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PubMed2006

Self-reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home.

The aim of this study was to describe habitual sleep, daytime symptoms, sleep-disturbing factors, current sleep during 1 week and fatigue in patients with peritoneal dialysis treatment at home and also discover predictions for sleep quality outcome. The knowledge should increase possibilities for supportive nursing health care. Fifty-five patients answered two mailed questionnaires and filled in a sleep diary. Of these, 60% had moderate, persistent sleep problems combined with daytime symptoms. Nocturnal awakenings with difficulties falling asleep again and a sleep duration predicted as 57% of sleep quality. Nocturnal pruritus and 'difficulties finding a comfortable sleeping position' were significant sleep-disturbing factors. Sleep quality predictors means progress in knowledge about the complexity of the situation for peritoneal dialysis patients. Poor sleep, daytime symptoms, sleep-disturbing factors and chronic fatigue need to be enlightened, especially for the nephrology nurses who are in a unique position to give supportive nursing health care.

Aged↗

PubMedDate not supplied

Clinical and parental assessment of sleep in children with attention-deficit/hyperactivity disorder referred to a pediatric sleep medicine center.

Frequently reported sleep problems in children with attention deficit-hyperactivity disorder (ADHD) referred to a pediatric sleep medicine center were assessed and compared with objective sleep assessments. A retrospective review of 97 children with ADHD (mean age of 8.3+/-3.0 years) was conducted. Polysomnography in 69 children revealed periodic limb movement disorder (PLMD) in 36% and sleep-disordered breathing in 7%, while actigraphy uncovered substantial variability in sleep schedules of 16 patients. Although parental subjective sleep complaints were verified by objective sleep assessments in a small proportion of cases, PLMD and night-to-night variability in sleep patterns were common.

Adolescent↗

PubMed2001

Evaluation of a fast forward rotating shift schedule in the steel industry with a special focus on ageing and sleep.

The aim of this study was to explore the effect of a change in the speed and direction of shift rotation on the sleep and wakefulness of younger and older workers. A continuous three-shift schedule was changed from a slow backward rotating (EEE-MMMNNN-----) to a fast forward rotating system (MMEENN----). Sixteen subjects (mean age 42 years) were studied before and one year after the change in schedule. Two age groups were compared: ten younger men (mean age 35 years) and six older men (mean age 53 years). The effects of the new work schedule were evaluated by a questionnaire (modified SSI), and on-site registrations with an actigraph and sleep log for one shift cycle (10-15 days) before and after the new schedule. After the change in schedule, subjective sleep problems decreased and alertness increased during the morning shifts. The change in schedule influenced sleep differently in the two age-groups. Both the subjective and objective quality of sleep improved among the older workers. The results indicate that a fast forward rotating shift schedule is more suitable for older workers than a slower backward rotating system.

Adaptation, Psychological↗

PubMed1998

Sleep disturbance in Smith-Magenis syndrome (del 17 p11.2).

Smith-Magenis syndrome (SMS) is a clinically recognizable multiple congenital anomaly and mental retardation syndrome caused by an interstitial deletion of chromosome 17 p11.2. Although the physical and molecular genetic features of SMS are increasingly well understood, work is more limited on SMS's behavioral phenotype, which includes self-injury, tantrums, and sleep disturbance. This study examines the sleep behaviors of 39 individuals with SMS, ranging in age from 1.6 to 32 years (mean = 10.5). Prominent sleep problems, seen in 65 to 100% of the sample, included difficulties falling asleep, shortened sleep cycles, frequent and prolonged nocturnal awakenings, excessive daytime sleepiness, daytime napping, snoring, and bed-wetting. Medication to facilitate sleep was used by 59% of SMS subjects. Possible etiologic mechanisms of sleep disturbance in SMS are discussed, as are recommended interventions.

Abnormalities, Multiple↗

PubMed1999

Identification of depressed patient types in the community and their treatment needs: findings from the DEPRES II (Depression Research in European Society II) survey. DEPRES Steering Committee.

