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PubMed2005

Sleep in spousal caregivers of people with Alzheimer's disease.

STUDY OBJECTIVE: This study examined differences in objective and subjective measures of sleep between caregivers and noncaregivers. DESIGN: Cross-sectional design. SETTING: All assessments were conducted within the home. PARTICIPANTS: Seventy-three community-dwelling spousal caregivers of patients with Alzheimer's disease and 40 noncaregiving controls. MEASUREMENTS AND RESULTS: Subjects completed a semistructured interview on sociodemographics, cognitive status of the care recipient, self-reported sleep quality, and functional outcome. A polysomnogram was conducted. Caregivers of patients with moderate to severe Alzheimer's disease reported significantly more sleep problems (P<.05) and more functional impairment as a result of sleepiness than noncaregivers (P<.01). Objectively, older caregivers of those with moderate to severe Alzheimer's disease slept less than older noncaregivers (P<.05); there were no other significant differences in objective sleep measures. There was a main effect for age, with older caregivers and older noncaregivers having lower sleep efficiency, less slow-wave sleep, and more stage 1 sleep than younger caregivers and noncaregivers (P<.05). CONCLUSIONS: This study suggests that nighttime sleep is shorter but not otherwise disrupted in caregivers of patients with moderate to severe Alzheimer's disease compared with noncaregivers, and the impact of caregiving on sleep disturbance may be most salient for older caregivers. It is possible that these older caregivers are more vulnerable to the effects of sleep disruption and thus have trouble falling back to sleep when the time is afforded them. Future work is needed to examine the differences in care practices in caregivers by age and dementia severity. Perhaps more importantly, studies examining the health consequences of shortened sleep in this group are needed.

Aged↗

PubMed1992

The association between hemoglobin and behavior problems in a sample of low-income Hispanic preschool children.

This cross-sectional study, conducted in 1988, examines the association between hemoglobin level and behavior problems in 236 Hispanic children, ages 2 to 5 years, residing in low-income census tracts in the Los Angeles area. Venous blood samples were analyzed for hemoglobin, mean corpuscular volume, free erythrocyte protoporphyrin, and lead. Family and child data were obtained through a home interview with the child's mother or guardian. Behavior problems were assessed using questionnaires modeled after Child Behavior Checklists for children ages 2 to 3 and 4 to 5 years. A significant correlation between decreasing hemoglobin values and increasing total behavior problems scores was found for girls, 2 to 3 and 4 to 5 years old. These associations remained significant in both age groups after adjusting for maternal education and marital status. Statistically significant inverse correlations also were found between hemoglobin and social withdrawal, sleep problems, and depression (internalizing subscale behaviors) in 2- to 3-year-old girls, and between hemoglobin and aggression and hyperactivity (externalizing subscale behaviors) in 4- to 5-year-old girls. The potentially negative consequences of these anemia-related behavior problems on children's development, learning ability, and parent-child relationships warrant further investigation.

California↗

PubMedDate not supplied

Nocturia: a problem that disrupts sleep and predicts obstructive sleep apnea.

Nocturia frequently is considered a benign problem that results from aging. Nocturia can result from poorly controlled diabetes, congestive heart failure, or urinary dysfunction. Also a symptom of obstructive sleep apnea (OSA), nocturia is a significant source of sleep disruption that may result in excessive daytime sleepiness. This article examines variables that contribute to nocturia, its effect on health, and the physiological mechanisms in OSA that evoke nocturia. Evaluation requires differentiation of the underlying causes that result in either increased frequency or increased nocturnal urine production, including symptoms of OSA.

Aged↗

PubMed2005

Sleep apnea is a manifestation of the metabolic syndrome.

