Showing papers on "Sleep disorder published in 2019"
TL;DR: This review highlights the treatment of sleep disturbance before, during and after depression, which probably plays an important role in improving outcomes and preventing the recurrence of depression.
Abstract: Sleep disturbance is the most prominent symptom in depressive patients and was formerly regarded as a main secondary manifestation of depression. However, many longitudinal studies have identified insomnia as an independent risk factor for the development of emerging or recurrent depression among young, middle-aged and older adults. This bidirectional association between sleep disturbance and depression has created a new perspective that sleep problems are no longer an epiphenomenon of depression but a predictive prodromal symptom. In this review, we highlight the treatment of sleep disturbance before, during and after depression, which probably plays an important role in improving outcomes and preventing the recurrence of depression. In clinical practice, pharmacological therapies, including hypnotics and antidepressants, and non-pharmacological therapies are typically applied. A better understanding of the pathophysiological mechanisms between sleep disturbance and depression can help psychiatrists better manage this comorbidity.
406 citations
TL;DR: A bidirectional relationship between sleep and Alzheimer's disease is supported by advances in understanding of sleep disturbance-induced increases in systemic inflammation, which can be viewed as an early event in the course of Alzheimer’s disease.
Abstract: Summary Nearly half of all adults older than 60 years of age report sleep disturbance, as characterised either by reports of insomnia complaints with daytime consequences, dissatisfaction with sleep quality or quantity, or the diagnosis of insomnia disorder. Accumulating evidence shows that sleep disturbance contributes to cognitive decline and might also increase the risk of Alzheimer's disease dementia by increasing β-amyloid burden. That sleep disturbance would be a candidate risk factor for Alzheimer's disease might seem surprising, given that disturbed sleep is usually considered a consequence of Alzheimer's disease. However, a bidirectional relationship between sleep and Alzheimer's disease is supported by advances in our understanding of sleep disturbance-induced increases in systemic inflammation, which can be viewed as an early event in the course of Alzheimer's disease. Inflammation increases β-amyloid burden and is thought to drive Alzheimer's disease pathogenesis. Improved understanding of the mechanisms linking sleep disturbance and Alzheimer's disease risk could facilitate the identification of targets for prevention, given that both sleep disturbance and inflammatory activation might be modifiable risk factors for Alzheimer's disease.
216 citations
TL;DR: Findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance, and the strength of evidence using four domains (risk of bias, directness of outcome measures, consistency of results, and precision of results) is determined.
Abstract: There is a growing interest in the effectiveness of mindfulness meditation for sleep disturbed populations. Our study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. To assess for relative efficacy, comparator groups were restricted to specific active controls (such as evidenced-based sleep treatments) and nonspecific active controls (such as time/attention-matched interventions to control for placebo effects), which were analyzed separately. From 3303 total records, 18 trials with 1654 participants were included. We determined the strength of evidence using four domains (risk of bias, directness of outcome measures, consistency of results, and precision of results). At posttreatment and follow-up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls (ES 0.03 (95% CI -0.43 to 0.49)) and (ES -0.14 (95% CI -0.62 to 0.34)), respectively. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention (ES 0.33 (95% CI 0.17-0.48)) and at follow-up (ES 0.54 (95% CI 0.24-0.84)). These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
203 citations
TL;DR: The meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression for current elite athletes, and from 16% for distress to 26% for Anxiety/Depression for former elite athletes.
Abstract: Objectives To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes. Design Systematic review and meta-analysis. Data sources Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane. Eligibility criteria for selecting studies We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders. Results Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression. Conclusions Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.
194 citations
TL;DR: A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages and is ready for clinical usage, and can be tested with big PSG data.
Abstract: Sleep disorder is a symptom of many neurological diseases that may significantly affect the quality of daily life. Traditional methods are time-consuming and involve the manual scoring of polysomnogram (PSG) signals obtained in a laboratory environment. However, the automated monitoring of sleep stages can help detect neurological disorders accurately as well. In this study, a flexible deep learning model is proposed using raw PSG signals. A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages. The performance of the system is evaluated using two public databases (sleep-edf and sleep-edfx). The developed model yielded the highest accuracies of 98.06%, 94.64%, 92.36%, 91.22%, and 91.00% for two to six sleep classes, respectively, using the sleep-edf database. Further, the proposed model obtained the highest accuracies of 97.62%, 94.34%, 92.33%, 90.98%, and 89.54%, respectively for the same two to six sleep classes using the sleep-edfx dataset. The developed deep learning model is ready for clinical usage, and can be tested with big PSG data.
