinical, laboratory and aetiological findings in 93 consecutive patients with rapid eye movement (REM) sleep behaviour disorder (RBD), which consists of excessive motor activity during dreaming in association with loss of skeletal muscle atonia of REM sleep. The patients were seen at the Mayo Sleep Disorders Center between January 1, 1991 and July 31, 1995. Eighty-one patients (87%) were male. The mean age of RBD onset was 60.9 years (range 36-84 years) and the mean age at presentation was 64.4 years (37-85 years). Thirty-two per cent of patients had injured themselves and 64% had assaulted their spouses. Subdural haematomas occurred in two patients. Dream content was altered and involved defence of the sleeper against attack in 87%. The frequency of nocturnal events decreased with time in seven untreated patients with neurodegenerative disease. MRI or CT head scans were performed in 56% of patients. Although four scans showed brainstem pathology, all of these patients had apparently unrelated neurodegenerative diseases known to be associated with RBD. Neurological disorders were present in 57% of patients; Parkinson's disease, dementia without parkinsonism and multiple system atrophy accounted for all but 14% of these. RBD developed before parkinsonism in 52% of the patients with Parkinson's disease. Five of the 14 patients with multiple system atrophy were female, and thus the strong male predominance in RBD is less evident in this condition. Psychiatric disorders, drug use or drug withdrawal were rarely causally related to RBD. Clonazepam treatment of RBD was completely or partially successful in 87% of the patients who used the drug. We conclude that RBD is a well-defined condition and that descriptions from different centres are fairly consistent. It is commonest in elderly males and may result in serious morbidity to patients and bed partners. There is a strong relationship to neurodegenerative disease, especially Parkinson's disease, multiple system atrophy and dementia, and neurologists should explore the possibility of RBD in patients with these conditions. RBD symptoms may be the first manifestations of these disorders and careful follow-up is needed. Neuroimaging is unlikely to reveal underlying disorders not suspected clinically. We confirm the effectiveness of clonazepam, but note that attention to the safety of the bed environment may be sufficient for patients with contraindications to the drug.

Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men.

Abstract: ContextIn young adults, sleep affects the regulation of growth hormone (GH) and cortisol The relationship between decreased sleep quality in older adults and age-related changes in the regulation of GH and cortisol is unknownObjectiveTo determine the chronology of age-related changes in sleep duration and quality (sleep stages) in healthy men and whether concomitant alterations occur in GH and cortisol levelsDesign and SettingData combined from a series of studies conducted between 1985 and 1999 at 4 laboratoriesSubjectsA total of 149 healthy men, aged 16 to 83 years, with a mean (SD) body mass index of 241 (23) kg/m2, without sleep complaints or histories of endocrine, psychiatric, or sleep disordersMain Outcome MeasuresTwenty-four–hour profiles of plasma GH and cortisol levels and polygraphic sleep recordingsResultsThe mean (SEM) percentage of deep slow wave sleep decreased from 189% (13%) during early adulthood (age 16-25 years) to 34% (10%) during midlife (age 36-50 years) and was replaced by lighter sleep (stages 1 and 2) without significant increases in sleep fragmentation or decreases in rapid eye movement (REM) sleep The transition from midlife to late life (age 71-83 years) involved no further significant decrease in slow wave sleep but an increase in time awake of 28 minutes per decade at the expense of decreases in both light non-REM sleep (−24 minutes per decade; P<001) and REM sleep (−10 minutes per decade; P<001) The decline in slow wave sleep from early adulthood to midlife was paralleled by a major decline in GH secretion (−372 µg per decade; P<001) From midlife to late life, GH secretion further declined at a slower rate (−43 µg per decade; P<02) Independently of age, the amount of GH secretion was significantly associated with slow wave sleep (P<001) Increasing age was associated with an elevation of evening cortisol levels (+193 nmol/L per decade; P<001) that became significant only after age 50 years, when sleep became more fragmented and REM sleep declined A trend for an association between lower amounts of REM sleep and higher evening cortisol concentrations independent of age was detected (P<10)ConclusionsIn men, age-related changes in slow wave sleep and REM sleep occur with markedly different chronologies and are each associated with specific hormonal alterations Future studies should evaluate whether strategies to enhance sleep quality may have beneficial hormonal effects

Sleep habits and sleep disturbance in elementary school-aged children.

