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PubMed2000

Time in bed, quality of sleep and school functioning of children.

This study describes the relationship of time in bed and quality of sleep with concentration and functioning at school. Neurotic and psychosomatic symptoms have been used as control variables. The sample consisted of 449 Dutch children in the seventh and eighth grades of elementary school. The age of the children varied between 9 y 5 mo and 14 y 5 mo. Seven schools participated in the research, with a total of 18 classes. The results indicated that 43% of the children had difficulty getting up in the morning. Furthermore, 15% of the children reported sleep problems and 25% did not feel rested at school. Time in bed and sleep quality show no relationship with concentration. Sleep quality, feeling rested at school and less distinct bedtimes were clearly related to school functioning. Another result was that children who had no difficulty getting up displayed more achievement motivation. Being open to the teacher's influence and achievement motivation depended mainly on sleep characteristics. Not getting bored at school, self-image as a pupil and control over aggressive behaviour were also influenced by gender, age, neuroticism and neurosomaticism.

Achievement↗

PubMed1996

[Coincidence of anxiety and sleep disorders. Overview and case reports].

Anxiety disorders and sleep disorders show various interrelations. This paper stresses the clinical importance of sleep problems in relation to anxiety disorders and of anxiety symptoms in patients with sleep disorders, in context with the relevant literature. Differential diagnostic aspects of overlapping of anxiety, sleep disturbances and organic diseases with anxiety-like symptoms are presented. Sleep-related panic attacks and anxiety in insomnia provide examples of the development of pathophysiological concepts coming from the coupling of sleep and anxiety. Case reports illustrate the relevance for clinical practice.

Adult↗

PubMedDate not supplied

Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow-up.

OBJECTIVE: Evidence concerning whether sleep disturbances in older adults predict mortality is mixed. However, data are limited to self-reported sleep problems and may be confounded with other comorbidities. We examined whether electroencephalographic (EEG) sleep parameters predicted survival time independently of known predictors of all-cause mortality. METHODS: A total of 185 healthy older adults, primarily in their 60s through 80s, with no history of mental illness, sleep complaints, or current cognitive impairment, were enrolled in one of eight research protocols between October 1981 and February 1997 that included EEG sleep assessments. At follow-up (mean [SD] = 12.8 [3.7] years after baseline, range = 4.1-19.5), 66 individuals were positively ascertained as deceased and 118 remained alive (total N = 184). RESULTS: Controlling for age, gender, and baseline medical burden, individuals with baseline sleep latencies greater than 30 minutes were at 2.14 times greater risk of death (p =.005, 95% CI = 1.25-3.66). Those with sleep efficiency less than 80% were at 1.93 times greater risk (p =.014, CI = 1.14-3.25). Individuals with rapid eye movement (REM) sleep percentages in the lowest 15% or highest 15% of the total sample's distribution (percentage of REM <16.1 or >25.7) were at 1.71 times greater risk (p =.045, CI = 1.01-2.91). Percentage of slow-wave sleep was associated with time to death at the bivariate level, but not after controlling for potential confounders. CONCLUSIONS: Older adults with specific EEG sleep characteristics have an excess risk of dying beyond that associated with age, gender, or medical burden. The findings suggest that interventions to optimize and protect older adults' sleep initiation, continuity, and quality may be warranted.

Aged↗

PubMed2006

Effectiveness of sleep management strategies for residents of aged care facilities: findings of a systematic review.

AIMS AND OBJECTIVES: The objectives of this systematic review were to determine the most effective tools for the assessment and diagnosis of sleep problems, as well as identify the most effective strategies for the promotion of sleep within this population. BACKGROUND: Experiencing reduced sleep quality is often associated with normal ageing, however this may be exacerbated for residents of aged care facilities. External factors such as noise, light and night-time nursing may impact negatively upon sleeping patterns. METHODS: Eleven electronic databases and the reference lists and bibliographies of included studies were searched. Papers were grouped according to type of intervention or assessment tool and presented in a narrative summary. CONCLUSIONS: The review identified many interventions to promote sleep. Multidisciplinary strategies such as combining a reduction in environmental noise, reduction of night-time nursing care and promotion of daytime activity, are likely to be most effective for promoting sleep in the population of interest. The use of sedating medications is cautioned, as their long-term efficacy in promoting sleep is questionable. Wrist actigraphy was found to be the most accurate objective sleep assessment tool. RELEVANCE TO CLINICAL PRACTICE: Lack of sleep, disturbed sleep and the overuse of medications especially sedations reduce the quality of life for older people. Effective, safe sleep interventions should be promoted and practised by nurses.