176 citations
TL;DR: Most of the data indicate a strong link between short sleep times and diabetes mellitus, obesity, and cardiovascular disorders, andPhysicians should consider sleep to be a modifiable risk factor for health status, with particular relevance to cardiovascular and metabolic disorders.
Abstract: Short sleep duration has a substantial influence on the overall health of an individual. Short sleep time can be a consequence of lifestyle habits, environmental factors, or the presence of a sleep disorder, such as insomnia or sleep-disordered breathing. Short sleep time is associated with increased morbidity and mortality, mainly from cardiovascular disorders (including coronary artery disease, arrhythmias, and hypertension). Several biological mechanisms have been proposed as a possible link between short sleep duration and these diseases, such as involvement of the autonomic nervous system, endothelial function, metabolic regulation, inflammation, and the coagulation system. In this Review, we provide an overview on the effects of short sleep duration on cardiovascular health and diseases and discuss the main pathophysiological mechanisms involved, taking into account both experimental data and clinical evidence.
173 citations
TL;DR: Prospective observational and MR analyses support short sleep duration as a potentially causal risk factor for MI and Investigation of sleep extension to prevent MI may be warranted.
137 citations
TL;DR: Observational evidence is provided on the association of obesity with sleep disturbances and viceversa with emphasis on possible pathophysiological mechanisms (hormonal and metabolic) that link these two pathological conditions.
Abstract: Epidemiological studies suggested an association between obesity and sleep disturbances. Obstructive sleep apnea is the most prevalent type of obesity-related sleep disorder that lead to an increased risk for numerous chronic health conditions. In addition the increased visceral adipose tissue might be responsible for the secretion of inflammatory cytokines that could contribute to alter the sleep-wake rhythm. Unhealthy food characterized by high consumption of fat and carbohydrate seems to negatively influence the quality of sleep while diet rich of fiber is associated to more restorative and deeper sleep. Although obesity could cause through several pathogenetic mechanisms an alteration of sleep, it has been reported that subjects suffering from sleep disorders are more prone to develop obesity. Experimental laboratory studies have demonstrated that decreasing either the amount or quality of sleep increase the risk of developing obesity. Experimental sleep restriction also causes physiological, hormonal and food behavioral changes that promote a positive energy balance and a compensatory disproportionate increase in food intake, decrease in physical activity, and weight gain. Thus, the aim of this review is to provide observational evidence on the association of obesity with sleep disturbances and viceversa with emphasis on possible pathophysiological mechanisms (hormonal and metabolic) that link these two pathological conditions.
125 citations
TL;DR: It is concluded that the long-term use of CP2305-containing tablets may improve the mental state, sleep quality, and gut microbiota of healthy adults under stressful conditions.
Abstract: Short-term administration of Lactobacillus gasseri CP2305 improves stress-associated symptoms and clinical symptoms in healthy young adults and in patients with irritable bowel syndrome, respectively. We evaluated the efficacy and health benefits of the long-term use of a tablet containing heat-inactivated, washed Lactobacillus gasseri CP2305 (CP2305) in healthy young adults. Sixty Japanese medical students (41 men and 19 women) preparing for the national examination for medical practitioners ingested CP2305-containing or placebo tablets once daily for 24 weeks. Intake of the CP2305 tablet significantly reduced anxiety and sleep disturbance relative to placebo, as quantitated by the Spielberger State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. Single-channel sleep electroencephalograms show that CP2305 significantly shortened sleep latency and wake time after sleep onset and increased the delta power ratio in the first sleep cycle. CP2305 also significantly lowered salivary chromogranin A levels compared with placebo. Furthermore, 16S rRNA gene sequencing of participant feces demonstrated that CP2305 administration attenuated the stress-induced decline of Bifidobacterium spp. and the stress-induced elevation of Streptococcus spp. We conclude that the long-term use of CP2305-containing tablets may improve the mental state, sleep quality, and gut microbiota of healthy adults under stressful conditions.