Obstructive sleep apnea (OSA) is a prevalent disorder particularly among middle-aged, obese men, although its existence in women as well as in lean individuals is increasingly recognized. Despite the early recognition of the strong association between OSA and obesity, and OSA and cardiovascular problems, sleep apnea has been treated as a 'local abnormality' of the respiratory track rather than as a 'systemic illness.' In 1997, we first reported that the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFalpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. Also, we reported a positive correlation between IL-6 or TNFalpha plasma levels and the body-mass-index (BMI). In subsequent studies, we showed that IL-6, TNFalpha, and insulin levels were elevated in sleep apnea independently of obesity and that visceral fat, was the primary parameter linked with sleep apnea. Furthermore, our findings that women with the polycystic ovary syndrome (PCOS) (a condition associated with hyperandrogenism and insulin resistance) were much more likely than controls to have sleep disordered breathing (SDB) and daytime sleepiness, suggests a pathogenetic role of insulin resistance in OSA. Other findings that support the view that sleep apnea and sleepiness in obese patients may be manifestations of the Metabolic Syndrome, include: obesity without sleep apnea is associated with daytime sleepiness; PCOS and diabetes type 2 are independently associated with EDS after controlling for SDB, obesity, and age; increased prevalence of sleep apnea in post-menopausal women, with hormonal replacement therapy associated with a significantly reduced risk for OSA; lack of effect of continuous positive airway pressure (CPAP) in obese patients with apnea on hypercytokinemia and insulin resistance indices; and that the prevalence of the metabolic syndrome in the US population from the Third National Health and Nutrition Examination Survey (1988-1994) parallels the prevalence of symptomatic sleep apnea in general random samples. Finally, the beneficial effect of a cytokine antagonist on EDS in obese, male apneics and that of exercise on SDB in a general random sample, supports the hypothesis that cytokines and insulin resistance are mediators of EDS and sleep apnea in humans. In conclusion, accumulating evidence provides support to our model of the bi-directional, feed forward, pernicious association between sleep apnea, sleepiness, inflammation, and insulin resistance, all promoting atherosclerosis and cardiovascular disease.

Comorbidity↗

PubMed2006

Sleep in children with attention-deficit hyperactivity disorder: a meta-analysis of polysomnographic studies.

The links between sleep and attention-deficit hyperactivity disorder (ADHD) have been a topic for intense ongoing research and clinical interest. Previous narrative literature reviews conveyed a consensus that parents of children with ADHD are more likely to report sleep problems in their children in comparison to parents of control children. However, when objective measures are considered the results appear to be more complex and inconsistent. This review is based on a meta-analysis of relevant polysomnographic studies. We assessed measures related to sleep architecture, breathing disorders, and periodic limb movements in sleep (PLMS), and the role of potential moderators such as age, gender, and other methodological factors. The meta-analysis revealed only one significant combined effect that indicates that children with ADHD are more likely than controls to suffer from PLMS. Factors such as age, gender, inclusion of adaptation night, and comorbidity appear to play a moderating role in the associations between sleep characteristics and ADHD. To provide new insight regarding the links between sleep and ADHD research in this field should adopt new strict guidelines and consider the role of multiple pertinent moderating factors.

Attention Deficit Disorder with Hyperactivity↗

PubMed1999

Sleep patterns in autistic children.

Sleep disturbances are regarded as a common clinical feature in autistic children. This concept is based primarily on informal observations or studies conducted with questionnaires. In this study we compared data obtained by questionnaires to that obtained with actigraphy. Among 22 autistic children, 12 were reported as having sleep problems and 8 patients completed 72 hours actigraphy. While the employment of questionnaires disclosed that autistic children had an earlier morning awakening time and multiple and early night arousals, actigraphic monitoring showed that with the exception of an earlier morning arousal time (p = .045), sleep patterns of autistic children were similar to that of normal children. Parental oversensitivity to sleep disturbances of the autistic children may explain this phenomenon.

Autistic Disorder↗

PubMed2003

The relationship between lifestyle regularity and subjective sleep quality.

In previous work we have developed a diary instrument-the Social Rhythm Metric (SRM), which allows the assessment of lifestyle regularity-and a questionnaire instrument--the Pittsburgh Sleep Quality Index (PSQI), which allows the assessment of subjective sleep quality. The aim of the present study was to explore the relationship between lifestyle regularity and subjective sleep quality. Lifestyle regularity was assessed by both standard (SRM-17) and shortened (SRM-5) metrics; subjective sleep quality was assessed by the PSQI. We hypothesized that high lifestyle regularity would be conducive to better sleep. Both instruments were given to a sample of 100 healthy subjects who were studied as part of a variety of different experiments spanning a 9-yr time frame. Ages ranged from 19 to 49 yr (mean age: 31.2 yr, s.d.: 7.8 yr); there were 48 women and 52 men. SRM scores were derived from a two-week diary. The hypothesis was confirmed. There was a significant (rho = -0.4, p < 0.001) correlation between SRM (both metrics) and PSQI, indicating that subjects with higher levels of lifestyle regularity reported fewer sleep problems. This relationship was also supported by a categorical analysis, where the proportion of "poor sleepers" was doubled in the "irregular types" group as compared with the "non-irregular types" group. Thus, there appears to be an association between lifestyle regularity and good sleep, though the direction of causality remains to be tested.

Adult↗

PubMed2005

Sleep complaints among older general practice patients: association with depression.

