失眠症的临床诊断学特征及其正念疗法的研究进展

失眠症的正念疗法(MBT-I)通过培育正念的习惯(初学者心态、不执着、放下、非评判、接纳、信任和耐心)、正念减压练习(关注呼吸、坐姿冥想、身体扫描、正念行走以及瑜伽等)及调整痛苦情绪的认知策略来减轻睡眠失调,并将失眠症的认知行为治疗(CBT-I)中刺激控制、睡眠限制及睡眠卫生的元素置于正念减压的框架内实施。MBT-I以团体体验形式进行,每周1次每次2 h,连续8周,有助于减少躯体疾病或心理问题对睡眠的负面影响;训练注意力控制,减少过度焦灼;降低睡眠相关过度觉醒,增强对情绪的调控能力;接纳当下的体验,而不是评判;减少对失眠的担忧,不过度努力入睡。     

Predictors of Alcohol Misuse and Abuse in Older Women

PURPOSE: To determine the predictive ability of self-report questions, physical measures, and biomarkers to detect alcohol misuse and abuse among older women. DESIGN AND METHODS: Healthy women volunteers age 60 and older who fit selection criteria were enrolled. The 135 participants were divided into nondrinkers (ND; n = 63) and drinkers (D; n = 72) based on self-reports of quantity and frequency of standard drinks consumed per month. The mean ages for the groups were 69.2 (ND) and 69.6 (D). FINDINGS: The best predictor was a score >0 on the T-ACE, a four-item instrument to detect alcohol abuse. Other significant predictors were: (a) behaviors: smoking, mixing over-the-counter (OTC) drugs with alcohol, heavy coffee drinking, using alcohol to sleep, and less sleep latency; and (b) biomarkers: higher mean corpuscular volume (MCV), hemoglobin (Hgb), hematocrit (Hct), and high-density lipoprotein cholesterol (HDL). The heaviest drinker subgroup had more physical stigmata, including broken blood vessels in nose and larger liver spans. CONCLUSIONS: The "best predictor model" showed that older women who were at risk for alcohol misuse or abuse had T-ACE scores of 1 or higher, used two or more OTC drugs regularly, drank large amounts of coffee, used alcohol to fall asleep, and had less sleep latency. Because positive T-ACE scores have high sensitivity and specificity for alcohol abuse, scores of 1 or greater should be addressed in clinical settings, e.g., referrals for more definitive diagnoses and relevant treatment.     

Associations between sleep and lifestyle behaviours among Australian nursing students: A cross-sectional study

BackgroundNursing students are at risk of inadequate sleep and poor lifestyle behaviours due to academic, clinical and personal stressors faced throughout their training. However, the relationship between lifestyle and sleep in this population is not well understood.AimThe aim of this study was to determine whether inadequate sleep was associated with poor diet, physical inactivity, alcohol consumption and smoking in Australian nursing students.MethodsUsing a cross-sectional design, nursing students (n = 470) completed an online questionnaire that assessed sleep and lifestyle behaviours. One-way ANOVA, t-tests, Pearson’s bivariate correlation and multiple regression testing were used to determine relationships between variables.FindingsMost nursing students experienced inadequate sleep (78%). Patterns of irregular eating, increased intake of discretionary foods, high-risk alcohol consumption and smoking were associated with indicators of inadequate sleep (p < 0.05). Frequent lunch intake (4–7 times per week) was associated with lower global sleep quality scores than irregular lunch intake (β: ?1.060, 95% confidence interval ?2.022, ?0.099), whereas alcohol score was associated with higher global sleep quality scores (β: 0.088, 95% confidence interval 0.011, 0.165) indicating poorer quality sleep, even after adjusting for confounding variables. No significant associations were found between sleep parameters and level of physical activity.ConclusionThis study highlights that nursing students experience inadequate sleep, and that poor lifestyle behaviours were associated with inadequate sleep in this sample. Strategies are needed to address inadequate sleep and poor lifestyle behaviours in nursing students, to support health, academic and clinic performance, as well as the transition to professional nursing practice.     

