Showing papers on "Sleep disorder published in 2010"

Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments.

Abstract: Study Objectives: To develop an archive of self-report questions assessing sleep disturbance and sleep-related impairments (SRI), to develop item banks from this archive, and to validate and calibrate the item banks using classic validation techniques and item response theory analyses in a sample of clinical and community participants

A systematic review of screening questionnaires for obstructive sleep apnea.

Abstract: Obstructive sleep apnea (OSA) may lead to life-threatening problems if it is left undiagnosed. Polysomnography is the “gold standard” for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group’s guideline. Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on “sleep-disorder patients”, and six studies were conducted on “patients without history of sleep disorders”. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. The existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easy-to-use features.

The Prevalence of Sleep Disorders in College Students: Impact on Academic Performance.

Abstract: Objective: To examine the prevalence of risk for sleep disorders among college students by gender and age, and their associations with grade point average (GPA). Participants: Participants were 1,845 college students at a large, southeastern public university. Methods: A validated sleep disorder questionnaire surveyed sleep data during the 2007–2008 academic year. Students’ GPAs were obtained from the office of the registrar. Results: Twenty-seven percent of students were at risk for at least one sleep disorder. African American and Asian students reported less risk for insomnia and fewer poor sleep practices relative to white and Latino students. Students reported insufficient sleep and a discrepancy between weekday and weekend amount of sleep. Students at risk for sleep disorders were overrepresented among students in academic jeopardy (GPA < 2.0). Conclusions: Many college students are at risk for sleep disorders, and those at risk may also be at risk for academic failure.

Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Abstract: Rationale: Obstructive sleep apnea (OSA), a treatable sleep disorder that is associated with alterations in glucose metabolism in individuals without diabetes, is a highly prevalent comorbidity of type 2 diabetes. However, it is not known whether the severity of OSA is a predictor of glycemic control in patients with diabetes. Objectives: To determine the impact of OSA on hemoglobin A1c (HbA1c), the major clinical indicator of glycemic control, in patients with type 2 diabetes. Methods: We performed polysomnography studies and measured HbA1c in 60 consecutive patients with diabetes recruited from outpatient clinics between February 2007 and August 2009. Measurements and Main Results: A total of 77% of patients with diabetes had OSA (apnea–hypopnea index [AHI] ≥5). Increasing OSA severity was associated with poorer glucose control, after controlling for age, sex, race, body mass index, number of diabetes medications, level of exercise, years of diabetes and total sleep time. Compared with patients without OSA, the adjusted mean HbA1c was increased by 1.49% (P = 0.0028) in patients with mild OSA, 1.93% (P = 0.0033) in patients with moderate OSA, and 3.69% (P < 0.0001) in patients with severe OSA (P < 0.0001 for linear trend). Measures of OSA severity, including total AHI (P = 0.004), rapid eye movement AHI (P = 0.005), and the oxygen desaturation index during total and rapid eye movement sleep (P = 0.005 and P = 0.008, respectively) were positively correlated with increasing HbA1c levels. Conclusions: In patients with type 2 diabetes, increasing severity of OSA is associated with poorer glucose control, independent of adiposity and other confounders, with effect sizes comparable to those of widely used hypoglycemic drugs.

Prevalence, Demographics, and Psychological Associations of Sleep Disruption in Patients With Cancer: University of Rochester Cancer Center-Community Clinical Oncology Program

Abstract: Purpose Sleep disruption is prevalent in patients with cancer and survivors, but the prevalence of insomnia, a distressing sleep disorder, in these populations has yet to be determined in large-scale studies. Patients and Methods A total of 823 patients with cancer receiving chemotherapy (mean age, 58 years; 597 female patients) reported on sleep difficulties in a prospective study. Results During day 7 of cycle 1 of chemotherapy, 36.6% (n = 301) of the patients with cancer reported insomnia symptoms, and 43% (n = 362) met the diagnostic criteria for insomnia syndrome. Patients with cancer younger than 58 years were significantly more likely to experience either symptoms of insomnia or insomnia syndrome (χ2 = 13.6; P = .0002). Patients with breast cancer had the highest number of overall insomnia complaints. A significant positive association was found between symptoms of insomnia during cycles 1 and 2 of chemotherapy (ϕ = .62, P < .0001), showing persistence of insomnia during the first two cycles of che...

Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report.

Abstract: Background. Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR * D) trial. Method. Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8% of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR 16 ) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively. Results. More than 90% of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3%) and mid-nocturnal insomnia (54.9%). The most common residual symptom domains were sleep disturbance (71.7%) and appetite/weight disturbance (35.9%). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse. Conclusions. Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.

Sleep Disorders in the Older Adult – A Mini-Review

Abstract: Approximately 50% of older adults complain of difficulty sleeping. Poor sleep results in increased risk of significant morbidity and mortality. The decrements seen in the sleep of the older adult are often due to a decrease in the ability to get needed sleep. However, the decreased ability is less a function of age and more a function of other factors that accompany aging, such as medical and psychiatric illness, increased medication use, advances in the endogenous circadian clock and a higher prevalence of specific sleep disorders. Given the large number of older adults with sleep complaints and sleep disorders, there is a need for health care professionals to have an increased awareness of these sleep disturbances to better enable them to assess and treat these patients. A thorough sleep history (preferably in the presence of their bed partner) is required for a proper diagnosis, and when appropriate, an overnight sleep recording should be done. Treatment of primary sleep problems can improve the quality of life and daytime functioning of older adults. This paper reviews the diagnoses and characteristics of sleep disorders generally found in the older adult. While aimed at the practicing geriatrician, this paper is also of importance for any gerontologist interested in sleep.

Insomnia with Short Sleep Duration and Mortality: The Penn State Cohort

Abstract: Study Objectives: Because insomnia with objective short sleep duration is associated with increased morbidity, we examined the effects of this insomnia subtype on all-cause mortality.

REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century.

Abstract: Background: Idiopathic REM sleep behavior disorder (RBD) may be the initial manifestation of synucleinopathies (Parkinson disease [PD], multiple system atrophy [MSA], or dementia with Lewy bodies [DLB]). Methods: We used the Mayo medical records linkage system to identify cases presenting from 2002 to 2006 meeting the criteria of idiopathic RBD at onset, plus at least 15 years between RBD and development of other neurodegenerative symptoms. All patients underwent evaluations by specialists in sleep medicine to confirm RBD, and behavioral neurology or movement disorders to confirm the subsequent neurodegenerative syndrome. Results: Clinical criteria were met by 27 patients who experienced isolated RBD for at least 15 years before evolving into PD, PD dementia (PDD), DLB, or MSA. The interval between RBD and subsequent neurologic syndrome ranged up to 50 years, with the median interval 25 years. At initial presentation, primary motor symptoms occurred in 13 patients: 9 with PD, 3 with PD and mild cognitive impairment (MCI), and 1 with PDD. Primary cognitive symptoms occurred in 13 patients: 10 with probable DLB and 3 with MCI. One patient presented with primary autonomic symptoms, diagnosed as MSA. At most recent follow-up, 63% of patients progressed to develop dementia (PDD or DLB). Concomitant autonomic dysfunction was confirmed in 74% of all patients. Conclusions: These cases illustrate that the α-synuclein pathogenic process may start decades before the first symptoms of PD, DLB, or MSA. A long-duration preclinical phase has important implications for epidemiologic studies and future interventions designed to slow or halt the neurodegenerative process.

The cost of poor sleep: workplace productivity loss and associated costs.

Abstract: Objective:To assess the impact of sleep disturbances on work performance/productivity.Methods:Employees (N = 4188) at four US corporations were surveyed about sleep patterns and completed the Work Limitations Questionnaire. Respondents were classified into four categories: insomnia, insufficient sle

Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort.