This study aimed to determine the prevalence of subjective sleep difficulties among general practice patients aged 60 years and over and to investigate their association with depression (CES-D>or=16). Sixty-three per cent of the 1029 participants reported experiencing sleep difficulties. Subjects who reported sleep problems were 3.7 times (95% confidence interval = 2.5 to 5.5) more likely to be depressed than those who did not (adjusted for age, sex, financial burden and perceived health). GPs should consider screening for the presence of depressive symptoms whenever older adults complain of sleep difficulties.

Aged↗

PubMedDate not supplied

Sleep in infants and young children: Part one: normal sleep.

The importance of sleep to overall health and well-being is becoming increasingly appreciated; however, clinicians may not have a sound understanding of the fundamentals of sleep. This review of normal pediatric sleep is meant to provide a foundation for the pediatric nurse practitioner to develop and use in clinical practice. Key concepts such as normal sleep physiology including biological rhythms and stages of sleep are discussed. Developmental changes in sleep seen in the transition from infancy to young childhood are highlighted, and strategies for instituting and maintaining normal sleep behaviors are recommended. Part 2 of this series will address common sleep problems experienced by young children.

Child Development↗

PubMed2003

Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance.

Obstructive sleep apnoea (OSA) is a very prevalent disorder particularly amongst middle-aged, obese men, although its existence in women as well as in lean individuals is increasingly recognized. Despite the early recognition of the strong association between OSA and obesity, and OSA and cardiovascular problems, sleep apnoea has been treated as a 'local abnormality' of the respiratory track rather than as a 'systemic illness'. In 1997, we first reported that the pro-inflammatory cytokines interleukin (IL)-6 and tumour necrosis factor-alpha (TNF alpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. Also, we reported a positive correlation between IL-6 or TNF alpha plasma levels and the body mass index (BMI). In subsequent studies, we showed that IL-6, TNF alpha, leptin and insulin levels were elevated in sleep apnoea independently of obesity and that visceral fat, was the primary parameter linked with sleep apnoea. The association of OSA with insulin resistance and diabetes type 2 has been confirmed since then in several epidemiological and clinical studies. Furthermore, our findings that women with polycystic ovary syndrome (PCOS, a condition associated with hyperandrogenism and insulin resistance) were much more likely than controls to have sleep disordered breathing (SDB) and daytime sleepiness support the pathogenetic role of insulin resistance in OSA. Other findings that support the view that sleep apnoea and sleepiness may be manifestations of a serious metabolic disorder, namely the Metabolic or Visceral Obesity Syndrome, include: obesity without sleep apnoea is associated with daytime sleepiness; PCOS and diabetes type 2 are independently associated with EDS after controlling for SDB, obesity and age; and increased prevalence of sleep apnoea in postmenopausal women, with hormonal replacement therapy associated with a significantly reduced risk for OSA. In conclusion, accumulating evidence provides support to our model of the bi-directional, feedforward, pernicious association between sleep apnoea, sleepiness, inflammation and insulin resistance, all promoting atherosclerosis and cardiovascular disease.

Adolescent↗

PubMed2001

Short-term prospective study of sleep disturbances in 5-8-year-old children.

UNLABELLED: The course and psychological correlates of disturbed sleep during middle childhood were investigated using parents' responses to questionnaires. Five specified sleep disturbances were explored in 614 5-8-y-old children, at baseline and at follow-up, 14 +/- 3 mo later. Difficulties falling asleep, in 6.2% of the children at baseline, persisted in 47.4% of the cases at follow-up; night-waking, in 18.6% at baseline, persisted in 45.5%; snoring, in 9.4% at baseline, persisted in 60%; nightmares, in 4.4% at baseline, persisted in 29.6%, and bedwetting, in 6% at baseline, persisted in 46%. Moreover, children with difficulties falling asleep at baseline frequently displayed bedtime resistance and shorter sleep at follow-up, while night-waking at baseline was related to co-sleeping at follow-up. Snoring at baseline was associated with a trend towards restless sleep at follow-up. Nightmares at baseline were related to several other sleep complaints as well as to behavioural difficulties during daytime at follow-up. Bedwetting at baseline was associated with tendencies towards hyperactivity at follow-up. Separate analyses of cases of persisting sleep disturbances showed that persisting difficulties falling asleep were associated with a need to remedy sleep problems, while persisting nightmares were strongly related to reports suggesting behavioural and emotional problems. CONCLUSION: During middle childhood, difficulties falling asleep, night-waking, snoring, nightmares or bedwetting commonly persist over the course of a year. Persistent nightmares frequently indicate significant psychological problems in affected children.

Age Factors↗

PubMed1996

Prevalence and correlates of snoring and observed apneas in 5,201 older adults.