121 citations
TL;DR: Among the respondents with insomnia, psychiatric comorbidities may have a negative impact on daytime alertness, general sleep quality, and insomnia severity, especially when the two conditions are present at the same time.
Abstract: Introduction: One of the most common sleep disorders, insomnia is a significant public health concern. Several psychiatric disorders, such as anxiety disorders and depression, have shown strong relationships with insomnia. However, the clinical impact of the combination of these two conditions on insomnia severity and sleep quality remains unknown. We investigated the relationship between sleep disturbance and psychiatric comorbidities in subjects with high risk for insomnia. Methods: We analyzed data from a nation-wide cross-sectional survey of Korean adults aged 19 ~ 69 years conducted from November 2011 to January 2012. The survey was performed via face-to-face interviews using a structured questionnaire. We used the insomnia severity index (ISI) to evaluate insomnia and defined respondents with ISI scores of ≥10 were considered to be at high risk for insomnia. To diagnose anxiety and depression, we used the Goldberg anxiety scale (GAS) and Patient Health Questionnaire-9 (PHQ-9), respectively. Results: Of the 2,762 respondents, 290 (10.5%) were classified as subjects with high risk for insomnia; anxiety [odds ratio (OR), 9.8; 95% confidence interval (CI), 7.3-13.1] and depression (OR, 19.7; 95% CI, 13.1-29.6) were more common in this population than in participants without insomnia. Of the participants with insomnia, 152 (52.4%) had neither anxiety nor depression, 63 (21.7%) only had anxiety, 21 (7.2%) only had depression, and 54 (18.6%) had both anxiety and depression. The group with both anxiety and depression was associated with worse scores on sleep-related scales than the other groups [high ISI, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale]. The relationship between outcome measures (ISI and PSQI) and psychiatric problems was significant only when anxiety and depression were present. The PSQI has a significant mediation effect on the relationship between psychiatric comorbidities and insomnia severity. Conclusion: Among the respondents with insomnia, psychiatric comorbidities may have a negative impact on daytime alertness, general sleep quality, and insomnia severity, especially when the two conditions are present at the same time. Clinicians should, therefore, consider psychiatric comorbidities when treating insomnia.
115 citations
TL;DR: It is suggested that sleep quality may alter the strength of the relationship between pre-sleep entrapment and awakening suicidal ideation, and Clinically, results underscore the importance of assessing and treating sleep disturbance when working with those experiencing suicidal Ideation.
Abstract: Copyright © Cambridge University Press 2018 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.. Background Sleep problems are a modifiable risk factor for suicidal thoughts and behaviors. Yet, sparse research has examined temporal relationships between sleep disturbance, suicidal ideation, and psychological factors implicated in suicide, such as entrapment. This is the first in-the-moment investigation of relationships between suicidal ideation, objective and subjective sleep parameters, and perceptions of entrapment.Methods Fifty-one participants with current suicidal ideation completed week-long ecological momentary assessments. An actigraph watch was worn for the duration of the study, which monitored total sleep time, sleep efficiency, and sleep latency. Daily sleep diaries captured subjective ratings of the same sleep parameters, with the addition of sleep quality. Suicidal ideation and entrapment were measured at six quasi-random time points each day. Multi-level random intercept models and moderation analyses were conducted to examine the links between sleep, entrapment, and suicidal ideation, adjusting for anxiety and depression severity.Results Analyses revealed a unidirectional relationship whereby short sleep duration (both objective and subjective measures), and poor sleep quality, predicted the higher severity of next-day suicidal ideation. However, there was no significant association between daytime suicidal ideation and sleep the following night. Sleep quality moderated the relationship between pre-sleep entrapment and awakening levels of suicidal ideation.Conclusions This is the first study to report night-to-day relationships between sleep disturbance, suicidal ideation, and entrapment. Findings suggest that sleep quality may alter the strength of the relationship between pre-sleep entrapment and awakening suicidal ideation. Clinically, results underscore the importance of assessing and treating sleep disturbance when working with those experiencing suicidal ideation.
TL;DR: This article provides a comprehensive review of automated sleep stage scoring systems, which were created since the year 2000, and shows that all of these signals contain information forSleep stage scoring.