Abstract: Study Objectives: To investigate the relationship between sleep duration and insomnia severity and the risk of all-cause death and cardiovascular disease (CVD) events

Developing mindfulness in college students through movement-based courses: Effects on self-regulatory self-efficacy, mood, stress, and sleep quality.

Abstract: Objective: This study examined whether mindfulness increased through participation in movement-based courses and whether changes in self-regulatory self-efficacy, mood, and perceived stress mediated the relationship between increased mindfulness and better sleep. Participants: 166 college students enrolled in the 2007–2008 academic year in 15 week classes in Pilates, Taiji quan, or GYROKINESIS. Methods: At beginning, middle, and end of the semester, participants completed measures of mindfulness, self-regulatory self-efficacy, mood, perceived stress, and sleep quality. Results: Total mindfulness scores and mindfulness subscales increased overall. Greater changes in mindfulness were directly related to better sleep quality at the end of the semester after adjusting for sleep disturbance at the beginning. Tiredness, Negative Arousal, Relaxation, and Perceived Stress mediated the effect of increased mindfulness on improved sleep. Conclusions: Movement-based courses can increase mindfulness. Increase...

Sleep deprivation impairs the accurate recognition of human emotions.

Abstract: Study Objectives: Investigate the impact of sleep deprivation on the ability to recognize the intensity of human facial emotions.

Clinical Uses of Melatonin: Evaluation of Human Trials

Abstract: During the last 20 years, numerous clinical trials have examined the therapeutic usefulness of melatonin in different fields of medicine. The objective of this article is to review, in depth, the science regarding clinical trials performed to date. The efficacy of melatonin has been assessed as a treatment of ocular diseases, blood diseases, gastrointestinal tract diseases, cardiovascular diseases, diabetes, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, infectious diseases, neurological diseases, sleep disturbances, aging and depression. Melatonin has been also used as a complementary treatment in anaesthesia, hemodialysis, in vitro fertilization and neonatal care. The conclusion of the current review is that the use of melatonin as an adjuvant therapy seems to be well funded for macular degeneration, glaucoma, protection of the gastric mucosa, irritable bowel syndrome, arterial hypertension, diabetes, side effects of chemotherapy and radiation in cancer patients or hemodialysis in patients with renal insufficiency and, especially, for sleep disorders of circadian etiology (jet lag, delayed sleep phase syndrome, sleep deterioration associated with aging, etc.) as well as in those related with neurological degenerative diseases (Alzheimer, etc.,) or Smith-Magenis syndrome. The utility of melatonin in anesthetic procedures has been also confirmed. More clinical studies are required to clarify whether, as the preliminary data suggest, melatonin is useful for treatment of fibromyalgia, chronic fatigue syndrome, infectious diseases, neoplasias or neonatal care. Preliminary data regarding the utility of melatonin in the treatment of ulcerative colitis, Crohn's disease, rheumatoid arthritis are either ambiguous or negative. Although in a few cases melatonin seems to aggravate some conditions, the vast majority of studies document the very low toxicity of melatonin over a wide range of doses.

Elevated Tribbles homolog 2–specific antibody levels in narcolepsy patients

Abstract: Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness and attacks of muscle atonia triggered by strong emotions (cataplexy) Narcolepsy is caused by hypocretin (orexin) deficiency, paralleled by a dramatic loss in hypothalamic hypocretin-producing neurons It is believed that narcolepsy is an autoimmune disorder, although definitive proof of this, such as the presence of autoantibodies, is still lacking We engineered a transgenic mouse model to identify peptides enriched within hypocretin-producing neurons that could serve as potential autoimmune targets Initial analysis indicated that the transcript encoding Tribbles homolog 2 (Trib2), previously identified as an autoantigen in autoimmune uveitis, was enriched in hypocretin neurons in these mice ELISA analysis showed that sera from narcolepsy patients with cataplexy had higher Trib2-specific antibody titers compared with either normal controls or patients with idiopathic hypersomnia, multiple sclerosis, or other inflammatory neurological disorders Trib2-specific antibody titers were highest early after narcolepsy onset, sharply decreased within 2-3 years, and then stabilized at levels substantially higher than that of controls for up to 30 years High Trib2-specific antibody titers correlated with the severity of cataplexy Serum of a patient showed specific immunoreactivity with over 86% of hypocretin neurons in the mouse hypothalamus Thus, we have identified reactive autoantibodies in human narcolepsy, providing evidence that narcolepsy is an autoimmune disorder

