Effect of Tai Ji Quan training on self-reported sleep quality in elderly Chinese women with knee osteoarthritis: a randomized controlled trail

ObjectiveThe purpose of this study was to explore the effects of a 24-week Tai Ji Quan training program on sleep quality, quality of life, and physical performance among elderly Chinese women with knee osteoarthritis (OA).MethodsA 24-week randomized, controlled trial of 46 elderly women with knee OA. Participants were randomly assigned to either a Tai Ji Quan group (n = 23) or a control group (n = 23). Participants in the Tai Ji Quan group completed training sessions three times per week, while those in the control group had bi-weekly educational classes. The primary outcome was total score of the Pittsburgh Sleep Quality of Index (PSQI). Secondary outcomes were: seven subscales of the PSQI; sleep latency; total sleep time; sleep efficiency; physical component summary (PCS) and mental component summary (MCS) of the 36-item Short Form Health Survey (SF-36); Berg Balance Scale (BBS); and Timed Up and Go (TUG).ResultsCompared with the control group, participants in the Tai Ji Quan group had significantly improved primary outcome (global PSQI score, p = 0.006) and secondary outcomes, including three PSQI sub-scores (sleep latency, p = 0.031; sleep duration, p = 0.043; daytime dysfunction, p = 0.007), total sleep time (p = 0.033), and SF-36 PCS (p = 0.006). The Tai Ji Quan group also had significant improvements compared with baseline in three PSQI sub-scores (sleep latency, p = 0.031; habitual sleep efficiency, p = 0.049; sleep disturbance, p = 0.016), sleep latency (p = 0.003), BBS (p = 0.001), and TUG (p = 0.006).ConclusionTai Ji Quan training is an effective treatment approach to improve sleep quality and quality of life in elderly Chinese women with knee OA.Trial registration: Chinese Clinical Trial Registry (June 16, 2013): ChiCTR-TRC-13003264.     

LONG-TERM EFFECTS OF MILD EXERCISE ON INTRAOCULAR PRESSURE IN ATHLETES AND SEDENTARY SUBJECTS

The long-term effects of acute submaximal exercise on intraocular pressures (IOPs) of right-and left-eyes and recovery times to basement levels of IOP in postexercise periods in sedentary and physically fit subjects were investigated. Twenty-five sedentary and 24 physically fit subjects, ranging in age 17 to 22 years, participated. Intraocular pressures were measured by a pneumotonometer. Measurements were taken in the morning at about nine (at rest) and immediately, 30 min and 2 h after acute submaximal exercise. In sedentary subjects, IOPs of both right- and left-eyes decreased immediate after exercise, but, these decreases in both eyes continued 30 min and 2 h after exercise. In physically fit subjects, IOPs of both right- and left-eyes increased immediate after exercise, but decreased after 30 min exercise compared to basement levels, and this decrease continued 2 h after exercise. Acute submaximal exercise decreased IOPs of right and left eyes over a period 2 h in sedentary and physically fit subjects. IOP reducing after exercise was different between right- and left-eyes in sedentary subjects. These results suggest that exercise can be used in ocular hypertension treatment.     

Long-term effects of mild exercise on intraocular pressure in athletes and sedentary subjects

The long-term effects of acute submaximal exercise on intraocular pressures (IOPs) of right-and left-eyes and recovery times to basement levels of IOP in postexercise periods in sedentary and physically fit subjects were investigated. Twenty-five sedentary and 24 physically fit subjects, ranging in age 17 to 22 years, participated. Intraocular pressures were measured by a pneumotonometer. Measurements were taken in the morning at about nine (at rest) and immediately, 30 min and 2 h after acute submaximal exercise. In sedentary subjects, IOPs of both right- and left-eyes decreased immediate after exercise, but, these decreases in both eyes continued 30 min and 2 h after exercise. In physically fit subjects, IOPs of both right- and left-eyes increased immediate after exercise, but decreased after 30 min exercise compared to basement levels, and this decrease continued 2 h after exercise. Acute submaximal exercise decreased IOPs of right and left eyes over a period 2 h in sedentary and physically fit subjects. IOP reducing after exercise was different between right- and left-eyes in sedentary subjects. These results suggest that exercise can be used in ocular hypertension treatment.     

