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PubMed2005

Sleep and medical disorders.

Extensive evidence links cardiovascular disease and sleep disordered breathing. OSA has adverse effects on blood pressure, cardiovascular status,and mortality. Effective CPAP therapy can improve blood pressure and cardiac function in patients who have OSA. Patients who have congestive heart failure have a high prevalence of sleep-disordered breathing, with OSA occurring in 30% of such patients and Cheyne-Stokes respiration in 40%.CPAP is the preferred mode of therapy for both types of sleep-disordered breathing in patients who have coexistent congestive heart failure. Nocturnal worsening of asthma is a common manifestation of this disease that indicates increased disease severity. Therapy focuses on judicious use of long-acting bronchodilators, and the presence of OSA should also be considered. COPD is frequently associated with impaired sleep, likely because of chronic dyspnea and sleep-associated hypoxemia. Appropriate therapy again includes long-acting bronchodilators and possibly nocturnal supplemental oxygen. Gastroesophageal reflux during sleep may lead to prolonged episodes of esophageal acid exposure and may be a common sequela of OSA, perhaps triggering nocturnal worsening of asthma. Endstage renal disease and chronic dialysis are commonly associated with a host of troublesome sleep problems,including OSA, RLS, PLMD, and daytime sleepiness.

Asthma↗

PubMedDate not supplied

Getting a good night's sleep: diagnosing and treating insomnia.

Sleep takes up one-third of our lives. At least it should. While complaints of insomnia are typically not the precipitating factor for the office visit, patients will reveal their sleeping difficulties when asked a few simple, straightforward questions. Sleep is at the top of the list for leading a physically and mentally healthy lifestyle, and sleep problems are the source of significant co-morbidities. Current research has provided information about the prevalence, morbidity, and diagnosis of insomnia and some tools for behavioral and pharmacological management of this disorder. Nurses with a good understanding of sleep theories can use sleep and rest as an intervention to promote healing after surgery.

Guidelines as Topic↗

PubMed1999

Zolpidem, a valuable alternative to benzodiazepine hypnotics for chronic insomnia?

Sleep quality and anxiety levels were examined using questionnaires and polysomnographic recordings in 22 chronic insomnia patients who regularly used benzodiazepines to treat their sleeping problems. After abruptly discontinuing their benzodiazepine medication, patients were randomly allocated to receive either a placebo or zolpidem 10 mg for 1 week, after which they entered an open extension phase, receiving zolpidem 10 mg for 3 weeks. Subjectively, sleep quality was considered mediocre during the use of a benzodiazepine hypnotic. One week after the discontinuation, an increase in sleep latency was observed in the placebo group, whereas zolpidem induced a significant decrease in sleep latency. Deterioration of other sleep variables (probably rebound) was not suppressed by zolpidem. An explanation for this could be the selective pharmacological profile of zolpidem. Polysomnographic differences between placebo and benzodiazepine and between placebo and zolpidem were not reflected by the subjective data on sleep and anxiety. Changes of sleep structure caused by hypnotics seem not always to be felt as such by patients. After 3-4 weeks of zolpidem treatment, the percentage of non-rapid eye movement-4 sleep increased significantly, corresponding with a significant subjective improvement of sleep quality. This indicates that zolpidem may restore physiological sleep.

Adult↗

PubMed2005

Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index.

