Subjective sleep quality and sleep problems in the general Japanese adult population.

To dimensionally describe subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and estimate the prevalence rate of sleep problems (PSQI global score > 5) in the general Japanese adult population, 1871 subjects randomly selected from the 1995 Census were examined. The PSQI component scores (mean +/- SD) widely ranged (e.g. 0.04 +/- 0.31 in hypnotic medication use for males aged 20-29 years, 0.03 +/- 0.18 in hypnotic medication use for females aged 20-29 years, 1.10 +/- 0.94 in sleep latency for males aged 80 or older, 1.52 +/- 1.03 in sleep latency for females aged 80 or older). Statistical significance was found in each component score among age groups by gender. The PSQI global scores (mean +/- SD) by age groups ranged from 4.00 +/- 2.59 to 5.02 +/- 3.89 for males (P < 0.39) and 4.30 +/- 2.34 to 6.75 +/- 4.10 for females (P < 0.001). The respective prevalence rates of sleep problems were 26.4% (95% CI = 23.6, 29.3) for males and 31.1% (95% CI = 28.1, 33.9) for females.     

The frequency and nature of sleep disorders in a community-based population of patients with Parkinson's disease

Sleep disturbances in Parkinson's disease (PD) are a common problem. The aim of this study was to detail the frequency and nature of sleep disorders in a representative population of PD patients. A recently identified prevalent population, consisting of 161 PD patients were used as a representative population. Twenty-seven of 122 (22%) patients were identified as having marked sleep disorders, with sleep fragmentation and nocturia being the most commonly reported problems. Sleep scores worsened with higher Hoehn and Yahr stages. Sleep disturbances are a relatively common complication of PD and worsen with increasing Hoehn and Yahr stage.     

睡眠障碍中的主观及客观评价方法(英文)

睡眠的主观及客观评价方法均能评估分析睡眠的结构形式和睡眠质量,在对睡眠障碍患者的诊断和治疗中有重要意义。但是很多研究表明,两种评价手段对睡眠障碍患者的评估结果并不完全一致,可能存在偏差,单凭主观评价或客观评价的个别参数不能确定睡眠质量的好坏,因此在临床上需根据两种评价方法的特点,结合使用。本文将对目前临床常用的几种主观评价和客观评价方法进行分析和比较。     

睡眠障碍中的主观及客观评价方法

睡眠的主观及客观评价方法均能评估分析睡眠的结构形式和睡眠质量,在对睡眠障碍患者的诊断和治疗中有重要意义。但是很多研究表明,两种评价手段对睡眠障碍患者的评估结果并不完全一致,可能存在偏差,单凭主观评价或客观评价的个别参数不能确定睡眠质量的好坏,因此在临床上需根据两种评价方法的特点,结合使用。本文将对目前临床常用的几种主观评价和客观评价方法进行分析和比较。     

A sleep disorders centre in the United Kingdom

The demographic features of 296 patients who consulted a sleep disorders centre in the United Kingdom were reviewed. Diagnosis after a sleep study was mainly that of sleep-related breathing disorders; however, various other sleep disorders were also diagnosed. Considering that most sleep disorders are diagnosed only after sleep investigations, it should be emphasized that such a facility should be well prepared in undertaking not only polysomnography but also various sleep investigations, including multiple sleep latency testing and actigraphy. In addition, several treatment options, including sleep hygiene, light therapy, and behavioural therapy, should be available. Therefore, a sleep disorders centre needs to be operated by sleep specialists.     

Obesity and mental disorders in the adult general population

OBJECTIVE: The aim of this study was to investigate (i) the associations between mental disorders (in particular the anxiety disorders) and obesity in the general population and (ii) potential moderators of those associations (ethnicity, age, sex, and education). METHODS: A nationally representative face-to-face household survey was conducted in New Zealand with 12,992 participants 16 years and older, achieving a response rate of 73.3%. Ethnic subgroups (Maori and Pacific peoples) were oversampled. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Height and weight were self-reported. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater. RESULTS: Obesity was significantly associated with any mood disorder (OR 1.23), major depressive disorder (OR 1.27), any anxiety disorder (OR 1.46), and most strongly with some individual anxiety disorders such as post-traumatic stress disorder (PTSD) (OR 2.64). Sociodemographic correlates moderated the association between obesity and mood disorders but were less influential in obesity-anxiety disorder associations. Adjustment for the comorbidity between anxiety and mood disorders made little difference to the relationship between obesity and anxiety disorders (OR 1.36) but rendered the association between obesity and mood disorders insignificant (OR 1.05). CONCLUSION: Stronger associations were observed between anxiety disorders and obesity than between mood disorders and obesity; the association between PTSD and obesity is a novel finding. These findings are interpreted in light of research on the role of anxiety in eating pathology, and deserve the further attention of researchers and clinicians.     