TL;DR: Sleep disorders are very common in patients with psychosis, may have wide-ranging negative effects, and merit routine assessment and treatment in psychiatric practice.
Abstract: Sleep disturbance is known to be associated with psychosis, but sleep disorders (eg, insomnia, nightmare disorder, sleep apnea) have rarely been investigated. We aimed to provide the first detailed assessment of sleep disorders and their correlates in patients with early psychosis. Sixty outpatients aged between 18 and 30 with nonaffective psychosis were assessed for sleep disorder presence, severity, and treatment using a structured diagnostic interview, sleep diaries, and actigraphy. Psychotic experiences, mood, and psychological wellbeing were also measured. Forty-eight patients (80%) had at least one sleep disorder, with insomnia and nightmare disorder being the most common. Comorbidity of sleep disorders within this group was high, with an average of 3.3 sleep disorders per patient. Over half of the sleep disorders had been discussed with a clinician but almost three-quarters had received no treatment. Treatment according to clinical guidelines was rare, occurring in only 8% of cases (n = 13). Sleep disorders were significantly associated with increased psychotic experiences, depression, anxiety, fatigue, and lower quality of life. Sleep disorders are very common in patients with psychosis, may have wide-ranging negative effects, and merit routine assessment and treatment in psychiatric practice.
TL;DR: It is concluded that sleep problems are both prevalent and increasing among students, and warrants attention as a public health problem in this population.
Abstract: The aim of this study was to describe sleep patterns and rate of insomnia according to diagnostic criteria in college and university students, as well as to examine potential changes in sleep problems from 2010 to 2018. Data stemmed from a national student health survey from 2018 for higher education in Norway (the SHoT study), which invited all 162,512 fulltime students in Norway. A total of 50,054 students (69.1% women) aged 18-35 years were included, yielding a response rate of 30.8%. Sleep parameters, reported separately for weekdays and weekends, included calculations of bedtime, rise time, sleep duration, sleep-onset latency, wake after sleep onset, sleep need and sleep deficit. Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th edn) criteria. For the trend analysis, we used one item measuring difficulties initiating and/or maintaining sleep, over three time points (2010, 2014 and 2018). The results from 2018 showed large weekday-weekend differences across most sleep parameters. Both male and female students obtained a mean sleep duration in the lower end of the normal range on weekdays (7:24 hr), but met their own sleep need and sleep recommendations at weekends (8:25 hr). The overall prevalence of insomnia was 34.2% in women and 22.2% in men. There was a substantial increase in sleep problems from 2010 (22.6%) to 2018 (30.5%), which was especially pronounced in women. We conclude that sleep problems are both prevalent and increasing among students. This warrants attention as a public health problem in this population.
TL;DR: There was strong evidence that longer sleep duration was associated with reduced problem behaviors, and other potential mediating variables need to be investigated in future research.
Abstract: Previous research examining the relationship between screen time (ST) and psychological health outcomes have primarily focused on one type of ST (i.e., television), while little research has considered other types of screens (e.g., videos, movies, social media), screen content (e.g., violent video games), or potential mediating variables. Therefore, the purpose of the present study was to assess ST types and content and their association with problem behaviors, and to determine whether these relationships were mediated by sleep duration. Parents and children provided cross-sectional baseline data (2016–18) as part of the Adolescent Brain Cognitive Development study, a broadly US representative sample of 11,875 children aged 9 to 10 years. Parents self-reported their children’s emotional and behavioral syndromes via the Child Behavior Checklist and sleep duration using one item from the Parent Sleep Disturbance Scale. Children self-reported their ST behavior, which comprised ST types (television/movies, videos, video games, and social media) and content (mature-rated video games and R-rated movies). Time spent in various ST types was positively associated with problem behaviors: watching television/movies was associated with a 5.9% increase in rule-breaking behavior (incidence rate ratio [IRR] = 1.059), 5% increase in social problems (IRR = 1.050), 4% increase in aggressive behavior (IRR = 1.040), and 3.7% increase in thought problems (IRR = 1.037). Greater time spent playing mature-rated video games was associated with greater somatic complaints (IRR = 1.041), aggressive behavior (IRR = 1.039), and reduced sleep duration (IRR = .938). Sleep duration mediated the relationship between ST (type and content) and problem behaviors, albeit the effect sizes were small. The largest effects were observed between sleep duration and all problem behaviors, with greater sleep duration predicting an 8.8–16.6% decrease in problem behaviors (IRRs ranging from .834 to .905). Greater time spent in ST behavior was associated with greater problem behaviors among children. There was strong evidence that longer sleep duration was associated with reduced problem behaviors. While sleep duration mediated the effects of ST on problem behaviors, other potential mediating variables need to be investigated in future research.