BACKGROUND: Insufficient sleep and obesity are common in the United States. Restricted sleep causes important neurocognitive changes, including excessive daytime sleepiness and altered mood. This may result in work-related injuries and automotive crashes. Evidence links sleep loss to hormonal changes that could result in obesity. This article examines the association between restricted sleep and obesity in a heterogeneous adult primary care population. METHODS: A total of 1001 patients from 4 primary care practices participated in this prospective study. Patients completed a questionnaire administered by a nurse or study coordinator concerning demographics, medical problems, sleep habits, and sleep disorders. Professional staff measured height and weight in the office. The relationship between body mass index (BMI) and reported total sleep time per 24 hours was analyzed after categorizing patients according to their BMI (calculated as weight in kilograms divided by the square of height in meters) as being of normal weight (<25), overweight (25-29.9), obese (30-39.9), or extremely obese (> or =40). RESULTS: Analyzable forms from 924 patients aged between 18 and 91 years indicated that (1) the mean BMI was 30; (2) women slept more than men; (3) overweight and obese patients slept less than patients with a normal BMI (patients reported less sleep in a nearly linear relationship from the normal through the obese group); and (4) this trend of decreasing sleep time was reversed in the extremely obese patients. CONCLUSIONS: This study found that reduced amounts of sleep are associated with overweight and obese status. Interventions manipulating total sleep time could elucidate a cause-and-effect relationship between insufficient sleep and obesity.

Adolescent↗

PubMed2003

Poor sleep increases the prospective risk for recurrent events in middle-aged women with coronary disease. The Stockholm Female Coronary Risk Study.

OBJECTIVE: We investigated the prognostic impact of sleep complaints in women with CHD and also examined whether the association between sleep problems and cardiac events could be explained by depression. METHODS: All women patients, aged 65 or under who were admitted with an acute coronary syndrome between 1991 and 1994 in Stockholm, were followed for 5 years for recurrent coronary events. Sleep complaints and depression were measured at baseline using standardized questionnaires. Quality of sleep, restorative function of sleep, and snoring were assessed by the Karolinska Sleep Questionnaire (KSQ), and depressive symptoms by a questionnaire developed by Pearlin. RESULTS: Poor sleep quality was associated with recurrent cardiac events. After multivariate adjustment for age, and standard risk factors, the hazard ratio (HR) for women with poor as compared with good sleep quality was 2.5 (95% CI: 1.2-5.2). Controlling for depression did not change this result substantial. Not waking up well-rested yielded a similarly increased risk (HR = 2.4; 95% CI: 1.2-4.6). Women with both poor sleep quality and depression had a worse prognosis than women free from these complaints (HR = 2.6; 95% CI: 1.0-6.4). Heavy snoring was not related to prognosis. CONCLUSIONS: Our results indicate that poor sleep and sleep without a restorative function are associated with poor prognosis in female coronary patients. This association is not explained by depressive symptoms or by standard coronary risk factors.

Aged↗

PubMed2001

Melatonin for treatment of sleep disorders in children with developmental disabilities.

This study explored the safety and efficacy of synthetic melatonin in the treatment of sleep problems in 20 children with developmental disabilities, in a randomized, double-blind, placebo-controlled 6-week trial of melatonin versus placebo. All but 2 children fell asleep more quickly when receiving melatonin than placebo. Overall, the greater the sleep latency (time to fall asleep) was at baseline or when receiving placebo, the more pronounced was the decrease in sleep latency with melatonin. The effect of melatonin on sleep latency was significant (P < .05). The duration of sleep while receiving melatonin was significantly greater than baseline (P < .007) but was not significantly different from placebo, and no difference in the number of awakenings was noted. No side effects were reported. Eleven of 18 parents (61%) correctly identified the weeks their child received melatonin. This study suggests that synthetic melatonin reduces sleep latency in children with developmental disabilities.

Antioxidants↗

PubMed1994

A health profile of spousal Alzheimer's caregivers. Depression and physical health characteristics.

1. For caregivers of persons with Alzheimer's disease (AD), each day holds unexpected challenges and losses of personal control. Both physical and emotional health are at risk for caregivers of persons with AD. 2. Depression is a problem for caregivers, whether the spouse with AD remains in the home or has been transferred to a nursing home. 3. It is important for clinicians to advise caregivers that depression is a treatable disorder. When a caregiver complains of sleep problems, a red flag for depression should go up.

Activities of Daily Living↗

PubMed2000

Prevalence of sleep disturbances in chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis.

