Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study

BackgroundTo explore the relationship between sleep disturbances and falls in an elderly Chinese population.MethodsData from 1726 individuals aged 70–87 years from the Rugao Longevity and Ageing Study were used. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep variables. Outcomes were falls ≥1 time per year and falls ≥2 times per year.ResultsA total of 22.7% of the participants experienced ≥1 fall, and 9.8% experienced ≥2 falls per year. Poor sleep quality was associated with ≥1 fall (OR 1.08, 95% CI 1.05–1.12; OR 1.27, 95% CI 1.14–1.41) and ≥2 falls (OR 1.08, 95% CI 1.03–1.14; OR 1.28, 95% CI 1.10–1.48), with an increase per PSQI score and SD PSQI score, respectively. In addition, sleep quality, sleep latency, sleep efficiency, and sleep disturbance subcomponents were associated with an increased risk of ≥1 fall with ORs of 1.44 (95% CI, 1.21–1.72), 1.23 (95%CI,1.09–1.40), 1.12 (95%CI, 1.01–1.23) and 1.70 (95% CI,1.35–2.14), respectively, and were associated with an increased risk of ≥2 falls with ORs 1.54 (95%CI, 1.22–1.96), 1.21(95%CI, 1.02–1.44), 1.17 (95% CI 1.02–1.33), and 1.78 (95%CI, 1.31–2.44), respectively. Further, participants slept ≤5 h per night had an increased risk of ≥1 fall (OR 2.34; 95%CI, 1.59–3.46) and ≥2 falls (OR 2.19; 95%CI, 1.30–3.69).ConclusionsPoor sleep quality and several subcomponent sleep symptoms were consistently associated with increased risk of falls ≥1 time and ≥2 times in Chinese elderly. The identification of sleep disturbances may help identify high-risk Chinese elders who may benefit from fall prevention education.     

Sleep disorders in patients with psoriasis: a cross-sectional study using non-polysomnographical methods

Background

Psoriasis is a chronic inflammatory skin disease which can cause sleep disturbances due to the disease itself or due to its complications. In this study, we aimed to analyze the array of sleep disturbances caused by psoriasis and to evaluate the interaction between the quality of sleep and the duration and severity of psoriasis.

Methods

Study subjects included 60 patients with plaque psoriasis and 60 sex- and age-matched controls. The Psoriasis Area and Severity Index (PASI) was used to evaluate severity of disease. Body mass index (BMI), medication usage, and duration of disease were recorded. All subjects completed the Epworth Sleepiness Scale (EES), Pittsburgh Sleep Quality Index (PSQI), insomnia severity index (ISI), Berlin-sleep apnea questionnaire, and questions based on criteria of the International Restless Legs Syndrome Study Group indicating the presence of restless legs syndrome (RLS).

Results

There were statistically significant and clinically relevant differences between the patients and controls regarding day-time sleepiness (ESS 5.3 vs 4.1, p?=?0.037), sleep quality (PSQI 14.4 vs 4.9, p?<?0.001), insomnia (ISI 19.7 vs 14.4, p?<?0.001), sleep apnea (high risk 30% vs 7%, p?=?0.01), and RLS (high risk 32% vs 0%, p?<?0.001).

Conclusions

Patients with psoriasis experience poor sleep quality and are at markedly increased risk for insomnia, obstructive sleep apnea, and restless legs syndrome. These findings suggest the importance of evaluating patients with psoriasis for conditions that affect sleep. The study results further suggest that simple screening tools may be useful for this task.

