抚触干预婴儿睡眠障碍的研究

目的探讨抚触与婴儿睡眠相关关系。方法对 10 0例健康新生儿做睡眠状态调查 ,平均每日睡眠时间为 17± 1.5h。将每日睡眠时间 <17h的 12 4例新生儿随机分为抚触组和对照组。对照组不做任何干预 ,抚触组每天用国际标准法抚触 2次 ,每次 15～ 2 0min。持续 3个月以上。观察 4 2d、3个月、6个月婴儿睡眠状态。结果抚触组 4 2d、3个月平均每日睡眠总时间多于对照组。 4 2d、3个月、6个月夜醒次数及时间、啼哭次数及时间少于对照组。睡眠障碍发生率及程度比对照组低而轻。建立规律睡眠时间早于对照组 ,两组差异有显著性意义 (P <0 .0 5 )。结论抚触有助于提高婴儿睡眠质量 ,减少睡眠障碍发生率 ,并能较早地建立规律睡眠时间 ,有利于婴儿的生长发育。     

婴儿早期睡眠/觉醒状况与气质相关性的研究

目的在家庭自然环境下,对6个月婴儿的睡眠/觉醒状况率先进行客观监测和气质分析,揭示婴儿早期睡眠与气质的相关性。方法采用腕表式睡眠活动记录仪,对39例健康足月婴儿的睡眠/觉醒状况进行连续监测,采用婴儿气质问卷(CITQ)评估气质类型和气质维度。结果 39例健康足月中,合并麻烦型气质9例,合并平易型气质30例。两组婴儿间各项睡眠参数分别进行统计分析,其结果无显著性差异(P>0.05)。在控制性别因素后,足月儿气质维度中的趋避性与夜间觉醒次数正相关(r=0.439,P=0.005),与夜间最长连续睡眠时间负相关(r=-0.324,P=0.044);情绪本质与睡眠效率正相关(r=0.347,P=0.035)。结论不同气质类型婴儿的睡眠/觉醒状况在本研究中尚未发现显著性差异。趋避性与夜间觉醒次数及夜间最长连续睡眠时间相关,情绪本质与睡眠效率相关;养育者应针对婴儿不同的气质特点采取相应的睡眠抚育方式,以促进婴儿健康睡眠的形成和身心的全面发展。     

A Brief Parental Education for Shaping Sleep Habits in 4-Month-Old Infants

Objective: To examine the effectiveness of a simple behavioral intervention with an educational booklet on the modification of parenting behaviors and the prevention of sleep disturbance in 4-month-old infants.Design: A prospective cohort design with cluster sampling controls in a primary care setting.Participants: A total of 136 mothers with 4-month-old infants who visited a local health check-up clinic and responded to the 3-month follow-up survey.Methods: At the health check-up, an intervention group was provided with 10 minutes of group guidance and a simple educational booklet designed to encourage parents to promote favorable sleep patterns in their infants. A control group was provided with standard education alone. The two groups were questioned 3 months later through a survey sent by mail. Main measurements were parenting behaviors of parents and night waking of infants.Results: Two undesirable maternal behaviors that reinforce night waking in infants exhibited a significantly greater improvement in the intervention group than in the control group. “Feed or check diaper promptly” behavior and “hold and soothe immediately” behavior after “night waking” in the infant were significantly decreased in the intervention group.Conclusions: Our findings suggest that increased night waking in infants was prevented in the intervention group. Our results indicate that the proportion of infant night waking was significantly higher in the control group, and there was also a tendency toward an increase in the proportion of infants who woke frequently and cried. These infant behaviors were not changed in the intervention group at the 3-month follow-up stage.     

婴幼儿睡眠问题调查及影响因素分析

目的 了解婴幼儿睡眠状况,分析婴幼儿睡眠问题的影响因素.方法 应用问卷调查136例婴幼儿睡眠状况及其影响因素.对结果进行描述性分析、单因素分析和多因素分析.结果 入睡困难是婴幼儿睡眠存在的主要问题,其次是频繁夜醒.影响因素有:家庭类型、父母文化程度、居室环境、出生后喂养方式、蛋白质类辅食添加时间、夜间进食次数、入睡方式、睡床情况、入睡前情绪等.结论 婴幼儿睡眠问题普遍存在,影响因素多为不正确的育儿行为.预防婴幼儿睡眠问题出现和提高婴幼儿睡眠质量,需对家长进行健康指导.     