Interactions between sleep normative data and sociocultural characteristics in the elderly

Objective

To present sleep patterns in elderly individuals and factors associated with short sleep and long daytime and nighttime sleep.

Methods

A total of 8091 subjects aged between 55 and 101 years representative of the noninstitutionalized general population of seven European countries (France, Finland, Italy, Germany, Portugal, Spain, and UK) were interviewed by telephone about their sleep habits and sleep disorders.

Results

The average sleep duration was 6 h and 57 min. Sleep duration was longer in men than in women. Five percent of the sample slept 5 h or less and 5% slept 9 h or more per night. Factors associated with short sleep (lower fifth percentile) were age, living in UK, no physical exercise, drinking six cups of coffee or more per day, taking a medication for sleep, difficulty initiating sleep, disrupted sleep, early morning awakening, and presence of an anxiety disorder. Factors associated with long sleep (≥95th percentile) were age, living in France, Portugal, or Spain, being underweight, no physical exercise, disrupted sleep, taking a medication for sleep, and presence of an anxiety disorder. Long daytime sleep (54 min or more) were age, being a man, being overweight or obese, physical disease, being dissatisfied with one's social life, smoking, drinking alcohol, and having a major depressive disorder.

Conclusion

Sleep patterns considerably varied among the countries in the elderly population. Extreme values of sleep duration (short and long sleep) were associated with several sleep and mental health problems.     

Dose-Response Effects of Aerobic Exercise on Quality of Life in Postmenopausal Women: Results from the Breast Cancer and Exercise Trial in Alberta (BETA)

Background

Exercise generally improves quality of life (QoL) and psychosocial functioning in adult populations but few randomized trials have examined dose-response effects.

Purpose

The purpose of the present study was to report the QoL and psychosocial outcomes from the Breast Cancer and Exercise Trial in Alberta (BETA).

Methods

Healthy but inactive postmenopausal women at risk for breast cancer were randomized to a year-long aerobic exercise intervention consisting of either 150 min/week (moderate volume group, n = 200) or 300 min/week (high volume group, n = 200). QoL was assessed at baseline and 1 year using the short form-36 health survey. Sleep quality, depression, anxiety, stress, self-esteem, and happiness were also assessed. Participant preference for group assignment (i.e., exercise volume) was assessed at baseline and tested as a moderator.

Results

There were no statistically significant dose-response effects of aerobic exercise on any QoL, sleep quality, or psychosocial outcome. Participant preference for group assignment did not moderate any QoL, sleep quality, or psychosocial responses. Marital status was a significant moderator (p for interaction = 0.01) and obesity showed a trend towards being a moderator (p for interaction = 0.08) of the dose-response effects of aerobic exercise on global sleep quality such that unmarried and obese women improved sleep quality with the higher volume of aerobic exercise.

Conclusions

A higher volume of aerobic exercise, approximately double the minimum public health guideline, did not provide additional QoL or psychosocial benefits compared to the minimum public health guideline in inactive postmenopausal women, even for women who preferred the higher volume of exercise at baseline.

Trial Registration

Trial Registration clinicaltrials.gov identifier: NCT1435005.

     

Sleep health, lifestyle and mental health in the Japanese elderly: ensuring sleep to promote a healthy brain and mind

The Ministry of Health, Labor and Welfare in Japan proposed a plan called "Health Japan 21," which adopted sleep as one of the specific living habits needing improvement. This has led to increased interest in mental health needs at community public health sites. In addition, it was reported from a recent 2000 survey that one in five Japanese, and one in three elderly Japanese, suffer from insomnia. Insomnia is becoming a serious social problem; so much so that alarm bells are ringing with insomnia listed as one of the refractory diseases of the 21st century. Against this background, in January 2001, Japan began a national project called "Establishing a Science of Sleep." This article is an overview of sleep and health in the elderly, sleep mechanisms and the characteristics of insomnia among the elderly. At the same time, it introduces the scientific basis for lifestyle guidance that is effective for ensuring comfortable sleep, an essential condition for a healthy, energetic old age, with actual examples from community public health sites. The present authors reported that a short nap (30 min between 1300 and 1500 h) and moderate exercise such as walking in the evening are important in the maintenance and improvement of sleep quality. The study was to examine the effects of short nap and exercise on the sleep quality and mental health of elderly people. "Interventions" by short nap after lunch and exercise with moderate intensity in the evening were carried out for 4 weeks. After the "intervention," wake time after sleep onset significantly decreased and sleep efficiency significantly increased, showing that sleep quality was improved. The frequency of nodding in the evening significantly decreased. As a result, the frequency of nodding before going to sleep decreased, and the quality of nocturnal sleep was improved. Present results demonstrated that the proper awakening maintenance during evening was effective in improving sleep quality. After the "intervention," mental health also improved with improving sleep quality. Furthermore, physical health also improved with improving sleep quality. These results suggest that this "intervention" technique is effective for the quality of life (QOL) and the activity of daily living (ADL) of elderly people.     