Aged↗

PubMedDate not supplied

Comparison of subjective sleep quality in patients with cancer and healthy subjects.

PURPOSE/OBJECTIVES: To compare the subjective sleep quality of a group of patients with cancer undergoing treatment and a normative sample of healthy comparison subjects. DESIGN: Secondary analysis of data from a single time point in a repeated measures descriptive-correlational study. SAMPLE/SETTING: Convenience sample of 15 patients with cancer receiving antineoplastic therapy and admitted to a tertiary university medical center for fever or neutropenia and 52 healthy comparison subjects without sleep disturbances. Although both groups were of similar age, a higher percentage of men comprised the comparison group. METHODS: Patients completed the Pittsburgh Sleep Quality Index (PSQI) on the first day of hospitalization to reflect their perceptions of sleep for the month prior to hospitalization. Healthy comparison subject scores on the PSQI were obtained from a published report outlining psychometric properties of the PSQI (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989). MAIN RESEARCH VARIABLES: Sleep latency, sleep duration, sleep efficiency, sleep disturbances, medication use, daytime dysfunction, and global sleep quality. FINDINGS: Patients with cancer reported significantly poorer overall sleep quality accompanied by more daytime dysfunction. The incidence of specific sleep disturbances, such as snoring and dyspnea, was not different between the groups. CONCLUSIONS: This small sample of patients reported significantly poorer sleep quality than an historical comparison group. Specific sleep disturbances commonly seen in the general population were not problematic for the patients with cancer. Limited sample size and use of an historical comparison group need to be considered in interpreting and applying these findings. Additional research is needed to further characterize the nature of sleep problems in patients with cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to assess sleep in their patients, including its impact on quality of life and functional status.

Adult↗

PubMedDate not supplied

Factors influencing sleeping pattern of infants.

Many families apply to pediatricians with complaints of sleep problems of their infants. It is very important to inform families about the sleep pattern of infants and factors influencing it, and to answer their questions about infantile sleep. A questionnaire was given to 165 families to elucidate the factors influencing continuous sleep pattern of the baby. Our study demonstrated that 50% of four-month-old and 96% of nine-month-old infants acquired continuous sleep pattern. Our figures were compatible and even higher than those in the literature. None of the factors studied has an independent effect on infantile continuous sleep pattern in multifactorial analysis. Early weaning does not facilitate acquisition of continuous sleep pattern by the baby. This will help to support prolonged breast-feeding. It may be advisable not to keep children beside their mother during sleep for a long period of time. Care of the children by the maternal grandmother may facilitate their acquisition of continuous sleep pattern.

Beds↗

PubMedDate not supplied

Nocturnal problems in postpolio syndrome: sleep apnea symptoms and nocturia.

Nocturia, generally accepted as an inevitable consequence of aging, is also a symptom of a potentially lethal condition--obstructive sleep apnea (OSA). The descriptive study reported in this article examined nocturia and sleep-related breathing problems in persons with postpolio syndrome (PPS) and tested the Sleep Disordered Breathing--Nocturia Model. This model describes the cascade of events that results in polyuria in persons with sleep-related breathing disorders. Data were analyzed with descriptive and inferential statistics. A 34-item questionnaire was published in the newsletter of a national polio support group, and the 584 respondents constituted a convenience sample. The results showed statistically significant associations between OSA symptoms, nocturia, poor sleep quality, daytime sleepiness, lower urinary tract symptoms, naps, and decreased self-rated health. Study limitations were the use of a convenience sample and possible self-selection of persons with more severe sleep and bladder problems. The results support the model and document how nocturia and sleep disturbances negatively impact persons with PPS.

Circadian Rhythm↗

PubMed1992

Substance use and work disabilities among a general population.