Abstract: Relatively little is known about sleep habits, sleep disturbances, and the consequences of disordered sleep in school-aged children. This descriptive study examined a variety of common sleep behaviors in a group of 494 elementary school children, grades kindergarten through fourth, using a battery of sleep questionnaires that included parent, teacher, and self-report surveys. The prevalence of parent-defined sleep problems ranged from 3.7% (Sleep-Disordered Breathing) to 15.1% (Bedtime Resistance), with 37% of the overall sample described as having significant sleep problems in at least one sleep domain. Younger children were more likely than older children to have sleep problems noted by parents (particularly bedtime struggles and night wakings), as well as by teacher and self-report. Children tended to identify more sleep problems by self-report, particularly sleep-onset delay and night wakings, than did their parents. Overall, approximately 10% of the sample was identified by all three measures as having significant problems with daytime sleepiness. The results of this study emphasize the importance of screening for sleep disorders in this age group in the clinical setting. The need for consensus regarding the use of sleep screening instruments and the definition of "problem" sleep in school-aged children is also discussed.

Sleep patterns and sleep disruptions in school-age children

Abstract: This study assessed the sleep patterns, sleep disruptions, and sleepiness of school-age children. Sleep patterns of 140 children (72 boys and 68 girls; 2nd-, 4th-, and 6th-grade students) were evaluated with activity monitors (actigraphs). In addition, the children and their parents completed complementary sleep questionnaires and daily reports. The findings reflected significant age differences, indicating that older children have more delayed sleep onset times and increased reported daytime sleepiness. Girls were found to spend more time in sleep and to have an increased percentage of motionless sleep. Fragmented sleep was found in 18% of the children. No age differences were found in any of the sleep quality measures. Scores on objective sleep measures were associated with subjective reports of sleepiness. Family stress, parental age, and parental education were related to the child's sleep-wake measures.

An epidemiological study of insomnia among the Japanese general population

Abstract: The study examined the prevalence and correlates of insomnia in a representative sample (n=3030) from the general population of Japan Using a structured questionnaire, we found that the overall prevalence of insomnia during the preceding month was 214%, including difficulty initiating sleep (DIS: 83%), difficulty maintaining sleep (DMS: 150%), and early morning awakening (EMA: 80%) Multiple logistic regression analysis showed that older age, being unemployed, lack of habitual exercise, poor perceived health, psychological stress, and being unable to cope with stress were associated with an increased prevalence of insomnia These findings indicate that the prevalence of insomnia in the general population of Japan is comparable to that reported in Western countries, and that insomnia is associated with multiple psychosocial factors