DEPRES II (Depression Research in European Society II), the first in-depth, pan-European survey of depression in the community, provided an opportunity to identify depressed patient types and their treatment needs. Cluster analysis applied to data generated from DEPRES II interviews revealed six depressed patient types with clearly differentiated profiles. The patient type with moderately impaired depression has episodic depression and minimal disability. By contrast, severe depression associated with anxiety presents with chronic symptoms, including anxiety and panic, and causes considerable disruption to normal life and employment. Depression associated with chronic physical problems and depression associated with social problems are characterized by chronic physical illness and relationship or financial difficulties, respectively, and sufferers are pessimistic about recovery. Depression associated with sleep problems is associated with symptoms of tiredness and broken or inadequate sleep, and is commonly caused by stress. Tiredness is also a principal symptom of depression associated with tiredness or fatigue, but sufferers' ability to sleep is unaffected. All patient types would benefit from antidepressant therapy. The depressed patient types identified from the DEPRES II data make intuitive sense, but now need to be tested for face validity in the primary care setting.

Cluster Analysis↗

PubMed1993

[Working conditions and health status from the workers' viewpoint].

In the present study details about disruptive factors in working conditions, elements injurious to health or general well-being, personal attitudes to work etc. have been obtained by means of a representative survey of about 2000 employed persons in Switzerland. The most frequent disruptive factors in working conditions (> 30%) are noise and too little time for family and friends. A relatively large number of employed persons (20-25%) complain about unsatisfactory ventilation, air pollution due to dust, smoke etc., draughts, uncomfortable temperature, dry air, lifting and carrying heavy weights, uncomfortable body positions at work, unsuitable working hours, as well as pressure on time, too much concentration required, pressure of responsibility, insufficient recognition and lack of information about the planning and results of work being done. In the field of health complaints, back problems and nervous tension are at the top of the list (39%), followed by fatigue, sleeping problems, neck or leg problems, burning eyes, and stomach and intestinal problems (25-34%). The analysis shows that interrelationships exist--sometimes in the sense of a vicious circle--between complaints about disruptive factors in work conditions, professional groups, health problems and attitudes to professional live. The results provide a comprehensive survey of the incidence of problems in the fields of worker protection.

Air Pollution↗

PubMed2004

Systemic growth hormone corrects sleep disturbance in Smith-Magenis syndrome.

Smith-Magenis syndrome (SMS) is a multiple congenital anomaly syndrome characterized by an interstitial deletion of chromosome 17p11.2. Sleep problems such as nocturnal awakening and abnormality in the percentage of rapid eye movement (REM) sleep are frequently observed in patients with SMS, and several medications have been administered to improve the sleep disorders. Here we present a female case of SMS showing early waking and reduction of REM sleep, which were corrected by human growth hormone (GH) replacement for her dwarfism. Also, we report changes in the sleep-wakefulness circadian rhythm and polysomnographical data before and after the start of human GH replacement. It is speculated that GH deficiency could be involved in sleep disturbance in SMS.

Abnormalities, Multiple↗

PubMed2003

Developmental stages of sleep from birth to adolescence, common childhood sleep disorders: overview and nursing implications.

Sleep is an important physiological process with profound impact on the body. Sleep undergoes normal developmental changes and common sleep problems are seen in general pediatric practice. This article discusses normal developmental changes related to sleep, common sleep disorders experienced by children and how nurses can assist parents in coping with these changes and disorders.

Adolescent↗

PubMed1998

Epidemiology of alcohol and medication as aids to sleep in early adulthood.

STUDY OBJECTIVES: In a representative sample of adults 18-45 years of age, this study addressed three questions about the use of sleep aids in the general population: (1) what are the past-year prevalences of the use of alcohol, over-the-counter medication and prescription medication to facilitate sleep? (2) among those who use these substances for sleep problems, what are the patterns of use? and (3) are there social factors, independent of sleep characteristics, that increase the likelihood of alcohol and medication use to aid sleep? DESIGN: The 1996 Detroit Area Survey was a random-digit-dial, computer-assisted survey of a representative sample of 2,181 adults ages 18-45 in the Detroit primary metropolitan statistical area. Eligible household response rate was 86.8%. RESULTS: In the general population, use of alcohol and medication as sleep aids in the past year was found to be fairly common: 13% used alcohol, 18% used medications and 5% used both. The prevalence of any substance use to aid sleep was 26%. The duration of use was short for the majority of users, less than 1 week. However, duration of use was greater for the majority of those using prescription sleep aids. A substantial minority of users report regular use lasting longer than 1 month: 15%, 9%, and 36% for alcohol, OTC medications, and prescription medications, respectively. Both sociodemographic and sleep characteristics were associated with alcohol and medication use to aid sleep. Difficulty falling asleep was the factor most strongly associated with use of substances to improve sleep. Sex, race/ethnicity, work shift, marital status and education were also significantly associated with one or more types of sleep aid use adjusting for difficulty falling asleep.