Using data derived from a representative survey of 869 Ontario adults, we examined the association between work disabilities and substance use, i.e., drinking, alcohol problems, sleeping pills, and tranquilizers. Overall, we found a significant association between substance use and disability. For alcohol problems, we found that those with moderate limitations reported the greatest number of problems, holding constant age, gender, income, and frequency of drinking. For the use of sleeping pills and especially tranquilizers, we found a strong positive relationship to limitation status. A number of significant interactions involving tranquilizer use showed that two groups, females with total limitations and those aged over 40 years with sensory disabilities, reported exceptionally high rates of tranquilizer use.

Adolescent↗

PubMed1999

Citalopram treatment of traumatic brain damage in a 6-year-old boy.

Traumatic brain damage may cause acute emotional symptoms such as uncontrolled crying, apathy, and sleep problems. Rehabilitation may be less effective in patients afflicted by these symptoms. Citalopram, a selective serotonin reuptake inhibitor (SSRI), has a documented immediate and dramatic effect on pathological crying in stroke patients. The present case history of a 6-year-old boy with a traumatic right-sided hemorrhage in the basal ganglia indicates that early SSRI treatment has a dramatic effect on pathological crying and in addition may have a concomitant beneficial effect on motor paresis, sleep disturbance, and neurobehavioral problems.

Basal Ganglia↗

PubMed1991

Sleep disturbances in survivors of the Nazi Holocaust.

OBJECTIVE AND METHOD: Sleep disturbances are commonly reported by victims of extraordinary stress and can persist for decades. This study was designed to test the hypothesis that survivors of the Nazi Holocaust would have significantly more and different sleep problems than depressed and healthy comparison subjects and that the severity of the survivors' problems would be correlated with length of time spent in a concentration camp. Forty-two survivors, 37 depressed patients, and 54 healthy subjects of about the same age, all living in the community, described their sleep patterns over the preceding month on the Pittsburgh Sleep Quality Index, a self-rating instrument that inquires about quality, latency, duration, efficiency, and disturbances of sleep, use of sleep medication, and daytime dysfunction. RESULTS: The survivors had significantly greater sleep impairment than the healthy comparison subjects, as measured by all subscales of the index, but had less impairment than the depressed patients except on the sleep disturbances and daytime dysfunction subscales. However, for specific items within these subscales, survivors had significantly more frequent awakenings due to bad dreams and had less loss of enthusiasm than the depressed subjects. Sleep disturbances and frequency of nightmares were significantly and positively correlated with the duration of the survivors' internment in concentration camps. CONCLUSIONS: These findings suggest that for some Holocaust survivors, impaired sleep and frequent nightmares are considerable problems even 45 years after liberation.

Aged↗

PubMed1991

Bedtime fading in the treatment of pediatric insomnia.

In this paper, the sleep-wake cycles of two children with severe sleep problems were regulated by delaying bedtimes, thus increasing the probability of short latency to sleep onset. A fading procedure was then utilized to advance the bedtimes and gradually increase duration of sleep. Several treatments had previously been attempted with both of these patients without success. The advantages of this treatment over other interventions for pediatric sleep disorders are discussed.

Arousal↗

PubMed1988

Sexual abuse: somatic and emotional reactions.

A chart review and telephone interview of 72 sexual abuse victims was conducted to determine if children and adolescents who are victims of sexual abuse suffer from symptoms similar to the "rape trauma syndrome," which has been reported in adults. Symptoms similar to the rape trauma syndrome were found in 48 of the 72 abused children and only 26 of the matched control group, p less than .01. Common somatic complaints in the sexual abuse patients included dysuria, vaginal discharge and chronic abdominal pain. Some of the emotional and behavioral problems noted during the follow-up period among the sexual abuse patients included sleep problems, runaway behavior, and suicide attempts. The duration of abuse and age of the victim at the time of abuse significantly affected the frequency of reported somatic symptoms, but the type of abuse and type of assailant did not significantly affect the frequency of reported somatic and emotional reactions. There was no difference in the occurrence of school problems and early pregnancy between sexually abused patients and controls. Since 67% of all sexually abused patients suffered from emotional and somatic reactions, close follow-up of these patients is indicated.

Adaptation, Psychological↗

PubMed2004

Sleep and menopause.