Daytime Sleepiness Predicts Mortality and Cardiovascular Disease in Older Adults

Abstract: INTRODUCTION: As part of the baseline examination in the Cardiovascular Health Study, sleep disturbance symptoms including snoring and daytime sleepiness, were assessed as potential risk factors or precipitants of cardiovascular disease (CVD). Because of the association of sleep disturbance with poorer health and the possible associations of sleep apnea with CVD, we hypothesized that those with poorer sleep or daytime sleepiness may be at increased risk of mortality or incident CVD. SETTING: Participants (n = 5888) were recruited in 1989, with an additional minority cohort recruited in 1993, in four US communities for a cohort study designed to evaluate risk factors for cardiovascular disease. METHODS: An interview-administered questionnaire regarding health and sleep habits with ongoing ascertainment of total mortality and cardiovascular disease morbidity and mortality, including total CVD morbidity and mortality, incident myocardial infarction, and congestive heart failure. RESULTS: Daytime sleepiness was the only sleep symptom that was significantly associated with mortality in both men and women. The unadjusted hazard ratio was 2.12 (1.66, 2.72) in women and 1.40 (1.12, 1.73) in men. Men who reported difficulty falling asleep also had an increased mortality rate (HR = 1.43 (1.14, 1.80)) which was not seen in women. The risks were attenuated with adjustment for age but remained significant for daytime sleepiness in women (HR = 1.82 (1.42, 2.34)) and for difficulty falling asleep in men. (HR = 1.29 (1.03, 1.63)). Frequent awakenings, early morning awakening, and snoring were not associated with a significantly increased risk of mortality in these older men and women. Crude event rates were evaluated for total incident cardiovascular morbidity and mortality, incident myocardial infarction, and incident congestive heart failure (CHF). Incident CVD rates were higher in both men and women with daytime sleepiness. The aged adjusted HR was 1.35 (95% Cl = 1.03, 1.76) in men and was 1.66 (95% CI = 1.28, 2.16) in women. Incident CVD was not higher in those with any other sleep disturbance including snoring. The risk of CVD events associated with daytime sleepiness was attenuated but remained significant in women after adjustment for age. Incident myocardial infarction (MI) rates were also higher in women with daytime sleepiness but were not significantly higher in men. Incident CHF rates were increased in both men and women with daytime sleepiness. In men, the age adjusted HR was 1.49 (95% CI, 1.12- 1.98) and in women, was 2.21 (95% CI, 1.64-2.98). Women reporting both daytime sleepiness and frequent awakening had a hazard ratio of 2.34 (95% CI, 1.66-3.29) for incident CHF compared with those with daytime sleepiness but without frequent awakening. This interaction was not found in men. CONCLUSIONS: In this study, daytime sleepiness was the only sleep disturbance symptom that was associated with mortality, incident CVD morbidity and mortality, MI, and CHF. These findings were stronger in women than men, i.e., the associations persisted for mortality, CVD, and CHF in women after adjustment for age and other factors. Thus, a report of daytime sleepiness identifies older adults at increased risk for total and cardiovascular mortality, and is an independent risk factor in women.

Evaluation of chronic insomnia

Abstract: Insomnia is a condition which affects millions of individuals, giving rise to emotional distress, daytime fatigue, and loss of productivity. Despite its prevalence, it has received scant clinical attention. An adequate evaluation of persistent insomnia requires detailed historical information as well as medical, psychological and psychiatric assessment. Use of a classification system for sleep disorders and familiarity with major diagnostic groups will facilitate the clinician's evaluation and treatment. Thorough assessment also requires attention to the unique aspects of presentation and specific set of etiologies which are associated with particular age groups.

Sleep complaints and depression in an aging cohort: A prospective perspective.

Abstract: OBJECTIVE: Most research on the association between sleep disturbances and depression has looked at cross-sectional data. The authors used two waves of data from a panel study of community residents aged 50 years or more to investigate this issue prospectively. METHOD: Data on symptoms of major depressive episodes and sleep problems were examined for a subgroup of the 1994 and 1995 surveys of the Alameda County (California) Study (N=2,370). The authors examined the effects of age, gender, education, marital status, social isolation, functional impairment, financial strain, and alcohol use. Depression was measured with 12 items that covered the DSM-IV diagnostic criteria for major depressive episodes, including insomnia and hypersomnia. RESULTS: The prevalences were 23.1% for insomnia and 6.7% for hypersomnia in 1994. Sleep was a significant correlate of depression, as were being female, older age, social isolation, low education, financial strain, and functional impairment. When sleep problems and depress...

Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea

Abstract: Patients with obstructive sleep apnea (OSA) are frequently obese and are predisposed to weight gain. They also have heightened sympathetic drive. We reasoned that noradrenergic activation of β3-receptors on adipocytes would inhibit leptin production, predisposing to obesity in sleep apnea. We therefore tested the hypothesis that obesity and predisposition to weight gain in OSA are associated with low levels of plasma leptin. We prospectively studied 32 male patients (43 ± 2 yr) with OSA who were newly diagnosed and never treated and who were free of any other diseases. Control measurements were obtained from 32 similarly obese closely matched male subjects (38 ± 2 yr). Leptin levels were 13.7 ± 1.3 and 9.2 ± 1.2 ng/ml in patients with OSA and controls, respectively (P = 0.02). Weight gain over the year before diagnosis was 5.2 ± 1.7 and 0.5 ± 0.9 kg in sleep apnea patients and similarly obese control subjects, respectively (P = 0.04). Muscle sympathetic activity was 46 ± 4 and 30 ± 4 bursts/min in patient...

Instability of sleep patterns in children with attention-deficit/hyperactivity disorder.

Abstract: Objective: To compare the stability of the sleep-wake system of children with attention-deficithyperactity disorder (ADHD) and contrds by objective and subjective measures. Method: Thirty-eight school-age boys with diagnosed ADHD and 64 contrd school-age boys were examined using actigraphic monitoring and sleep diaries, over 5 consecutive nights. Results: Increased instability in sleep onset, sleep duration, and true sleep were found in the ADHD group compared with the control group. Discriminant analysis revealed that children’s dassificabon (ADHD versus control) could be significantly predicted on the basis of their sleep measures. Conclusions: The findings support the hypothesis that instability of the sleepwake system is a characteristic of children with ADHD. Given the potential negative effects of disturbed or unstable sleep on daytime functioning, it is recommended that a thorough sleep assessment be conducted when a sleep disturbance is suspected or when symptoms associated with daytime sleepiness or decreased arousal level are present. J. Am. Acad. Child Adolesc. fsychiate 2000,39(4):495501. Keywwds: attention-deficivhyperactMty disorder, sleep, actigraph, instability.

Hallucinations, REM sleep, and Parkinson's disease: a medical hypothesis.

Abstract: Background: Patients with PD can have disabling visual hallucinations associated with dopaminergic therapy. Sleep disorders, including vivid dreams and REM sleep with motor behaviors (RBD), are frequent in these patients. Methods: The association of hallucinations and REM sleep both at night and during the day was examined in 10 consecutive nondemented patients with long-standing levodopa-responsive PD and hallucinations. Seven patients presented with paranoia and paranoid delusions. Overnight sleep recordings and standard multiple daytime sleep latency test were performed. The results were compared to those of 10 similar patients with PD not experiencing hallucinations. Results: RBD was detected in all 10 patients with hallucinations and in six without. Although nighttime sleep conditions were similar in both groups, hallucinators tended to be sleepier during the day. Delusions following nighttime REM period and daytime REM onsets were observed in three and eight of the hallucinators, and zero and two of the others. Daytime hallucinations, coincident with REM sleep intrusions during periods of wakefulness, were reported only by hallucinators. Postmortem examination of the brain of one patient showed numerous Lewy bodies in neurons of the subcoeruleus nucleus, a region that is involved in REM sleep control. Conclusion: The visual hallucinations that coincide with daytime episodes of REM sleep in patients who also experience post-REM delusions at night may be dream imagery. Psychosis in patients with PD may therefore reflect a narcolepsy-like REM sleep disorder.

