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PubMed1999

Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit.

The etiology of sleep disruption in patients in intensive care units (ICUs) is poorly understood, but is thought to be related to environmental stimuli, especially noise. We sampled 203 patients (121 males and 82 females) from different ICUs (cardiac [CCU], cardiac stepdown [CICU], medical [MICU], and surgical [SICU]) by questionnaire on the day of their discharge from the unit, to determine the perceived effect of environmental stimuli on sleep disturbances in the ICU. Perceived ICU sleep quality was significantly poorer than baseline sleep at home (p = 0.0001). Perceived sleep quality and daytime sleepiness did not change over the course of the patients' stays in the ICU, nor were there any significant differences (p > 0.05) in these parameters among respective units. Disruption from human interventions and diagnostic testing were perceived to be as disruptive to sleep as was environmental noise. In general, patients in the MICU appeared to be more susceptible to sleep disruptions from environmental factors than patients in the other ICUs. Our data show that: (1) poor sleep quality and daytime sleepiness are problems common to all types of ICUs, and affect a broad spectrum of patients; and (2) the environmental etiologies of sleep disruption in the ICU are multifactorial.

Adult↗
PubMed2006

Sleep quality in patients with fibromyalgia using the Pittsburgh Sleep Quality Index.

OBJECTIVE: To characterize and quantify the sleep complaints of patients with fibromyalgia (FM) using the Pittsburgh Sleep Quality Index (PSQI). METHODS: The PSQI was applied to 30 patients with FM according to American College of Rheumatology classification criteria and to 30 healthy controls in individual sessions under similar conditions. RESULTS: The median global PSQI scores were [median (25-75%)] 12.0 (10-16) and 3.0 (2.0-5.0) in patients with FM and controls, respectively (p < 0.001). All PSQI component scores except sleep medications were significantly higher in patients than controls. Sleep latency, sleep disturbances, and daytime dysfunction were the most frequent sleep difficulties experienced by patients with FM. CONCLUSION: Our results indicate that the PSQI is a useful instrument for characterizing and quantifying sleep disturbances in patients with FM.

Female↗
PubMed2004

Effects of changing from typical to atypical antipsychotic drugs on subjective sleep quality in patients with schizophrenia in a Japanese population.

OBJECTIVE: To investigate the effects of the atypical antipsychotic drugs risperidone, olanzapine, quetiapine, and perospirone on the subjective quality of sleep in patients with schizophrenia. METHOD: Subjects were 92 inpatients (mean age = 59.9 years) who had been receiving treatment with conventional antipsychotic drugs and who met the DSM-IV criteria for schizophrenia. Subjects were randomly assigned to receive 1 of 4 atypical antipsychotic drugs (olanzapine, perospirone, quetiapine, and risperidone). Subjective sleep quality and psychopathology were assessed twice: at baseline and 8 weeks after switching. Data were collected from June 2001 to December 2001. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), and psychopathology was measured by the Positive and Negative Syndrome Scale (PANSS). RESULTS: Subjective sleep quality as assessed by the PSQI was significantly improved with administration of olanzapine, risperidone, or quetiapine, but not with perospirone, in comparison with conventional antipsychotic drugs. Multiple regression analysis revealed that the improvement of sleep quality with administration of atypical antipsychotic drugs was predicted by poor sleep quality at baseline. In addition, improvement of sleep quality was significantly correlated with improvement of negative symptoms as assessed by the PANSS. CONCLUSION: These results demonstrated that atypical antipsychotic drugs improved subjective quality of sleep in patients with schizophrenia compared with conventional antipsychotic drugs, suggesting that the marked potency of serotonin-2 receptor blockade in atypical antipsychotic drugs may be involved in the mechanism of this improvement. These improvements were correlated with improvement of negative symptoms.

Adult↗
PubMedDate not supplied

Sleep quality and the role of sleep medications for veterans with chronic pain.