The objectives of this study were to describe the prevalence of snoring, observed apneas, and daytime sleepiness in older men and women, and to describe the relationships of these sleep disturbances to health status and cardiovascular diseases (CVD). A cross-sectional design was employed to study sleep problems, CVD, general health, psychosocial factors, and medication use. The subjects were participants in the Cardiovascular Health Study, which included 5,201 adults, aged 65 and older, who were recruited from a random sample of Medicare enrollees in four U.S. communities. Study measures employed were sleep questions, echocardiography, carotid ultrasound, resting electrocardiogram, cognitive function, cardiopulmonary symptoms and diseases, depression, independent activities of daily living (IADLs), and benzodiazepine use. Thirty-three percent of the men and 19% of the women reported loud snoring, which was less frequent in those over age 75. Snoring was positively associated with younger age, marital status, and alcohol use in men, and obesity, diabetes, and arthritis in women. Snoring was not associated, however, with cardiovascular risk factors or clinical CVD in men or women. Observed apneas were reported much less frequently (13% of men and 4% women) than snoring, and they were associated with alcohol use, chronic bronchitis, and marital status in men. Observed apneas were associated with depression and diabetes in women. In both men and women, daytime sleepiness was associated with poor health, advanced age, and IADL limitations. The conclusions of the study were that loud snoring, observed apneas, and daytime sleepiness are not associated cross-sectionally with hypertension or prevalent CVD in elderly persons.

Activities of Daily Living↗

PubMed2003

Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography.

BACKGROUND: Obstructive sleep apnea (OSA) is common in severely obese subjects (body mass index [BMI] > 35). Overnight polysomnography (OPS) is the "gold standard" method of evaluating this condition; however, it is time-consuming, inconvenient, and expensive. Selection of patients for OPS would be enhanced if we could better predict those likely to have clinically significant OSA. STUDY OBJECTIVE: To look for clinical and biochemical predictors of OSA in symptomatic patients presenting for obesity surgery. DESIGN AND PATIENTS: Symptoms suggestive of OSA were sought in a structured interview. We report OPS results of 99 consecutive subjects in whom OSA was clinically suspected. Predictors of apnea-hypopnea index (AHI) were sought from an extensive preoperative data collection. Multivariate linear and logistic analysis was used to identify independent predictors of AHI. RESULTS: Symptoms were poor predictors of AHI, with observed sleep apnea the only positive predictor. Four clinical and two biochemical factors independently predicted AHI: observed sleep apnea, male sex, higher BMI, age, fasting insulin, and glycosylated hemoglobin A(Ic) (r(2) = 0.42). Neck circumference (the best single measure) could replace BMI and sex in the analysis (r(2) = 0.43). With cutoffs selected, a simple scoring system using these six factors provides a method of predicting those with moderate or severe OSA. A score > or = 3 provides a sensitivity and specificity of 89% and 81%, and 96% and 71% for AHIs of > or = 15 and > or = 30, respectively. None of the 31 subjects with scores of 0 or 1 were found to have an AHI > or = 15. CONCLUSION: We explore sleep disturbance and report a simple method of predicting OSA in severely obese symptomatic subjects. This should assist in limiting the use of OPS to those with greater risk and provide a method of assessing risk in those not presenting primarily with a sleep problem.

Adult↗

PubMed2003

Teaching family medicine medical students about sleep disorders.

OBJECTIVES: A 3.5-hour workshop was developed to teach family medicine medical students about sleep disorders. DESCRIPTION: This family medicine clerkship requirement engages students in role-plays and provides them with didactic information about common sleep problems. EVALUATION: Fifty-one students completed questionnaires assessing their knowledge prior to the workshop, 2 weeks and 6 months after the workshop, and their clinical behavior after the workshop. CONCLUSIONS: A role-play-based workshop is an effective, fun way to improve students' sleep knowledge and skills. Students retain that information over a 6-month period and are able to apply it during their clinical clerkships.

Education↗

PubMed2006

Psychometric properties of the MOS (Medical Outcomes Study) Sleep Scale in patients with neuropathic pain.