The effect of submaximal exercise on platelet aggregation during late follicular and midluteal phases in women

INTRODUCTION: The key role of platelets in the pathogenesis of atherosclerosis prompted considerable interest on the effect of physical exercise on platelets. Due to probable menstrual cycle variations, only a limited number of investigations have studied the effect of exercise on platelets in women. The study was undertaken to determine the effect of acute submaximal exercise on platelet aggregation and thromboxane A(2) (TxA(2)) formation in females during their late follicular and midluteal phases. MATERIALS AND METHODS: Twelve healthy, sedentary, female volunteers performed 15 min of cycling exercise at a workload that increased their heart rate to 75% of maximal in two phases of the menstrual cycle. The maximal rate of ADP and collagen-induced platelet aggregation was evaluated on citrated whole blood using the impedance technique. Thrombin-induced thromboxane A(2) formation was evaluated by the measurement of thromboxane B(2) (TxB(2)) level by enzyme-linked immunoassay. RESULTS AND CONCLUSION: No significant difference was found between maximal rates of platelet aggregation measured in the different phases of menstrual cycle. Collagen-induced platelet aggregation and platelet count increased significantly after the exercise in both late follicular and midluteal phases (p<0.05). ADP-induced platelet aggregation did not change due to the exercise during the two phases of menstrual cycle. The thromboxane B(2) level measured in the midluteal phase was significantly higher than that measured in late follicular phase at rest. It was significantly increased after the exercise in late follicular phase while no significant difference was found between pre-exercise and postexercise levels in the midluteal phase. The differences in thromboxane A(2) formation were pointed out in the changes in platelet reactivity status. The inhibitory systems for platelets need further investigations. Our findings support the idea that menstrual variations do not have pronounced and acute effects on both platelet aggregation and response of platelets to acute exercise.     

An objective measure of reinforcement and its implications for exercise promotion in sedentary Hispanic and Anglo women

An objective measure for the assessment of exercise and sedentary activity choices was evaluated for reliability in 38 sedentary women, aged 18-45, in El Paso, TX. Twenty-two Hispanic women and 16 Anglo women participated. An equal number of obese and nonobese women comprised each group of participants. Using five computer-generated slot machine games, participants were allowed to earn points for access to a bicycle/stair stepper or videos/magazines. Exercise alternatives remained easily accessible while the sedentary choices became progressively difficult to access. Two sessions were completed at least 2 weeks apart for reliability. Reliability for choosing to be physically active from session to session was rI = .83 for all participants, rI = .90 for Hispanics, and rI = .74 for Anglos. Hispanic women earned twice the number of points for access to exercise (m = 20 +/- 2; 40% of the available points) as Anglo women (m = 10 +/- 3; 20% of the available points), independent of body mass index (BMI) or socioeconomic status (SES). Hispanic women's choices to exercise were independent of acculturation level; however, Hispanic women of higher SES and lower BMI chose to exercise more than Hispanic women of lower SES and higher BMI. Hispanic women may find exercise more reinforcing than Anglo women, which has important implications for exercise interventions. In addition, results indicated that self-reported liking and enjoyment of exercise were not related to the choice to actually engage in exercise. The behavioral economic methods presented in this study provide preliminary results to support the use of an objective, reliable method to assess the determinants of exercise and sedentary activity choices in sedentary, Hispanic and Anglo women.     

Strength and physiological response to exercise in patients with chronic fatigue syndrome

OBJECTIVE: To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome (CFS) who do not have a current psychiatric disorder. METHODS: Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity. RESULTS: Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise. CONCLUSIONS: Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function.     