OBJECTIVE: The purpose of this study was to investigate the nature of sleep problems in veterans presenting to a pain clinic, factors that predict likelihood of being prescribed a sleep medication, types of medications prescribed, and the relationships between sleep medication use and sleep quality, pain, and depression. DESIGN/SETTING/PATIENTS: Participants were 201 consecutive patients referred to a Veterans Affairs outpatient pain clinic. They were administered the Pittsburgh Sleep Quality Index, Multidimensional Pain Inventory, and Beck Depression Inventory at intake and 2-month follow-up. Sleep and opioid medication prescriptions were also monitored. RESULTS: Pain severity did not predict global sleep quality; global sleep quality was not predictive of pain severity. Greater depression predicted both more severe pain and more sleep impairment. Having previously been prescribed such medications was the only significant predictor of being prescribed a sleep medication at the time of the 2-month assessment. For the 45% of participants on sleep medications, these medications were not associated with any significant change in pain factors or depression. However, sleep medication use was associated with worse global sleep quality, sleep duration, and sleep efficiency. Opioid prescription was not a significant predictor of sleep factors, pain-related variables, or depression symptoms. DISCUSSION: Results suggest depression may contribute more significantly to sleep problems than pain-related variables in this population. The data suggest the need for controlled, prospective studies of sleep medication to further investigate the impact of sleep medications on sleep components in patients with chronic pain.

Adult↗
PubMed2005

Sleep quality and more common sleep-related problems in medical students.

BACKGROUND AND PURPOSE: The aim of this paper is to conduct a survey based on a questionnaire that would characterize nighttime and daytime habits in medical students; to estimate how subjective sleep quality is associated with nighttime and daytime habits and sleep problems in students; to estimate how academic progress and workload is associated with subjective sleep quality, nighttime and daytime habits and sleep problems in students; and to estimate the prevalence of self-reported sleep problems in Estonian medical students. PATIENTS AND METHODS: The study group included 413 medical students of the University of Tartu, aged 19-33 years. The self-reported Sleep and Daytime Habits Questionnaire (S&DHQ) covered demographic characteristics (4 questions) and sleep and daytime habits (24 questions). Of the latter, 18 multiple-choice questions provided answers expressed as discontinuous variables on a nominal scale, 4 questions provided answers expressed as continuous variables on an interval scale, and 2 questions provided answers expressed as quality characterization on a five-point scale. The supplement includes information about lifestyle and academic progress on a four-point scale. RESULTS: The S & DHQ could be used to study sleep problems in young medical students. The subjective sleep quality of students was as follows: excellent-29%; good-40%; satisfactory-24%; poor 6%; very poor-1%. Sleep quality is associated with academic progress (R=0.174; P<0.001), leisure activity (R=0.210; P<0.001), and living conditions (R=0.195; P<0.001). Sleep quality is not associated with students' daily (R=0.021; P>0.05) or nightly workload (R=0.0664; P>0.05). Daytime sleepiness poses a significant problem for students and is associated both with sleep disorders and work while studying. CONCLUSIONS: The study demonstrates that complaints about sleep problems are common in young medical students.

Achievement↗
PubMed2002

Sleep quality and responses to insufficient sleep in women on different work shifts.

1. The aim of this study was to examine degrees of cognitive behavioural effects of fatigue, mood changes and somatic responses to sleep loss in women with and without sufficient sleep, and to explore possible links between effects of sleep loss and specific sleep disturbances in selected groups. 2. A total 156 women working in a casualty department on different work shifts responded to a questionnaire which measured sleep quality, strain and symptoms related to working conditions, as well as effects of sleep loss. 3. About 40% of the women had perceived insufficient sleep during the last 6 months. They perceived significantly worse sleep quality and a higher degree of strain according to working conditions than the others. Palpitation and dysphoria as effects of sleep loss were independently predicted by sleep quality. Dysphoria was also predicted by difficulty in falling asleep. Cognitive behavioural effects of fatigue was predicted by disturbed sleep. Palpitation effects led to a 10-fold increase in the probability of cognitive behavioural effects of fatigue. The effects were most prominent among women suffering from gastrointestinal problems of long duration and chronic pain. 4. Responses to reduced sleep quality in women constitute a form of stress, with sympathetic activation, increased susceptibility to infection, moderate cognitive impairment, mood changes and somatic distress.

