Sleep duration and overweight/obesity in children: Review and implications for pediatric nursing

Purpose. The purpose of this study was to review evidence from the last 5 years (2006–2011) regarding a relationship between sleep duration and childhood overweight/obesity. Conclusions. Among the 25 studies selected from PubMed and Web of Knowledge databases, all indicated significant associations between short sleep duration and childhood overweight/obesity. Studies explored a range of pediatric populations, methodologies, and potential contributing factors. Practice Implications. Childhood sleep duration may be a modifiable risk factor in preventing obesity. In addition to identifying and assessing patients' sleep habits, nurses play important roles as educators regarding the importance of adequate sleep and promoting it in children.     

Influence of Hispanic Ethnicity in Prevalence of Diabetes Mellitus in Sleep Apnea and Relationship to Sleep Phase

Abstract

Introduction: Recent studies have shown a strong association between insulin resistance, diabetes mellitus, and obstructive sleep apnea (OSA). This association has not been previously reported in the Hispanic population. The objective of this study was to study the prevalence of diabetes in a cohort of Hispanic patients with OSA in comparison with a white cohort. Method: We performed a retrospective chart review of 103 Hispanic patients and 69 white patients with OSA. All patients had undergone full-night baseline polysomnography. We excluded charts of patients who underwent split-night studies and those who did not have rapid eye movement (REM) sleep. Results: Both groups were well matched in terms of age, gender distribution, and body mass index. The prevalence of self-reported diabetes in Hispanic patients with OSA was 42.71% compared with 24.28% of whites (P = 0.005). A REM apnea hypopnea index (AHI) of > 20 was significantly associated with an increased prevalence of diabetes in the Hispanic population; this association was not seen in the white population. Conclusion: There was a very high prevalence of diabetes in an unselected cohort of Hispanic patients with OSA compared with white patients.     

孕期睡眠与子代出生体质量相关性的研究进展

目前孕期睡眠与子代出生体质量之间关系的研究结论尚不一致，多项研究认为孕妇孕期睡眠呼吸障碍（sleepdisordered breathing,SDB）、孕期睡眠不足、睡眠质量差与子代低出生体质量相关。孕妇睡眠姿势与子代出生体质量相关性的研究较少，有研究发现孕妇仰卧位睡眠可导致子代低出生体质量。孕期睡眠障碍和子代出生体质量之间的关联模式尚须进一步的纵向研究证实，同时客观的睡眠时间和睡眠质量测量方法有待探讨。本文主要从SDB、睡眠持续时间、睡眠质量及睡眠姿势4个方面来阐述孕期睡眠与子代出生体质量之间关系的研究进展。     

Clinical,anatomical, and physiologic relationship between sleep and headache

The intimate relationship between sleep and headache has been recognized for centuries, yet the relationship remains clinically and nosologically complex. Headaches associated with nocturnal sleep have often been perceived as either the cause or result of disrupted sleep. An understanding of the anatomy and physiology of both conditions allows for a clearer understanding of this complex relationship and a more rational clinical and therapeutic approach. Recent biochemical and functional imaging studies in patients with primary headache disorders has lead to the identification of potential central generators which are also important for the regulation of normal sleep architecture. Medical conditions (e.g. obstructive sleep apnea, depression) that may disrupt sleep and lead to nocturnal or morning headache can often be identified on clinical evaluation or by polysomnography. In contrast, primary headache disorders which often occur during nocturnal sleep or upon awakening, such as migraine, cluster headache, chronic paroxysmal hemicrania, and hypnic headache, can readily be diagnosed through clinical evaluation and managed with appropriate medication. These disorders, when not associated with co-morbid mood disorders or medications/analgesics overuse, seldom lead to significant sleep disruption. Identifying and classifying the specific headache disorder in patients with both headache and sleep disturbances can facilitate an appropriate diagnostic evaluation. Patients with poorly defined nocturnal or awakening headaches should undergo polysomnography to exclude a treatable sleep disturbance, especially in the absence of an underlying psychological disorder or analgesic overuse syndrome. In patients with a well defined primary headache disorder, unless there are compelling historical or examination findings suggestive of a primary sleep disturbance, a formal sleep evaluation is seldom necessary.     

The Relationship Between Headaches and Sleep Disturbances

The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have casual relations, or may be associated in the same patient with mutual reinforcements.
We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated.
The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache.
For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemi-crania were not modified by polysomnography.
The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication.
Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction.
In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.     

