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PubMed1987

Evaluation and diagnosis of sleep disorders patients.

Using the biopsychosocial model, physicians can thoroughly assess patients with sleep disorders in the office setting. A careful sleep history, drug history, general medical assessment, and psychiatric evaluation along with an appraisal of the interplay between the patient's condition and his environment can provide all of the elements needed for diagnosis and treatment formulation. The main components of the sleep history include: defining the specific sleep problem, assessing the disorder's clinical course, differentiating between sleep disorders, evaluating the sleep-wakefulness patterns, questioning the bed partner, and obtaining a family history of sleep disorders. The drug history provides important information regarding the role of various medications, which may cause sleep difficulty during their administration or following withdrawal. Implementing a complete medical assessment is necessary for the identification of certain medical conditions that may be associated with sleep disorders. Finally, a thorough psychiatric evaluation and assessment of the psychosocial consequences of the patient's disorder should be conducted. In general, sleep laboratory diagnostic studies are of limited usefulness. These studies are indicated primarily when sleep apnea is suspected or when the sleep attacks of narcolepsy are present in the absence of auxiliary symptoms.

Adult↗

PubMed2006

Sleep impairment in patients with painful diabetic peripheral neuropathy.

OBJECTIVE: This study evaluated sleep impairment associated with painful diabetic peripheral neuropathy (DPN), a neuropathic pain condition. Sleep is of critical concern for DPN because sleep impairment and its comorbidities may influence type 2 diabetes progression. METHODS: This is a supplemental analysis of sleep data from a burden of illness study of patients with painful DPN (N=255, 61+/-12.8 y old, 51.4% women). Sleep was evaluated using the Medical Outcomes Study Sleep measure (MOS-Sleep). MOS-Sleep scores were compared with general population norms (N=1011), the MOS chronic disease sample (N=3445), and patients with postherpetic neuralgia (N=89). The MOS-Sleep Sleep Adequacy score was compared with data from the MOS diabetes subsample (N=590). RESULTS: Patients with painful DPN reported impaired sleep relative to the general population (P<0.001), the chronic disease sample (P<0.001), and postherpetic neuralgia patients (P<0.05). Self-rated MOS-Sleep Sleep Adequacy was significantly less for the painful DPN than for the diabetes sample (P<0.001), although self-reported hours of sleep were not significantly different. Multiple regression indicated that age, average daily pain, and anxiety and depression symptom levels were each significantly (P<0.01) associated with, and collectively accounted for, 47% of variance in the MOS-Sleep Sleep Problems Index. DISCUSSION: Painful DPN is associated with considerable sleep impairment. Given the recognized association between sleep impairment, type 2 diabetes and metabolic and affective disturbance, and the known adverse impact of affective disturbance on diabetes self-care, addressing these features-pain, sleep, and affective disturbance-is an important aspect of care for patients with painful DPN.

Adolescent↗

PubMed1991

Prevalence of problem behavior in Dutch children aged 2-3.

The present study provides prevalence data on behavioral and emotional problems in Dutch preschool children from the general population. The Child Behavior Checklist for ages 2-3 (3) was completed by parents of 421 children aged 2-3 living in the Dutch province of Zuid-Holland. Mean 3-week test-retest reliability of the instrument was .79 (pearson correlation) and the mean interparent agreement was .47. The CBCL/2-3 scores correlated positively and significantly (mean r of .65) with the BCL, an instrument designed to measure behavior problems, and not substantially (mean r of -.06) with the MCDI, an instrument to assess the child's level of general development. For each of the 99 problem items the prevalence rates were presented graphically for boys and girls in 6-months age-groups. The prevalence rates of individual problem items ranged from 1% to 80%. Sixteen percent of the items was scored for more than half of the sample, indicating that the behavior covered in these items may be quite common in young preschool children. In this sample 7.8% of the children were estimated to have a behavior problem, which compares well to the rates found in other studies. No age, sex, or SES differences in total problem scores were found. Almost all significant age, sex, and SES differences found for individual items were small. Age differences found for individual problem items probably reflect the growing self-other differentiation in 2-3-year-olds. Analysis of sex differences revealed that boys were rated to be more aggressive and oppositional and as having more developmental problems, and that girls were rated to have more sleep problems. SES differences were found for items which reflect hyperactive, undercontrolled, dependent, and depressed behaviors. Comparison of problem scores for referred and nonreferred preschool children indicated higher scores for referred children on 72 of the 99 problem items. The largest differences were found for the items Doesn't get along with other children, Wants a lot of attention, and Can't concentrate. Based on the total problem score 70 percent of the children could be correctly classified as referred or non-referred. A large percentage of children, however, was incorrectly classified based on the total problem score alone.