痴呆相关性睡眠障碍的发生机制和处理

多数痴呆患者存在不同程度的睡眠障碍。但目前人们对痴呆相关性睡眠障碍的了解甚少。本文综述了痴呆相关性睡眠障碍的临床表现、发病机理和治疗方法。褪黑素治疗和其他一些方法能改善痴呆患者的睡眠障碍。     

急性脑卒中患者睡眠障碍的特点

目的探讨急性脑卒中患者睡眠障碍的特点。方法采用匹兹堡睡眠质量指数量表(PSQI)对168例急性脑卒中患者与98例正常对照者的睡眠状况进行测评分析,同时采用Barthel指数(BI)与NIHSS分别评价脑卒中患者的日常生活活动能力与神经功能缺损程度。结果脑卒中组睡眠障碍发生率、PSQI总分以及睡眠质量、入睡时间、睡眠障碍、催眠药物、日间功能障碍的得分均显著高于正常对照组(P0.05~0.01)。脑卒中组男性睡眠障碍发生率显著低于女性(P0.05),正常对照组男性及女性睡眠障碍发生率差异无统计学意义。脑卒中组女性睡眠障碍发生率显著高于正常对照组(P0.05)。脑卒中组年龄50岁患者的PSQI总分显著高于脑卒中组50~59岁、60~69岁、≥70岁的患者及对照组各年龄段患者(均P0.01)。与无睡眠障碍患者比较,脑卒中组睡眠障碍患者的BI显著降低,NIHSS评分显著升高(均P0.001)。结论急性脑卒中患者更易伴发睡眠障碍,在年龄50岁伴神经功能缺损的女性患者中更明显。     

Development and validation of prediction models for neurocognitive disorders in adult patients admitted to the ICU with sleep disturbance

BackgroundNeurocognitive disorders (NCDs) and sleep disturbance are highly prevalent in the perioperative period and intensive care unit (ICU). There has been a lack of individualized evaluation tools designed for the high‐risk NCDs in critically ill patients with sleep disturbance.ObjectivesThe aim of this study was to develop and validate prediction models for NCDs among adult patients with sleep disturbance.MethodsThe R software was used to analyze the dataset of adult patients admitted to the ICU with sleep disturbance, who were diagnosed following the codes of the International Classification of Diseases, 9th Revision (ICD‐9) and 10th Revision (ICD‐10) using the MIMIC‐IV database. We used logistic regression and LASSO analyses to identify important risk factors associated with NCDs and develop nomograms for NCDs predictions. We measured the performances of the nomograms using the bootstrap resampling procedure, sensitivity, specificity of the receiver operating characteristic (ROC), area under the ROC curves (AUC), and decision curve analysis (DCA).ResultsThe prediction models shared the 10 risk factors (age, gender, midazolam, morphine, glucose, diabetes diseases, potassium, international normalized ratio, partial thromboplastin time, and respiratory rate). Cardiovascular diseases were included in the logistic regression, the sensitivity was 74.1%, and specificity was 64.6%. When platelet and Glasgow Coma Score (GCS) were included and cardiovascular diseases were removed in the LASSO prediction model, the sensitivity was 86.1% and specificity was 82.8%. Discriminative abilities of the logistic prediction and LASSO prediction models for NCDs in the validation set were evaluated as the AUC scores, which were 0.730 (95% CI 0.716–0.743) and 0.920 (95% CI 0.912–0.927). Net benefits of the prediction models were observed at threshold probabilities of 0.567 and 0.914.ConclusionsThe LASSO prediction model showed better performance than the logistic prediction model and should be preferred for nomogram‐assisted decisions on clinical risk management of NCDs among adult patients with sleep disturbance in the ICU.     

Relationships of psychiatric disorders with sleep duration in an adult general population sample

The objective was to explore psychiatric disorders as potential predictors of sleep duration. A cross-sectional survey study with a probability sample of residents of a northern German area was carried out. There were 4075 study participants, aged 18–64 years, with a participation rate of 70.2%. Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) provided diagnoses of nicotine and alcohol dependence, alcohol abuse, depressive, anxiety and somatoform disorders according to the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV), and included questions about sleep duration. Results show that subjects with a short sleep duration of 5 h or less had significantly increased odds ratios (OR) for current nicotine dependence (OR 1.9,; confidence interval, CI, 1.2–2.9), alcohol dependence (OR 2.6, CI 1.2–5.6), depressive disorder (OR 3.0, CI 1.7–5.4) or anxiety disorder (OR 2.1, CI 1.3–3.4) compared to individuals who never had the respective psychiatric disorder after adjustment for sex, age, and school education in a multinomial regression analysis. The conclusion is drawn that current nicotine or alcohol dependence, depressive, and anxiety disorders may add to short sleep duration in this random adult general population sample.     