Patients with end-stage renal failure (ESRF) are reported to have a high prevalence of sleep disorders, such as daytime sleepiness, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). However, there are few published data from Southeast Asia. A sleep questionnaire was administered to 201 patients (103 men) at the continuous ambulatory peritoneal dialysis (CAPD) outpatient clinic to assess sleep problems. Patients had a mean age of 56.7 +/- 12 (SD) years, with a mean body mass index (BMI) of 23.6 +/- 3.5 kg/m(2). Daytime sleepiness was the most frequent symptom (77.1%), and frequent awakening occurred in 69% of the patients. Sleep-onset insomnia and sleep-maintenance insomnia occurred in 73% and 60% of the patients, respectively. Sixty-two percent of the patients reported symptoms of RLS, which significantly correlated with sleep-onset insomnia (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5 to 5.5; P = 0.001) and sleep-maintenance insomnia (OR, 2.1; 95% CI, 1.2 to 3.8; P = 0.014). The prevalence of OSAS was estimated by the frequency of the following symptoms: extremely loud snoring, 7 patients (3.5%); observed choking, 21 patients (10.5%); witnessed apnea, 11 patients (5.6%); snoring and witnessed apnea, 6 patients (3%); disruptive snoring, 29 patients (14.4%); and disruptive snoring and witnessed apnea, 3 patients (1.5%). This questionnaire survey confirmed a high prevalence of daytime sleepiness, insomnia, and RLS in patients with ESRF undergoing CAPD but showed a relatively low prevalence of OSAS of up to 14.4%, which may be related to the low BMI of these patients with ESRF compared with other populations. Whether this contributes to the overall better survival observed in some Asian patients with ESRF undergoing dialysis needs further investigation.

Adolescent↗

PubMed2003

Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder.

OBJECTIVES: This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing (SDB). Therefore, we assessed potential relationships between objectively measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit/hyperactivity disorder (ADHD) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking. METHODS: Parents of 5- to 7-year-old children in public schools were surveyed about their child's sleeping habits using a validated questionnaire. The questionnaire also asked whether they believed their child to be hyperactive or have ADHD. Children with reported symptoms of ADHD and control children were randomly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests. RESULTS: The questionnaire response rate was 47.6% (n = 5728). Frequent and loud snoring was reported for 673 children (11.7%). Similarly, 418 (7.3%) children were reported to have hyperactivity/ADHD, 313 (76.5%) of which were boys. Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children. After assessment with the Conners' Parent Rating Scale, 44 children were designated as having "significant" symptoms of ADHD, 27 as "mild," and 39 designated as "none" (controls). Overnight polysomnography indicated that obstructive sleep apnea was present in 5% of those with significant ADHD symptoms, 26% of those with mild symptoms, and 5% of those with no symptoms. In the cohort, no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function. CONCLUSIONS: An unusually high prevalence of snoring was identified among a group of children designated as showing mild symptoms of ADHD based on the Conners' ADHD index identified from a community sample. However, whereas SDB is not more likely to occur among children with significant ADHD symptoms, it is significantly highly prevalent among children with mild hyperactive behaviors. Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms, and they seem to impose significant but mild effects on daytime neurobehavioral functioning. We conclude that in children with significant symptoms of ADHD, the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations. Furthermore, SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment.

Age Factors↗

PubMed2001

Individualizing therapy for early, middle-of-the-night and late-night insomnia.

Many patients with insomnia describe their sleep problems as an inability to remain asleep throughout the night, resulting in next-day fatigue that may adversely affect daytime functioning. To be most effective, insomnia treatment should be tailored to resolving underlying causes of the condition and managing specific sleep complaints. Therefore, hypnotic therapy administered prior to bedtime, as is currently recommended for most compounds, is not appropriate for all insomnia patients. Ideally, behavioral interventions should be combined with a rapid-acting agent that can be administered at virtually any time during the night without producing residual effects the following day. Zaleplon, a new non-benzodiazepine sleep medication, provides the clinician with an effective and safe pharmacotherapeutic option for insomnia management. Its rapid rates of absorption and elimination allow for treatment of symptoms when they occur, either at bedtime or later at night, without incurring significant risk for the development of next-day impairment of psychomotor and cognitive functioning.