Sleep quality and quality of life among the elderly people

ObjectiveTo determine sleep quality and the quality of life of the elderly people.Materials and methodsThis study sample consisted of 187 elderly people. Data were collected with a personal information form, Pittsburgh Sleep Quality Index and Turkish Version of WHOQOL-BREF-quality of life scale.ResultsIt was found out that sleep quality of the elderly people was poor. It was noted that there was a close correlation between age and sleep quality and quality of life of the elderly people, and sleep quality and quality of life decreased as the age of the elderly people increased. It was explored that there was a significant difference between gender, marital status, educational status, the person with whom the elderly people lived, presence of a physical disease, diagnosis of a disease and sleep quality and quality of life (p < 0.05).ConclusionsThe elderly people have a low sleep quality and there is a close relationship between sleep quality and the quality of life. The quality of sleep should be continued by ensuring sleep hygiene among the elderly people and thus the quality of life should be increased.     

Sleep deprivation and hormone therapy in postmenopausal women

BACKGROUND AND PURPOSE: Sleep complaints increase after menopause, but literature on the effect of postmenopausal hormone therapy (HT) on sleep is controversial. The purpose of this study was to determine the effect of ageing and HT on sleep quality, assessed using polysomnography, and on the accuracy of the subjective estimation of sleep quality in women before and after sleep deprivation. PATIENTS AND METHODS: Twenty postmenopausal women (aged 58-72 years) were recruited: 10 HT-users and 10 non-HT-users. Eleven young women (aged 20-26 years) served as controls. Polysomnography and subjective sleep quality were measured on four consecutive nights: adaptation, baseline, 40-h sleep deprivation and recovery. RESULTS: Although the postmenopausal women slept worse than the controls at baseline, and in particular during the recovery night, their recovery response to sleep deprivation was well preserved. At baseline, HT-users had a shorter latency to rapid eye movement (REM) (P=0.043), with fewer awakenings from slow wave sleep (SWS) (P=0.029) but more from REM (P=0.033) than non-HT-users. During recovery, the HT-users had more stage 2 sleep (P=0.048) and less slow wave activity (SWA) in the first non-rapid eye movement (NREM) sleep episode (P=0.021) than the non-HT-users. The poor correlation between subjective and objective sleep quality at baseline became significant during recovery. CONCLUSIONS: Although sleep in postmenopausal women was worse than in young controls, the recovery response following sleep deprivation was relatively well preserved. HT offered no significant advantage to sleep at baseline and slightly weakened the recovery response to prolonged wakefulness.     

Quantitative association between nocturnal voiding frequency and objective sleep quality in the general elderly population: the HEIJO-KYO cohort

ObjectiveA significant association between nocturia and subjective sleep quality has previously been reported; however, the association between nocturia and objective sleep quality remains unclear. The purpose of this study was to evaluate the quantitative association between nocturnal voiding (NV) frequency and objective sleep quality in a large, general, elderly population.MethodsNocturnal voiding frequency, objective sleep quality, and subjective sleep quality were measured among 1086 community-based elderly individuals using actigraphy and the Pittsburgh Sleep Quality Index (PSQI) questionnaire.ResultsIn multivariate analyses adjusted for potential confounding factors (such as age, gender, body mass index, medication use, renal function, bedtime, rising time, daytime physical activity, endogenous melatonin levels, and bedroom light levels), increased NV frequency, ranging from zero, one, two, three or more voids, was significantly associated with poorer objective sleep quality, including lower sleep efficiency (SE) and longer wake after sleep onset (WASO) (mean SE, 86.3, 84.8, 83.6, and 81.2%, respectively; p for trend <0.001; mean WASO: 42.6, 49.0, 53.6, and 66.1 min, respectively; p for trend <0.001), but shorter sleep onset latency (SOL) (mean SOL, 3.0, 3.0, 2.8, and 2.8 log min, respectively; p for trend = 0.018). In addition, an increased NV frequency was significantly associated with poorer subjective sleep quality in a multivariate model (mean PSQI global score, 4.60, 4.86, 5.22, and 5.48, respectively; p for trend 0.012).ConclusionThe present study revealed a quantitative association between NV frequency and objective sleep quality in the general elderly population.     