Adolescent↗

PubMedDate not supplied

Symptom experience in women after hysterectomy.

OBJECTIVE: To review the literature addressing the symptom experience of women after hysterectomy. DATA SOURCES: Computerized searches in MEDLINE and CINAHL, as well as texts and references cited in articles. Key concepts in the searches included hysterectomy, sleep disturbance and pain, hysterectomy and fatigue, hysterectomy, depression, and depressed mood. STUDY SELECTION: Articles and comprehensive works relevant to key concepts and published after 1970, with an emphasis on new findings from 1990 to 2000. Sixty-four citations were identified as useful to this review. DATA EXTRACTION: Data were organized under the following headings: women and hysterectomy, biopsychosocial perspectives, common symptoms after hysterectomy (pain, disturbed sleep, fatigue, depressed mood, anxiety), and significance of review (implications). DATA SYNTHESIS: Literature suggests that after a hysterectomy, women experience complications during the postoperative recovery period that may vary with the type of surgical procedure. During this period, the quantity and quality of sleep as well as other symptoms (pain, fatigue, anxiety, and depression) are influenced by various physiologic, psychologic, and social factors. Despite limited evidence that sleep problems may occur frequently during the recovery period, only a few researchers have systematically examined sleep patterns in women after hysterectomy. None of these studies, however, used objective sleep measures or examined multiple dimensions of these women's lives. CONCLUSIONS: This review conceptualized the women's symptom experience as the experience of specific symptoms (pain, sleep disturbance, fatigue, depressed mood, and anxiety) that were influenced by biopsychosocial factors.

Anxiety↗

PubMedDate not supplied

Help-seeking for insomnia among adult patients in primary care.

OBJECTIVE: To clarify the patient characteristics associated with seeking medical help for insomnia. METHODS: A consecutive sample (n = 700) of adults attending a non-urgent primary care appointment was screened for sleep problems. A follow-up mailed survey then assessed insomnia symptoms, daytime impairment, beliefs about sleep, medication use, sleepiness and fatigue, and medical help-seeking. RESULTS: Fifty-two percent of patients with probable insomnia reported discussing this with a physician. Multivariate logistic regression analyses indicated that discussing one's probable insomnia with a physician was independently associated with having a greater number of medical conditions (OR, 2.19 [95% CI, 1.13 to 4.22]), being more highly educated (1.67 [95% CI, 1.11 to 2.51]), sleeping less per night (OR, 0.71 [95% CI, 0.52 to 0.96]), and greater perceived daytime impairment due to insomnia (OR, 2.07 [95% CI, 1.06 to 4.03]). CONCLUSIONS: Primary care patients often seek medical help when they experience insomnia. Clinical treatment ought to especially target poor sleepers presenting with significant insomnia-related impairment, medical morbidity, or both. Future research should further clarify the role of medical and psychiatric comorbidities and determine whether resolution of insomnia and its consequences improves the outcomes of common medical conditions.

Adult↗

PubMed2002

Prevalence of night sweats in primary care patients: an OKPRN and TAFP-Net collaborative study.