OBJECTIVE: This study assessed the psychometric properties of the MOS Sleep Scale in neuropathic pain (NeP). METHODS: Psychometric properties were tested in patients with neuropathic pain enrolled in a prospective study exploring the effectiveness of gabapentin for 3 months. Participants also completed scales for pain intensity, anxiety, depression, disability, and health-related quality of life. Feasibility, reliability, validity and sensitivity to change were measured in this study. RESULTS: Six-hundred-three patients [58.4+/-14.4 years (65.1% female), mean+/-SD] with pain for 1.2+/-3.3 years were included. The MOS Sleep Scale was acceptable (items with missing data <10% and floor and ceiling effects <50% per item and <15% per domain) and reliable (Cronbach's alpha between 0.64 and 0.87, and test-retest intraclass correlation coefficients between 0.79 and 0.91, p<0.001 for all cases). After adjusting for confounders, the MOS Sleep Scale was able to distinguish between sex, present pain intensity, level of disability and presence of anxiety or depression. Correlations with other scales were moderate; rho-coefficients between -0.21 and 0.57 (p<0.01, all cases). The scale was sensitive to change after treatment with gabapentin; after adjusting, responders (50% reduction in baseline pain) showed a decrease in sleep problems index of -25.6+/-14.3 points vs. -12.1+14.5 points in nonresponders (F=80.5, df=1/398, p<0.0001). Score reduction in summary index and subscales correlated significantly with pain intensity reduction (Pearson r-coefficients between 0.428 and 0.116, p<0.01, all cases). CONCLUSIONS: The MOS Sleep Scale showed good psychometric properties and was sensitive to changes in patients with NeP of broad aetiology.

Adult↗

PubMedDate not supplied

Postnatal classes on prevention of sleeplessness in young children.

Parents of young babies attended evening classes on prevention of sleeping problems in pre-school children. The aim was to test the consumer-appeal of this preventative approach. Content focused on individual behavioural differences in babies as well as adaptation of parenting strategies to avoid some of the common pitfalls in the management of sleep-related behaviours. Parents' views were obtained and were favourable. Results are discussed in terms of the timing and format of similar prevention programmes.

Consumer Behavior↗

PubMed2003

Sleeping characteristics of adults undergoing outpatient elective surgery: a cohort study.

STUDY OBJECTIVE: To describe sleeping patterns of adults before and after outpatient surgery. DESIGN: Observational cohort study. SETTING: Outpatient surgical facility. PATIENTS: 127 consenting adults, including 92 surgery patients and 35 community controls. INTERVENTIONS: Participants' sleep was measured for two days before and 2 days after outpatient surgery. MEASUREMENTS: Sleep was measured using actigraphy; additional measurements were made of anxiety (STAI), pain and energy (VAS), recovery (PHRI), and sleep history. MAIN RESULTS: Approximately 23% of patients experienced clinically significant sleep impairment after surgery, a more difficult recovery, increased pain, and lower energy. In contrast, only 2.9% of the community control group experienced clinically significant sleep impairment during the same time period. Also, patients in the surgery group experienced significantly more True Wake Time postoperatively than did control patients (p = 0.029). The surgery group also experienced more Night Awakenings >5 minutes than the control group (p = 0.006), but not more overall Night Awakenings (p = 0.106). Finally, of the patients in the surgery group, those who had higher state anxiety in the holding area also had more difficulty sleeping over the 4-day monitoring period (True Sleep Time was lower, 352 +/- 187 vs. 229 +/- 225, p = 0.009). CONCLUSIONS: A moderate proportion of adults experience postoperative sleeping problems.

Adult↗

PubMedDate not supplied

Anxiety symptoms in allergic patients: identification and risk factors.

OBJECTIVES: Multiple relationships between anxiety, allergic symptoms, and treatment difficulties have been observed. The aim of the present study was to estimate the prevalence of anxiety disorders in outpatients with various allergic diseases, to identify diagnostic cues or possible risk factors, and to test the usefulness of self-administered questionnaire screening at the allergy clinic. METHODS: Six hundred forty-six (646) consecutive patients with rhinoconjunctivitis (59.3%), asthma (26.8%), or "other" allergy (13.9%), aged 16 to 65 years, completed self-administered questionnaires in six outpatient allergy clinics; 60 of the respondents also participated in structured psychiatric interviews. Anxiety was measured with the Spielberger State-Trait Anxiety. RESULTS: According to the interviews, STAI-T > 52 predicted with 86% accuracy a current psychiatric diagnosis, without differentiating between anxiety and depression. Using this threshold, the rate of anxiety and/or depressive disorders is estimated as 19% (95% CI: 15.9-22.1) in our unselected allergic outpatient sample; 46% of these patients never received any psychopharmacological treatment, indicating that anxiety related disorders are underdiagnosed and undertreated. Risk indicators were female gender; asthma; perennial symptoms; sleep problems; nonspecific allergy triggers like strong emotions; stressful situations; and considerable limitation in everyday activities attributed to the allergic symptoms. CONCLUSIONS: Our findings confirm a high rate of anxiety and/or depressive disorders in patients visiting the allergy clinic. Self-administered questionnaires such as STAI-T provide reliable help for the identification of these frequent psychiatric problems.

Adolescent↗