The mediating and moderating effects of sleep hygiene practice on anxiety and insomnia in hospital nurses

This study aimed to test the mediating and moderating effects of sleep hygiene practice on the relationship between anxiety and insomnia severity in hospital nurses. A cross‐sectional survey was employed, and a convenience sample was recruited from one regional hospital in Taiwan. Participants completed the following self‐report questionnaires over a 3‐month period in 2009: the Insomnia Severity Index, the Beck Anxiety Inventory, and Sleep Hygiene Awareness and Practice Scale. The results indicated that nurses with more anxiety tended to have higher insomnia severity. Further, nurses with poor sleep hygiene practice had more insomnia. Sleep hygiene practice partially mediated the effects of anxiety on insomnia severity. Also, sleep hygiene practice was a moderator in the relationship between anxiety and insomnia severity with age and work units as covariates. Sleep hygiene practice mediated and moderated the relationship between anxiety and insomnia severity after controlling the variables of age and work units. Continuing to learn and train sleep hygiene practice might promote nurses' sleep hygiene, and thereby ameliorate anxiety and reduce the risk of insomnia.     

疗养基层军官失眠相关因素调查分析及护理对策

目的 探讨疗养基层军官失眠的发生率及相关因素，提出护理对策。方法 通过问卷方法对71例疗养基层军官进行调查。结果 46．4％的疗养员有不同程度的失眠，表现为入睡困难、睡眠减少和睡眠持续障碍。结论 疗养员失眠的因素为各种心理压力；针对这些因素，应采取心理护理和行为矫正等措施，使疗养员养成良好的睡眠习惯。     

PS2-40: Do Women Really Smoke and Drink During Pregnancy: A Detailed Look into Cleaning the Smoking and Alcohol Variables

Background In many epidemiologic studies smoking and alcohol are often examined as an exposure variable when focusing on health conditions associated with these lifestyle factors. Furthermore, smoking and alcohol have almost become standard confounding variables in epidemiologic studies when examining other exposures. We highlight the challenges associated with cleaning and analyzing the smoking and alcohol variables within various sources of administrative data when conducting pregnancy studies. Methods We compared information on smoking and alcohol use among pregnant women from the VDW vitals table, social history table, and birth certificate data from Georgia State. Encounter data for smoking from the social history table was cleaned based the contact dates and quit dates falling within the pregnancy period and various combinations of 'yes', 'no', and 'quit' were examined based on these dates. Categories of smoking were created and compared to data in the VDW and on birth certificates. Similarly, we examined information on alcohol use during pregnancy from the social history table, including information reported in the 'alcohol comment' field. Results (more detailed results will be available at the time of the conference):We found inconsistencies in how smoking during pregnancy was reported in birth certificate data versus the social history table. However, this inconsistency was only among smokers and former smokers, whereas information for non-smokers was consistent across the different sources. Within the social history table there were many pregnant women that had 'yes' for the 'drink alcohol' field, however many of these women had information in the 'alcohol comment' field stating that they did not drink during pregnancy. After creating levels of alcohol use during pregnancy we found inconsistencies with information on the birth certificate. Conclusions While it is important to assess smoking and alcohol during pregnancy for the purposes of either a confounding variable or an exposure variable. We highlighted how these two variables (one from the VDW) are inconsistent across various data sources and both variables must be used with caution. NOTE: In order to present these data we feel a presentation is more suitable than a poster.     