OBJECTIVE: To estimate the prevalence and factors associated with night sweats among adult primary care patients. STUDY DESIGN: This was a cross-sectional study. POPULATION: Adult patients in 2 primary care practice-based research networks (PBRNs) during 1 week in the summer and 1 week in the winter in the years 2000 and 2001. OUTCOME MEASURES: We measured the prevalence of pure night sweats and night and day sweats in all patients and subgroups defined by age and sex, clinical variables associated with night sweats, and the frequency, severity, and rate of reporting. RESULTS: Of the 2267 patients who participated, 41% reported experiencing night sweats within the last month, including 23% with pure night sweats and an additional 18% with day and night sweats. The prevalence of night sweats in both men and women was highest in the group aged 41 years to 55 years. In multivariate analyses, factors associated with pure night sweats in women were hot flashes and panic attacks; in men, sleep problems. Variables associated with night and day sweats in women were increased weight, hot flashes, sleep disturbances, use of antihistamines, selective serotonin reuptake inhibitors (SSRIs), and other (non-SSRI, non-tricyclic) antidepressants; in men, increased weight, hot flashes, and greater alcohol use. A majority of patients had not reported their night sweats to their physicians, even when frequent and severe. CONCLUSIONS: Night sweats are common and under-reported. Pure night sweats and night and day sweats may have different causes. With regard to the etiologies of pure night sweats, panic attacks and sleep disorders need further investigation.

Adult↗

PubMedDate not supplied

A questionnaire on sleep behaviour in the first years of life: preliminary results from a normative sample.

The authors developed a questionnaire in Italian for investigating sleep problems in infants and toddlers. Applying the questionnaire, they conducted an exploratory investigation into the sleep behaviour of a sample of normal children during their first three years of life in order to gather preliminary data regarding the ease of use of the instrument. The questionnaire and the results of its first application (in an Italian sample of 50 healthy children aged 10-39 months) are presented. The results provide interesting information on the sleep behaviour of the young children in our sample and prompt reflections in relation to the instrument employed. The sleep behaviour questionnaire emerged, above all, as easy to use and readily comprehensible to those participating in this research study. Furthermore, it provided parents with an opportunity to reflect upon their child and his/her rhythms (in particular sleep-wake rhythms) and upon their own ability to manage these rhythms. This instrument seems, on the basis of these preliminary data, to allow the tracing of a well-defined and complete picture of the sleep behaviour of the healthy child in the first years of life.

Adult↗

PubMed1996

Self report on sleep symptoms in older adults: correlates of daytime sleepiness and health.

Sleep problems in the healthy elderly were studied in 628 community-dwelling older adults. Self-report of daytime sleepiness in this group was evaluated. Self-reported snoring was significantly associated with reports of daytime sleepiness (p < 0.001), and reported health showed significant associations with age group (p < 0.001), reports of breathing problems (p < 0.001), and reports of excessive daytime sleepiness (p < 0.01). The data strongly support the impact of sleep-related factors on self-perceptions of health in community dwelling older adults. Even as a subjective self-report measure, snoring readily predicts self-reported problems with daytime sleepiness.

Age Factors↗

PubMed2004

Nocturnal seizures.

As a subset of epilepsy, nocturnal seizures amplify one of the major problems of epilepsy in general: episodes are less likely to be directly witnessed than daytime seizures, and therefore diagnosis and characterization are more difficult. As a sleep problem, nocturnal seizures are not benign, and the resulting sleep disruption can cause daytime somnolence and concentration difficulty. This article outlines three major topics in nocturnal seizures: differential diagnosis (distinguishing between seizures and parasomnias), the effects of nocturnal seizures on sleep structure, and specific syndromes of primarily or exclusively nocturnal seizures.

Diagnosis, Differential↗

PubMed1999

Drug treatment of patients with insomnia and excessive daytime sleepiness: pharmacokinetic considerations.