Obtaining a thorough sleep history and routinely screening for obstructive sleep apnea

PURPOSE: To present a clinical case study of obstructive sleep apnea (OSA) and discuss a potential correlation between OSA, unexplained distal pain symptoms, and pyschoemotional concerns. DATA SOURCES: A review of the scientific literature was performed on OSA using the Cumulative Index of Nursing and Allied Health Literature and MEDLINE. CONCLUSIONS: OSA is potentially life threatening and can have serious consequences to a patient's health. Many of the obvious signs of OSA occur at night, and the symptoms of OSA may correspond to a variety of other diseases. Clinicians should recognize a possible correlation between OSA and unexplained distal pain symptoms as well as psychoemotional concerns. These clinically associated conditions may be less apparent but may dramatically affect quality of life. By improving recognition and treatment of OSA, morbidity and mortality can be reduced and quality of life can be improved for patients and their families. IMPLICATIONS FOR PRACTICE: It is imperative that clinicians are attentive and take detailed histories to recognize the clinical signs and symptoms of OSA, paying more attention to the less obvious symptomatology that may be significantly impacting quality of life.     

Sleep Deficiency and Psoriasis: Implications for Clinical Practice

Adults with psoriasis experience sleep deficiency due to poor sleep habits, underlying sleep disorders (obstructive sleep apnea, insomnia), and symptoms of pruritus and pain. This article aims to provide an overview of (1) psoriasis, (2) sleep deficiency in psoriasis, (3) sleep assessment, and (4) the clinical implications of sleep deficiency in psoriasis. Routine assessment and treatment of sleep deficiency in clinical practice may improve quality of life, facilitate disease management, and decrease health care utilization.     

儿童睡眠及睡眠障碍影响因素的调查研究

目的了解乌鲁木齐市不同年龄儿童睡眠时间及睡眠障碍的发生情况，探讨其可能的影响因素。方法于2002年6月-2003年6月在乌鲁木齐市随机抽取2个行政区4000名2—12岁儿童，对其睡眠状况进行统一问卷调查。结果（1）我市各年龄儿童平均睡眠时间均低于国际标准，其主要影响因素为儿童的年龄、睡眠比和入睡时间以及父母的年龄、文化程度。（2）我市儿童睡眠障碍的总发生率为39．70％，不同年龄儿童睡眠障碍的类型有所不同。影响儿童睡眠障碍的主要因素依次为父母一方或双方睡眠障碍的存在、孩子患扁桃体炎的次数、夜问哺患发作的次数和入睡时间。结论乌鲁木齐市2-12岁儿童的睡眠时间普遍较少，睡眠障碍的发生率较高，其影响因素与孩子的年龄、睡眠习惯、健康状况及遗传等多方面因素有关，故应引起大家的共同关注，减少睡眠问题带来的健康隐患。     

The Association of Sleep and Pain: An Update and a Path Forward

Ample evidence suggests that sleep and pain are related. However, many questions remain about the direction of causality in their association, as well as mechanisms that may account for their association. The prevailing view has generally been that they are reciprocally related. The present review critically examines the recent prospective and experimental literature (2005–present) in an attempt to update the field on emergent themes pertaining to the directionality and mechanisms of the association of sleep and pain. A key trend emerging from population-based longitudinal studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain. Microlongitudinal studies employing deep subjective and objective assessments of pain and sleep support the notion that sleep impairments are a stronger, more reliable predictor of pain than pain is of sleep impairments. Recent experimental studies suggest that sleep disturbance may impair key processes that contribute to the development and maintenance of chronic pain, including endogenous pain inhibition and joint pain. Several biopsychosocial targets for future mechanistic research on sleep and pain are discussed, including dopamine and opioid systems, positive and negative affect, and sociodemographic factors.     

住院患者夜间睡眠质量及其影响因素的调查

目的了解住院患者夜间睡眠状况及其影响因素,并比较护理人员和患者关于住院患者夜间睡眠状况和影响因素的不同看法。方法采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）量表和自行设计的住院患者夜间睡眠状况调查表（患者卷和护士卷）分别对397例患者（内科254例,外科143例）和101位夜班护士进行调查。结果在397例患者中,45.6%的住院患者存在睡眠质量问题。单因素分析结果显示：护士护理别的患者发出的声响、夜间治疗护理、电话铃声、空调发出的声音、护士交谈声、治疗仪器发出的声音、护士脚步声是干扰住院患者夜间睡眠的环境因素;疾病本身带来的不适、夜间起来上厕所、药物的夜间服用是生理及病理生理方面的影响因素;对病情的担心、情绪厌烦、想念亲人、难以自控等心理因素导致患者难以入睡。Logistic回归分析结果显示：影响住院患者夜间睡眠的因素包括对病情的担心、疾病本身带来的不舒适、夜间起来上厕所和护士的脚步声等。91.1%的护士能够意识到大部分住院患者的夜间睡眠状况较正常人差;患者和护士认为睡眠影响因素的排序在总体上比较一致,但在各自总体中所占的比例仍有较多项目存在统计学差异。结论大部分住院患者存在睡眠质量问题,其影响因素是多方面的;护理人员应从患者角度出发,系统了解住院患者的睡眠状况,采取个体化护理对策,改善住院患者的睡眠质量,促进其身心早日康复。     