Systematic review on the effectiveness of caffeine abstinence on the quality of sleep

Aim. The aim of the present study is to review the effects of caffeine abstinence on the quality of sleep. Background. Insomnia is a common problem and abstinence from caffeine is the most popular component in sleep hygiene advice. However, there have been inconsistent results relating to the effectiveness of caffeine abstinence in improving sleep. Design. Systematic review. Methods. We browsed several electronic databases and reference lists of articles about the correlation of caffeine consumption and sleep deprivation. We selected the articles according to predefined inclusion and exclusion criteria. Two reviewers assessed the quality of trials, which were selected according to the Jadad quality assessment scale. We included the trials scoring three or above in the systematic review and extracted their data. We assessed the heterogeneity of the studies before we considered whether or not to combine the studies’ results. Results. Three randomised control trials fulfilled the selection criteria among which two trials scored ≥3 on the Jadad scale. We included these two trials in our systematic review. The designs and outcome measurements of these two trials were not homogeneous, therefore, we did not combine their results. Instead, we conducted a critical appraisal. In one trial, caffeine abstinence was associated with significant lengthening of sleep duration (p < 0·01) and better sleep quality (p < 0·05). In another trial, subjects had less difficulty falling asleep on days when they drank decaffeinated coffee (p < 0·05). Conclusions. The results showed that caffeine abstinence for a whole day could improve sleep quality. Thus, health practitioners were recommended to include caffeine abstinence in the instructions for sleep hygiene. Relevance to clinical practice. This study demonstrates the effectiveness of caffeine abstinence in improving sleep quality. It provides evidence for the practice of including caffeine abstinence in sleep hygiene advice.     

Insomnia and physical activity in adults with prediabetes

This secondary analysis study examines the relationship between physical activity and symptoms of insomnia among adults with prediabetes (N = 958) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). The sample of participants were generally obese, middle-aged, and racially diverse. NHANES questions included symptoms of insomnia, sleep duration, and sleep latency. Body mass index (BMI) was calculated from measured height and weight; at least 2 days of ActiGraph activity monitor data determined mean steps walked. Men walked more steps than women; however, women had more insomnia symptoms. There were significant associations between insomnia symptoms and increased sleep latency and decreased sleep duration. Multiple regression analysis showed that younger age, lower BMI, higher self-rated health, high school education, and fewer insomnia symptoms were significantly related to increased steps walked. The findings indicate that insomnia in adults with prediabetes may be a barrier to their adapting an active lifestyle.     

Insomnia and circadian variation of attacks in episodic migraine

OBJECTIVES: To assess the influence of insomnia on the 24-hour temporal pattern of migraine. BACKGROUND: Migraine attacks have been reported to occur in a harmonic (monophasic) or a biphasic 24-hour cyclic manner, and in some studies to have preponderance in the morning hours. The influence of insomnia on the circadian pattern has not been evaluated. METHOD: Based on a previous study of the circadian variation in migraine, an explorative data analysis was made to compare the circadian pattern of insomnia-related migraine attacks to the circadian pattern of migraine attacks not related to insomnia. If the patients reported difficulties in falling asleep and/or maintaining sleep the night prior to the reported attack or the night the attack occurred, the attack was defined as insomnia-related. Relapses were not counted as distinctive attacks. RESULTS: Sixty-eight female migraineurs (mean +/- SD age: 35.5 +/- 7.0) prospectively recorded 1869 migraine attacks. Five hundred-and-thirty-three attacks (29%) were insomnia-related. Insomnia-related attacks had a biphasic temporal pattern with one peak in the morning hours and one peak after noon. They had a preponderance in the morning hours compared to attacks not related to insomnia (t= 3.27, df = 62, P= .002). In 79% of attacks insomnia was experienced prior to the headache. CONCLUSIONS: Episodic morning migraine is associated with insomnia. The cause and consequences of insomnia in migraine is not clarified, but sleep obviously protects against attacks rather than provokes them.     