Many midlife women obtain inadequate sleep, and sleep problems are common during the menopause transition. This article reviews the research literature on sleep and sleep disorders during menopause. Few studies have included subjective and objective measures of sleep quality or studied women during different menopause stages. Potential mechanisms associated with the emergence of insomnia and sleep-disordered breathing during menopause are discussed along with effects of estrogen and progesterone on sleep. It is argued that sleep quality is an important determinant of health status and quality of life for women during and beyond menopause.

Estrogen Replacement Therapy↗

PubMed2006

The factor structure of the General Health Questionnaire (GHQ): a scaled version for general practice in Spain.

BACKGROUND: The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values. METHODS: We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting. RESULTS: Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items. CONCLUSIONS: The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to 'Sleep disturbances' was found.

Adolescent↗

PubMed2000

Sleep loss and daytime sleepiness in the general adult population of Japan.

There are few epidemiological studies on sleep loss and daytime sleepiness in the general adult population of Japan. A total of 4000 adult people, aged 20 and over, were randomly drawn from five areas of Japan, and 3030 individuals were interviewed and completed a questionnaire including information about sleep duration and sleep problems. Overall, 29% slept less than 6 h at night, 23% reported having insufficient sleep, and 6% took sleep enhancing medications. The prevalence rates were 21% for symptoms of insomnia and 15% for excessive daytime sleepiness. Symptoms of insomnia were more prevalent in the elderly, whereas young people were more likely to report short sleep duration, subjective insufficient sleep and excessive daytime sleepiness. A multiple logistic regression model revealed that excessive daytime sleepiness had significant associations with young people, short sleep duration, insomnia symptoms, subjective insufficient sleep and sleep enhancing medication use. Short sleep duration was the strongest predictor of excessive daytime sleepiness. The findings indicate that sleep loss and excessive daytime sleepiness in the Japanese adult population are common, and comparable to those reported in Western countries. Excessive daytime sleepiness in the general adult population seems more likely to be attributed to short sleep duration.

Adult↗

PubMed2005

Sleep disturbances and childhood sexual abuse.

OBJECTIVE: This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption [e.g., depression and posttraumatic stress disorder (PTSD)]. METHOD: Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories. RESULTS: Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD. CONCLUSIONS: Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse.

Adolescent↗

PubMed2006

Factors associated with caregiver reports of sleep disturbances in persons with dementia.

OBJECTIVE: This investigation examined the relationship between caregivers' reports of sleep disturbances in persons with Alzheimer disease (AD) and actigraphic records of patients' sleep-wake activity, and explored the factors associated with discrepancies in this relationship. METHOD: Forty-six patients with AD living with their caregivers participated. Before study entry, all caregivers reported poor patient sleep quality using the Neuropsychiatric Inventory (NPI) Nighttime Behavior Scale. Patient sleep-wake activity was recorded for one week using an Actillume wrist-movement recorder. RESULTS: Although all patients were reported by caregivers to have multiple sleep disturbances, 41% of patients had actigraphic sleep efficiencies in the normal range and 43% averaged eight or more hours of sleep nightly. In bivariate analyses, greater patient percent nighttime sleep (indicative of more discrepancy between subjective reports and objective outcomes) was associated with less patient cognitive, physical and functional impairment, lower self-rated depression, higher self-rated quality of life, and less daytime sleepiness. No patient variable significantly predicted total patient nocturnal sleep time. In both bivariate and multivariate analyses, greater patient percent sleep and total sleep time were also associated with caregiver factors, particularly greater use of criticism as a behavior management strategy. CONCLUSION: The study suggests that both patient and caregiver factors contribute to reported sleep problems in community-dwelling patients with AD, and that caregiver reports and objective sleep assessments frequently may not agree. Treatments should consider these dyadic contributions rather than focusing on caregiver reports of patient symptoms alone.

Adult↗

PubMedDate not supplied

Sleep management--the hidden agenda.

The management of apparent sleep problems is often not straight-forward because of a proportion of clients attending with a 'hidden agenda', requiring more in-depth long-term treatment for psychological problems. This paper looks at a sample of 100 consecutive referrals to a community sleep clinic in the East End of London and attempts to address the question of who comes to the sleep clinic and why. A proportion of clients responded to brief intervention of a behavioural nature but 19% were referred on to other services for psycho-therapeutic help.

Ambulatory Care Facilities↗