Among a sample of Iranian premenopausal and menopausal women differences in mood,sleep and health quality are small

Background. Anecdotal evidence suggests that mood, sleep, and health quality change in women from premenopausal to menopausal period; however, data supporting these assumptions from non-Western countries are scarce. The aim of the present study was therefore to assess premenopausal and menopausal Iranian women with regard to mood, sleep, and general health. Methods. One hundred and twenty Iranian women took part in the study. Sixty were in a premenopausal state (mean age (M): = 46.9 years) and 60 in a menopausal state (M = 53.8 years). They completed a series of self-rating questionnaires related to sleep, mood, and health quality. Results. Compared to premenopausal women, menopausal women reported more difficulties such as falling asleep, and less general physical activities and vitality. No statistically significant differences were found for sleep quality, sleep schedules, difficulties in social life, general mood state, or general physical and mental health. Menopausal women reported to be more irritable, and to have more energy. Conclusions. Data suggest that among a sample of Iranian premenopausal and menopausal women, differences in mood, sleep, and general health are small. Data, therefore, do not support “beliefs” and hearsay that mood, sleep, and general health do decrease from premenopausal to menopausal state.     

Efficacy and tolerability of indiplon in older adults with primary insomnia

OBJECTIVE: To evaluate the efficacy and safety of indiplon in elderly patients with primary insomnia. PATIENTS AND METHODS: Elderly patients, 65-80 years (N=358; 55% female; mean age, 71 years) who met the criteria for primary insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) for three months were randomized to two weeks of double-blind nightly treatment with 5 mg or 10 mg indiplon or placebo. Daily self-assessments by the patients included latency to sleep onset (LSO), total sleep time (TST), number of awakenings (NAW), wake time after sleep onset (WASO), and sleep quality. Data were collected between July, 2002, and October, 2003, at 52 clinical research sites in North America. RESULTS: Treatment with indiplon was associated with significant reduction in LSO at Week 1 for the 5 mg (34.6+/-1.8 min) and 10 mg doses (30.4+/-1.6 min) relative to placebo (47.4+/-2.5 min; p<0.0001 for both comparisons). During Week 2, LSO remained shorter on both indiplon doses compared to placebo (5 mg, p=0.016; and 10 mg, p=0.0028). During both study weeks, treatment with indiplon was also associated with significant improvement, relative to placebo, in TST, NAW, WASO, and sleep quality. The frequency of adverse events was similar in the indiplon 5 mg and placebo groups; somnolence, nausea, depression and decreased appetite were slightly more common in the indiplon 10 mg group. CONCLUSION: In elderly patients with primary insomnia, indiplon 5 mg and 10 mg were efficacious in inducing and maintaining sleep and improving sleep quality during the two weeks of treatment. Indiplon 5mg was well-tolerated, with no serious adverse events and no significant changes in electrocardiogram (ECG) or routine clinical laboratory evaluations; the 10mg dose produced slightly greater efficacy as well as somewhat increased adverse events.     

Sleep: a marker of physical and mental health in the elderly.

OBJECTIVE: The objective of this study was to determine the occurrence and recognition of common sleep-related problems and their relationship to health-related quality-of-life measures in the elderly. METHOD: A total of 1,503 participants with a mean age of 75.5 (+/- 6.8, range: 62-100) years from 11 primary care sites serving primarily elderly patients were interviewed. Subjects completed a five-item sleep questionnaire and the SF-12. A Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) score was calculated. A systematic medical chart review was conducted to determine whether sleep problems were identified by the healthcare providers. RESULTS: A total of 68.9% of patients reported at least one sleep complaint and 40% had two or more. Participants most commonly endorsed (45%) that they had "difficulty falling asleep, staying asleep, or being able to sleep." The number and type of sleep problems endorsed was associated with both physical and mental health quality-of-life status. Excessive daytime sleepiness was the best predictor of poor mental and physical health-related quality of life. Even when all five sleep questions were endorsed, a sleep complaint was only reported in the chart 19.2% of the time. CONCLUSIONS: When elicited, sleep complaints predicted the general physical and mental health-related quality-of-life status in elderly populations with comorbid medical and mental illnesses. Yet, questions regarding sleep are not an integral component of most clinical evaluations. Given the growing evidence of a relationship between sleep and health, identification of sleep disorders could lead to improved management of common age-related chronic illnesses and quality of life of elderly patients.     