Insomnia and excessive daytime sleepiness (EDS) are frequently observed conditions in the general public. A national survey in the USA in 1979 indicated that 35% of American adults experience insomnia in the course of a year. The prevalence of EDS varies depending on the survey (0.3 to 13.3%), but a recent study stated that 2.4% of individuals reported that they continually fell asleep at work. These problems are often long term and negatively affect the individuals' quality of life. People with these sleep problems often have difficulties maintaining high levels of productivity at work or pursuing their daily activities; individuals with insomnia lack the feeling of being rested or refreshed in the morning and EDS is unavoidable in most cases. Behavioural therapy has been shown to be effective for many people affected with insomnia and EDS. However, pharmacological treatments using hypnosedatives and central nervous system (CNS) stimulants are usually necessary, and effective, for those with more severe cases. These compounds have thus been widely prescribed in clinical practice (e.g., 2.6% of all adults surveyed used medically prescribed hypnosedatives and 4.5% used over-the-counter drugs to promote sleep). The onset and duration of action of these hypnosedatives and CNS stimulant drugs are important factors to be considered when prescribing these compounds. These factors primarily depend on physicochemical properties (lipid solubility and protein binding), as well as the pharmacokinetic profile (absorption, distribution, elimination and clearance) of the compounds. Significant differences in profile exist amongst hypnosedatives and CNS stimulants, and these differences may account for the observed variations in clinical action and adverse effects during and after treatment. In this review, we will introduce recently obtained knowledge of the pharmacokinetics of hypnosedatives and CNS stimulants and their applications for patients affected with insomnia and EDS.

Humans↗

PubMed2000

Polysomnographic respiratory findings in patients with Arnold-Chiari type I malformation and basilar invagination, with or without syringomyelia: preliminary report of a series of cases.

Patients with craniocervical disorders (CCD) show a wide variety of symptoms and signs suggesting cerebellar and/or high cervical lesion. The anatomic localization of respiratory centers and their possible injury may explain the presence of respiratory disturbances in these diseases. The aim of this preliminary study was to evaluate the polysomnographic findings in a group of patients with CCD, most of them with Arnold-Chiari malformation type I, since sleep apnea has been referred to in isolated cases in the literature. Eleven patients (seven females and four males) with CCD diagnosed by magnetic resonance imaging referred from the neurosurgery unit were submitted to clinical history, physical examination with sleep questionnaires, and scored on the Epworth Sleepiness Scale. Full night polysomnography was performed in an Oxford SAC system where EEG, electro-oculography, electrocardiography, chin and leg electromyography, chest and abdominal efforts, airflow, and oximetry were recorded continuously. Nine patients presented with Arnold-Chiari type I malformation, of whom six showed associated syringomyelia. The other two had basilar invagination. Ninety percent of these patients complained of sleep problems (snoring, choking, and witnessed apneas) and 72% presented hypersomnolence (ESS >9). The polysomnographic findings showed sleep fragmentation in 81% of the patients and a reduction of rapid eye movement sleep in 63%. The apnea/hypopnea index was above 5 in 72%, with a predominance of central apnea. Patients with craniocervical disorders present a higher probability of displaying sleep respiratory disturbances. Their sleep complaints should be assessed and patients should be submitted to an overnight sleep recording in order to identify sleep apnea.

Adult↗

PubMed2006

The explanatory models of depression in low income countries: listening to women in India.

INTRODUCTION: Women, and persons facing social and economic disadvantage, are at greater risk for depressive disorders. Our objective was to describe the explanatory models of illness in depressed women, in particular, their idioms of distress, and their views of their social circumstances and how this related to their illness. METHOD: We carried out a qualitative investigation nested in a population based cohort study of women's mental and reproductive health in Goa, India. We purposively sampled women who were ever-married and who had been found to be suffering from a depressive disorder on the basis of a structured diagnostic interview. In-depth interviews were carried out about six months apart exploring stressors in women's lives, a typical day in their recent lives, and their illness narratives (idioms of distress, causal models, impact of illness, help-seeking). RESULTS: 35 women consented to participate in the study, 28 completing both interviews. Women gave expression to their problems primarily through somatic complaints, typically a variety of body aches, autonomic symptoms, gynecological symptoms and sleep problems. There was frequent mention of overall "weakness" and tiredness. Economic difficulties and difficulties with interpersonal relationships (particularly related to marital relationships) were the most common causal models. However, women rarely considered biomedical concepts, for example, the notion that they may suffer from an illness or that their complaints were due to a biochemical disturbance in the brain. Despite the lack of a biomedical concept, most of the participants had sought medical help, typically for reproductive and somatic complaints. CONCLUSIONS: We recommend the use of somatic idioms as the defining clinical features, and a broader, psychosocial model for understanding the aetiology and conceptualization of the clinical syndrome of depression for public health interventions and mental health promotion in the Indian context.

Adaptation, Psychological↗