TL;DR: An overview of the current knowledge on the relationship between the circadian rhythm, sleep disorders, and ADHD is presented and a novel view on ADHD, where a part of the ADHD symptoms are the result of chronic sleep disorders is proposed, with most evidence for the delayed circadian rhythm as the underlying mechanism.
Abstract: Attention-deficit/hyperactivity disorder (ADHD) is highly associated with the delayed sleep phase disorder, a circadian rhythm sleep–wake disorder, which is prevalent in 73–78% of children and adults with ADHD. Besides the delayed sleep phase disorder, various other sleep disorders accompany ADHD, both in children and in adults. ADHD is either the cause or the consequence of sleep disturbances, or they may have a shared etiological and genetic background. In this review, we present an overview of the current knowledge on the relationship between the circadian rhythm, sleep disorders, and ADHD. We also discuss the various pathways explaining the connection between ADHD symptoms and delayed sleep, ranging from genetics, behavioral aspects, daylight exposure, to the functioning of the eye. The treatment options discussed are focused on improvement of sleep quality, quantity, and phase-resetting, by means of improving sleep hygiene, chronotherapy, treatment of specific sleep disorders, and by strengthening certain neuronal networks involved in sleep, e.g., by sensorimotor rhythm neurofeedback. Ultimately, the main question is addressed: whether ADHD needs to be redefined. We propose a novel view on ADHD, where a part of the ADHD symptoms are the result of chronic sleep disorders, with most evidence for the delayed circadian rhythm as the underlying mechanism. This substantial subgroup should receive treatment of the sleep disorder in addition to ADHD symptom treatment.
TL;DR: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019, which describes the state of the art in intensive care and emergency medicine in 2019.
Abstract: Sleep is controlled by two major regulatory systems: a circadian system that drives 24-h periodicity (Process C), and a homeostatic system (Process S) that ensures adequate amounts of sleep are obtained. Both processes are disturbed in critically ill patients, potentially due to exposure to sleep-altering medications (e.g., propofol), the structure of the intensive care unit (ICU) environment (e.g., workflow), aggravation of a pre-existing sleep disorder, and/or effects of acute illness (e.g., sepsis). As a result, patients may experience delirium, poor respiratory function, and dysregulated immune system reactivity. Several methods of measuring sleep in the ICU exist, although all provide their own challenges. A number of intervention-based therapies to improve ICU sleep and circadian rhythm disturbances have been explored, including noise reduction protocols, music therapy, light treatment, and different modes of mechanical ventilation. These studies have met with limited success.
TL;DR: With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.
Abstract: Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems. Recent research indicates that insufficient sleep, disrupted sleep, and sleep disorders affect many aspects of human health including sexual function. In fact, patients with urological disorders or erectile dysfunction (ED) may have a sleep disorder that contributes to their urological or sexual dysfunction. Obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders and are associated with ED and/or other urological disorders. Therefore, careful attention should be paid to the diagnosis and treatment of concomitant sleep disorders in patients with sexual dysfunction. In this review, we provide an overview of what sleep is and how it is assessed in the clinic or laboratory; our current understanding of the functions of sleep and sleep health; a description of common sleep disorders, as well as how they are diagnosed and treated; and how sleep and its disorders are associated with male sexual dysfunction. Sleep is considered to be a 'third pillar of health', along with diet and exercise. With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.
TL;DR: It is well-established that cognitive behavioural therapy for insomnia (CBT-I) improves self-reported sleep disturbance, however the impact on objective sleep is less clear, and a meta-analysis found no evidence that CBT-I reliably improves PSG-defined sleep parameters.
TL;DR: Older adults with objective social isolation may experience sleep disturbance, depression, and fatigue because they feel socially isolated, not just because they are deprived of social networks.