右佐匹克隆与阿普唑仑辅助治疗抑郁症睡眠障碍对照研究

目的探讨右佐匹克隆辅助治疗抑郁症睡眠障碍的疗效及安全性。方法选取符合《中国精神障碍分类与诊断标准第3版》（CCMD-3）抑郁症诊断标准的门诊或住院抑郁症伴失眠患者,按随机数字表分为右佐匹克隆组和阿普唑仑组,二组均观察2周。两组患者均在治疗前、治疗后第2周末采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）评定;在治疗前、治疗后第2周末采用汉密尔顿抑郁量1表-24（Hamihon Depression Rating Scale,HAMD-24）评定;在治疗后第1、2周末采用副反应量表（Treatment Emergent Symptom Scale,TESS）评定。以PSQi的减分率判定疗效。结果右佐匹克隆组和阿普唑仑组治疗后PSQI评分经t检验（t=-3．58,P〉0．05）差异无统计学意义;但两组各因子分比较,治疗后日间功能障碍因子分右佐匹克隆组显著低于阿普唑仑组（t=5．18,P〈0．05）。右佐匹克隆组嗜睡、头昏各1例,阿普唑仑组嗜睡10例、头昏6例,两组经x。检验差异均有统计学意义（X^2=6．67、3．89,P〈0．01或0．05）;结论右佐匹克隆辅助治疗抑郁症睡眠障碍疗效显著,与阿普唑仑相比疗效没有差异。对日间功能的影响显著低于阿普唑仑,不良反应发生率少于阿普唑仑。     

Estimated sleep debt and work stress in Japanese white-collar workers.

Sleep debt on weekdays in Japanese white-collar workers, estimated using a questionnaire, was associated with age, overtime, and self-rated workload.     

Prevalence of mood disorders in the rural population of Udmurtia

A sample of 855 rural adult inhabitants of Udmurtia was interviewed by means of the Composite International Diagnostic Interview (CIDI) in order to investigate the incidence and prevalence of mood disorders. Depression affected 30.5% of the population according to ICD-10, and 22% according to DSM-III-R over a 12-month period. Depressive disorders were more common in women (40.5%) than in men (17.4%), and in subjects who were widowed (68.8%), divorced (55.6%) or had poor family relationships. Depression was not related to ethnicity, educational level, income or living conditions. Depression showed a high level of comorbidity with social phobia in Udmurts and with persistent somatoform pain disorder in Russian women. The annual incidence of depressive episode was 7.5%, and the highest risk of depression was among younger women and older men.     

Clinical characteristics of circadian rhythm sleep disorders

Abstract From our practice at the sleep disorders clinic in Kohnodai Hospital, National Center of Neurology and Psychiatry (NCNP), we report the clinical characteristics of circadian sleep-wake rhythm disorders. Nearly 90% of circadian rhythm sleep disorders were diagnosed as delayed sleep phase syndrome (DSPS) or as non-24 sleep-wake syndrome (non-24). While DSPS was equally common in males and females, non-24 was more frequently seen in men. It was of psychiatric interest that a considerable number of patients had depressive states in the course of their circadian rhythm sleep disorders. Difficulty in adapting to social life was more severe in patients with non-24 than in those with DSPS.     

The genetics of sleep apnea

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a complex chronic condition that is undoubtedly influenced by multiple factors. Accumulating data suggest that there are strong genetic underpinnings for this condition. It has been estimated that approximately 40% of the variance in the apnea hypopnea index (AHI) may be explained by familial factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAHS phenotype. Although the role of specific genes that influence the development of OSAHS have not yet been identified, current research in rodents suggests that several genetic systems may be important. In this chapter, we shall first define the OSAHS phenotype, and then review the evidence that suggests an underlying genetic basis of OSAHS, the risk factors for OSAHS that may be inherited, and potential candidate genes.     

Demography of sleep disturbances associated with circadian rhythm disorders in Japan

To clarify the demography of delayed sleep phase syndrome (DSPS), non-24-h sleep-wake syndrome, and irregular sleep-wake pattern in Japan, a cross-sectional nationwide epidemiological survey was conducted. 1525 adults (age: 15-59 years) were randomly sampled from telephone directories, and they received screening questions over the phone. Persons who were suspected of having the disorders were requested to fill out the second questionnaire, and asked to keep a sleep log for 4 weeks. Diagnoses were made according to the International Classification of Sleep Disorders criteria. As a result, the prevalence of DSPS was estimated to be 0.13%.     