Adult↗
PubMed2004

Perceived quality of life in schizophrenia: relationships to sleep quality.

We examined the relationship between perceived quality of life (QOL) and subjective quality of sleep among schizophrenia patients, and its relation to symptom severity, side effects and emotional distress. One hundred and forty five schizophrenia patients were comprehensively evaluated with standardized measures of symptom severity, adverse effects, emotional distress, QOL, and sleep quality (the Pittsburgh Sleep Quality Index, PSQI). Partial correlation and multiple regression analyses were performed. Poor sleepers reported lower mean scores on all QOL domains, they were more depressed and distressed, and had more adverse effects to medications with concomitant distress than good sleepers. The negative relationship between complaints of poor sleep quality and QOL measures remained significant when the confounding effect of depression, side effects, and distress was partialled from the correlation matrix. Daytime dysfunction (a component of the PSQI) accounted for 12.6% of the variance in QOL index scores. Thus, poor QOL reported by schizophrenia patients is substantially associated with poor sleep quality. This association appears both independently and synergistically with depression, distress and side effects of medications.

Adolescent↗
PubMed1998

Psychometric evaluation of the Pittsburgh Sleep Quality Index.

The Pittsburgh Sleep Quality Index (PSQI) measures sleep quality and disturbance retrospectively over a 1-month period using self-reports. Although the PSQI has been used in a variety of populations, published psychometric data are limited. The goal of this study was to examine psychometric properties of the PSQI among four populations: bone marrow transplant patients (n=155); renal transplant patients (n=56); women with breast cancer (n=102); and women with benign breast problems (n=159). Results supported PSQI internal consistency reliability and construct validity. Cronbach's alphas were 0.80 across groups and correlations between global and component scores were moderate to high. PSQI scores were moderately to highly correlated with measures of sleep quality and sleep problems, and poorly correlated with unrelated constructs. Individuals with sleep problems, poor sleep quality, and sleep restlessness had significantly higher PSQI scores in comparison to individuals without such problems.

Adult↗
PubMed2003

P300 amplitude in subjects with primary insomnia is modulated by their sleep quality.

OBJECTIVE: The hyperarousal hypothesis is evaluated while controlling the influence of the quality of sleep in the night preceding the evaluation. METHOD: Eleven primary insomniacs and 11 healthy age matched controls participated to the study. Participants filled in 2 weeks of sleep logs and self-monitored their subjective tension the evening before and the morning after each night. Afterwards, subjects were called in to the Lab for a recording session of the P300 ERP (oddball paradigm) once after a night of bad sleep quality (N-) and once after a night of good sleep quality (N+). RESULTS: The main result of the present study indicated that the P300 amplitude at Fz in insomniacs resulted higher following a N- and lower following a N+ with respect to controls. CONCLUSIONS: This result suggests that cortical hyperarousal in primary insomniacs is not a stable individual characteristic, but is associated with the poor quality of their nocturnal sleep.

Adolescent↗
PubMed2001

Sleep quality and blood pressure dipping in obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with poor sleep quality and a high incidence of nondipping. The aim of this study was to determine the association of sleep quality and nocturnal blood pressure (BP) dipping in an OSA population. METHODS: A total of 44 untreated subjects with mild to severe OSA underwent overnight-attended polysomnography and 24-h ambulatory BP monitoring. Subjects were off antihypertensive medication. The percentage of slow wave sleep, percentage of time awake after sleep onset during the sleep period, sleep efficiency, and arousal index were chosen as measurements of sleep quality. Dipping was evaluated using the change in systolic BP, diastolic BP, and mean arterial pressure. Patients were classified as dippers and nondippers based on a nocturnal drop in mean arterial pressure > 10%. Differences between groups were evaluated by independent sample t tests. Pearson correlation and linear regression were used to evaluate the association of sleep quality and dipping. RESULTS: There were no differences between dippers and nondippers with regard to body mass index, age, or respiratory disturbance index. A total of 84% were nondippers. No difference was found between dippers and nondippers in sleep quality. None of the sleep quality measures correlated with the measurements of dipping. In multiple regression analyses, the percentage of slow wave sleep and arousal index each independently predicted only a small percentage of the variance (approximately 10%) of nocturnal DBP dipping. CONCLUSIONS: The prevalence of nondipping was very high in a population of untreated patients with mild to severe OSA. Nonetheless, sleep quality did not appear to be related to BP dipping.