Affective Symptoms↗

PubMed2000

Health related quality of life and psychological wellbeing in patients with dilated cardiomyopathy.

OBJECTIVE: To assess the health related quality of life and psychological wellbeing of patients with dilated cardiomyopathy, and relate these to clinical variables and psychological adjustment. DESIGN: Postal questionnaire survey of 99 adult patients with dilated cardiomyopathy, selected at random from a larger database (60.6% response rate). Assessments included the short form 36 (SF-36) health survey, the hospital anxiety and depression scales, the sleep problems index, and a measure of psychological adjustment to cardiomyopathy. RESULTS: Patients with dilated cardiomyopathy reported significant impairments in physical functioning, role limitations owing to physical and emotional problems, social functioning, mental health, perceptions of general health, sleep, and vitality. Anxiety and depression levels were higher than in population samples. Impairment in several domains of quality of life was associated with low shortening fraction, high left ventricular end diastolic diameter, and the presence of heart failure and mitral regurgitation. Patients with familial cardiomyopathy had less impairment in quality of life than those with non-familial disease. Psychological adjustment scores were associated with several aspects of quality of life and emotional wellbeing. In multivariate analysis, demographic and clinical variables accounted for 0.1-40.7% of the variance in different domains of quality of life, and psychological adjustment scores accounted for an additional 0.5-22.4% of variance. CONCLUSIONS: Patients with dilated cardiomyopathy experience pronounced restrictions in quality of life and psychological wellbeing. These limitations are only partly accounted for by symptoms and the severity of underlying disease. Patients may benefit from efforts to improve psychological adjustment to the condition.

Adolescent↗

PubMed2001

Sleep and sleep disorders in pregnancy.

Sleep problems are common in pregnant women. This review examines sleep in normal pregnancy; discusses the physiologic bases for alterations in sleep, including hormonal and mechanical factors; and correlates these factors with changes in sleep of pregnant women, as determined subjectively by surveys and objectively by polysomnographic studies. The changes in respiratory physiology during pregnancy, the possible predisposition of the pregnant woman to sleep-disordered breathing because of these changes, and results of published studies of sleep-disordered breathing in pregnancy are discussed. Finally, the effect of pregnancy on other sleep disorders and the management of these sleep disorders during pregnancy are outlined, including changes in management necessitated by this state. The paucity of available data and the need for further studies of incidence and outcomes of sleep disorders in the pregnant woman are emphasized.

Central Nervous System↗

PubMed2001

Correlates of global sleep dissatisfaction in the German population.

STUDY OBJECTIVES: Global sleep dissatisfaction (GSD) is not part of the habitual insomnia symptoms in epidemiological studies. Furthermore, none of these studies has examined the relative importance of the various factors correlated to sleep dissatisfaction. This study aims to examine the links between GSD and insomnia and to find the factors contributing to GSD. DESIGN: A cross-sectional telephone survey was conducted in Germany (66 million inhabitants 15 years of age or older) with a representative sample of 4,115 subjects aged 15 years or older. Interviewers used the Sleep-EVAL system. The questionnaire covered several topics that were grouped into six classes of variables identified as potential factors associated with sleep dissatisfaction: sociodemographic descriptors, environmental factors, life habits, health status, psychological factors, sleep/wake factors. SETTING: N/A. PARTICIPANTS: A representative sample of 4,115 subjects aged 15 years or older INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Overall, 7% of the subjects reported being GSD; 95.5% of them had at least one insomnia symptom. The duration of insomnia symptom(s) was 20 months longer in GSD subjects compared to insomnia subjects without GSD. The prevalence of GSD was higher in women than in men and increased with age. The most significant predictive factors for GSD were: 1) for sleep/wake schedule variables: night sleep duration less than 6 hours (OR: 4.0 and over) and sleep latency greater than 30 minutes. 2) for sociodemographic variables: age between 65 and 74 (OR: 6.7) 3) for health variables: Upper airway disease (OR: 7.1); 4) for mental health variables: anxiety symptoms (OR: 3.0); 5) for environmental factors: too hot bedroom (OR=2.5) 6) for life habit factors: the need of a particular object in order to fall asleep (OR: 2.4). CONCLUSIONS: This study confirms that GSD is a better indicator of an underlying pathology than the classical insomnia symptoms alone: compared to insomniac subjects without GSD, subjects with GSD were two times more likely to report excessive daytime sleepiness, and eight times more likely to have a diagnosis of sleep or mental disorder. Furthermore, in car drivers, road accidents in the previous year were two times more frequent with GSD drivers as compared to insomnia drivers without GSD. Subjects with GSD were more than 10 times more likely to seek help for their sleep problems and five times more likely to use a sleep medication than insomnia subjects without GSD.

