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PubMed2006

Insomnia in Parkinson's disease: frequency and progression over time.

OBJECTIVES: To examine the development of nocturnal sleeping problems in patients with Parkinson's disease (PD) over an 8-year period and to study the clinical and demographic correlates of insomnia. METHODS: 231 patients were included in a population-based prevalence study in 1993, and re-examined in 1997 and 2001. At all study visits, we applied semi-structured interviews to obtain information on clinical and demographic data, as well as on nocturnal sleeping problems. Standardised rating scales of parkinsonism, depression and cognitive impairment were used. The relationship between insomnia and demographic and clinical variables was analysed using population-averaged logistic regression models for correlated data. 231 patients were included at baseline, 142 were available for re-evaluation in 1997 and 89 patients in 2001. RESULTS: Most nocturnal sleeping problems varied little in prevalence over time, whereas problems related to turning in bed and vivid dreaming or nightmares increased. Insomnia was present in 54-60% of the patients at each of the three study visits and varied considerably in individual patients over time. The presence of insomnia was closely related to disease duration, higher Montgomery-Asberg Depression Rating Scale scores and female sex. CONCLUSION: Insomnia is a highly frequent complaint in patients with PD. It fluctuates over time in individual patients, and its origin seems to be multifactorial. Physicians should be aware of the high prevalence of insomnia in patients with PD and should examine their patients for a possible coexisting depression.

Aged↗
PubMed2006

The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study.

OBJECTIVE: Chronic widespread pain (CWP) is strongly associated with psychosocial distress both in a clinical setting and in the community. The aim of this study was to determine the contribution of measures of psychosocial distress, health-seeking behaviour, sleep problems and traumatic life events to the development of new cases of CWP in the community. METHODS: In a population-based prospective study, 3171 adults aged 25-65 yrs free of CWP were followed-up 15 months later to identify those with new CWP. Baseline data were available on their scores from a number of psychological scales including Illness Attitude Scales (IAS), Somatic Symptom Checklist (SSC), Hospital Anxiety & Depression Scale, Sleep Problems Scale, and Life Events Inventory. RESULTS: 324 subjects [10%, 95% confidence interval (CI) 9.2, 11.3] developed new CWP at follow-up. After adjustment for age and sex, three factors independently predicted the development of CWP: scoring three or more on the SSC [odds ratio (OR) 1.8, 95% CI 1.1, 3.1], scoring eight or more on the Illness Behaviour subscale of the IAS (OR 3.3, 95% CI 2.3, 4.8), and nine or more on the Sleep Problem Scale (OR 2.7, 95% CI 1.6, 3.2). Subjects exposed to all three factors were at 12 times the odds of new CWP than those with low scores on all scales. CONCLUSION: Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.

Adult↗
PubMed1999

Television-viewing habits and sleep disturbance in school children.

OBJECTIVE: To investigate the relationship between specific television-viewing habits and both sleep habits and sleep disturbances in school children. METHODS: The parents of 495 children in grades kindergarten through fourth grade in three public elementary schools completed two retrospective survey questionnaires, one assessing their children's sleep behaviors and the other examining television-viewing habits of both the child and the family. Sleep domains assessed included bedtime resistance, sleep onset delay, sleep duration, anxiety around sleep, parasomnias, night wakings, and daytime sleepiness. Teachers from all three schools also completed daytime sleepiness questionnaires (N = 402) for the sample. RESULTS: Most of the television-viewing practices examined in this study were associated with at least one type of sleep disturbance. Despite overall close monitoring of television-viewing habits, one quarter of the parents reported the presence of a television set in the child's bedroom. The television-viewing habits associated most significantly with sleep disturbance were increased daily television viewing amounts and increased television viewing at bedtime, especially in the context of having a television set in the child's bedroom. The sleep domains that appeared to be affected most consistently by television were bedtime resistance, sleep onset delay, and anxiety around sleep, followed by shortened sleep duration. The parent's threshold for defining "problem sleep behavior" in their child was also important in determining the significance of the association between sleep disturbance and television-viewing habits. CONCLUSION: Health care practitioners should be aware of the potential negative impact of television viewing at bedtime. Parents should be questioned about their children's television-viewing habits as part of general screening for sleep disturbances and as part of anticipatory guidance in regards to healthy sleep habits in children. In particular, the presence of a television set in the child's bedroom may be a relatively underrecognized, but important, contributor to sleep problems in school children.

Analysis of Variance↗
PubMed1996

Self-reported sleep disturbance among African-American elderly: the effects of depression, health status, exercise, and social support.