Adult↗
PubMed2025

Gut metagenome and plasma metabolome profiles in older adults suggest pyruvate metabolism as a link between sleep quality and frailty.

Poor sleep quality is associated with increased frailty in older adults, but the role of the gut microbiome in this relationship remains unclear. Here, gut metagenome and plasma metabolome were profiled in 1,225 individuals aged 62-96 years. Poor sleep quality was associated with reduced abundances of potential probiotics such as Faecalibacterium prausnitzii and elevated abundances of pathobionts. A gut microbiome sleep quality index (GMSI) was developed to quantify microbial balance related to better sleep quality; higher GMSI scores were inversely associated with frailty and related clinical traits. Pyruvate metabolism emerged as a key microbial pathway linking sleep quality to frailty, with features such as F. prausnitzii abundance and microbial pyridoxal 5'-phosphate biosynthesis implicated in this connection. These findings deepen our understanding of microbiome-metabolome pathways related to sleep quality and frailty in aging and provide a valuable resource for future longitudinal and interventional studies.

Humans↗
PubMed1993

Effect of sleep quality on symptoms of irritable bowel syndrome.

A prospective, one-month diary study was conducted with 23 adult irritable bowel syndrome (IBS) patients in order to determine the relationship between IBS and the quality of sleep. Subjects were screened through history and diagnostic studies. Accepted patients then completed a daily diary of IBS symptoms and sleep quality. At baseline, most subjects (74%) characterized themselves as "poor sleepers." Using pooled time series analysis, the study found a significant correlation between morning IBS symptoms and the quality of the prior night's sleep (P < 0.001), a finding not previously reported in the literature. A less strong but still significant correlation (P < 0.05) was found between end of day IBS symptoms and the quality of sleep during the prior evening. Morning IBS symptoms seem to rise or fall in close association with the prior night's quality of sleep. The study supports the hypothesis that IBS symptoms are related to a disturbance in sleep.

Adult↗
PubMed2003

Determination of the minimal clinically significant difference on a patient visual analog sleep quality scale.

The amount of change in quality of sleep (QOS), as measured by a 100-mm visual analog scale (VAS), that constitutes a minimum clinically significant difference was determined. A total of 428 patients with insomnia aged 55 years and older received placebo (2 weeks), prolonged release melatonin 2 mg (3 weeks) and then placebo (2 weeks). Sleep quality was assessed by the end of each period using the Leeds Sleep Evaluation Questionnaire (LSEQ) QOS variable and a five-point severity-rating scale. The mean difference between current and preceding VAS scores in patients improving or worsening by 1 point was 13 mm (95% CI 11-16). Correlation analysis indicated that a change of 1 point was associated with a mean change of 10.3 mm on the VAS. In conclusion, a change of 10 mm change in the 100-mm VAS QOS variable of the LSEQ, signifies an important change in patients' sleep quality.

Adult↗
PubMed2001

The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD.

Sleep quality and posttraumatic stress disorder (PTSD) were examined in 151 sexual assault survivors, 77% of whom had previously reported symptoms of sleep-disordered breathing (SDB) or sleep movement disorders (SMD) or both. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Posttraumatic Stress Scale (PSS). High PSQI scores reflected extremely poor sleep quality and correlated with PSS scores. PSQI scores were greater in participants with potential SDB or SMD or both. PSQI or PSS scores coupled with body-mass index and use of antidepressants or anxiolytics predicted potential sleep disorders. The relationship between sleep and posttraumatic stress appears to be more complex than can be explained by the current PTSD paradigm; and, sleep breathing and sleep movement disorders may be associated with this complexity.