Delayed sleep timing is associated with low levels of free-living physical activity in normal sleeping adults

Objective and BackgroundWe and others have reported that experimentally induced short sleep does not affect resting metabolic rate and leads to increased laboratory-measured 24-h energy expenditure. Here, we aimed to determine if sleep timing and/or quality are related to physical activity (PA) levels.MethodsMeasures of PA via waist actigraphy, sleep diary, and sleep quality questionnaires were collected over a 7–18-day period in 22 adults (mean age ± standard deviation (SD): 35.8 ± 4.6 years, and mean body mass index ± SD: 23.8 ± 1.1 kg/m²) who were on their habitual sleep–wake and activity schedules.ResultsDuring the recording period, mean (±SD) bedtime and wake times were 00:17 ± 1:07 h (range: 22:02–02:07 h) and 08:20 ± 1:14 h (range: 06:30–10:11 h), respectively. After controlling for sleep duration, later bedtime, wake time, and midpoint of sleep were associated with less time spent in moderate-to-vigorous PA (p = 0.013, p = 0.005, and p = 0.007, respectively), and increased time in sedentary PA (p = 0.016, p = 0.013, and p = 0.013, respectively).ConclusionsCurrent results suggest that even relatively small alterations in sleep timing may influence PA. However, causality cannot be inferred from this cross-sectional study. Clinical intervention studies should be conducted to assess the relationship between sleep timing and energy balance.     

Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia

ObjectiveTo assess the efficacy of moderate aerobic physical activity with sleep hygiene education to improve sleep, mood and quality of life in older adults with chronic insomnia.MethodsSeventeen sedentary adults aged ?55 years with insomnia (mean age 61.6 [SD ± 4.3] years; 16 female) participated in a randomized controlled trial comparing 16 weeks of aerobic physical activity plus sleep hygiene to non-physical activity plus sleep hygiene. Eligibility included primary insomnia for at least 3 months, habitual sleep duration <6.5 h and a Pittsburgh Sleep Quality Index (PSQI) score >5. Outcomes included sleep quality, mood and quality of life questionnaires (PSQI, Epworth Sleepiness Scale [ESS], Short-form 36 [SF-36], Center for Epidemiological Studies Depression Scale [CES-D]).ResultsThe physical activity group improved in sleep quality on the global PSQI (p < .0001), sleep latency (p = .049), sleep duration (p = .04), daytime dysfunction (p = .027), and sleep efficiency (p = .036) PSQI sub-scores compared to the control group. The physical activity group also had reductions in depressive symptoms (p = .044), daytime sleepiness (p = .02) and improvements in vitality (p = .017) compared to baseline scores.ConclusionAerobic physical activity with sleep hygiene education is an effective treatment approach to improve sleep quality, mood and quality of life in older adults with chronic insomnia.     

Monitoring of ventilation during the early part of cardiopulmonary exercise testing: the first step to detect central sleep apnoea in chronic heart failure