Adolescent↗

PubMed2006

Sleep issues in children with physical disabilities and their families.

Sleep has a significant impact on the daily functioning of children and their parents. The purpose of this study was to describe the sleep patterns, issues, and strategies used to facilitate sleep in children with and without physical disabilities and their families. Data were collected from questionnaires completed by caregivers and siblings. Caregivers of children with physical disabilities reported significantly greater concerns regarding general sleep problems, safety, and discomfort at night, night wakening, daytime irritability, interference with daytime activities and sleep-related health concerns in children with physical disabilities than in their counterparts. Caregivers, but not siblings, in families of children with physical disabilities experienced an increased prevalence of sleep issues. The most frequently cited strategies to alleviate problems were the establishment of consistent routines and provision of calming, supportive sleep environments. Pediatric therapists need to assess and address sleep issues to promote the well-being of children and their families.

Adolescent↗

PubMed1989

[Snoring: physiopathology, surgical treatment and a modified uvulo-palato-pharyngoplasty].

Sleep apnea, now recognized as a specific clinicopathological entity, had received little attention until late 1960 when described by Gastaud. Since that time, following the works of Ikematsu, Guillemineault and Fujita, there has been rapid extension in the knowledge and understanding of sleep problems and associated surgery. Snoring, whether part of the sleep apnea syndrome or alone, may be explained with the help of an aerodynamic model comparing the pharynx to a Starling resistance. The factors nasal obstruction, abnormal mass in the upper respiratory airways and transmural resistance are discussed in the light of this model. To modify some of the above factors, surgical techniques have been described. We feel these conventional techniques do not take into account the normal healing process of inverted double C scars. We have modified the classic technique by sectioning the palatopharyngeus muscle and used Z-plasty to close the surgical defect. This is followed by a limited resection of the soft palate. As a consequence, the soft palate is being brought forward in the healing process and the oropharynx AP diameter is enlarged. This minimal type of resection of the soft palate precludes complications of velopharyngeal incompetency or relative pharyngeal stenosis. We have studied 200 snorers and operated on 90 of them, 25 according to the standard technique and 65 with the modified technique. The modified technique, while limiting the amount of palate to be removed and also the morbidity, is easy to standardize and offers as good results with fewer risks.

Adult↗

PubMed1983

[Clinico-physiologic analysis of sleep disorders among patients with borderline states].

In patients with an anxious syndrome of the neurotic genesis, complaints of sssleep disorders correlate with the clinical pattern of asthenic disturbances and objective changes in the sleep character (a reduction in delta-leep, frequent awakenings). In cases of hysterical neuroses, there is a dissociation between the intact structure of sleep and the absence of asthenic symptomatology on the one hand and complaints of marked sleep disturbances on the other. In cases of neurosis-like schizophrenia despite a reduction in delta-sleep, asthenic symptomatology is almost absent and complaints of sleep problems are rather formal in nature. The pathogenesis of sleep disorders in neurotic patients, including the role of anxiety in objective sleep pattern alternations, is discussed. A hypothesis relating the specific characteristics of thought to a diminished need for delta-leep in schizophrenics is proposed.

Adolescent↗

PubMedDate not supplied

Sleep: what is normal at six months?

Health visitors and general practitioners are often asked for help because of what parents perceive as a baby's sleeping problem. Many parents expect that the baby will be sleeping continuously through the night from a given age, often as early as six weeks old. The conflict between the parents' expectations and the baby's behaviour leads the parents to seek help. Analysis of the first 640 questionnaires received from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Study show that many six-month-old babies have broken nights. Only 16% slept through the night at six months old. Half woke occasionally, 9% woke most nights, 5% woke once every night and a further 17% woke more than once per night, ranging from twice to eight times. For 16% of six-month-olds there was no regular sleeping pattern. Parents use a variety of strategies when the baby wakes at night, including rocking or cuddling, giving a dummy or feeding with milk or another drink. By six months old, 61% of babies slept in a room on their own, but 15% were always or usually brought into the parents' bed if they woke, and 34% sometimes 28% of babies aged six months routinely slept in the parents' bedroom. Knowing that their baby's behaviour pattern is "normal" and shared by many other babies of the same age is often reassuring to parents.