婴幼儿睡眠问题调查及影响因素分析

目的了解婴幼儿睡眠状况，分析婴幼儿睡眠问题的影响因素。方法应用问卷调查136例婴幼儿睡眠状况及其影响因素。对结果进行描述性分析、单因素分析和多因素分析。结果入睡困难是婴幼儿睡眠存在的主要问题，其次是频繁夜醒。影响因素有：家庭类型、父母文化程度、居室环境、出生后喂养方式、蛋白质类辅食添加时间、夜间进食次数、入睡方式、睡床情况、入睡前情绪等。结论婴幼儿睡眠问题普遍存在，影响因素多为不正确的育儿行为。预防婴幼儿睡眠问题出现和提高婴幼儿睡眠质量，需对家长进行健康指导。     

Changes in infant sleep problems after a family-centered intervention

PURPOSE: To describe a family-centered intervention for sleep disturbed infants and its effect on the infants' sleep pattern. METHODS: The sample consisted of 33 infants (6-23 month of age) hospitalized because of sleep problems in The City Hospital in Reykjavik, Iceland, and 33 mothers and 30 fathers. Infants' sleep patterns were assessed by a 1-week diary and by interviews with parents before hospital admission, 1 week and 2 months after discharge. The intervention was based on correction of day-sleep rhythm, support of self-comforting capabilities of the infant, and education of parents in regard to the infants' characteristics and developmental status. Changes in day naps and infant irritability over daytime also improved significantly. FINDINGS: Night sleep improved significantly 1 week after discharge and even more so 2 months later. CONCLUSIONS: Offering a family-centered intervention improves infants' sleep patterns up to 2 months after discharge.     

Sleep patterns and fatigue in new mothers and fathers

The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents' work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.     

Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer

Goals Previous investigations have shown that women undergoing chemotherapy for breast cancer experience both disturbed sleep and fatigue. However, most of the previous research examined women either during or after chemotherapy. This study examined sleep, fatigue, and circadian rhythms in women with breast cancer before the start of chemotherapy.Patients and methods Eighty five women with Stages I–IIIA breast cancer who were scheduled to begin adjuvant or neoadjuvant anthracycline-based chemotherapy participated. Each had sleep/wake activity recorded with actigraphy for 72 consecutive hours and filled out questionnaires on sleep, fatigue, depression, and functional outcome.Main results On average, the women slept for about 6 h a night and napped for over an hour during the day. Sleep was reported to be disturbed and fatigue levels were high. Circadian rhythms were robust, but women who were more phase-delayed reported more daily dysfunction (p<0.01).Conclusions The data from the current study suggest that the women with breast cancer likely experience both disturbed sleep and fatigue before the beginning of chemotherapy. Although their circadian rhythms are robust, breast cancer patients with more delayed rhythms experience more daily dysfunction secondary to fatigue. These data suggest that strategies to improve disturbed sleep and to phase-advance circadian rhythms prior to initiation of chemotherapy may be beneficial in improving daily function in breast cancer patients.     

Overnight duty impairs behaviour, awake activity and sleep in medical doctors.

BACKGROUND: The impact of prolonged work cycles among senior doctors remains disputed. We evaluated the effects of overnight duty on awake activity and sleep quality in senior doctors in emergency medical specialties. METHODS: Thirty-six healthy doctors were monitored during a 2-week period including three separate 84 h on-call cycles. An on-call cycle consisted of the night and the day before night duty; the night duty itself and the subsequent 2 days and nights after night duty. The first day after night duty could either be worked or not. Actigraphy was used to measure physical activity and to evaluate sleep duration and quality. A standardized questionnaire was used to assess daytime performance and night sleep quality. RESULTS: Night actigraphy demonstrated that on-call work induced a significant reduction in sleep duration that was not recovered during the subsequent two nights. Sleep during the night duty itself was fragmented and of poor quality. Awake activity was significantly impaired on the day after night duty. Although subjectively night sleep quality did not differ between the nights before and after night duty, all subjective daytime parameters were impaired the day after night duty, and mood, fatigue and concentration remained altered on the second day. Working the day after night duty impaired objective measurements of daytime activity and sleep quality during the subsequent two nights. CONCLUSIONS: On-call night work in acute specialties induces sleep debt associated with prolonged impairment of awake activity, sleep quality and performance. Not working the following day after an on-call night allows partial recovery of sleep quality to begin.     