Abstract: Objective: Older adults are at higher risk of experiencing social isolation, which has been linked to impaired physical and mental health. The link between social isolation and health might be due ...
TL;DR: This meta-analysis supports the finding that sleep disorders, particularly nightmares and insomnia, increase the risk of suicidal behaviour in depressed patients.
Abstract: The potential link between sleep disorders and suicidal behaviour has been the subject of several reviews. We performed this meta-analysis to estimate the overall association between sleep disorders and suicidal behaviour and to identify a more specific relationship in patients with depression. A systematic search strategy was developed across the electronic databases PubMed, EMBASE and the Cochrane Library from inception to January 1, 2019 for studies that reported a relationship between sleep disorders and suicidal behaviour in depressed patients. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to measure the outcomes. Heterogeneity was evaluated by Cochran’s Q test and the I2 statistic. The Newcastle-Ottawa Scale (NOS) was adopted to evaluate the methodological quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. We calculated the overall association between sleep disorders and suicidal behaviour and estimated more specific categories, including insomnia, nightmares, hypersomnia, suicidal ideation, suicide attempt, and completed suicide. A total of 18 studies were included in this study. Overall, sleep disorders were closely related to suicidal behaviour in patients with depression (OR = 2.45 95% CI: 1.33 4.52). The relatively increased risks of sleep disorders with suicidal ideation, suicide attempt and completed suicide ranged from 1.24 (95% CI: 1.00 1.53) to 2.41 (95% CI: 1.45 4.02). Nightmares were found to be highly correlated with the risk of suicidal behaviour (OR = 4.47 95% CI: 2.00 9.97), followed by insomnia (OR = 2.29 95% CI: 1.69 3.10). The certainty of the evidence was rated as very low for the overall outcome and the major depression subgroup and was rated as low for the depression subgroup. This meta-analysis supports the finding that sleep disorders, particularly nightmares and insomnia, increase the risk of suicidal behaviour in depressed patients. Considering that all included studies were observational, the quality of the evidence is rated as very low. More well-designed studies are needed to confirm our findings and to better explain the mechanisms by which sleep disorders aggravate suicidal behaviour in depressed patients.
TL;DR: Path analysis indicated that sleep problems at baseline predicted later development of ADHD symptoms in younger children and somatic complaints in older children, and sensory over-responsivity predicted future sleep problems in children with ASD.
Abstract: The chronicity of sleep disturbance and its relation to co-occurring symptoms in children with autism spectrum disorder (ASD) are not well understood. The current study examined longitudinal relations among sleep and co-occurring symptoms in a large well-characterized sample of 437 children with ASD assessed at baseline and follow-up (M = 3.8 years later). Twenty-three percent experienced worsening sleep problems over time, while 31.5% showed improvement. Path analysis indicated that sleep problems at baseline predicted later development of ADHD symptoms in younger children and somatic complaints in older children. For younger children, sensory over-responsivity predicted future sleep problems. Findings suggest that sensory over-reactivity may contribute to sleep problems in some children with ASD, and that sleep problems may result in poor daytime functioning.
TL;DR: The overall prevalence of symptoms of sleep disorders in the psychiatric outpatient sample was 40.75% (163/400), and the prevalence for symptoms of narcolepsy, sleep breathing disorder, PLMS/RLS, circadian rhythm disorder and parasomnia were 12.5%, 14.5, and 13.8% respectively.
Abstract: Difficulty falling asleep or maintaining sleep, poor sleep quality, nightmares, and excessive daytime sleepiness are some of the key clinical symptoms of sleep disturbances observed among individuals with psychiatric illnesses. This study aimed to determine the prevalence of symptoms of sleep disorders including parasomnia, narcolepsy, obstructive sleep apnea, circadian rhythm disorder and restless leg syndrome/periodic limb movement (RLS/PLMS) and its correlates in patients with psychiatric diagnoses. Patients aged 21–65 years (n = 400) attending the outpatient clinics with a primary diagnosis of either schizophrenia, mood or anxiety disorder based on ICD-9 criteria were included in this cross-sectional study. Sociodemographic information was collected and screening questions pertaining to specific symptoms of sleep disorders were administered by a study team member. The overall prevalence of symptoms of sleep disorders in the psychiatric outpatient sample was 40.75% (163/400). The prevalence for symptoms of narcolepsy, sleep breathing disorder, PLMS/RLS, circadian rhythm disorder and parasomnia were 12.5%, 14.5%, 14.8%, 4.5%, and 13.8% respectively. These symptoms were associated with age, low physical activity, and anxiety disorder. Results highlight the high prevalence of symptoms of sleep disorders in psychiatric patients. Present study findings should be confirmed using diagnostic interviews and objective measures.