Prevalence and impact of sleep disorders and sleep habits in the United States

Abstract: Purpose Epidemiologic studies on sleep disorders in the USA have mostly focused on specific disorders in specific groups of individuals. Most studies on sleep habits and sleep-related difficulties have focused on children and adolescents. The authors describe the prevalence of the three common physician-diagnosed sleep disorders (insomnia, sleep apnea, and restless legs syndrome (RLS)) by age, gender, and race in the US population. In addition, the authors describe the sleep habits and sleep-related difficulties in carrying routine daily activities. The authors also investigate the impact of the sleep disorders on performing routine daily activities.

Polysomnographic diagnosis of idiopathic REM sleep behavior disorder.

Abstract: The presence of either excessive tonic chin EMG activity during REM sleep, or excessive phasic submental or limb EMG twitching is required to diagnose REM sleep behavior disorder (RBD). The aim was to identify cut-off values and to assess the sensitivity and specificity of these values taken separately or combined to diagnose idiopathic RBD patients. Eighty patients presenting with a clinical diagnosis of idiopathic RBD and 80 age- and gender-matched normal controls were studied in the sleep laboratory. Receiver operating characteristic curves were drawn to find optimal cut-off values for three REM sleep EMG parameters. Tonic and phasic EMG activity were measured in the chin, but not in the limbs. Videos were examined during the recording but were not systematically reviewed by the authors. Total correct classification of 81.9% was found for tonic chin EMG density ≥30%; 83.8% for phasic chin EMG density ≥15% and 75.6% for ≥24 leg movements per hour of REM sleep. Five patients did not fulfill any of these three polysomnographic (PSG) criteria. Conversely, one subject of the control group met the PSG criteria for RBD. This study estimates the diagnostic value of a visual scoring method for the diagnosis of idiopathic RBD and establishes cut-off values to be used in clinical and research set-ups. For the five RBD patients who did not show chin EMG abnormalities, it cannot be excluded that they had increased phasic EMG activity in the upper limbs and presented visible motor activity.

Effects of sleep deprivation on dissociated components of executive functioning.

