Biomedical subjects

Melanie K Means

Publications and source records attributed to Melanie K Means.

6 recordsLinked to original sources

PubMed2006

Defining insomnia: quantitative criteria for insomnia severity and frequency.

STUDY OBJECTIVE: Recent efforts have been made to develop quantitative frequency, duration, and severity criteria for insomnia. The current study was conducted to test a range of frequency and severity criteria sets for discriminating primary insomnia sufferers from normal sleepers. PARTICIPANTS: Seventy-two adults with primary insomnia and 88 age-matched normal sleepers. METHODS: Participants completed 14 consecutive nights of sleep logs to monitor their home sleep patterns. Receiver-operator characteristic curve analyses were used to compare a range of severity and frequency criteria sets for discriminating the insomnia and normal-sleeper groups. In addition, sensitivity and specificity tests were conducted for a range of wake-time severity cutoffs based on 2-week mean sleep-log data. RESULTS: Receiver-operator characteristic curve analyses showed that no 1 combination of severity and frequency criteria maximized sensitivity and specificity. Rather, the optimal frequency cutoff decreased as the severity criterion increased. Analyses of mean sleep-log data showed that an average sleep-onset latency or middle-of-the-night wake time (ie, time awake between sleep onset and final morning awakening) cutoff of 20 minutes or longer over 2 weeks of sleep-log monitoring appeared to best maximize sensitivity (94.4%) and specificity (79.6%) for insomnia classification. CONCLUSIONS: The optimal quantitative insomnia criteria found herein differ from those previously proposed. Nonetheless, results suggest that quantitative criteria derived from sleep-log data may be useful for classification of primary insomnia.

Adult↗

PubMed2005

Cognitive-behavioral therapy for primary insomnia.

Primary insomnia (PI) is a prevalent form of sleep difficulty that impairs diurnal functioning, reduces quality of life and enhances health care utilization/costs for millions worldwide. Whereas the underlying pathophysiology of PI remains poorly understood, it is widely accepted that a host of cognitive and behavioral factors play important roles in perpetuating this condition. As such, a multi-factorial, cognitive-behavioral therapy (CBT) has emerged as a "treatment of choice" for managing the sleep/wake complaints of PI sufferers. This article considers the nature and relative merits of CBT for treating PI patients. In addition, this article reviews studies supporting the general efficacy and clinical effectiveness of CBT for treating PI complaints. Issues related to treatment implementation as well as factors that mediate patients' responses to CBT and predict treatment acceptance/outcome are also considered. Finally, remaining questions regarding CBT's application to PI are considered, and suggestions for future research are provided.

Cognitive Behavioral Therapy↗

PubMed2004

CPAP compliance in sleep apnea patients with and without laboratory CPAP titration.

Advances in auto-adjusting positive airway pressure technology for obstructive sleep apnea now permit this treatment to be initiated outside of the sleep laboratory environment, bypassing the need for laboratory-based titration studies. Thus far, little research has addressed how such developments may affect compliance to continuous positive airway pressure (CPAP). We tested the effect of laboratory CPAP exposure and technologist support in a retrospective chart review of 98 veterans with obstructive sleep apnea to determine whether patients who received standard laboratory CPAP titration complied better with CPAP than did patients who received no laboratory CPAP titration. Fifty patients underwent standard technician-attended polysomnography (PSG) with CPAP titration, and 48 patients underwent unattended PSG with no laboratory trial of CPAP (first CPAP exposure was at home). Objective CPAP compliance measures were obtained from CPAP units at follow-up visits. Attended-PSG patients wore CPAP significantly longer per night on average (5.0 hours vs 3.9 hours) and tended to wear CPAP on more nights (76.5% vs 64.2%) compared with unattended-PSG patients. These findings suggest that patients' sleep laboratory experience with CPAP and the support and education provided by sleep technologists are important factors in facilitating CPAP compliance.

Continuous Positive Airway Pressure↗

PubMed2004

A pilot study of inexpensive sleep-assessment devices.

Polysomnography (PSG), the gold standard sleep-assessment methodology, is impractical for many applications. Although alternative assessment methodologies are available, it is not clear which most correlates with PSG measures. This study compared sleep log (SL), actigraphy (ACT), and the REMview (RV) device for estimating PSG sleep measures. Thirty-three participants with various sleep-disorder diagnoses underwent 1 night of monitoring with PSG, RV, ACT, and SL. RV provided accurate estimates of most sleep variables. The accuracy of ACT and SL estimates depended on the sleep variable. These findings indicate that the selection of an alternative methodology should consider the sleep measure of interest in addition to the relative merits and drawbacks of each device.

Adult↗

PubMed2003

Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea.

It is generally believed that obstructive sleep apnea (OSA) causes depression in some patients, yet it is unknown whether this depression is an actual clinical phenomenon or purely a result of overlapping somatic/physical symptoms shared by both disorders. The present study investigated changes in both somatic and affective/cognitive symptoms of depression associated with the introduction of continuous positive airway pressure (CPAP) treatment for OSA. Participants were 39 outpatients (35 males, 4 females) with no current or past mental health problems, diagnosed with OSA in a hospital sleep disorders clinic. The Beck Depression Inventory (BDI) was administered prior to treatment and again 3 months after CPAP. Total BDI scores improved after CPAP, independent of objectively monitored CPAP compliance rates. Both somatic and affective/ cognitive symptoms of depression improved in a similar manner after treatment. Our findings suggest that depressive symptoms experienced by OSA patients are not solely the result of physical OSA symptoms but include a mood component as well. We introduce a hypothetical model to conceptualize the relationship between OSA and depression.

Adolescent↗

PubMed2003

Accuracy of sleep perceptions among insomnia sufferers and normal sleepers.

OBJECTIVE: To examine the distribution, consistency, and correlates of sleep time perceptions in primary insomnia sufferers and normal sleepers across settings (laboratory and home). METHODS: Fifty-two middle-aged and older insomnia sufferers and 49 matched normal sleepers underwent multiple nights of laboratory and home polysomnography (PSG) and provided concurrent subjective estimates of their sleep. Descriptive statistics, cluster analyses, and inferential tests were used to examine the nature of sleep time perceptions, identify subgroups with distinctive patterns such as perceptions, and explore factors that may contribute to these subgroups' distinctive sleep perceptions. RESULTS: Consistent with previous studies, the insomnia sufferers, as a group, showed a greater tendency to underestimate the time they slept than did the normal sleepers, but the accuracy of sleep time perceptions varied widely within each sample. Correlational analyses showed that study participants in each sample showed a moderate level of consistency in how accurately they estimated sleep time across nights. Subsequent cluster analyses conducted to identify subgroups with distinctive patterns of sleep time perceptions yielded four subgroups within the insomnia sample and three subgroups within the normal sleeper sample. Although the sleep setting significantly affected sleep perceptions for one insomnia subgroup, both laboratory and home objective-subjective sleep comparisons provided similar impressions regarding the relative accuracy of each subgroup's nocturnal sleep/wake perceptions. Finally, varying patterns of subgroup differences were noted across several common psychometric measures. CONCLUSIONS: The underestimation of sleep time is not a generic characteristic that separates all insomnia sufferers from normal sleepers. Sleep setting, personality traits, and perhaps constitutional factors appear to influence perceptions of sleep and wake time duration.

Analysis of Variance↗