Activation of the prostaglandin system in response to sleep loss in healthy humans: Potential mediator of increased spontaneous pain

Insufficient duration of sleep is a highly prevalent behavioral pattern in society that has been shown to cause an increase in spontaneous pain and sensitivity to noxious stimuli. Prostaglandins (PGs), in particular PGE2, are key mediators of inflammation and pain, and we investigated whether PGE2 is a potential mediator in sleep-loss-induced changes in nociceptive processing. Twenty-four participants (7 females, age 35.1 ± 7.1 years) stayed for 7 days in the Clinical Research Center. After two baseline days, participants were randomly assigned to either 3 days of 88 h of sleep deprivation (TSD, N = 15) or 8 h of sleep per night (N = 9), followed by a night of recovery sleep. Participants rated the intensity of various pain-related symptoms every 2 h across waking periods on computerized visual analog scales. PGE2 was measured in 24-h-urine collections during baseline and third sleep deprivation day. Spontaneous pain, including headache, muscle pain, stomach pain, generalized body pain, and physical discomfort significantly increased by 5–14 units on a 100-unit scale during TSD, compared to the sleep condition. Urinary PGE2 metabolite significantly increased by about 30% in TSD over sleep condition. TSD-induced increase in spontaneous pain, in particular headache and muscle pain, was significantly correlated with increase in PGE2 metabolite. Activation of the PGE2 system appears to be a potential mediator of increased spontaneous pain in response to insufficient sleep.     

Parental sleep experiences on the pediatric oncology ward

Purpose

Parents of pediatric oncology patients are encouraged to sleep on the ward with their child to provide additional care throughout the night. The purpose of this study was to provide the first prevalence estimates of self-reported sleep quantity and quality among parents accommodated on the pediatric oncology ward, compared to parents of age-matched controls.

Methods

Parents of children receiving in-patient cancer treatment and parents of healthy, age-matched children completed a self-report questionnaire, including validated measures of parental sleep and psychological distress, demographic, and clinical characteristics.

Results

In total, 114 parents participated (52 parents of children with cancer; 62 control parents; over all response rate 70 %). Parents on the pediatric oncology ward reported sleeping 5.7 h (SD?=?1.8) on average, in comparison to control parents who reported sleeping 7.0 h at home (SD?=?1.4; t?=?4.3, p?<?0.001). Parents reported waking an average of 4.6 times (SD?=?0.3) per night on the ward, compared to control parents who reported 2.0 (SD?=?0.2) nighttime awakenings (t?=?7.69, p?<?0.001). Parents of children with cancer were significantly more likely to report that they had slept “badly” (67.3 versus 21.0 %; χ²?=?21.9, p?<?0.001). Significant predictors of sleep duration included anxiety (p?=?0.013) and caffeine consumption (p?=?0.017). Parents who slept on the ward attributed poor sleep to feelings of anxiety, environmental noise, and child-related factors.

Conclusions

Parents who sleep on the pediatric oncology ward experience poor sleep outcomes, including inadequate duration and frequent interruptions. The detrimental effects of sleep deprivation on parents' ability to cope during this challenging time require further investigation and intervention.     

Experimental pain perception remains equally active over all sleep stages

The literature on sensory perception during sleep suggests that light sleep (Stage 2) is more responsive to external sensory stimulation (e.g. sound, electrical shock) than deep sleep (Stages 3 and 4) and REM sleep. The main objective of this study was to characterize the specificity of nociceptive stimulation to trigger sleep arousal–awakening over all sleep stages. Thirteen healthy adults (e.g. without pain or sleep problems; six female and seven male of a mean age of 24.2±1.3 years) were included in the study. The responses to noxious intramuscular 5% hypertonic infusion were compared to innocuous vibrotactile and to respective control stimulations: isotonic infusion and auditory stimulations. These stimulations were applied during wakefulness and were repeated during sleep. Polygraphic signals (e.g. brain activity, heart rate) signals were recorded to score sleep arousal over all sleep stages. A subjective assessment of sleep quality was made on next morning. No overnight sensitization or habituation occurred with any of the experimental stimulations. The vibratory–auditory stimulations and the noxious hypertonic infusions triggered significantly (P<0.05) more awakenings in sleep Stage 2 and in REM than their respective control stimulations. In sleep Stage 2, both vibratory+auditory stimulations and the noxious hypertonic infusions has the same awakening response frequency (≈30%), however, with the noxious infusions the response frequency were similar in sleep Stages 3 and 4 (P<0.05) and in REM (trend). Compared to the baseline night, sleep quality was lower following the night with noxious stimulation (90.1±2.7 and 73.3±7.4 mm, respectively; P<0.03). These data suggest that pain during sleep could trigger a sleep awaking response over all sleep stages and not only in light sleep.     