Young adult women: lifestyle and health locus of control

A study of 76 young adult women, 38 nursing students and 38 non-nursing students, examined their lifestyle practices and health locus of control (HLOC) Findings revealed a significant difference between reported lifestyle practices and the career choice of these young adult women The lifestyle practice areas in which the most notable differences occurred included use of seat belts, frequency of alcohol use, frequency of junk food intake, use of illegal drugs and hours of sleep per night While differences in HLOC were evident between nursing and non-nursing students, no relationship was found between a young woman's HLOC and her lifestyle practices The differences in HLOC showed that nurses were more frequently pure internal whereas most non-nurses were found to be double externals The pure chance category had the fewest number of respondents The difference in lifestyle practices between these young adult women can be explained in part by curriculum variations, as can the difference in HLOC patterns     

Pharmacologic management of chronic insomnia

Chronic insomnia is a common disorder that is under recognized, under diagnosed and under treated. Initial assessment should focus on identifying and treating, if present, any secondary causes of insomnia. Primary insomnia can be treated with behavioral and/or pharmacological therapy. A thorough sleep history can identify the type of insomnia present, its severity, and can consequently guide therapy. Behavioral therapy has been shown to be equivalent to or superior to pharmacologic therapy, at least in some patients. It is a reasonable initial approach, although there are barriers to its use. There are several pharmacologic agents available, some of which are more effective at reducing time to fall asleep and others for maintaining sleep. There is some evidence to indicate that combining the approaches may impair outcomes. There is little data on the long-term use of pharmacologic agents.     

The prevalence of insomnia: the importance of operationally defined criteria

Previous studies on the prevalence of sleep disturbances have shown that insomnia occurs in 3.2-42% of different populations. The wide reported variation in prevalence prompted a rigorous definition of insomnia to be introduced in this study. Randomly selected members of the population aged 30 to 65 years from two geographically different rural parts of central Sweden answered a sleep questionnaire. The response rates were 69.2% and 70.2%, respectively. Females significantly more often reported difficulty in falling asleep (7.1% of the women and 5.1% of the men). Among women 8.9 and among men 7.7% of individuals reported trouble with nocturnal awakenings. Using a stringently defined concept of insomnia as a disorder of initiating sleep (DIS), the prevalence rate of insomnia among women was 1.1% and among men 0.5%. Defining insomnia as a disorder of maintaining sleep (DMS), the prevalence among both women and men was 1.1%. Defining insomnia as a disorder of initiating and maintaining sleep (DIMS), the prevalence rate was 1.7% among women and 1.4% among men. This prevalence, which is lower than previously reported, demonstrate the importance of an operational definition of insomnia.     

Cognitive behavioral therapy for insomnia associated with traumatic brain injury: a single-case study

OBJECTIVE: To test the efficacy of a cognitive behavioral therapy (CBT) for insomnia with a patient with traumatic brain injury (TBI). DESIGN: Single-case study. SETTING: Outpatient rehabilitation center. PARTICIPANT: A man in his late thirties who sustained a moderate TBI in a motor vehicle crash and who developed insomnia. He complained of difficulties falling asleep and staying asleep, despite pharmacotherapy with zopiclone. INTERVENTIONS: Eight weekly individual CBT sessions. Treatment included stimulus control, sleep restriction, cognitive therapy, and sleep hygiene education. MAIN OUTCOME MEASURES: Sleep diary and polysomnography data. RESULTS: Sleep onset decreased from 47 to 18 minutes, and nocturnal awakenings dropped from 85 to 28 minutes on average at posttreatment. Sleep efficiency also increased substantially (58% to 83%). Polysomnography evaluations corroborated the diary data by showing a decrease in total time awake (63.2 to 26.3 min) and in the number of awakenings (21 to 7.5). The majority of gains were well maintained at 1- and 3-month follow-up assessments. CONCLUSIONS: These preliminary results suggest that sleep disturbances after TBI can be alleviated with a nonpharmacologic intervention. CBT for post-TBI insomnia is a promising therapeutic avenue deserving more scientific and clinical attention.     