Child Development↗

PubMed2004

Increased utilization of health services by insomniacs--an epidemiological perspective.

OBJECTIVES: Epidemiological data describing the prevalence of sleep complaints in Hungary and its region are lacking; furthermore, limited information is available on health care use by individuals with sleep complaints. We assessed the prevalence of sleep complaints, insomnia in particular, in a nationally representative sample of the Hungarian population and assessed health care utilization by insomniacs. METHODS: Cross-sectional study, enrolling a nationally representative sample (N=12,643) of the adult Hungarian population. A battery of questionnaires was administered during a home interview. The Athens Insomnia Scale (AIS), additional questions on sleep behavior, as well as questions on current medical therapy for somatic and mental disorders were included in the battery of questionnaires administered. Psychosocial and demographic characteristics were also tabulated. RESULTS: Forty-seven percent of the sample reported at least one complaint related to sleep. Based on the AIS we report a 9% prevalence of insomnia in the total sample. Sleep deprivation was highly prevalent in the younger and middle-aged groups. The frequency of sleep problems increased with age. Individuals diagnosed with insomnia reported more frequent utilization of health services, including sick leave, emergency visits and hospitalization, than those without insomnia. CONCLUSION: Sleep complaints and sleep deprivation are frequent problems in the Hungarian population and are associated with increased health care utilization. The prevalence of insomnia in our sample was similar to what has been previously reported from other countries. The high prevalence of sleep-deprived individuals warrants further attention. Interventions that effectively improve insomnia may also reduce health care utilization by the affected individuals.

Adult↗

PubMed2006

Sleep complaints and their relation with drug treatment in patients suffering from Parkinson's disease.

The aim of this research was to quantify sleep problems in patients suffering from Parkinson's disease by means of the new Parkinson's Disease Sleep Scale (PDSS) and to correlate such problems with the possible influence of current drug treatment. A total of 70 patients (36 men and 34 women) with a diagnosis of Parkinson's disease were enrolled. Their mean age was 69.7 +/- 8.2 years, and duration of disease was 7.4 +/- 4.8 years. All patients completed the PDSS and the Unified Parkinson's Disease Rating Scale (UPDRS Parts I-IV). Drug consumption and doses were registered. The mean score on the PDSS scale was 109.23 +/- 19.75 and on the UPDRS III scale was 25.24 +/- 11.35. The lowest scores were obtained in Item 3 (sleep fragmentation): 5.53 (2.46); and in Item 8 (nocturia): 5.75 (2.91). There was a weak correlation between the PDSS and UPDRS III (cc = -0.355, P = 0.003), PDSS and UPDRS I (cc = -0.272, P = 0.02), and PDSS and UPDRS IV (cc = -0.416, P < 0.001). Motor conditions, mental state, and drug complications influence sleep quality. Although this effect was significant, it was not of a great magnitude. Dopaminergic drugs did not increase daytime sleepiness. As a whole, sleep quality in patients who took dopaminergic agonists did not differ from that of patients who took levodopa in monotherapy.

Aged↗

PubMed2001

Emotional and behavioural problems in a sample of Finnish three-year-olds.

Behavioural and emotional problems in Finnish three-year-olds was studied using the Child Behavior Checklist for ages 2-3 as a standardised rating scale at well-baby clinics in two cities in Finland. Altogether 374 questionnaires were analysed which is 71% of the target population. When compared with studies from other countries the mean scores and prevalences of preschool children's problem behaviours were rather similar. Boys were reported to be more destructive than girls. Parental education level, living in one-parent family and parental unemployment were associated with a higher level of problem behaviours. No significant differences were found in emotional or behavioural problems related to the child's day care. Co-sleeping with parents was associated with sleep problems.

Affective Symptoms↗

PubMedDate not supplied

Omega-3 fatty acids in boys with behavior, learning, and health problems.

The purpose of the study reported here was to compare behavior, learning, and health problems in boys ages 6 to 12 with lower plasma phospholipid total omega-3 or total omega-6 fatty acid levels with those boys with higher levels of these fatty acids. A greater frequency of symptoms indicative of essential fatty acid deficiency was reported by the parents of subjects with lower plasma omega-3 or omega-6 fatty acid concentrations than those with higher levels. A greater number of behavior problems, assessed by the Conners' Rating Scale, temper tantrums, and sleep problems were reported in subjects with lower total omega-3 fatty acid concentrations. Additionally, more learning and health problems were found in subjects with lower total omega-3 fatty acid concentrations. (Only more colds and more antibiotic use were reported by those subjects with lower total omega-6 fatty acids). These findings are discussed in relation to recent findings for omega-3 experimentally deprived animals.