Effects of music and music video interventions on sleep quality: A randomized controlled trial in adults with sleep disturbances

ObjectivesThe present study aimed to compare the effects of music and music video interventions on objective and subjective sleep quality in adults with sleep disturbances.DesignA randomized controlled trial was performed on 71 adults who were recruited from the outpatient department of a hospital with 1100 beds and randomly assigned to the control, music, and music video groups.InterventionsDuring the 4 test days (Days 2–5), for 30 min before nocturnal sleep, the music group listened to Buddhist music and the music video group watched Buddhist music videos. They were instructed to not listen/watch to the music/MV on the first night (pretest, Day 1) and the final night (Day 6). The control group received no intervention.Main outcome measuresSleep was assessed using a one-channel electroencephalography machine in their homes and self-reported questionnaires.ResultsThe music and music video interventions had no effect on any objective sleep parameters, as measured using electroencephalography. However, the music group had significantly longer subjective total sleep time than the music video group did (Wald χ² = 6.23, p = 0.04).ConclusionOur study results increase knowledge regarding music interventions for sleep quality in adults with sleep disturbances. This study suggested that more research is required to strengthen the scientific knowledge of the effects of music intervention on sleep quality in adults with sleep disturbances. (ISRCTN94971645)     

个体化音乐干预联合耳穴贴压疗法对肺癌术后患者睡眠质量的影响

目的：探讨个体化音乐干预联合耳穴贴压疗法对肺癌术后患者睡眠质量的影响。 方法：将240例患者随机分为耳穴组、音乐组、音乐联合耳穴组及对照组各60例。对照组给予常规术后护理,其余各组均在常规护理的基础上,音乐组给予个体化音乐干预,耳穴组给予耳穴贴压,音乐联合耳穴组给予个体化音乐联合耳穴贴压干预,对所有入组患者均于术前晚及出院前采用匹兹堡睡眠质量指数(PSQI)量表进行睡眠质量评定。结果：4组患者术前晚PSQI各维度得分比较差异无统计学意义（P＞0.05）。4组患者出院时PSQI各维度得分比较显示,音乐组、耳穴组、音乐联合耳穴组3组分别与对照组比较,差异均有统计学意义（P＜0.05）;音乐组、耳穴组与音乐联合耳穴组3组间两两比较,差异无统计学意义（P＞0.05）。结论：个体化音乐干预、耳穴贴压、音乐干预联合耳穴贴压均可改善肺癌术后患者的睡眠质量,但音乐干预联合耳穴贴压疗法并不优于单独音乐干预或耳穴贴压疗法。     

Evaluating a family-centred intervention for infant sleep problems

AIM: This paper reports a study to describe changes in parents' distress after a family-centred intervention for sleep problems of infants. BACKGROUND: Infant sleep problems are common and are related to depressive symptoms in mothers, but their impact on fathers has rarely been studied. Because childhood sleep problems and parental distress are associated, their interdependence should be recognized in research and in paediatric sleep practice. METHODS: All children hospitalized for sleep problems in a hospital in Iceland in 1997-1998 and their parents were studied using a pre- and post-test quasi-experimental design. The sample consisted of 33 infants (6-23 months of age), 33 mothers and 30 fathers. Parents' distress was assessed before and after treatment with regard to: (1) fatigue and resulting symptom distress; (2) parenting stress; (3) state-anxiety; and (4) depressive symptoms. Infants were treated for a variety of sleep problems by a paediatric nurse. The parents were simultaneously treated for distress by either the paediatric nurse or a specialist, depending on the nature of their problems. RESULTS: Mothers and fathers experienced a high degree of distress before the intervention, with no significant difference between them. Two months after the intervention both parents' distress had significantly improved. Parents' degree of distress was at a psychopathological level before the intervention but was reduced to population norms 2 months after the intervention. The paediatric nurse intervention was sufficient to reduce distress for 83% of parents. CONCLUSIONS: Health care professionals who care for infants with sleep problems should pay attention to the distressed responses of parents and support their recovery. An intervention such as that described here could be used by nurses for this purpose.     

对脑干缺血合并睡眠障碍患者实施护理干预的效果

目的探讨护理干预对脑干缺血合并睡眠障碍患者的效果。方法选取100例脑干缺血合并睡眠障碍的患者,按照随机数字法将患者随机分为干预组（n=56）和对照组（n=44）。对照组给予脑干缺血患者常规护理和常规药物治疗,针对睡眠障碍患者遵医嘱予艾司唑仑1mg每晚睡前服用。干预组除了以上治疗外,在整个住院期间进行了综合护理干预。结果干预组和对照组干预前匹兹堡得分分别为（11．01±4．42）、（12．84±1．04）,两组比较差异无统计学意义（P〉0．05）;干预后分别为（2．01±0．42）、（8．01±1．42）,两组比较差异有统计学意义（P〈0．05）。结论正确、有针对性的护理干预可以改善患者的睡眠情况,护理人员有必要为出现睡眠障碍的患者提供睡眠认知及行为干预。     