BACKGROUND AND PURPOSE: To evaluate the prediction of nocturnal central sleep apnoea (CSA) syndrome from the presence of periodic breathing (PB) on diurnal monitoring of pre-exercise (cardiopulmonary exercise test [CPX]) parameters. CSA syndrome is commonly found in congestive heart failure (CHF) patients and has several prognostic and therapeutic implications but is frequently undiagnosed. Awake PB pattern is sometimes observed during the CPX cardiopulmonary monitoring period of gas exchanges in CHF patients referred to the stress test laboratory for routine peak VO2 determination. PATIENTS AND METHODS: Forty-five consecutive ambulatory patients (2 women/43 men; 60.2+/-11.7 years old) with clinically moderate to severe CHF (New York Heart Association [NYHA] class II/III: 22/23; mean+/-standard deviation left ventricular ejection fraction [LVEF]: 30.5+/-6.6%) underwent a classical maximal CPX test including a 2-min period (pre-test) of gas exchange monitoring and nocturnal ambulatory polygraphic monitoring. PB was defined when a cyclical pattern of VE, VO2, VCO2, was visually noted during the pre-exercise period and/or during the first 4 min of the CPX. CSA syndrome was retained as a central apnoea-plus-hypopnea index (cAHI) equal to or more than 10/h. The sleep study scoring procedure was done independently of the knowledge of the CPX results. Sensitivity, specificity and predictive values were calculated and receiver operating characteristic (ROC) curve analysis was constructed. RESULTS: Peak VO2 reached 16.4+/-5.2 mL kg(-1)min(-1) (55% of the theoretical value adjusted for gender and age). The polygraphy was completed and validated (at least five consecutive hours of sleep) in all cases. CSA syndrome was found in 28 (62%) patients (mean cAHI: 19.3+/-8.6/h). Sensitivity for the prediction of CSA syndrome reached 92.9% (two false-negative patients with a cAHI of nine) and specificity 94.1% with a predictive accuracy of 93.3%. The only false-positive patient suffered a moderate but significant obstructive sleep apnoea syndrome. Using ROC curve analysis, the W value reached 0.99 for the prediction of CSA from the presence of PB. The presence of CSA syndrome, using logistic regression analysis, is associated with a more severe functional status (NYHA: p<0.01, peak VO2: p<0.002), a lower basal and peak end-expiratory CO2 pressure (PETCO2, all p<0.03), a worse LVEF (p<0.01) and age equal to or more than 60 years (p<0.03). CONCLUSIONS: The observation of PB in the preliminary period of the CPX test in CHF patients appeared highly predictive of the presence of CSA syndrome during sleep and could prompt the use of polygraphic monitoring in severe CHF patients.     

Increased slow wave sleep and reduced stage 2 sleep in children depending on exercise intensity

BACKGROUND: There is controversy about the consequences of physical exercise on human sleeping behaviors. Evidence suggests that voluntary physical exercise affects brain structures and functions. However, there are inconsistent data regarding the effects of exercise on sleep architecture and sleep continuity, especially the amounts of slow wave sleep (SWS) and rapid eye movement (REM) sleep. OBJECTIVE: The aim of the present study was to investigate the effects of moderate and high intense physical exercise on vigilance state and sleep patterns in school-aged children. METHODS: Eleven healthy children (12.6+/-0.8 years old) were recruited for this polysomnographic study and underwent two exercise sessions. The two exercise sessions on a bicycle ergometer were performed 3-4h prior to bedtime, lasted 30min and varied in intensity. The moderate-intensity exercise was at 65-70% of maximal heart rate (HR(max)) while the high-intensity exercise was at 85-90% HR(max) to exhaustion. Polysomnographic and physiological measurements, including oximetry, were made on three nights in random order and separated by 1 week. Vigilance tests were carried out before and after the three sleep periods. RESULTS: Only high-intensity exercise resulted in a significantly elevated SWS proportion and less sleep in stage 2 as well as a higher sleep efficiency and shorter sleep onset latency. No significant effects on REM sleep were found. CONCLUSION: The results suggest that exercise intensity is responsible for the effects on stage 2 sleep and SWS in children and support the hypothesis of homeostatic sleep regulation.     

Relationship between prenatal maternal stress and sleep quality in Chinese pregnant women: the mediation effect of resilience

ObjectiveTo examine the relationship between prenatal maternal stress, resilience, and sleep quality, and to determine whether resilience plays a mediating role in the relationship between prenatal maternal stress and sleep quality among pregnant women.MethodsTwo hundred and thirty-one pregnant women in their second trimester participated in the study. They completed questionnaires, including: the Pittsburgh Sleep Quality Index (PSQI), the Pregnancy Stress Rating Scale (PSRS), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). A structural equation model was used to analyze the relationships among prenatal maternal stress, resilience, and sleep quality, with resilience as a mediator.ResultsPrenatal maternal stress was negatively associated with sleep quality in pregnant women (p < 0.01), whereas resilience was positively associated with sleep quality (p < 0.01). Furthermore, resilience mediated the relationship between prenatal maternal stress and sleep quality, and the mediation effect ratio was 22.0% (p < 0.01).ConclusionsThe risk factor for disturbed sleep was pregnancy-specific stress; however, the protective factor for sleep quality was resilience. This finding could provide scientific evidence for the development of intervention strategies with which to improve sleep quality in pregnant women.