     

Sleep disturbances among a group of dementia participants

AimDementia patients are found to have more sleep disturbances that can affect their quality of life and functional and cognitive abilities, and these disturbances are associated with greater risk of psychiatric symptoms. The aim of this study is to investigate the presence of sleep disturbances among a group of moderately patients with dementia and their effects on the development of depression, apathy, daytime sleepiness, apathy, and caregiver stress.MethodBaseline demographic data were collected in 105 participants with a mean age of 79 years. Sleep disturbance was measured by Sleep Disorder Inventory (SDI). The Epworth Sleep scale (ESS) was used to measure excessive daytime sleepiness, while the Cornell Depression score (CDS) was used to measure for the presence of depressive symptoms. The Starkstein Apathy scale was used for assessment of apathy on sleep and the Zarit Burden Interview (ZBI) was used to evaluate carer stress. We found that patients on hypnotics generally have a higher SDI (4.7 vs, 1.48, p = 0.021) and higher CDS (9.3 vs. 4.9, p = 0.033). There was no statistical significant difference in different cholinesterase inhibitors on SDI, ESS, CDS, apathy score, and carer stress. SDI was positively correlated with ESS, CDS, and ZBI, but not related to the MMSE score and apathy. Linear regression found that ESS, CDS, and ZBI were independently associated with SDI.ConclusionSleep problems in dementia patients are associated with carer stress, excessive daytime sleepiness, and depression using simple objective assessment instruments. This study helps to provide insights into sleep disturbances in dementia patients and highlights the importance of this frequently missed aspect in the care of dementia patients and their caregivers.     

老年阻塞性睡眠呼吸暂停综合征睡眠障碍特点与认知损害相关性分析

目的 分析老年阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的睡眠障碍特点与认知损害相关性. 方法 受检老年人36例,分为OSAS组(18例),对照组(18例),均进行多导睡眠图(polysomnography,PSG)家庭睡眠监测、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、爱泼沃斯思睡量表(Epworth sleepiness scale,ESS)测试,检测简易智力状态(mini-mental state examination,MMSE)、记忆商(MQ)并进行画钟测验、词表学习、符号数字测验等认知功能评估. 结果 (1)OSAS组Delta睡眠比例减少、最低和平均血氧饱和度明显减少、呼吸暂停及低通气指数(apnea and hypopnea index,AHI)及氧减指数明显增加(P＜0.05).(2)OSAS组MMSE、MQ、符号数字测验、画钟测验成绩较差(P＜0.05).(3)OSAS组MMSE评分与年龄呈负相关(r=-0.533,P＜0.05),与平均血氧水平呈正相关(r=0.409,P＜0.05).MQ与MMSE、入睡潜伏期、氧减指数相关(r分别为0.726,0.495,0.645,P均＜0.05). 结论 老年OSAS以深睡眠减少、血氧饱和度降低等为其睡眠障碍特点,可能是引起记忆、视空间、操作学习等认知功能损害的重要原因.     

Poor sleep is responsible for the impaired nocturnal blood pressure dipping in elderly hypertensive: A cross-sectional study of elderly

Objective: This study was aimed to assess whether sleep disorder was associated with an increased risk of less nocturnal blood pressure (BP) dipping in elderly patients with hypertension.

Methods: Cases were 1006 patients, aged >60 years, who were admitted to hospital with diagnosed hypertension during 2016–2017, and were divided into three groups with the systolic nocturnal BP dipping of 10%, and 0% as the cut-off value. The patients’ sleep was evaluated by Pittsburgh sleep quality index (PSQI).

Results: Compared to non-dipper BP rhythm patients (n = 382) and dipper BP rhythm patients (n = 132), reverse dipper patients (n = 492) exhibited higher PSQI score and had higher scores on six components with the exception of use sleep drug (p < 0.05). Multivariate logistic regression indicated that poor sleep, which was defined as high score of PSQI or its seven components, was associated with prevalence of reverse dipper in elderly hypertensive (odds ratio (OR) = 1.17, (95% confidence interval (CI), 1.13–1.21, p < 0.05) after adjusting for risk factors of hypertension. Multiple linear regression analysis showed that there was a significant negative correlation between PSQI score (include its seven components) and nocturnal BP dipping value after adjusting for risk factors of hypertension (β = ?0.584, p < 0.001).