Adult↗
PubMed1989

Sleep-wake patterns and subjective sleep quality of day and night workers: interaction between napping and main sleep episodes.

Five hundred and ninety-three women electronics workers were studied to determine if there was any association between their subjective sleep quality and their sleep patterns. They were 108 day workers, 107 permanent night workers, 216 workers on weekly phase-advance (night/afternoon/morning), and 162 workers on two-weekly phase-delay (morning/afternoon/night) rotating shift schedules. The study was part of a larger survey on night workers involving a self-administered questionnaire. The proportion of nappers was higher in night workers than in day, morning, and afternoon shift workers. Nappers had shorter main sleep, but their total sleep duration was generally the same as that of nonnappers. Compared to nonnappers, a higher proportion of day and morning shift workers who napped did not sleep well. Permanent night workers, with the highest proportion of nappers, had more workers sleeping well than rotating night workers. Subjects who slept well were those with longer total and main sleep and generally started the main sleep earlier. The results indicate a relationship between subjective sleep quality, sleep length, main sleep start, and napping behavior. Whether this relationship is causal is difficult to establish as sleep quality may also reflect the general health status, and this may result in differences in sleep behavior.

Adult↗
PubMedDate not supplied

[Subjective sleep quality and spectral analysis of electroencephalography during nocturnal sleep].

INTRODUCTION: The relation between subjective sleep quality and the stages of polysomnography is unclear. Computerized sleep analysis provides a reliable tool for the study of sleep dynamics. OBJECTIVE: To study the relation between subjective sleep quality and spectral EEG parameters during nocturnal sleep. MATERIAL AND METHODS: Nocturnal sleep were recorded ambulatory in 26 subjects aged from 8 to 63. The following variables were extracted from EEG signal (Fz-Pz) quantified through the Fast Fourier Transformation (FFT): delta maximum, spectral peak, delta sleep time, efficiency and desynchronized sleep. A sleep diary was administered in the morning to assess the subjective sleep quality. Multiple regression and Anova were used for statistical analysis. RESULTS: Efficiency and delta maximum became significant predictors accounting for 54% of subjective sleep variance. The item 'how was your sleep?' was answered in a different way according to the delta maximum. CONCLUSIONS: Sleep depth, measured by spectral analysis, is an important predictor of the subjective sleep quality. The sleep classification in discrete stages ignores this feature.

Adolescent↗
PubMed2001

Partners of patients with sleep apnoea/hypopnoea syndrome: effect of CPAP treatment on sleep quality and quality of life.

BACKGROUND: The sleep apnoea/hypopnoea syndrome (SAHS) causes snoring, apnoeas, and restlessness during sleep which partners frequently complain about. A study was undertaken to determine the impact on partners of SAHS and of treatment of the patient with continuous positive airway pressure (CPAP). METHODS: Forty nine partners and patients with SAHS booked for CPAP treatment completed in house and validated questionnaires (Pittsburgh sleep quality index, Short Form 36 self-reported health status) before the patient started treatment. Twenty three couples in whom the index SAHS patient had no driving problems were recruited to a randomised crossover trial with 1 month limbs of CPAP and placebo capsule. At the end of each limb the partners' sleep was monitored by home polysomnography (PSG) and questionnaires were completed. RESULTS: Before treatment partners frequently reported moderate to severe disturbance from patient snoring/apnoeas/restlessness and had poor sleep quality and self-reported health status. In the crossover study (22 completed) the partners' objective sleep quality did not differ between CPAP and placebo, but they reported benefit from treatment of the patients with CPAP in subjective sleep quality (p=0.05) and disturbance to sleep (p=0.03). The reported change in partners' sleep quality between pre-study and following CPAP treatment correlated positively with CPAP use (r=0.5, p=0.01). CONCLUSIONS: Partners of patients with SAHS have poor sleep quality and self-reported health status but only subjective sleep quality benefits from treatment of the patient with CPAP.

Cross-Over Studies↗