Practice parameters for the evaluation of chronic insomnia

Abstract: Chronic insomnia is the most common sleep complaint which health care practitioners must confront. Most insomnia patients are not, however, seen by sleep physicians but rather by a variety of primary care physicians. There is little agreement concerning methods for effective assessment and subsequent differential diagnosis of this pervasive problem. The most common basis for diagnosis and subsequent treatment has been the practitioner's clinical impression from an unstructured interview. No systematic, evidence-based guidelines for diagnosis exist for chronic insomnia. This practice parameter paper presents recommendations for the evaluation of chronic insomnia based on the evidence in the accompanying review paper. We recommend use of these parameters by the sleep community, but even more importantly, hope the large number of primary care physicians providing this care can benefit from their use. Conclusions reached in these practice parameters include the following recommendations for the evaluation of chronic insomnia. Since the complaint of insomnia is so widespread and since patients may overlook the impact of poor sleep quality on daily functioning, the health care practitioner should screen for a history of sleep difficulty. This evaluation should include a sleep history focused on common sleep disorders to identify primary and secondary insomnias. Polysomnography, and the Multiple Sleep Latency Test (MSLT) should not be routinely used to screen or diagnose patients with insomnia complaints. However, the complaint of insomnia does not preclude the appropriate use of these tests for diagnosis of specific sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, and narcolepsy that may be present in patients with insomnia. There is insufficient evidence to suggest whether portable sleep studies, actigraphy, or other alternative assessment measures including static charge beds are effective in the evaluation of insomnia complaints. Instruments such as sleep logs, self-administered questionnaires, symptom checklist, or psychological screening tests may be of benefit to discriminate insomnia patients from normals, but these instruments have not been shown to differentiate subtypes of insomnia complaints.

Development of parasomnias from childhood to early adolescence.

Abstract: Objectives. This study examines the prevalence and developmental changes of parasomnias and assesses gender differences, relationships between parasomnias, and associations with anxiety and family adversity using data collected during the course of a longitudinal study of a representative sample of children from Quebec. Method. The present analyses are based on results available for 664 boys and 689 girls for whom mothers have completed questions concerning demographics, parasomnias, and anxiety level. For the prevalence and developmental aspects of parasomnias, prospective data were collected at annual intervals from 11 to 13 years old and retrospective data for the period between ages 3 and 10 years were collected when the children were 10 years old. Results. Somniloquy, leg restlessness, and sleep bruxism are the most frequent parasomnias. More girls were afflicted with leg restlessness, while enuresis and somniloquy were more common in boys. High anxiety scores were found in children suffering from night terrors, somniloquy, leg restlessness, sleep bruxism, and body rocking. Parasomnias were unrelated to the index of family adversity. Conclusions. Although sleepwalking, night terrors, enuresis, and body rocking dramatically decreased during childhood, somniloquy, leg restlessness, and sleep bruxism were still highly prevalent at age 13 years, paralleling results found in adults. Sleepwalking, night terrors, and somniloquy are conditions often found together. The only robust gender difference was for enuresis. High anxiety scores in parasomnias are reported for the first time in a large, controlled study. Sociodemographic variables do not seem to play a major role in the occurrence of parasomnias.

The apnea-ECG database

Abstract: Sleep apnea is a sleep disorder with a high prevalence in the adult male population. Sleep apnea is regarded as an independent risk factor for cardiovascular sequelae such as ischemic heart attacks and stroke. The diagnosis of sleep apnea requires polysomnographic studies in sleep laboratories with expensive equipment and attending personnel. Sleep apnea can be treated effectively using nasal ventilation therapy (nCPAP). Early recognition and selection of patients with sleep related breathing disorders is an important task. Although it has been suggested that this can be done on the basis of the ECG, careful quantitative studies of the accuracy of such techniques are needed. An annotated database with 70 nighttime ECG recordings has been created to support such studies. The annotations were based on visual scoring of disordered breathing during sleep.

Parental and self-report of sleep in children with attention-deficit/hyperactivity disorder.

Abstract: Results: Children with ADHD had significantly higher (more sleep-disturbed) scores on all sleep subscales of the Children’s Sleep Habits Questionnaire (parent measure) than did controls; average sleep duration as reported by parents was also significantly shorter in the ADHD group. Children with ADHD also reported their own sleep to be more disturbed than controls did on the Sleep Self-report, particularly on items relating to bedtime struggles (P range, .05-.001). There was a much higher correlation between parent and child sleep report items for the children with ADHD (mean correlation, 0.55) than for the control children. Conclusions: Sleep disturbances, particularly at bedtime, are frequently reported by both parents and children with ADHD. Children undergoing evaluation for ADHD should be routinely screened for sleep disturbances, especially symptoms of sleep-disordered breathing. The causes of sleep-onset delay in children with ADHD should be considered in designing intervention strategies for children with difficulty falling and staying asleep.