Conclusions: In elderly patients with hypertension, poor sleep quality individuals were more prone to reverse dipper BP rhythm. Even adjusting for the effect of known risk factors of hypertension, poor sleep may contribute to attenuated BP dipping in elderly hypertensive.     

Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis

Sleep disturbances are common in patients of cirrhosis and has a significant effect on their health related quality of life (HRQOL). Thus far, no study has demonstrated a systematically studied significant correlation between the sleep disturbance observed and the neuropsychiatric impairment status of patients of cirrhosis. On the basis of PHES, we divided 100 cirrhotics into those having minimal hepatic encephalopathy (MHE) (PHES≤?5) and those not (NMHE). Now, in these MHE (n=46) and NMHE (n=54) patients, sleep disturbance was measured with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and HRQOL with SF-36(v2) questionnaire. Sixty (60 %) patients were found to be ‘poor sleepers’ (PSQI>5) while 38 (38 %) patients had excessive daytime sleepiness (ESS≥11). Univariate and multivariate analyses showed MHE has significant effect among ‘poor sleepers’ (P<0.0001) as well as on those with EDS (P<0.0001). Significant correlation existed between PHES and both the sleep parameters of PSQI (r = ?0.518, P <0.0001) as well as ESS (r = ?0.383, P <0.0001), implying independently strong correlation between poor cognition and the presence of night time sleep disturbance and excessive daytime sleepiness among cirrhotics. Significant correlation existed between PSQI and ESS and the various scales and component scores of SF-36(v2) signifying the negative impact of sleep disturbance on the HRQOL. In conclusion, both night time sleep disturbance and excessive daytime sleepiness have significant relation with the neuropsychiatric impairment in patients of cirrhosis and are significantly associated with the observed impairment in HRQOL.     

Subjective sleep quality and daytime sleepiness in a large sample of patients with chronic fatigue syndrome (CFS)

Chronic fatigue syndrome (CFS) is characterised by incapacitating fatigue in combination with a number of minor criteria, including unrefreshing sleep without further specifications, in the absence of psychiatric and internal disease. As little data exist on subjective sleep quality and daytime sleepiness, these parameters were assessed in a large sample of CFS patients. Consecutive patients with a diagnosis of CFS in a tertiary referral centre filled out the Fatigue Questionnaire (FQ), Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Inclusion comprised 415 individuals (mean age 40.5 yr, SD 7.9, range 18-64; 86% female). Mean FQ (26.90; SD 4.04), mean Global Physical Health from the MOS SF-36 (29.30; SD 12.25) and Global Mental Health from the MOS SF-36 (49.62; SD 18.31) scores corresponded with literature data for similar CFS samples. High mean ESS (10.51; SD 5.52) and global PSQI (10.17; SD 4.02) were observed. No significant relationship was found between ESS and global PSQI. In contrast, regression analysis demonstrated a significant cubic relation between ESS and 'PSQI without daytime dysfunction'. A subgroup (n=69) with an insomnia-like phenotype low ESS (<5), high PSQI (mean 11.51; SD 3.86) was observed. The assessment of subjective sleep quality and daytime sleepiness in a large sample of CFS patients indicated high mean PSQI and ESS values. ESS and 'PSQI without daytime dysfunction' were inversely related at the spectral ends of ESS. A distinct subgroup with clinical features of insomnia was identified.     