Abstract: SLEEP LOSS IS A GROWING THREAT TO SAFETY IN MODERN SOCIETIES, AS BOTH WORK HOURS AND COMMUTE TIMES ARE EXTENDED.1 SLEEP LOSS impairs performance on simple cognitive tasks such as signal detection and reaction time (RT) tests.2 Many occupational settings, however, require executive functioning—the ability to initiate, monitor, and stop actions so as to achieve goals3—in order to execute complex tasks such as interpersonal communication, creative problem solving, and decision making.4 Thus, an important question is to what extent executive functions are impaired by sleep loss.5 The real-world relevance of this question is illustrated by occupational disasters including the nuclear meltdown of Chernobyl, the grounding of the Exxon Valdez, and the disastrous launch decision of the Challenger space shuttle, all of which involved complex decision errors for which sleep loss has been cited to be a contributing factor. Several studies have examined deficits in executive functioning during sleep deprivation.6–20 Between studies there has been considerable inconsistency as to whether and how executive functions were found to be impaired.21 For example, two recent studies found that sleep deprivation impaired performance on a go/no-go task,8,9 which is typically considered to measure the ability to inhibit a prepotent response. Another study, using Stroop task performance as an index of ability to inhibit a prepotent response, reported that this executive function was not impaired during sleep deprivation.19 Similarly, one study reported that sleep deprivation changed behavioral decisions involving risk on a lottery choice task,16 while another study using a different gambling task observed no significant differences in choices made after sleep loss.20 Inconsistencies like these have made it difficult to derive a uniform account of whether and how sleep deprivation affects executive functions. Horne and colleagues12 have posited that sleep deprivation especially impairs performance on tasks tapping executive functions because these tasks selectively rely on the prefrontal cortex. A basis for this theory is provided by EEG-based and neuroimaging evidence that sleep loss affects the frontal lobes more than most other brain areas. For instance, studies have shown that sleep pressure, as operationalized by increased theta power density in the waking EEG, is most evident in frontal areas during total sleep deprivation (TSD).22,23 Using PET neuroimaging, which allows greater anatomical specificity, it has been documented that TSD decreases metabolism specifically in the prefrontal cortex.24 From findings like these it has been inferred that sleep loss would impair executive functioning and performance on tasks that rely on prefrontal cortical function more than non-executive task performance. In this vein, a parallel between the cognitive impairments seen in sleep deprivation and those seen in aging has been hypothesized,12 as both conditions seem to selectively involve reduced activity in the prefrontal cortex. There is ample evidence, however, that sleep deprivation also impairs performance on cognitive tasks requiring relatively little executive control.25 This includes the psychomotor vigilance test (PVT), a simple RT task measuring sustained attention.26 Based in part on detailed analyses of RT data from the PVT, Dinges and colleagues postulated that performance impairment during sleep deprivation is caused by an increase in moment-to-moment variability of attention resulting from the interaction of the homeostatic drive for sleep, the circadian drive for wakefulness, and compensatory effort to perform.27 They hypothesized that the variability in performance due to difficulty sustaining attention would transfer to a wide variety of cognitive tasks since “attention is a requirement of many goal-directed activities.”27 According to this “state instability” theory, sleep deprivation does not necessarily cause impairments in executive functions tasks because of selective deficits in the prefrontal cortex, but at least in part due to deficits in the ability to sustain attention. The theory implies that through impairment of sustained attention, sleep deprivation affects cognitive performance globally, including not only executive functioning and other higher order cognitive processes, but many other aspects of performance as well. One reason that different views exist as to how and why executive functioning may be degraded during sleep deprivation is that the tasks commonly used to measure executive functions do not allow dissociation of the various cognitive processes contributing to performance. By definition, executive functions operate on other cognitive processes, and any task that targets executive functions therefore also implicates non-executive cognitive processes (i.e., the task impurity problem).3 As such, a low score on an executive functions test does not necessarily arise from impairment of the target executive functions; it could also result from impairment of other component cognitive processes involved in the task.28 In the present laboratory study, we investigated sleep-deprived performance on an executive functions battery. The tasks in the battery were selected because they allow for the dissociation of some of the intertwined components of cognitive performance. Our battery made it possible to isolate 2 specific executive function components: working memory scanning efficiency, and suppression of irrelevant information that leads to proactive interference (that is, inhibition of information that is no longer relevant). Both of these executive function components involve the prefrontal cortex.29,30 They are associated with working memory capacity, and are fundamentally important to executive control during complex task performance.28 We investigated the extent to which working memory scanning efficiency, resistance to proactive interference, and other elements of task performance are affected by acute TSD.