An American Academy of Sleep Medicine Review

Abstract: Summary: Insomnia is a condition which affects millions of individuals, giving rise to emotional distress, daytime fatigue, and loss of productivity. Despite its prevalence, it has received scant clinical attention. An adequate evaluation of persistent insomnia requires detailed historical information as well as medical, psychological and psychiatric assessment. Use of a classification system for sleep disorders and familiarity with major diagnostic groups will facilitate the clinician's evaluation and treatment. Thorough assessment also requires attention to the unique aspects of presentation and specific set of etiologies which are associated with particular age groups.

Sleep architecture and respiratory disturbances in children with obstructive sleep apnea.

Abstract: Little is known regarding sleep architecture in children with the obstructive sleep apnea syndrome (OSAS). We hypothesized that sleep architecture was normal, and that apnea increased over the course of the night, in children with OSAS. We analyzed polysomnographic studies from 20 children with OSAS and 10 control subjects. Sleep architecture was similar between the groups. Of obstructive apneas 55% occurred during rapid eye movement (REM) sleep. The apnea index, apnea duration, and degree of desaturation were greater during REM than non-REM sleep. OSAS data from the first and third periods of the night (periods A and C) were compared. Both the overall and the REM apnea index increased between periods A and C (11 to 25/h, p < 0.02; and 24 to 51/h, p < 0.01, respectively). There was no difference in SaO2 over time. Spontaneous arousals, but not respiratory-related arousals, were more frequent during non-REM than REM sleep; these did not change from periods A to C. We conclude that children with OSAS have n...

Physical findings and the risk for obstructive Sleep apnea : The importance of oropharyngeal structures

Abstract: In this study, we hypothesized that anatomic abnormalities of the oropharynx, particularly narrowing of the airway by the lateral pharyngeal walls, tonsils, and tongue, would be associated with an increased likelihood for obstructive apnea among patients presenting to a sleep disorders center. To test this hypothesis, we used data from a cohort of 420 patients presenting to the Penn Center for Sleep Disorders. Associations between individual variables in the clinical evaluation model and sleep apnea as defined by a re-spiratory disturbance index greater than or equal to 15 events per hour were characterized by odds ratios (ORs) with 95% confidence intervals (CIs). Multivariable logistic regression was used to simultaneously estimate ORs for multiple variables and to control for other relevant patient characteristics. Results showed that narrowing of the airway by the lateral pharyngeal walls (OR 5 2.5; 95% CI, 1.6‐3.9) had the highest association with obstructive sleep apnea (OSA) followed by tonsillar enlargement (OR 5 2.0; 95% CI, 1.0‐3.8), enlargement of the uvula (OR 5 1.9; 95% CI, 1.2‐2.9), and tongue enlargement (OR 5 1.8; 95% CI, 1.0‐3.1). Low-lying palate, retrognathia, and overjet were not found to be significantly associated with OSA. Controlling for BMI and neck circumference, only lateral narrowing and enlargement of the tonsils maintained their significant (OR 5 2.0 and 2.6, respectively). A subgroup analysis examining differences between male and female subjects showed that no oropharyngeal risk factor achieved significance in women while lateral narrowing was the sole independent risk factor in men. These findings suggest that enlargement of the oropharyngeal soft tissue structures, particularly the lateral pharyngeal walls, is associated with an increased likelihood of OSA among patients presenting to sleep disorders centers.

Prevalence and patterns of problematic sleep among older adolescents.

Abstract: Objective Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence. Method A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19–24 years of age). Results Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder. Conclusions Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.