Sleep Quality in Asthma: Results of a Large Prospective Clinical Trial

Rationale. Previous studies have suggested that asthmatics have an increased incidence of sleep disturbances. However, these studies have been limited by reliance on population surveys or small numbers of participants. Objectives. We sought to measure sleep quality and daytime sleepiness in a cohort of symptomatic asthmatics and to measure the effects of improved asthma control on sleep quality. Methods. Data were collected in sub-study of a large multi-center randomized double-masked controlled trial of mild-moderate asthmatics evaluating the effect of low-dose theophylline on asthma control in comparison to montelukast and placebo. Each participant was administered sleep symptom questionnaires at randomization and at the final visit (6 months after randomization). These included the Pittsburgh Sleep Quality Questionnaire (PSQI) and the Epworth Sleepiness Scale (ESS). Measurements and main results. Data were available for 487 participants. Baseline mean values were: age 40 ± 15 years, 74% female, forced expiratory volume in 1 second (FEV₁) 79 +16 percent predicted, Juniper Asthma Control Questionnaire (ACQ) score 2.35 ± 0.63, PSQI 7.8 ±4, and ESS 8.5 ±4.9. There were no significant differences in the PSQI or ESS between the three treatment groups. Significant correlations were found at baseline between the global PSQI score and ACQ and quality of life and marginally with lung function. Significant correlation existed between improvements in PSQI and ESS with improved asthma control and quality of life. Conclusions. Sleep disturbances are common in asthmatics and are associated with asthma control and quality of life. Clinicians caring for asthmatics may need to complete a more detailed sleep history in patients with poorly controlled asthma. In addition, low-dose theophylline does not seem to impair sleep quality in asthmatics.     

Stage-matched intervention for adherence to CPAP in patients with obstructive sleep apnea: a randomized controlled trial

Purpose

The objective of the study was to evaluate the effectiveness of stage-matched intervention on adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome.

Methods

One hundred and ten Chinese patients with newly diagnosed obstructive sleep apnea syndrome were enrolled in this study. They were randomly assigned into stage-matched care (SMC) and standard care (SC) groups (55 patients in each group). Patients in the SMC group received stage-matched intervention at different stages of behavior changes, and the SC group received only routine care. The intervention was based on the health action process approach theory and included risk perception, outcome expectancy, and self-efficacy. Questionnaires included the Self-Efficacy Measure for Sleep Apnea, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI). Data were collected at baseline and 1 and 3 months after home CPAP treatment, and hours of CPAP usage was also recorded at 1 and 3 months of follow-up.

Results

At 1 month, CPAP usage was 5.59?±?0.56 h/night (mean ± SD) vs 5.28?±?0.67 h/night in the SMC and SC groups, respectively (p?=?0.016). At 3 months, CPAP usage was 5.65?±?0.50 vs 5.26?±?0.82 h/night in the SMC and SC groups, respectively (p?=?0.006). Repeated ANOVA analysis demonstrated that risk perception, outcome expectancy, and self-efficacy in the SMC group were significantly higher than those of the SC group (p?<?0.05). Moreover, the time × group interaction was significant for outcome expectancy and self-efficacy, indicating that the groups differed significantly in changes in outcome expectancy and self-efficacy over the three time points. There was a significant difference between the SMC and SC groups in terms of improvement in ESS (p?<?0.001) and PSQI (p?=?0.013) after 3 months of CPAP treatment.

Conclusions

Stage-matched intervention could not only facilitate intention formation and enhance treatment self-efficacy but significantly improve CPAP adherence in OSA patients for the 3-month treatment.     

Prevalence of Restless Legs Syndrome and Its Effects on Sleep and Health-Related Quality of Life in Patients With Heart Failure

BackgroundRestless legs syndrome (RLS) is a neurological disorder characterized by leg restlessness and dysesthesia. Although the relationship between RLS and heart failure (HF) has been reported, the prevalence and clinical significance of RLS in patients with HF remain to be elucidated.Methods and ResultsWe enrolled consecutive patients with HF who were admitted to our institutions. RLS was diagnosed using the International Restless Legs Syndrome Study Group criteria. Subjective sleepiness, sleep quality, and quality of life (QoL) were assessed using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and 8-item Short Form (SF-8), respectively. Among the 133 patients, 18 (13.6%) had RLS and were younger than those without RLS (62.4±13.4 vs 70.0±12.2, P = .017). The RLS group had significantly disrupted sleep quality and QoL, with greater PSQI score (8.0±3.2 vs 5.9±3.3, P = .015) and lower SF-8 physical component summary (PCS) score (35.6±6.5 vs 40.7±9.5, P = .031), despite similar ESS and SF-8 mental component summary scores. In the multivariable regression analysis, RLS was associated with greater PSQI (β=0.211; P = .014) and lower PCS score (β=?0.177; P = .045).ConclusionIn the patients with HF, RLS was prevalent, and sleep quality and QoL may be disrupted by RLS.     