A warm footbath before bedtime and sleep in older Taiwanese with sleep disturbance

A single-group crossover design was used to examine the effects of a warm footbath on body temperatures, distal-proximal skin temperature gradient (DPG), and sleep outcomes in 15 Taiwanese elders with self-reported sleep disturbance. Body temperatures and polysomnography were recorded for three consecutive nights. Participants were assigned randomly to receive a 41 degrees C footbath for 40 minutes before sleep onset on night 2 or night 3. Mean DPG before lights off was significantly elevated on the bathing night. There were no significant differences in sleep outcomes between the two nights. However, when the first two non-rapid eye movement (NREM) sleep periods were examined, the amount of wakefulness was decreased in the second NREM period on the bathing night.     

Assessment of heart rate circadian rhythms in paroxysmal atrial fibrillation

Heart rate (HR) variations during night sleep and in the early predawn period in healthy subjects and patients with paroxisms of artrial fibrillation were used to assess HR circadian rhythms. Daily ECG monitoring was performed in 19 healthy subjects (mean age 36.0 +/- 7.05 years) and patients with paroxisms of atrial fibrillation (mean age 55.15 +/- 3.91 years). In healthy subjects, HR responsiveness during night sleep and in the early predawn hours was more prominent than in patients with paroxisms of atrial fibrillation. The number of HR spikes at night was 20.42 +/- 3.73 and 14.23 +/- 2.8 (p < 0.001) and one hour before waking 3.74 +/- 1.33 and 1.92 +/- 1.04 (p < 0.001) respectively; premorning activation coefficient was 0.19 +/- 0.007 and 0.13 +/- 0.007 (p < 0.05). It is concluded that HR responsiveness during the night sleep and the early predawn period in healthy subjects is higher than in patients with paroxisms of articular fibrillation. The number of HR spikes at night and one hour before waking as well as premorning activation coefficient can be used to assess RH circadian rhythms.     

Sleep disturbances and depressive symptoms in healthy postpartum women: a pilot study

In this pilot study we examined the relationship between objective and subjective sleep disturbances and depressive symptoms in 22 healthy primiparous postpartum women within 3 months after delivery. We found that none of the women in our study had clinically significant depression scores on the Edinburgh Postnatal Depression Scale; nonetheless, a variable duration of night-time sleep from night to night during the 7-day monitoring period and reported awakening too early were significantly correlated with increased depressive symptoms. Results suggest that first-time mothers who complain of irregular night-time sleep duration and waking up too early should be screened and evaluated for potential postpartum depressive symptoms.     

Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: An experimental crossover trial

Background

The decrease in core body temperature before sleep onset and during sleep is associated with dilation of peripheral blood vessels, which permits heat dissipation from the body core to the periphery. A lower core temperature coupled with a higher distal (hands and feet) temperature before sleep are associated with shorter sleep latency and better sleep quality. A warm foot bath is thought to facilitate heat dissipation to improve sleep outcomes.

Objectives

This study examined the effect of a warm footbath (40 °C water temperature, 20-min duration) on body temperature and sleep in older adults (≥55 years) with good and poor sleep.

Design

Two groups and an experimental crossover design was used.

Setting and participants

Forty-three adults responded to our flyer and 25 participants aged 59.8 ± 3.7 years (poor sleeper with a Pittsburgh Sleep Quality Index score ≥ 5 = 17; good sleepers with a Pittsburgh Sleep Quality Index score < 5 = 8) completed this study.

Methods

All participants had body temperatures (core, abdomen, and foot) and polysomnography recorded for 3 consecutive nights. The first night was for adaptation and sleep apnea screening. Participants were then randomly assigned to either the structured foot bathing first (second night) and non-bathing second (third night) condition or the non-bathing first (second night) and foot bathing second (third night) condition.

Results

A footbath before sleep significantly increased and retained foot temperatures in both good and poor sleepers. The pattern of core temperatures during foot bathing was gradually elevated (poor sleepers vs. good sleepers = +0.40 ± 0.58 °C vs. +0.66 ± 0.17 °C). There were no significant changes in polysomnographic sleep and perceived sleep quality between non-bathing and bathing nights for both groups.

Conclusion

A footbath of 40 °C water temperature and 20-min duration before sleep onset increases foot temperatures and distal–proximal skin temperature gradients to facilitate vessel dilatation and elevates core temperature to provide heat load to the body. This footbath does not alter sleep in older adults with good and poor sleep.