脑卒中患者睡眠障碍特点研究

目的观察脑卒中患者睡眠障碍的特点。方法应用专业量表对350例脑卒中患者的睡眠状况进行评估及统计分析。结果脑卒中患者睡眠障碍主要表现为入睡困难、早醒、睡眠维持障碍、睡眠结构紊乱、日间过度睡眠、发作性睡病等;女性患者的睡眠障碍发生率高于男性(P<0.05)。结论脑卒中患者的睡眠障碍发生率显著高于一般人群;女性脑卒中患者睡眠障碍总体发生率高于男性患者;女性患者入睡困难、早醒、睡眠维持障碍、睡眠结构紊乱的发生率高于男性患者;男性患者日间过度睡眠、发作性睡病及其他类型的发生率高于女性患者。     

Relationship between sleep apnoea syndrome,snoring and headaches

There is still a controversy regarding the relationship between sleep apnoea syndrome and headaches, especially morning headaches. Our objectives were: (i) to compare the prevalence and the clinical data of headaches in sleep apnoea syndrome (SAS) and control (snorers) groups defined by polysomnographic recording; (ii) to analyse the clinical improvement of headaches with appropriate treatment; and (iii) to correlate headaches with mood disorders, and nocturnal respiratory and architectural sleep parameters in order to understand the underlying pathophysiological mechanisms. This is a prospective study of 324 consecutive patients referred to our sleep centre for snoring. Of these, 312 patients who underwent sleep polysomnography were finally included. Patients and controls were interviewed about their medical past, headache history and clinical characteristics, their daytime sleepiness (Epworth's sleepiness scale) and their mood disorders (Zerssen's scale). Follow-up of patients with headaches (SAS and control groups), treated or not, was also assessed. According to our definition of SAS, patients were dissociated in SAS (n=164) and snorers (n=148). Fifty-three SAS patients had headaches, of whom 58.5% (n=30) suffered from morning headaches. However, there was no statistical difference between the two groups concerning the prevalence and the clinical characteristics of headaches. In addition, headaches and morning headaches were not correlated with nocturnal respiratory and architectural sleep parameters, nor with excessive daytime sleepiness, but were strongly correlated with mood disorders. In 36 SAS patients, headaches improved under treatment, but this was not statistically different from what was found among untreated snorers. Headaches and morning headaches are common in patients with SAS but may be considered as a non-specific symptom. The underlying mechanisms are not fully elucidated but depression could play an important role. Despite this absence of specificity, the treatment of SAS, especially nasal continuous positive airway pressure, leads to an improvement in headaches in several cases.     

儿童阻塞性睡眠呼吸暂停低通气综合征的诊治

【目的】探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床特点和早期诊断及治疗的方法。【方法】分析经鼻咽侧位X线摄片、纤维鼻咽镜检查及多道睡眠监测(polysomnography,PSG)确诊为OSAHS的86例患儿的临床症状和体征的特点,并对其中72例扁桃体、腺样体肥大的患儿进行了手术治疗。【结果】OS AHS患儿的主要症状是睡眠时有打鼾、呼吸不畅、呼吸暂停、听力下降。术后69例患儿临床症状明显缓解,占95.8%。术后2~4个月内,对60例患儿复查PSG,发现睡眠呼吸低通气指数、夜间血氧饱和度低于0.90的时间所占睡眠时间的百分比、最长呼吸暂停时间较术前均明显改善,且差异有显著性(P<0.05)。【结论】扁桃体和腺样体是儿童OSAHS的主要病因,PSG是诊断的依据,手术切除是其主要的治疗手段。     

Primary care assessment and management of sleep disorders

PURPOSE: To review the functions of sleep and describe an appropriate sleep assessment for the identification of sleep disorders for nurse practitioners (NP) in primary care. Guidelines for management and referral are included. DATA SOURCES: Selected and the author's experience. CONCLUSIONS: The incidence of sleep deprivation in the United States is generally unacknowledge by the public as well as health care professional. Unfortunately, the castastrophic and debilitating consequences that result from alterations in sleep are usually noted after significant physical and emotional damage have occurred. IMPLICATIONS FOR PRACTICE: An assessment of sleep hygiene and the physical, emotional, or lifestyle changes that alter sleep patterns should be a part of the NP's routine encounter with patients. Referral is indicated for suspicion of obstructive sleep apnea, narcolepsy, restless leg syndrome, complex motor activity, or if the condition fails to respond to therapeutic management.