Acetamides↗

PubMed2005

Psychological and physical sequelae of intimate partner violence among women with limitations in their activities of daily living.

OBJECTIVE: To compare the psychological and physical sequelae of physical/sexual intimate partner violence in women with and without activity limitations. METHODS: We analyzed data from the Canadian 1999 General Social Survey. We included women reporting intimate partner violence in the previous 5 years (n = 897). RESULTS: As a result of the violence, women with activity limitations were significantly more likely to feel ashamed/guilty (21.7 vs. 14.5%), depression/anxiety (31.5 vs. 19.8%), fearful (43.0 vs. 33.0%), lowered self-esteem (35.2 vs. 21.1%), increased caution/awareness (20.3 vs. 10.9%), and problems relating to men (16.4 vs. 5.4%). Significantly more women with activity limitations reported physical injury from violence (57.0 vs. 36.6%) and having to take time off from everyday activities (42.1 vs. 30.3%). Women with activity limitations had higher medication use for sleeping problems (OR = 3.17, 95% CI = 1.36, 5.73), anxiety (OR = 3.29, 95% CI = 1.75, 6.19) and depression (OR = 2.63, 95% CI = 1.41, 4.90). CONCLUSION: Results suggest an additive effect between intimate partner violence and activity limitations that adds disproportionately to the burden of health for women with activity limitations.

Activities of Daily Living↗

PubMed2004

Acute consequences of the menopausal transition: the rise of common menopausal symptoms.

More than 80% of women experience psychologic or physical symptoms in the late reproductive years, with varying degrees of severity and disruption in their lives. Patients and clinicians have misconceptions about what changes are considered "normal" or"abnormal" during this period. Of importance to clinicians, large-scale longitudinal studies recently have been conducted to better characterize and explore changes during this period. This article re-views the current evidence regarding the acute symptoms of the menopausal transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning.

Adolescent↗

PubMed2001

Melatonin therapy for REM sleep behavior disorder.

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia with clinical symptoms that include punching, kicking, yelling and leaping out of bed in sleep. Polysomnographic (PSG) finding showed REM sleep without muscle atonia. Clonazepam is generally used for treating RBD symptoms but melatonin was reported to be effective so we reconfirmed the effect of melatonin on RBD patients in the present study. We used melatonin (3-9 mg/day) which could ameliorate problem sleep behaviors remarkably, as well as %tonic activity in PSG variables. In the present study, melatonin was reconfirmed to be effective in RBD symptoms, especially for patients with low melatonin secretion, while its mechanism was not clearly known in the present study.

Electromyography↗

PubMedDate not supplied

Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome.

OBJECTIVE: To determine the relationship between sleep disturbances and fatigue in women with fibromyalgia (FM) and those with chronic fatigue syndrome (CFS) and to assess whether any differences existed between the two groups. DESIGN: Descriptive comparative. SETTING: Community program on chronic fatigue syndrome and related disorders. PARTICIPANTS: Sixty-three women who attended the program; 13 had CFS, and 50 had FM. MAIN OUTCOME MEASURES: A moderately strong relationship between fatigue and sleepiness was found (r = .63, p < .01). Trouble staying asleep was the highest rated sleep disturbance, and fatigue was the most common subjective feeling reported. Women with CFS reported significantly more trouble staying asleep than women with FM, t(61) = 1.81, p < .03. CONCLUSIONS: Data from this study support that women with FM and CFS encounter problems sleeping. Clinicians are encouraged to assess women with FM and CFS for their quality of sleep rather than amount of sleep. Researchers are encouraged to continue study of sleep disturbances in women with FM and CFS to improve understanding of the disturbances and to test the effectiveness of sleep interventions.

Adult↗

PubMed2001

Insomnia: therapeutic approach.