Correlations among insomnia symptoms, sleep medication use and depressive symptoms

Aim: To elucidate the factors associated with insomnia symptoms and the use of sleep medication, and the correlations among insomnia symptoms, sleep medication use and depressive symptoms in the general population. Methods: This survey was conducted in a rural community of Japan. Questionnaires consisted of basic information, the Pittsburgh Sleep Quality Index, and a 12‐item version of the Center for Epidemiological Studies Depression scale, and were administered to all community members aged 20 years or over. A total of 2822 respondents with valid answers were subjected to analysis. Results: Occurrence of insomnia symptoms appeared to be associated with advancing age and existence of depressive symptoms. The extent of sleep medication use in the entire sample was 9%, and the value in the subjects with insomnia symptoms was 26%. Sleep medication use in insomniacs was associated with female sex and advancing age as well as higher scores in subcomponents of both poor subjective sleep quality and prolonged delay of sleep onset. Depressive symptoms were worst in the group with insomnia symptoms using sleep medication, and were significantly lower in the group without insomnia symptoms using sleep medication. Conclusions: Our study revealed that female sex, advancing age, depressive symptoms, poor sleep quality, and prolonged delay of sleep onset appeared as risk factors for sleep medication use. Insomnia symptoms were suspected to act as an exacerbating factor for depressive symptoms. However, our findings suggested that appropriate use of sleep medication could reduce depressive symptoms in the subjects with insomnia symptoms.     

Relationship between stress coping and sleep disorders among the general Japanese population: a nationwide representative survey

ObjectiveTo clarify the prevalence of stress, and examine the relationship between sleep disorders and stress coping strategies among highly stressed individuals in the general Japanese population.MethodsA cross-sectional nationwide survey was undertaken in November 2007. Men and women were randomly selected from 300 districts throughout Japan. Data from 7671 (3532 men (average age 53.5 ± 17.0 years) and 4139 women (average age 53.9 ± 17.7 years)) were analyzed. Participants completed a self-reported questionnaire on stress, sleep disorders, and stress coping strategies in the previous month.ResultsHighly stressed individuals comprised 16.6% (95% confidence interval 15.8–17.5%) of the total sample, and most were aged 20–49 years. In multiple logistic regression, symptoms of insomnia (ie, difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening), excessive daytime sleepiness, nightmares, daytime malfunction, and lack of rest due to sleep deprivation were more prone to occur in highly stressed individuals. In addition, logistic regression analysis controlling for other adjustment factors revealed that stress coping strategies such as ‘giving up on problem-solving’, ‘enduring problems patiently’, ‘smoking’ and ‘drinking alcohol’ were positively associated with the above-mentioned sleep disorders. On the other hand, stress coping strategies such as ‘exercising’, ‘enjoying hobbies’, and ‘sharing worries’ were inversely associated with the above-mentioned sleep disorders.ConclusionsDistraction-based stress coping (eg, hobbies, exercise, and optimistic thinking) was found to be preferable to problem-based stress coping in a highly stressed Japanese general population.     

Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey

Background Among Hispanics, Non-Hispanic Whites and Non-Hispanic Blacks studies have found lower risk for psychiatric disorders among the foreign-born than among the US-born. We examine the association of nativity and risk for psychiatric disorder in a national sample of the Asian-American (AA) population. Methods Data on 1,236 AAs from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) are analyzed using logistic regression and discrete time survival models to specify differences between the foreign-born and US-born in the lifetime occurrence of mood, anxiety and substance use disorders. Results Foreign-born AAs had significantly lower risk for all classes of disorder compared with US-born AAs (OR = 0.16–0.59). Risk for all classes of disorder was lowest for those foreign-born AAs who arrived in the US as adults. Among foreign-born AAs risk of first onset was lowest relative to the US-born in years prior to their arrival in the US and tended to rise to levels equal to that of the US-born with longer duration of residence in the US. Conclusions Among AAs, risk for psychiatric disorders is lower among the foreign-born than among the US-born. The pattern of change in risk over time suggests that both the developmental timing and the duration of experience in the US contribute to increases in risk.     

The present and the future of sleep research in Asia

Abstract In recent years, recognition of the importance of sleep, not only as a health problem but also as a social problem, has brought about worldwide growing interest in sleep and sleep research. In Asian countries, the number of sleep researchers is increasing rapidly and as a result the Asian Sleep Research Society (ASRS) was founded in 1994. This paper reviews the main topics of basic and clinical sleep research which have been investigated recently in Japan and in Asian countries. The subjects of sleep research in Asia in the future will be, in principle, similar to those in other countries of the world. However, the author suggests several subjects which are more or less specific to Asia and which should be studied in association, such as epidemiological longitudinal study of sleep disorders in developing countries, characteristics of sleep and dreaming in oriental culture and philosophy, etc. The roles of ASRS in dissemination of information, promotion of training and education, and enlightenment of public and government were also emphasized.