Sleep Patterns Before, During, and After Deployment to Iraq and Afghanistan

Abstract: ACCORDING TO A 2008 REPORT FROM THE NATIONAL SLEEP FOUNDATION, AMERICANS ARE WORKING MORE AND SLEEPING LESS, WITH THE AVERAGE work day lasting 9 hours 28 minutes and time in bed only 6 hours 55 minutes.1 The US military is at particularly high risk for sleep disturbances due to hazardous working conditions, inconsistent work hours, harsh environments, routine exposure to loud noises, and crowded sleeping spaces.2,3 Exposures to these adverse working conditions are often intensified during deployments, including the current increased operational tempo, with lengthy and frequent deployments, as well as demanding training exercises. Deployment-related factors may lead to sleep complaints, including circadian desynchronosis, total or partial sleep deprivation, lengthy sleep latency, and wakening after sleep onset that may, in turn, exacerbate mental and physical health symptoms following deployment.2,3 The quantity and quality of sleep affect many aspects of physical and mental health.4–12 Military personnel deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom may be at increased risk for chronic sleep loss, as well as many other adverse physical and mental conditions, compared with nondeployed military personnel.13–15 Sleep deprivation has been studied extensively and is associated with many physical and psychological effects, including increased risk-taking behavior,7,11 decreased threat detection,10 impaired decision making,7,11,12 performance degradation,4,8,9 mood disturbances,8 and tunnel vision.6 Short sleep duration has also been associated with obesity, weight gain, and heart disease.5,16,17 A recent cross-sectional study of 156 deployed US Air Force Airmen found that 40% of respondents suffered from at least 1 sleep disturbance, and 75% of respondents reported diminished sleep quality while deployed when compared to sleep quality at home.3 The purpose of this study was to determine any association between deployment in support of the operations in Iraq and Afghanistan and sleep quantity and quality in a large military population. We hypothesized that military personnel who had deployed would have more trouble sleeping and sleep less than those who have not deployed. The Millennium Cohort Study18 includes all Service branches of the US military, active-duty, Reserve, and National Guard personnel. A substantial proportion (22%) of cohort members were deployed in support of the operations in Iraq and Afghanistan between baseline and follow-up surveys. This population provided valuable information on sleep patterns, as well as behavioral, occupational, and demographic characteristics among participants who completed their survey during and after deployment.

Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death.

Abstract: Purpose This study aims to determine whether obstructive sleep apnea independently increases the risk of coronary events, including death from cardiovascular causes.

The Effect of Short Sleep Duration on Coronary Heart Disease Risk is Greatest Among Those with Sleep Disturbance: A Prospective Study from the Whitehall II Cohort

Abstract: STUDY OBJECTIVES: Short sleep duration is associated with increased CHD (coronary heart disease) mortality and morbidity, although some evidence suggests that sleep disturbance is just as important. We investigated whether a combination of short sleep duration and sleep disturbance is associated with a higher risk of CHD than their additive effects. SETTING: The Whitehall II study. PATIENTS OR PARTICIPANTS: The Whitehall II study recruited 10,308 participants from 20 civil service departments in London, England. Participants were between the ages of 35 and 55 years at baseline (1985-1988) and were followed up for an average of 15 years. INTERVENTIONS: N/A. MEASUREMENTS: Sleep hours and sleep disturbance (from the General Heath Questionnaire-30) were obtained from the baseline survey. CHD events included fatal CHD deaths or incident nonfatal myocardial infarction or angina (ICD-9 codes 410-414 or ICD-10 120-25). RESULTS: Short sleep duration and sleep disturbance were both associated with increased hazards for CHD in women as well as in men, although, after we adjusted for confounders, only those reporting sleep disturbance had a raised risk. There was some evidence for an interaction between sleep duration and sleep disturbance. Participants with short sleep duration and restless disturbed nights had the highest hazard ratios (HR) of CHD (relative risk:1.55, 95% confidence interval:1.33-1.81). Among participants who did not report any sleep disturbance, there was little evidence that short sleep hours increased CHD risk. CONCLUSION: The effect of short sleep (< or = 6 hours) on increasing CHD risk is greatest among those who reported some sleep disturbance. However, among participants who did not report any sleep disturbance, there was little evidence that short sleep hours increased CHD risk.

The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial.

Abstract: BACKGROUND:Sleep disorders affect many patients with chronic pain conditions. Cannabis has been reported by several patient populations to help sleep. We evaluated the safety and efficacy of nabilone, a synthetic cannabinoid, on sleep disturbance in fibromyalgia (FM), a disease characterized by wide