Insomnia is a common complaint. Transient and short-term insomnias usually result from stress or the use of certain pharmaceuticals or drugs and may be managed by reduced caffeine use, behavioral means, and/or pharmacologic treatment. Long-term insomnia is often a symptom of a medical or psychiatric condition or a primary sleep disorder. A diagnostic workup is expected; treatment should focus on the causative condition, as well as addressing the sleep problem itself. Established medications for the symptomatic treatment of insomnia include benzodiazepines, zolpidem, zaleplon, and certain antidepressant or occasionally antihistaminic drugs.

Humans↗

PubMed2006

Sleep duration and its correlates in a sample of Saudi elementary school children.

INTRODUCTION: This study was conducted to estimate sleep duration in Saudi elementary school children, sleep habits and practices that may affect it, and compare our results to published data in other societies. METHODS: Parents of elementary school children were surveyed regarding their children's bedtime, rise time, sleep duration at night and daytime nap duration during weekdays and weekends. A questionnaire inquiring about demographical data, specific sleep problems and habits, and home environment was completed by the parents. RESULTS: The study comprised 511 (50.5 percent) boys and 501 (49.5 percent) girls. During weekdays, bedtime for the whole group was 21.3 +/- 1.8 hours, rise time was 5.9 +/- 0.5 hours, total sleep time (TST) was 8.4 +/- 1.1 hours, and TST and nap was 9.98 +/- 1.3 hours. Multivariate analysis revealed that TST was affected by regularity of bedtime, mother's level of education, daytime naps, and the habits of watching television (TV) and playing computer games after 20.00 hours. CONCLUSION: Nighttime sleep duration is shorter in Saudi school children compared to published data. Several factors appeared to affect sleep duration, including mother's educational level, daytime naps and watching TV at night.

Adolescent↗

PubMed1993

Informational yield of comprehensive Geriatric Home Assessment.

OBJECTIVE: The purpose of this study was to compare the relative informational yield of Geriatric Home Assessments with medical charts of patients seen in family practice settings. METHODS: The information from comprehensive Geriatric Home Assessments of 28 well-established patients, conducted by small groups of medical students in a family practice clerkship, was compared with information available in the medical charts of these patients for the previous three years. RESULTS: For no problem studied was identification in the medical chart as high as from the Geriatric Home Assessment. Problems with family/social support, inadequate dental care, and immunization deficiencies were frequently noted in the Geriatric Home Assessment but only rarely in the medical chart. Concordance between Geriatric Home Assessment and medical charts was greatest for depression/anxiety, sensory loss, smoking, dizziness, and sleep problems. CONCLUSIONS: While evaluation of the utilization of information was beyond the scope of the current study, the results suggest the potential usefulness of complementing office care with home assessments in establishing a data base for the medical management of elderly patients in primary care settings.

Activities of Daily Living↗

PubMed1997

Patterns of behaviour problems among pre-school children.

BACKGROUND: Previous research has suggested that behavioural problems displayed during the pre-school years are best understood as undifferentiated difficulties in manageability. The present study explored this issue, by examining the structure of British parents' ratings of their pre-school children's behavioural problems. METHOD: The 19-item Behavioural Checklist (BCL; Richman, 1977) was completed by 1047 parents of 3-year-old children taking part in an epidemiological survey of child development. RESULTS: Factor analysis revealed six factors representing poor social adjustment, poor emotional adjustment, sleep problems, over-activity/inattention, eating problems and soiling. When these scores were used as a basis for cluster analysis, problem types clustered around six centres. The first, and largest, grouping was of children with no problems. Three further large groupings displayed specific but moderate problems (over-active, timid, and naughty children). The final two groupings displayed more extreme problems including anti-social behaviour. In one group these were accompanied by severe emotional problems and in the other by signs of hyperactivity. The reliability and validity of these clusters was supported. Parental ratings of behaviour problems taken when the children were 8-years-old suggested that the children in the hyperactive/conduct group were likely to have continued difficulties. CONCLUSION: This paper argues against the homogeneity of pre-school behaviour problems but supports the idea that problems of a clinically significant level are likely to be co-morbid, with either problems of emotional regulation (neurotic) or those of behavioural regulation (hyperactive) accompanied by problems of conduct.

Analysis of Variance↗