Night‐time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis

Background: Sleep–wake disturbances are common in patients with cirrhosis and are generally attributed to the presence of hepatic encephalopathy. Aim: To determine the relationship between sleep and neuropsychiatric disturbances in patients with cirrhosis. Methods: The study population comprised 87 patients, classified as neuropsychiatrically unimpaired or as having minimal/overt hepatic encephalopathy. Nineteen healthy volunteers served as controls. Validated questionnaires were used to assess sleep quality [Pittsburgh sleep quality index (PSQI)], day‐time sleepiness [Epworth sleepiness scale (ESS)] and diurnal preference. Health‐related quality of life (H‐RQoL) was assessed using the 36‐item short form health profile (SF‐36v1) and the chronic liver disease questionnaire. Results: Patients slept significantly less well than the healthy volunteers (PSQI score: 8.4 ± 4.9 vs. 4.6 ± 2.5, P<0.01) and had more pronounced day‐time sleepiness (abnormal ESS: 21 vs. 0%; χ²=3.8, P=0.05). No significant relationships were observed between sleep indices and the presence/degree of hepatic encephalopathy. H‐RQoL was significantly impaired in the patients (SF‐36v1 physical score: 36 ± 15 vs. 50 ± 10, P<0.001; SF‐36v1 mental score: 46 ± 11 vs. 50 ± 10, P<0.01); night‐time sleep disturbance was an independent predictor of poor H‐RQoL (P<0.01). Conclusions: Sleep–wake abnormalities are common in patients with cirrhosis; they significantly affect H‐RQoL but are not related to the presence of hepatic encephalopathy.     

Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial

OBJECTIVES: To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. DESIGN: Randomized, controlled trial with allocation to tai chi or exercise control. SETTING: General community. PARTICIPANTS: One hundred eighteen women and men aged 60 to 92. INTERVENTION: Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks. MEASUREMENTS: Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores. RESULTS: Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) (P<.01), PSQI global score (P=.001), and ESS scores (P=.002) in comparison with the low-impact exercise participants. Tai chi participants reported sleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=-28.64 to -7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71-82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores. CONCLUSION: Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.     

Brief Behavioral Therapy and Bupropion for Sleep and Fatigue in Young Adults With Crohn’s Disease: An Exploratory Open Trial Study

Background/AimsSleep disturbances and fatigue are common symptoms amongst patients with Crohn’s disease (CD). The aim of this study was to test the feasibility and effects of a pragmatic, stepped-care intervention for the treatment of poor sleep quality and fatigue in adolescents and young adults with CD.MethodsThis study is a two-phase open trial exploring interventions for sleep and fatigue. After the initial comprehensive assessment which included quantitative measures and an interview to evaluate sleep and physical and mental health, the 12-week intervention consisted of two sequential steps: 1) a brief behavioral therapy for sleep in inflammatory bowel disease (IBD) (BBTS-I; 4 weeks) and 2) adding the psychotropic medication, bupropion sustained release (BUP-SR; 8 weeks), for the subset of subjects continuing to experience fatigue.Results232 CD patients (median age=24, median sex=female) were approached over 18 months, of whom 112 screened positive on the Pittsburgh Sleep Quality Index (PSQI) and multi-dimensional fatigue inventory (MFI), with 68 CD patients completing the more comprehensive baseline assessment. Of the 68 patients, 52 participated in Phase I of the BBTS-I intervention. Following 4-weeks of the BBTS-I, there were significant improvements in sleep quality (p < .001) and fatigue (p < .001). As part of Phase II, of the 52 patients who met fatigue threshold criteria, 33 patients participated in the BUP-SR+BBTS-I arm while 19 participated in the BBTS-I only intervention group. After 8 weeks of Phase II, both intervention groups saw significant further improvement in sleep, fatigue, anxiety and depressive symptoms, but without significant differences between the two intervention groups.ConclusionsA stepped-care approach shows that we can improve sleep disturbance with BBTS-I in CD patients, but fatigue only partially improves. For a subset of patients who chose to add BUP-SR to their behavioral therapy, fatigue improves further but not to a statistically significant effect compared to behavioral therapy alone.     