TL;DR: An overview of previous studies that have linked Alzheimer's disease and sleep is provided and future works that will aid the development of a novel disease-modifying therapy and prevention of AD via targeting impaired sleep through non-pharmacological and pharmacological interventions are proposed.
Abstract: Sleep disturbance is a common symptom in patients with various neurodegenerative diseases, including Alzheimer's disease (AD), and it can manifest in the early stages of the disease. Impaired sleep in patients with AD has been attributed to AD pathology that affects brain regions regulating the sleep⁻wake or circadian rhythm. However, recent epidemiological and experimental studies have demonstrated an association between impaired sleep and an increased risk of AD. These studies have led to the idea of a bidirectional relationship between AD and impaired sleep; in addition to the conventional concept that impaired sleep is a consequence of AD pathology, various evidence strongly suggests that impaired sleep is a risk factor for the initiation and progression of AD. Despite this recent progress, much remains to be elucidated in order to establish the benefit of therapeutic interventions against impaired sleep to prevent or alleviate the disease course of AD. In this review, we provide an overview of previous studies that have linked AD and sleep. We then highlight the studies that have tested the causal relationship between impaired sleep and AD and will discuss the molecular and cellular mechanisms underlying this link. We also propose future works that will aid the development of a novel disease-modifying therapy and prevention of AD via targeting impaired sleep through non-pharmacological and pharmacological interventions.
TL;DR: The current review summarizes the available evidence regarding the association between vitamin D and sleep, focusing on both clinical and preclinical studies.
TL;DR: Impairments of neural circuit switching and imbalance between inhibitory and excitatory neuronal populations are likely responsible for episodic sleep disturbances in Parkinson’s disease, in particular RBD.
Abstract: Sleep disturbances are common and a major source of disability in Parkinson's disease (PD). Primary and secondary insomnia, rapid eye movement sleep behavior disorder (RDB), central sleep apnea, restless legs, and nocturnal akinesia are common sleep disturbances in PD. Prodromal presence of RBD is associated with a more severe motor and non-motor PD subtype implying a significant disease-modifying effect of this parasomnia. Other disease-modifying mechanisms of sleep disturbances in PD include impaired glymphatic clearance, endoplasmic reticulum stress, nocturnal brain deoxygenation and inflammatory processes among others. Impairments of neural circuit switching and imbalance between inhibitory and excitatory neuronal populations are likely responsible for episodic sleep disturbances, in particular RBD. As neural circuits may predict patterns of α-synuclein propagation in the nervous system, impairments of such circuits are of high relevance for PD pathophysiology. Future research is needed to determine whether appropriate treatment for disturbed sleep might slow progression of PD.
TL;DR: Sleep disruption enhances different pain facilitatory measures of CS in males and females suggesting that sleep disturbance may increase risk for chronic pain in males or females via distinct pathways.
Abstract: Study objectives Females demonstrate heightened central sensitization (CS), a risk factor for chronic pain characterized by enhanced responsivity of central nervous system nociceptors to normal or subthreshold input. Sleep disruption increases pain sensitivity, but sex has rarely been evaluated as a moderator and few experiments have measured CS. We evaluated whether two nights of sleep disruption alter CS measures of secondary hyperalgesia and mechanical temporal summation in a sex-dependent manner. We also evaluated differences in measures of pain sensitivity. Methods Seventy-nine healthy adults (female n = 46) participated in a randomized crossover experiment comparing two consecutive nights of eight pseudorandomly distributed forced awakenings (FA [-200 min sleep time]) against two nights of undisturbed sleep (US). We conducted sensory testing the mornings following Night 2; the heat-capsaicin pain model was used to induce secondary hyperalgesia. Results FA reduced total sleep time (REM and NREM Stage 3) more profoundly in males. We observed divergent, sex-dependent effects of FA on secondary hyperalgesia and temporal summation. FA significantly increased secondary hyperalgesia in males and significantly increased temporal summation in females. Sex differences were not attributable to differential sleep loss in males. FA also significantly reduced heat-pain threshold and cold pressor pain tolerance, independently of sex. Conclusions Sleep disruption enhances different pain facilitatory measures of CS in males and females suggesting that sleep disturbance may increase risk for chronic pain in males and females via distinct pathways. Findings have implications for understanding sex differences in chronic pain and investigating sleep in chronic pain prevention efforts.