Pre-sleep cognitive activity: a comparison of sleep-onset insomniacs and good sleepers.

Abstract: Objective. Pre-sleep cognitive activity has been implicated in the maintenance of sleep-onset insomnia. The present study aimed to investigate the focus of attention, content and characteristics of cognition during the pre-sleep period. Method. A semi-structured clinician-administered interview designed to index the content of pre-sleep cognition was completed by individuals diagnosed with sleeponset insomnia (N = 30) and good sleepers (N = 30). Result. The pre-sleep cognitive activity of insomniacs could be distinguished from that of good sleepers by being more focused on worries, problems and noises in the environment, and less focused on ‘nothing in particular’. In terms of content, the insomnia group were more likely to think about not sleeping or about something that had happened during the day. Insomniacs experienced their presleep cognitive activity as more occupying, less intentional, for a longer duration, and as causing more difficulty with sleep onset compared to good sleepers. Pre-sleep imagery was reported at similar rates across diagnosis, but was more distressing and more likely to be associated with strong physical sensations for the insomniac group compared with the good sleeper group. Conclusion. The present study provides a comprehensive investigation of presleep cognitive activity and raises a number of areas for future research including monitoring of bodily sensations, imagery, problem-solving and non-active strategies in facilitating sleep onset.

Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years.

Abstract: OBJECTIVES: The purpose of this study was to determine if reported nighttime sleep problems and daytime sleepiness were associated with reported falling during the previous 12 months in a representatively sampled older adult population. DESIGN: Random-digit dial telephone survey. SETTING: Representatively sampled older adult population living in northern California. PARTICIPANTS: Participants were 971 women and 555 men, aged 64 to 99 years. MEASUREMENTS: Twenty-minute telephone interview adapted from the National Health Interview Survey. RESULTS: Two hundred and eighty-four participants reported falling during the previous 12 months (19% of the sample). Significantly more women fell than men (20% and 14%, respectively, P < .001). The following variables were significant risk factors for falling in univariate analyses: female gender, being unmarried, living alone, income less than $15,000 per year, difficulty walking, having more than one chronic medical condition, history of cardiovascular disease, hypertension, arthritis, sensory impairment, psychological difficulties, and nighttime sleep problems. All of the nighttime sleep problem variables remained significant risk factors for falling after controlling for other risk factors for falling. CONCLUSIONS: The results provide support for an independent association between reported sleep problems and falls in an older population. One of the implications of these data is that behavioral research focusing on the effectiveness of insomnia treatment in old age should not only examine typical sleep-related outcomes (e.g., total time asleep, number of awakenings) but also the occurrence of falls as well.

Sleep Quality and Presleep Arousal in Chronic Pain

Abstract: This study was designed (1) to characterize the extent and nature of sleep complaints of chronic pain patients and (2) to examine the factors that predict sleep quality. A heterogeneous sample of 51 outpatients with benign, chronic pain was recruited from newspaper and pain clinic advertisements. Patients completed a variety of self-report instruments including the Multidimensional Pain Inventory, the Pittsburgh Sleep Quality Index, the Pre-Sleep Arousal Scale, and the Beck Depression Inventory. Sleep complaints were reported by 88% of the sample. Presleep cognitive arousal, rather than pain severity, was found to be the primary predictor of sleep quality.

Cognitive-behavioral treatment of insomnia secondary to chronic pain.

Abstract: Sixty participants with insomnia secondary to chronic pain were assigned randomly to either a cognitive-behavioral therapy (CBT) or a self-monitoring/waiting-list control condition. The therapy consisted of a multicomponent 7-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Treated participants were significantly more improved than control participants on self-report measures of sleep onset latency, wake time after sleep onset, sleep efficiency, and sleep quality, and they showed less motor activity in ambulatory recordings of nocturnal movement. At a 3-month follow-up assessment, treated participants showed good maintenance of most therapeutic gains. These results provide the 1st evidence from a randomized controlled trial that CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions.