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PubMed1997

An instrument to measure functional status outcomes for disorders of excessive sleepiness.

This article reports the development of the functional outcomes of sleep questionnaire (FOSQ). This is the first self-report measure designed to assess the impact of disorders of excessive sleepiness (DOES) on multiple activities of everyday living. Three samples were used in the development and psychometric analyses of the FOSQ: Sample 1 (n = 153) consisted of individuals seeking medical attention for a sleep problem and persons of similar age and gender having no sleep disorder; samples 2 (n = 24) and 3 (n = 51) were composed of patients from two medical centers diagnosed with obstructive sleep apnea (OSA). Factor analysis of the FOSQ yielded five factors: activity level, vigilance, intimacy and sexual relationships, general productivity, and social outcome. Internal reliability was excellent for both the subscales (alpha = 0.86 to alpha = 0.91) and the total scale (alpha = 0.95). Test-retest reliability of the FOSQ yielded coefficients ranging from r = 0.81 to r = 0.90 for the five subscales and r = 0.90 for the total measure. The FOSQ successfully discriminated between normal subjects and those seeking medical attention for a sleep problem (T157 = -5.88, p = 0.0001). This psychometric evaluation of the FOSQ demonstrated parameters acceptable for its application in research and in clinical practice to measure functional status outcomes for persons with DOES. Thus, the FOSQ can be used to determine how disorders of excessive sleepiness affect patients' abilities to conduct normal activities and the extent to which these abilities are improved by effective treatment of DOES.

Activities of Daily Living↗
PubMedDate not supplied

The association between pubertal status and sleep duration and quality among a nationally representative sample of U. S. adolescents.

Many hormones play important roles in both pubertal development and sleep regulation. Because of the possible consequences of impaired sleep, including impaired health and cognition, it is important to examine whether an association between pubertal stage and sleep exists. The aim of this analysis is to examine the association between sleep and adolescent growth and developmental stage in a large sample of adolescents ages 12-16 years from a nationally representative longitudinal study. This analysis used the public-use data set of the National Longitudinal Study of Adolescent Health, an extensive survey of health and behavior among adolescents in the United States. The study included two interviews approximately 1 year apart. Pubertal development, sleep variables, and height are self-reported. Pubertal development scores were calculated by summing responses to three questions for each sex. The sleep variables include sleep duration, frequent insomnia (once/week or more), frequently waking tired (once/week or more), and insufficient sleep. The results indicate a sex difference in the association between sleep problems and pubertal development. Among females, there was a significant increase in sleep problems with increasing pubertal development score, but not among males. The negative association between sleep duration and pubertal development score, however, was significant in both males and females. There is no association between sleep duration and height velocity (inches/year) in this sample. The results, which are based on a large sample size, warrant further examination with more objective measures into the association between sleep and growth and development among adolescents.

Adolescent↗
PubMed2003

Alterations in serum melatonin and sleep in individuals in a sub-arctic region from winter to spring.

METHODS: In a sub-arctic region at 69 degrees N, seven individuals with self-reported insomnia during the 'dark period' and seven without, were followed with repeated measures of melatonin and questioned on ten different sleep variables, from the beginning of January to the vernal equinox in March. RESULTS: The distribution of melatonin over a 24-hour period (five time points) indicated an increase in melatonin levels in both groups in the middle of January and a decrease at the time of year when the sun first rises over the horizon (23rd-24th of January). Moreover, an indication of a delayed phase shift of melatonin secretion was found during the dark period, which returned to "normal" secretion during the night at the equinox in March. Individuals with sleep problems had a slower return to "normal" melatonin secretion than those without sleep problems. A positive correlation between morning tiredness and morning levels of melatonin was found among individuals with sleep disturbances, but not in controls. CONCLUSION: This study indicates changes in the internal circadian rhythm in humans at the end of the annual dark period of winter when there is a rapid increase in the number of hours of sunlight. For vulnerable individuals, the disturbance in sleep, and in particlar morning tiredness, lasts at least until the vernal equinox in March.

Adult↗
PubMed2005

Quality of sleep and quality of life in renal transplantation patients.

INTRODUCTION: Sleep and sleep-related disorders are common among end-stage renal disease patients. In the general population and hemodialysis patients, insomnia impairs health-related quality of life (HRQOL). The aims of this study were to examine the prevalence of sleep problems among renal transplantation patients and the relationship between the quality of sleep and the HRQOL. METHODS: Pittsburgh Sleep Quality Index (PSQI) for measuring quality of sleep, WHOQOL-BREF for quality of life, and Beck Depression Inventory (BDI) were applied to 100 renal transplant patients. RESULTS: Thirty (30%) subjects were "poor sleepers" (global PSQI > 5). Poor sleepers were younger (mean age: 31 vs 37); less educated (mean years of education: 7.80 vs 9.55), and more depressed (mean BDI scores 13.63 vs 7.18). There were significant inverse correlations between global PSQI and physical health (r = -0.31; P < .001) and psychological state (r = -.20; P = .04) with a significant correlation with BDI scores (r = .36; P < .001). The BDI score (P < .001) was the only significant factor of physical health, psychological state, and social functioning. BDI score (P < .001) and education (P < .022) were significant predictors of environmental conditions. CONCLUSION: Sleep problems are not as common among transplant as dialysis patients, but still higher than the general population. Poor sleep seems to be a part of depressive symptomatology. Severity of depression and lower education were more negatively effective factors on the quality of life of these patients than the quality of sleep.

Adult↗
PubMed2001

Daytime sleepiness and other sleep disorders in Parkinson's disease.

BACKGROUND: PD is associated with a variety of sleep problems. The dopamine agonists (DA) pramipexole and ropinirole were recently implicated in causing "sleep attacks" and motor vehicle accidents. METHODS: In order to determine the overall rate of subjective sleep problems in PD and to determine if any factors, including specific medications, correlate with sleep pathology, the authors surveyed consecutive patients with PD seen over a 3-month period in a Movement Disorders Clinic. The authors collected demographic and medication data, and the patients completed the Epworth Sleepiness Scale (ESS), questions assessing the presence of restless legs syndrome (RLS), a modified National Sleep Foundation sleep survey, and specific questions regarding falling asleep while driving. RESULTS: A total of 320 patients completed the questionnaire. The authors eliminated 17, six for incomplete data and 11 for having a primary diagnosis other than PD. The mean age of the remaining 303 patients was 67.1 +/- 10.7 years, and the mean duration of PD was 9.1 +/- 5.7 years. The ESS scores averaged 11.1 +/- 5.9, and in 50.2% of patients the score was abnormally high (>10). Stepwise regression analysis found that sleepiness correlated with longer duration of PD (p < 0.001), more advanced PD (p < 0.004), male sex (p < 0.001), and the use of any DA (p < 0.003). The soporific effects of the three most common DA (pramipexole, ropinirole, and pergolide) were similar. Falling asleep while driving was reported by 63/279 (22.6%) of current drivers and correlated with higher ESS scores (p < 0.05). Other sleep disorders, including RLS, were also frequently reported. CONCLUSION: Daytime sleepiness is common in PD and correlates with more advanced and longer duration of PD, and male sex. The DA were also independently associated with daytime sleepiness, but in this group, no single DA was more culpable than the others.

Adult↗
PubMed2004

Nonpharmacologic treatments for pediatric sleeplessness.

Because of the high prevalence of sleep problems in children and adolescents, as well as the profound negative impact that pediatric sleeplessness has on daytime functioning, pediatric practitioners must be aware not only of the causes of sleeplessness but also how to treat sleep problems effectively with nonpharmacologic interventions. This article provided an overview of common pediatric disorders that present as pediatric sleeplessness and are effectively treated by behavioral interventions. Although more studies on behavioral interventions for pediatric sleeplessness are needed, behavioral approaches have been shown to be effective in addressing concerns related to bedtime problems, night wakings, insufficient sleep, insomnia, and DSPS. Behavioral interventions are effectively used for children with special needs, including developmental disabilities, ADHD, and mood disorders.

Behavior Therapy↗
PubMed1983

Sleep behavior of preterm children at three years of age.

Caregivers of 50 preterm children completed a questionnaire relating to their child's sleep behavior at three years of age. Assessments of the children's EEGs at term and three months, medical status at birth and at four, nine and 24 months, caregiver-child interaction at one, eight and 24 months, the Bayley Scales at 25 months and the Stanford-Binet at five years of age were also obtained. Sleep disturbances were frequently noted at three years of age. However, by five years of age, the number of reported sleep-problem children was greatly reduced, and they were not the same children with sleep problems at three years. Surprisingly, children with the greatest difficulty falling asleep at night at three years were likely to have had fewer medical problems, higher scores on the Bayley scales, and more positive social interactions with their caregivers in the first two years. The relationships among early physical, psychological and social development and sleep behavior are discussed.

Age Factors↗
PubMedDate not supplied

Prevalence of sedative drug use in geriatric in-patients: a multi-centre study.

OBJECTIVE: This cross-sectional study registered the prevalence of sedative drug use and withdrawal strategies in geriatric in-patients from 30 centres in nine European countries. METHODS: We conducted a survey among young geriatricians using a standardised questionnaire on sedative drug use for more than three weeks. The study population consisted of 1972 in-patients aged 75 years or older. Acute care (620), intermediate care/rehabilitation (359), long-term care (261), terminal care (47) and nursing home (685) settings were represented. The pre-specified outcomes included the prevalence of sedative drug use; the identification of main prescribers and main reasons for prescribing and, the assessment of withdrawal policy, including psychological counselling and involvement of general practitioners. RESULTS: Prevalence of sedative use was highest in long-term care (72%), followed by nursing homes (70%) and terminal care (59%). Geriatricians started prescribing sedatives after admission on 52% of all occasions. The main reasons for prescribing were continuation of medication taken at home (37%), sleep problems emerging after admission (26%) and post-admission worsening of existing sleep problems (20%). Most prescribers (70%) applied an active withdrawal policy. Short-term withdrawal programmes were mostly applied (57%). Most patients (60%) were psychologically counselled during withdrawal from sedatives. General practitioners were often (60%) involved in withdrawal policy. CONCLUSION: The prevalence of prescription of sedative drugs in geriatric in-patients is high. Appropriate setting specific guidelines are needed to control use of sedatives in geriatric in-patients and to ensure withdrawal from these drugs whenever possible.

Aged↗
PubMed1994

Pediatricians and sleep disorders: training and practice.

OBJECTIVE: A series of studies were conducted to investigate pediatricians' training, knowledge, and practices regarding sleep and sleep disorders in children and adolescents. METHOD AND RESULTS: Study 1, a national survey of 156 pediatric residency programs, found that pediatricians receive a mean of 4.8 hours of instruction on sleep and sleep disorders, although the mode and median hours of instruction is 0 hours. In study 2, 88 pediatricians completing a questionnaire concerning general knowledge about sleep disorders in children and adolescents received a mean score of 71.8% (range, 40% to 93%). Pediatricians appear to know the most about developmental issues and sleep hygiene and the least about specific disorders such as narcolepsy and parasomnias. In the third study, 183 pediatricians were surveyed about their actual beliefs and practices regarding young children's sleep problems. Together, those surveyed reported that approximately 25% of their patients experience some type of sleep problem. Most pediatricians recommend behavioral interventions, although 14.8% of pediatricians report prescribing pharmacological treatments, and 48.9% inform parents that their child is likely to outgrow the problem. CONCLUSIONS: The results of these studies support the need for more education in sleep and sleep disorders in children and adolescents within medical schools, pediatric residency programs, and the practicing pediatric community.

Adolescent↗
PubMedDate not supplied

Sleep disturbance after burn injury.

This study describes sleep disturbance and related factors in a group of 74 patients at 1 week after discharge using a sleep problems questionnaire developed by the authors. Results indicated that a significant proportion of patients reported a problem with their sleep (73%). Several items were identified as highly prevalent, including frequent nighttime awakenings (87%), napping during the daytime (65%), sleeping alone (64%), experiencing pain during the night (62%), and difficulties with sleep onset (62%). Results suggest numerous possible interventions to improve patients' sleep quality. The usefulness of a more extensive questionnaire was also indicated.

Adolescent↗
PubMedDate not supplied

Problems experienced by patients receiving parenteral nutrition at home: results of an open interview study.

BACKGROUND: Home parenteral nutrition (HPN) is offered to patients who are unable to absorb sufficient nourishment from normal oral food intake or tube feeding. Major causes include severe motility disorders and limited resorption surface in the small intestine. HPN is a lifesaving therapy but has severe consequences on daily life. The aim of this study was to make an inventory of the problems experienced by patients receiving HPN. METHODS: Open interviews were held with 48 patients from the 2 major centers for HPN in the Netherlands, centered around the question: Which 3 HPN problems have the most severe impact on your daily life? Data were analyzed using content analysis. RESULTS: The respondents mentioned 7 central problems: negative emotions, physical problems, social limitations, dependence on others, incapability, complications, and patient-care provider problems. In addition, practical problems were mentioned: sleeping problems, financial problems, and the "hospital atmosphere" at home. The latter issues formed less of a problem for the patients. CONCLUSION: The main underlying elements in the lives of many HPN patients appeared to be loss, longing, and grief. In contrast, a smaller proportion of the patients expressed that they had clearly adapted to life with HPN. By means of the HPN, they were still alive and enjoying all the things they could still do.

Adult↗
PubMed1999

[Sleep disorders in healthy children follows often a "learnt" behavioral pattern. Diurnal rhythm disturbances are dominating among children with functional disabilities].

A children's sleep disorders clinic was started as a project supported by the Swedish National Board for Health and Welfare in 1994. During the first three years 71 children, 21 girls and 50 boys aged 0.5-26 years, were clinically examined by a child neurologist/somnologist and a child psychologist. Psychological follow-up was offered. Twenty-five children were healthy, in the others several types of medical conditions were found. Twenty-five children were mentally retarded. In children with physical impairments the most common sleep problems were circadian sleep disturbances, in the healthy ones habitual insomnias were the most common finding. Taking a detailed history was important for correct sleep diagnosis and was often therapeutic. In healthy children with habitual insomnia psychological support was often successful. Melatonin was of benefit in circadian sleep disorders, and only in these. Other medications were used in a restrictive way, mostly as a temporary support.

Abnormalities, Multiple↗
PubMedDate not supplied

[Prognostic value of early risk indicators. Longitudinal 3-year study of children at risk].

Four hundred and fifteen Parisian pre-school children were followed for 3 years (1974-1977). Four epidemiological questionnaires carried out at the ages of 3, 9, 18 and 36 months provided information on the familial and social situation as well as the physical and psychological development of the children. A cluster analysis was carried out on the behaviour variables of the 3 year-old children and 3 different groups were identified. Most children (69%) belonged to the first group, characterized by the absence of difficulties or the presence of few minor symptoms and 10% of the children belonged to the third group, a "high risk group" because of the frequency of the symptoms. Children of the "high risk group" and matched controls were followed up till their school entrance (7 years of age) and compared on different variables: health problems, sleep disorders, school problems, psychosomatic symptoms, difficulties in communicating with others. Comparison between the high risk group and controls permits discussion of the predictive value of early functional disorder risk indicators.

Child, Preschool↗
PubMed1997

[Study on quality of sleep and mental health in patients with hyperthyroidism].

Sleep quality and psychical health were investigated with Pittsburgh Sleeping Quality Index (PSQI) and SCL-90 in 128 patients with hyperthyroidism. The results showed that: 1. The PSQI scores of the patients with ages over 35 years old were higher than that less than 35 years old (P < 0.05). 2. Sleep problems occurred in 87.55% of the patients. Sleep quality of 9.38% of patients were worse. The sleep quality of the female patients were better than the male (P < 0.05). 3. Apart from interpersonal sensitivity, paranoid ideation and psychoticism, scores of the rest were higher than the general people (P < 0.05). 10.2% of the patients with hyperthyroidism had psychical problems. 4. Apart from sleep time and using sleep pill, there was a high correlation between the scores of SCL-90 and PSQI (P < 0.05-P < 0.001). The results showed that sleep problems of the patients with hyperthyroidism affected their psychical health. Lower sleep quality was a main dangerous factor which affected psychical health of the patients with hyperthyroidism.

Adult↗
PubMed2006

Relationships between sleep, physical activity and human health.

Although sleep and exercise may seem to be mediated by completely different physiological mechanisms, there is growing evidence for clinically important relationships between these two behaviors. It is known that passive body heating facilitates the nocturnal sleep of healthy elderly people with insomnia. This finding supports the hypothesis that changes in body temperature trigger somnogenic brain areas to initiate sleep. Nevertheless, little is known about how the core and distal thermoregulatory responses to exercise fit into this hypothesis. Such knowledge could also help in reducing sleep problems associated with nocturnal shiftwork. It is difficult to incorporate physical activity into a shiftworker's lifestyle, since it is already disrupted in terms of family commitments and eating habits. A multi-research strategy is needed to identify what the optimal amounts and timing of physical activity are for reducing shiftwork-related sleep problems. The relationships between sleep, exercise and diet are also important, given the recently reported associations between short sleep length and obesity. The cardiovascular safety of exercise timing should also be considered, since recent data suggest that the reactivity of blood pressure to a change in general physical activity is highest during the morning. This time is associated with an increased risk in general of a sudden cardiac event, but more research work is needed to separate the influences of light, posture and exercise per se on the haemodynamic responses to sleep and physical activity following sleep taken at night and during the day as a nap.

Activity Cycles↗
PubMed1998

An investigation into sleep characteristics of children with autism and Asperger's Disorder.

OBJECTIVE: The aim of the study was to investigate the specificity of sleep problems in children with autism and further explore the currently unclear association between sleep problems and daytime behaviour. METHODOLOGY: The Pervasive Developmental Disorder (PDD) group consisted of 31 children with autism and 7 children with Asperger's Disorder ranging in age from 44 to 152 months. The control group consisted of 36 children ranging in age from 63 to 171 months. The children were matched on age and gender, and group-matched on IQ level. A sleep diary was completed by parents over a 2-week period, in addition to several behaviour questionnaires. RESULTS: Results showed that children in the PDD group exhibited qualitatively and quantitatively different sleep patterns to nonautistic control children. CONCLUSIONS: The findings were discussed in light of current literature concerning circadian rhythm dysfunction, social difficulties, and abnormal melatonin levels in children with autism.

Autistic Disorder↗