心内科老年患者失眠原因调查及护理效果

目的调查心内科老年患者失眠原因,并观察其护理效果。方法选择2011年3月—2013年11月在我院心内科住院治疗的失眠的老年患者143例,采用自行设计的睡眠情况调查表对患者及其家属进行失眠原因调查,并实施个体化的护理干预。统计护理干预前后患者匹兹堡睡眠质量指数(PSQI)评分,观察患者入睡潜伏期、睡眠时间及觉醒次数。结果调查结果显示,影响患者失眠的因素主要为疾病原因,占23.08%;其次为心理压力大、环境因素,分别占21.63%、19.71%。护理干预后患者的入睡潜伏期、觉醒次数少于护理干预前,睡眠时间长于护理干预前(P0.05)。护理干预前患者PSQI评分为(11.23±4.32)分,护理干预7 d后为(8.23±2.99)分,护理干预14 d后为(5.83±1.32)分,干预14 d后PSQI评分低于护理干预7 d后,护理干预7 d后低于护理干预前(P0.05)。结论对心内科老年患者的失眠原因进行分析,实施有针对性的护理干预能明显改善患者睡眠质量,有利于患者康复。     

So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents

Background

Sleep impairment is highly prevalent among resident physicians and is associated with both adverse patient outcomes and poor resident mental and physical health. Risk factors for sleep problems during residency are less clear, and no screening model exists to identify residents at risk for sleep impairment.

Objective

The objective of this study was to assess change in resident sleep during training and to evaluate utility of baseline sleep screening in predicting future sleep impairment.

Design

This is a prospective observational repeated-measures survey study.

Participants

The participants comprised PGY-1 residents across multiple specialties at Partners HealthCare hospitals.

Main Measures

Main measures used for this study were demographic queries and two validated scales: the Pittsburgh Sleep Quality Index (PSQI), measuring sleep quality, and the Epworth Sleepiness Scale (ESS), measuring excessive daytime sleepiness.

Key Results

Two hundred eighty-one PGY-1 residents completed surveys at residency orientation, and 153 (54%) completed matched surveys 9 months later. Mean nightly sleep time decreased from 7.6 to 6.5 hours (p?<?0.001). Mean PSQI score increased from 3.6 to 5.2 (p?<?0.001), and mean ESS score increased from 7.2 to 10.4 (p?<?0.001). The proportion of residents exceeding the scales’ clinical cutoffs increased over time from 15 to 40% on the PSQI (p?<?0.001) and from 26 to 59% on the ESS (p?<?0.001). Baseline normal sleep was not protective: 68% of residents with normal scores on both scales at baseline exceeded the clinical cutoff on at least one scale at follow-up. Greater age and fewer children increased follow-up PSQI score (p?<?0.001) but not ESS score.

Conclusions

During PGY-1 training, residents experience worsening sleep duration, quality of sleep, and daytime sleepiness. Residents with baseline impaired sleep tend to remain impaired. Moreover, many residents with baseline normal sleep experience sleep deterioration over time. Sleep screening at residency orientation may identify some, but not all, residents who will experience sleep impairment during training.

     

Evaluation of latent links between irritable bowel syndrome and sleep quality

AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this study.Data on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Q...     

Association of suicidal ideation with poor sleep quality among Ethiopian adults

Objective

The objective of this study was to examine the extent to which poor sleep quality is associated with suicidal ideation among Ethiopian adults.