The prevalence and correlates of self-reported difficulties in initiating and maintaining sleep were investigated for a sample of 998 Black elderly. In terms of prevalence, only 68.3 percent of this sample had no trouble falling asleep. Over 14.5 percent of men and 23.6 percent of women participants in this study reported sleep latencies exceeding thirty minutes. Almost 13 percent reported getting less than four hours of sleep at night. Moreover, 14.5 percent of participants wake up at least three times during a typical night's sleep other than to use the bathroom and 45.3 percent said when they wake up during the night, they remain awake at least thirty minutes before falling back to sleep. Compared to men, women reported longer sleep latency, waking up more frequently at night, and were more likely to visit a health practitioner for sleeping problems. Multivariate analysis indicates that self-reported sleep problems were significantly greater among Black elderly who were women, with a higher level of depression/anxiety, those with a higher number of chronic illnesses, those who did not exercise, and those who reported lower levels of emotional social support.

Black or African American↗
PubMed2004

Health and performance factors in health care shift workers.

OBJECTIVES: To assess the impact of shift work on health care workers. SUBJECTS AND METHODS: A cross-sectional study assessed health and performance markers of 188 day and night shift nonphysician health care workers. RESULTS: Night-shift workers were more likely to report difficulty with routine orders, lower energy levels, unpredictable work schedules, and sleep disturbance but no difference with injuries or motor vehicle crashes. A classification of day shift, night shift without unpredictable schedule or sleep problems, and night shift with unpredictable schedule or sleep problems revealed a trend of increased difficulty with routine orders, suggesting a "dose response effect." CONCLUSIONS: Findings suggest an association with night shift health care workers and adverse health and performance markers. A "higher-risk" subgroup may benefit from targeted interventions to reduce potential adverse effects from shift work and improve health care delivery.

Adult↗
PubMed2005

Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.

This study aimed at investigating the relationships between work-related psychosocial factors, worry about work conditions and health complaints (sleeping problems, headache and stomach symptoms) among female and male ambulance personnel. Out of 4000 ambulance personnel in Sweden, 1500 (300 female and 1200 male personnel) were randomly selected. They answered a questionnaire including items on self-reported health complaints, individual characteristics, work-related psychological demands, decision latitude, social support and worry about work conditions. Twenty-five per cent of the female and 20% of the male ambulance personnel reported two or more health complaints sometimes or often. According to the demand-control-support questionnaire, ambulance personnel reported a generally positive psychosocial work environment, although psychological demands were associated with sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Another factor that was significantly associated with health complaints among both genders was worry about work conditions. When worry about work conditions was added to the regression models, this variable took over the role from psychological demands as a predictor for health complaints among the female ambulance personnel. The prevalence of sleeping problems, headache and stomach symptoms were significantly associated with psychological demands among both female and male ambulance personnel. Notably, worry about work conditions seems to be an important risk factor for health complaints. This suggests that worry about work conditions should not be neglected when considering risk factors among ambulance personnel.

Adult↗
PubMed2005

A longitudinal follow-up study of young children's sleep patterns using a developmental classification system.

Sixty-eight families participated in a longitudinal study that included video observations of sleep during the 1st year of life and annual follow-up phone interviews until the children were 4 years of age. Results revealed that approximately 19% of children have a sleep problem at 2 years of age, defined either by research criteria or parental report, and that sleep problems diminished over time. Approximately 25% of children were reported to be cosleeping at each follow-up interview, but only a third of the parents reported this behavior to be problematic. A subgroup of infants (33%), who were considered stable, non-self-soothers in the 1st year, were more likely to have a sleep onset problem and be cosleeping at the 2-year follow-up assessment.

Age Factors↗
PubMedDate not supplied

Exploring the complexity of sleep disturbances in persons with HIV/AIDS.

Sleep disturbances are influenced by physiological, psychological, and environmental factors. Many persons living with HIV/AIDS manifest a variety of sleep disorders. Although completion of a brief sleep assessment can be helpful to determine the presence of a sleep problem, more in-depth investigation is necessary when sleep problems are reported. This pilot work used an open-ended interview guide developed from elements of Hauri's comprehensive sleep history. A convenience sample of six HIV-positive clients was interviewed during January 1997. In addition to answering open-ended questions about sleep-wake patterns, participants completed the Pittsburgh Sleep Quality Index and a personal characteristics form. HIV-severity information was obtained from the medical record. A complete sleep evaluation includes a thorough history and physical assessment, with a special focus on underlying pathology and medication use such as over-the-counter drugs, vitamins and herbal products, and mood-altering substance use. Treatment plans can include instruction about a variety of cognitive behavioral strategies. The nurse plays a major role in assessing, evaluating, teaching, and referring, which can contribute to identification of strategies that can improve quality of life.

Adult↗
PubMed2004

Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting: the Quality of Sleep in Allergic Rhinitis study.

BACKGROUND: Sleep disturbances due to allergic rhinitis can contribute to daytime fatigue, impair mood, and decrease daytime functioning. OBJECTIVE: To measure allergic rhinitis patients' nocturnal rhinitis-related quality of life using a new, validated disease-specific instrument, the Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ). METHODS: This open-label study was conducted in a primary care setting. Adult patients with seasonal or perennial allergic rhinitis rated nocturnal rhinitis-related quality of life using the NRQLQ and sleep disturbances using the Pittsburgh Sleep Quality Index (PSQI) at baseline and after 3 weeks of treatment with triamcinolone acetonide aqueous nasal spray (TAA AQ), 220 microg/d. Changes from baseline in overall and individual domain scores for both the NRQLQ and PSQI were evaluated using t tests for paired differences. RESULTS: The majority of the patients (N = 651) were female (58%), were white (85%), and shared a bed with a partner (63%). Mean +/- SD patient age was 45.7 +/- 15.5 years. TAA AQ treatment was associated with significant improvements in overall NRQLQ score (mean +/- SD change, -1.5 +/- 1.3; P < .001) and in individual domain scores (P < .001 for sleep problems, symptoms during sleep, symptoms upon waking in morning, and practical problems). Similarly, overall and individual PSQI domain scores were statistically significantly improved (P < .001). There were strong correlations between NRQLQ and PSQI scores (all comparisons P < .001). CONCLUSIONS: Treatment with TAA AQ for 3 weeks resulted in statistically significant improvements in nocturnal rhinitis-related quality of life and sleep quality in allergic rhinitis patients treated in a primary care setting.

Administration, Intranasal↗
PubMed2000

Habitual snoring in an outpatient population in Japan.

In order to investigate the occurrence and history of sleep problems in Japan, the 11-Centre Collaborative Study on Sleep Problems (COSP) project was carried out. Complaints of snoring are examined, and its prevalence, risk factors and screening reliability are discussed. The subjects who participated in the study were 6445 new outpatients from a general hospital. They were asked to answer a sleep questionnaire that consisted of 34 items with seven demographic items; each item was composed of four grades of frequency. In order to offset possible seasonal variations in sleep habits, data were collected across four seasons. Sleep patterns, insomnia, hypersomnia, parasomnia and circadian rhythm sleep disorders were covered. Habitual snoring was seen in 16.0% of males and 6.5% of females. Male predominance was noted. From these data, the relationship between habitual snoring and sleep complaints was statistically analyzed. Habitual snorers (HS) were observed to wake up more frequently during sleep (17.8% of males, 21.5% of females) than were non-habitual snorers (NHS; 6.6% of males, 9.7% of females). Mid-sleep awakening of HS was also more frequent than it was for NHS; however, there were no differences in difficulty in falling asleep and early morning awakening. Body mass index, cigarette smoking and alcohol consumption were also correlated with habitual snoring.

Adult↗
PubMed1993

Sleep disorders in children.

Many children experience some type of sleep problem. Often, these are transient problems with no long-lasting sequelae. But in certain cases, sleep problems may significantly impact on functioning and well-being. Sleep disorders in children can be classified into two major categories. Dyssomnias include those disorders that result in difficulty either initiating or maintaining sleep or involve excessive sleepiness. Parasomnias are disorders that disrupt sleep after it has been initiated but do not result in complaints of insomnia or excessive sleepiness. Even though sleep disorders in children are common, not enough is known. This article reviews the dyssomnias and parasomnias experienced by children, discusses methodological limitations of the studies reviewed, and presents future directions for research in this field.

Adolescent↗
PubMed2002

Nonpharmacologic sleep promotion: bright light exposure.

This paper presents findings on utilizing bright light to entrain the sleep-wake cycle in order to improve the perceived quality of sleep.The feasibility of including bright light as one of the nonpharmacologic nursing interventions for sleep promotion is discussed. A decade ago, nurses relied on sleeping pills to solve patients' sleep problems (Halfens et al. 1991). Reported obstacles to the development of sleep management tools included insufficient knowledge of sleep (Edéll-Gustafasson et al. 1994) and unfamiliarity with effective nursing methods for tackling sleep problems (Halfens et al. 1991). Ten years later, nurses took the initiative in sleep promotion activities. In their book, Morgan and Closs (1999) introduced several sleep management methods in nursing practice. Floyd et al. (2000) summarized that 12 nonpharmacologic interventions used by nurses in the past to promote sleep. These 12 interventions are categorized according to their mechanism of action as relaxation, noise management, circadian repatterning and sleep hygiene. Light is thought to regulate the circadian system (Dawson & Van den Heuvel 1998) as a major synchronizer of endogenous circadian cycles (Dijk et al. 1995).