Child↗

PubMed2000

Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders.

Patients with end-stage renal disease (ESRD) have an annual mortality rate exceeding 20%, although some survive many years. The ESRD population has a high incidence of sleep disorders, including sleep apnea and periodic limb movements in sleep (PLMS). Sleep disorders result in sleep deprivation, which can negatively affect immune function and cardiovascular-related outcomes, common causes of death in patients with ESRD. This study examined predictors of mortality in patients with ESRD with sleep problems. Twenty-nine consecutive patients with ESRD reporting disrupted sleep or daytime sleepiness were studied by all-night polysomnography. All patients were followed up until death, transplantation, or study termination. Among the variables studied, including such previously reported predictors as serum albumin level, urea reduction ratio, and hematocrit, only the PLMS index (PLMSI), arousing PLMSI (APLMSI), and total number of arousals per hour of sleep significantly predicted mortality. The 20-month survival rate with a PLMSI less than 20 was greater than 90% versus 50% for a PLMSI of 20 or greater (exact log-rank, P = 0.007). For the deceased versus survivor groups, mean PLMSI was 119.1 versus 19.8 (P = 0.01) and APLMSI was 48.1 versus 7.8 (P = 0.00006), with a mean survival of 10.3 versus greater than 25.5 months, respectively (P = 0.001). Median survival of patients with a PLMSI greater than 80 was only 6 months. PLMSI, APLMSI, and total arousals per hour of sleep were strongly associated with mortality in patients with ESRD with sleep disorders independent of other factors and may be novel predictors of near-term mortality.

Aged↗

PubMed2005

Attachment, sleep quality, and depressed affect.

This study examined the role of attachment insecurity in sleep problems among married adults (N=78 couples). Using the Pittsburgh Sleep Quality Index and structural equation modeling, attachment anxiety was associated with higher levels of self-reported sleep difficulties for men and women, whereas attachment avoidance was not. Depressed affect was included as a control variable, and the effect of attachment anxiety remained significant. Men and women did not differ significantly in the magnitude of the effect of attachment anxiety on sleep quality. In addition, there were no cross-partner effects of attachment insecurity on sleep quality or depressed affect. Implications and future directions are discussed.

Adult↗

PubMed1994

Daytime sleepiness in insomnia: behavioral, biological and subjective indices.

We compared three measures of daytime sleepiness, sleep behavior (as measured by the multiple sleep latency test), a biological index of sleepiness (pupillometry) and subjective sleepiness (as measured by the Stanford Sleepiness Scale), in evaluating middle-aged individuals with psychophysiological insomnia (n = 20) or no sleep problem (n = 20). Subjects underwent polysomnography (PSG) and four multiple sleep latency test/pupillometry trials the following day. The results determined that neither behavioral, biological nor subjective indices distinguished these two groups. Differentiating the insomniacs into true insomniac (n = 14) and normal sleeping insomniac (insomniacs with sleep efficiency greater than 90%, n = 6) subgroups based upon PSG did not improve daytime discriminations. Furthermore, nighttime sleep experience, measured by either PSG or self-report, was not a strong predictor of these daytime indices among either insomniacs or noninsomniacs. The results of this study support the conclusions that insomniacs do not exhibit heightened levels of daytime sleepiness and that routine fluctuations in sleep exert minimal influence on daytime sleepiness among insomniacs and noninsomniacs. The former finding is likely due either to insomniacs satisfying their biological sleep need despite poor sleep or chronic physiological hyperarousal preventing both sleep and sleepiness.

Adult↗

PubMed2005

Actigraphic assessment of sleep in young adults with Asperger syndrome.

A high prevalence of subjective insomnia in adults with Asperger syndrome has been reported. In the present study the sleep quality of these patients was studied using wrist actigraphy. Nineteen adults with Asperger syndrome and frequent feelings of insomnia were compared with 10 controls devoid of neuropsychiatric disorders and subjective sleep problems during six consecutive nights. The patients had similar actigraphic sleep profile to the controls. The subjective low sleep quality in patients was not reflected in actigraphic assessment of sleep. This finding suggests that pervasive anxiety inherent in persons with Asperger syndrome predisposes them to insomnia complaints.

Adult↗