Methods

A cross-sectional study was conducted among 1054 adults attending outpatient clinical facilities in Ethiopia. Standardized questionnaires were utilized to collect data on demographics, sleep quality, lifestyle, and depression status. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9), while the Pittsburgh Sleep Quality Index (PSQI) questionnaire was utilized to assess sleep quality. Multivariate logistic regression models were fit to estimate adjusted odds ratio (AOR) and 95 % confidence intervals (95 % CI).

Results

The prevalence of suicidal ideation was 24.3 % while poor sleep quality (PSQI global score of >5 vs. ≤5) was endorsed by 60.2 % of participants. After adjustment for confounders including depression, poor sleep quality was associated with more than 3-fold increased odds of suicidal ideation (AOR = 3.59; 95 % CI 2.34–5.51). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in a 20 % increased odds for suicidal ideation, even after adjusting for depression (AOR = 1.20; 95 % CI 1.14–1.27). Participants with both poor sleep quality and depression had much higher odds (AOR = 23.22, 95 % CI 14.10–38.28) of suicidal ideation as compared with those who had good sleep quality and no depression although inferences from this analysis are limited due to the wide 95 % CI.

Conclusion

Suicidal ideation and poor sleep quality are highly prevalent. Individuals with poor sleep quality have higher odds of suicidal ideation. If confirmed, mental health services need to address sleep disturbances seriously to prevent suicidal episodes.

     

The evaluation of perceived stress and associated factors in elderly caregivers

ObjectiveFactors associated with perceived stress in older people have been studied previously, but this investigation in elderly caregivers is still scarce in the literature. Our aim was to assess factors that are associated with perceived stress in a sample of elderly caregivers.MethodsThis cross-sectional investigation assessed 341 elderly caregivers who cared for a dependent older person at home. They answered questionnaires including the Perceived Stress Scale (PSS-14), a sociodemographic and care characterization, health and cognitive status, and burden related to care.ResultsThe mean score in PSS-14 was 18.5 ± 9.9. Self-reported pain, difficult to sleep, “very poor/poor” self-rated health, impaired cognitive status, more people living in the house and higher levels of burden related to care were associated with higher levels of perceived stress.DiscussionThe results highlight the importance of the development of stress-reduced interventions directed to elderly caregivers focusing on the associated variables in this study. Attention should be given to cognitive decline prevention and strategies to avoid or reduce burden in the elderly caregivers.     

Clinical significance of obstructive sleep apnea in middle aged and elderly

ObjectivesThe aim of the present study is to compare the clinical characteristics of obstructive sleep apnea between elderly (age ≥ 65 years) and middle aged (age ≥ 25 and < 65 years) patients.Patients and methodsA retrospective study was performed in patients referred for daytime sleepiness, habitual nocturnal snoring and witnessed apnea spells, from 2008 to 2011. Patients with obstructive sleep apnea were classified into two groups according to age at first identification of respiratory pauses during sleep: an elderly onset group (n = 116) and, randomly selected middle aged control group (n = 116). The demographic characteristics, clinical presentations, Epworth sleepiness scale (ESS) and polysomnographic variables were compared between groups.ResultsSleep efficacy was significantly lower in the elderly group. No significant differences in body mass index (BMI), neck circumference, ESS, apnea hypopnea index (AHI) or O₂ saturation indexes were seen between elderly and middle aged groups. As for variables by gender in the elderly group, no significant differences in BMI, neck circumference, ESS, sleep efficacy or AHI were seen between female and male patients in the elderly group. Mean O₂ saturation and lowest O₂ saturation indexes were significantly lower in female patients.ConclusionsOur data suggest that the clinical characteristics of obstructive sleep apnea in the elderly onset group seemed to remain milder when compared with the middle aged patients. This finding may be due to the smaller physiologic response to respiratory events. Also, the clinical presentations between female and male patients in the elderly group were found almost similar in the study group.