Aged↗
PubMed2006

[Attention deficit-hyperactivity disorder and sleep disorders].

The attention deficit hyperactivity disorder (ADHD) is an heterogeneous, complex and common childhood disorder that causes significant impairment of child's functioning. This paper reviews the epidemiology, etiology, diagnosis, comorbidity, course and treatment of ADHD. Special attention is paid to sleep problems both because these 2 conditions frequently co-exist and because there is substantial evidence that ADHD psychopathology and sleep-wake regulation share common neurobiologic mechanisms. Moreover, there could be an overlap between symptoms of ADHD and certain sleep problems such as obstructive sleep apnea syndrome, restless leg syndrome and periodic limb movements of sleep. Children undergoing evaluation for ADHD should be systematically assessed for sleep disturbances because treatment of sleep disorders is often associated with improved symptomatology and decreased need for stimulants.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Evaluating the effects of medical disorders on sleep in the older patient.

Older adults often experience sleep disturbances, but most fall to mention these sleep problems to their physicians out of a false belief that sleep troubles are just a consequence of getting older. On the contrary, sleep complaints in older adults are often the result of medical or psychiatric illnesses that can be managed, resulting in a return to restful sleep. It is important for physicians and patients to communicate about sleep disturbances, and for physicians to ask appropriate questions targeted at identifying the underlying cause of the sleep problem, particularly in patients with chronic medical conditions.

Aged↗
PubMed1994

Family relationships and infant feeding problems.

Feeding and associated sleep problems with young babies are often linked to relationship difficulties between the parents themselves, and to their own family experiences as children, writes child psychotherapist DILYS DAWS. Here she describes her work within the primary health care team to help parents explore and resolve these emotional and practical issues.

Adult↗
PubMed2002

The Parkinson's disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson's disease.

BACKGROUND: No formal instruments are available for quantifying sleep problems in Parkinson's disease. OBJECTIVE: To develop a new sleep scale to quantify the various aspects of nocturnal sleep problems in Parkinson's disease, which may occur in up to 96% of affected individuals. METHODS: Employing a multidisciplinary team approach, a visual analogue scale was devised addressing 15 commonly reported symptoms associated with sleep disturbance in Parkinson's disease-the Parkinson's disease sleep scale (PDSS). In all, 143 patients with Parkinson's disease completed the PDSS, covering the entire spectrum of disease from newly diagnosed to advanced stage. As controls, 137 age healthy matched subjects also completed the scale. Test-retest reliability was assessed in a subgroup of subjects. The Epworth sleepiness scale was also satisfactorily completed by 103 of the patients with Parkinson's disease. RESULTS: PDSS scores in the Parkinson group were significantly different from the healthy controls. Patients with advanced Parkinson's disease had impaired scores compared with early/moderate disease. Individual items of the scale showed good discriminatory power between Parkinson's disease and healthy controls. Relevant items of the PDSS correlated with excessive daytime sleepiness. The scale showed robust test-retest reliability. CONCLUSIONS: This appears to be the first description of a simple bedside screening instrument for evaluation of sleep disturbances in Parkinson's disease. A combination of subitems may help identify specific aspects of sleep disturbance, which in turn may help target treatment.

Adult↗
PubMed2002

Symptoms of sleep disturbances among children at two general pediatric clinics.

OBJECTIVE: We assessed the frequency of childhood sleep problems at 2 general pediatric clinics. STUDY DESIGN: Parents of 1038 unselected children (554 boys) aged 2.0 to 13.9 years completed a validated Pediatric Sleep Questionnaire while waiting for appointments. RESULTS: Habitual snoring was reported in 176 (17%) of the children. Criterion scores suggestive of sleep-disordered breathing were found in 115 (11%) of the children, in 29% of children at the clinic for neurologic indications, and in 21% of children at the clinic for noninfectious respiratory indications. Insomnia (ie, unrefreshing sleep or difficulty with sleep onset, sleep maintenance, or early morning awakening from sleep) was reported in 430 (41%) of the children; > or =2 symptoms were present in 191 (18%) of the children. Excessive daytime sleepiness was suggested in 148 (14%) of the children, and 390 (38%) had symptoms of sleep terrors, sleepwalking, or nocturnal bruxism. CONCLUSIONS: Sleep problems such as sleep-disordered breathing, insomnia, excessive sleepiness, and parasomnias are frequent among children seen at general pediatric practices.

Adolescent↗