TL;DR: Overall, CBT is a promising treatment for improving post-stroke fatigue, sleep quality and depression and warrant extension to a phase III clinical trial.
Abstract: The objective of this study was to evaluate the effectiveness of individual cognitive behavioural therapy (CBT) for post-stroke fatigue and sleep disturbance compared to treatment as usual (TAU). In a parallel two-group pilot randomised controlled trial of 15 participants, nine were allocated to eight weekly sessions of adapted CBT and six continued usual care rehabilitation. The primary outcome was the Fatigue Severity Scale (FSS-7) at two and four months from baseline. Secondary outcomes included measures of sleep, mood and quality of life. Outcomes were assessed by a rater who was blind to group membership. At the four-month endpoint, the CBT group demonstrated significantly reduced fatigue relative to TAU (FSS-7 mean difference: 1.92, 95% CI: 0.24 to 3.60). Significant group differences also emerged for sleep quality and depression, favouring the CBT group. Insomnia and physical quality of life improved immediately post-therapy but were no longer superior to TAU at follow-up. Overall, CBT is a promising treatment for improving post-stroke fatigue, sleep quality and depression. Gains were maintained for two months after therapy cessation and represented large treatment effects. These findings highlight the feasibility of the intervention and warrant extension to a phase III clinical trial.
TL;DR: The associations between menopausal stage and/or hormone levels and sleep problems, mood and reduced cognitive performance are considered and the role of estrogen and menopause hormone therapy (MHT) in cognitive function, sleep and mood are discussed.
Abstract: During the menopausal transition, which begins four to six years before cessation of menses, middle-aged women experience a progressive change in ovarian activity and a physiologic deterioration of hypothalamic-pituitary-ovarian axis function associated with fluctuating hormone levels. During this transition, women can suffer symptoms related to menopause (such as hot flushes, sleep disturbance, mood changes, memory complaints and vaginal dryness). Neurological symptoms such as sleep disturbance, “brain fog” and mood changes are a major complaint of women transitioning menopause, with a significant impact on their quality of life, productivity and physical health. In this paper, we consider the associations between menopausal stage and/or hormone levels and sleep problems, mood and reduced cognitive performance. The role of estrogen and menopause hormone therapy (MHT) in cognitive function, sleep and mood are also discussed.
TL;DR: Addressing fragmented sleep or sleep architecture could be used to increase emotional memory and learning processes and thus ameliorate responses to trauma exposure, reduce PTSD severity, and improve treatment.
Abstract: The emotional memory and learning model of PTSD posits maladaptive fear conditioning, extinction learning, extinction recall, and safety learning as central mechanisms to PTSD. There is increasingly convincing support that sleep disturbance plays a mechanistic role in these processes. The current review consolidates the evidence on the relationships between emotional memory and learning, disturbed sleep, and PTSD acquisition, maintenance, and treatment. While disrupted sleep prior to trauma predicts PTSD onset, maladaptive fear acquisition does not seem to be the mechanism through which PTSD is acquired. Rather, poor extinction learning/recall and safety learning seem to better account for who maintains acute stress responses from trauma versus who naturally recovers; there is convincing evidence that this process is, at least in part, mediated by REM fragmentation. Individuals with PTSD had higher “fear load” during extinction, worse extinction learning, poorer extinction recall, and worse safety learning. Evidence suggests that these processes are also mediated by fragmented REM. Finally, PTSD treatments that require extinction and safety learning may also be affected by REM fragmentation. Addressing fragmented sleep or sleep architecture could be used to increase emotional memory and learning processes and thus ameliorate responses to trauma exposure, reduce PTSD severity, and improve treatment. Future studies should examine relationships between emotional memory and learning and disturbed sleep in clinical PTSD patients.