儿童及青少年失眠的临床特征及治疗研究概况

儿童及青少年是生命历程的关键阶段,许多有助于确定当前和未来健康结果的行为模式在此间得以确立,儿童及青少年精神卫生保健至关重要。儿童及青少年失眠受青春期生理发育、学校及家庭等社会环境、心理行为等多种因素影响,囊括了入睡困难、睡眠时间不足、睡眠质量差和日间困倦等一系列症状,明显影响其精神状态和生活学习质量。儿童及青少年失眠的治疗方法以睡眠卫生教育、认知行为治疗和正念冥想等综合治疗为主。笔者从失眠的相关成因、症状和治疗方法3个方面对儿童及青少年失眠作一综述,为其临床诊疗提供参考。     

Primary headache and sleep disturbances in adolescents

OBJECTIVE: The aim of the present study was to assess sleep patterns and the prevalence of sleep problems in adolescents with primary headaches using a validated sleep screening instrument, as well as to test the association between headache and pain features and adolescent sleep behaviors. BACKGROUND: Sleep disturbance is a common complaint that has long been associated with primary headaches, but there exists limited evidence of the headache-sleep relationship among teens. METHODS: Sixty-nine adolescents aged 13 to 17 years (M= 14.7; SD= 1.4) were evaluated for headaches at 2 pediatric neurology departments (90% migraine; 10% tension-type headache diagnoses). Participants completed the School Sleep Habits Questionnaire and a standardized questionnaire regarding headache characteristics. RESULTS: Sleep complaints were prevalent among adolescents with headaches including insufficient total sleep (65.7%), daytime sleepiness (23.3%), difficulty falling asleep (40.6%), and night wakings (38%). Statistically significant relationships between headache characteristics (eg, frequency, pain intensity) and teen sleep behaviors also emerged. CONCLUSIONS: Our findings provide further support for an association between headache and sleep disturbances among adolescents with primary headaches. This information may provide further understanding of the nature and course of the patient's headache experience, as well as facilitate treatment planning to include recommendations for promoting good sleep hygiene.     

心脏介入术后失眠原因调查分析及护理对策

目的探讨心脏介入术后失眠的原因及护理对策。方法采用自行设计的心脏介入术后睡眠情况问卷调查表,对156例行心脏介入术患者术后睡眠状况进行问卷筛查。结果93%的患者术后第1天出现失眠,以经皮冠状动脉腔内成形术(PTCA)患者为主(96%)。入睡困难和睡眠维持障碍(早醒伴再入睡困难)是最常见的症状。失眠的原因依次为:肢体制动、腰背酸痛、排尿困难、环境因素及精神心理因素。结论通过调查分析对心脏介入术后失眠有了进一步了解,有效的护理对策能提高患者的睡眠质量。     

Diagnosis and management of insomnia

Insomnia is a significant public health issue. Good sleep is essential for emotional and physical wellbeing. The importance of adequate sleep is evidenced by the fact that insomnia can adversely affect physical and mental health. The National Heart, Lung, and Blood Institute Working Group on Insomnia defines insomnia as an experience of inadequate or poor-quality sleep characterized by one or more of the following: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning, or unrefreshing sleep. The symptoms of insomnia also include daytime consequences such as tiredness, lack of energy, difficulty concentrating, or irritability. Insomnia can be a symptom of an underlying medical, psychiatric, sleep, or circadian disorder or a disorder in itself (i.e., primary insomnia). This paper will present information about the prevalence, morbidity, causes, and diagnoses of insomnia, and the behavioral and pharmacologic management of this disorder.     

Insomnia and lifestyle-related diseases

As both insomnia and lifestyle-related diseases are associated with a variety of underlying factors, they have been considered to occur as a complication of each other. Moreover, evidence has been presented in recent studies that they are closely related to each other as risks of development and exacerbation. As unhealthy lifestyle-habits have long been recognized to increase the risks of lifestyle-related diseases and their worsening, it is natural that sleep, which takes up one third of a person's life, is markedly associated with disorders such as hypertension and diabetes. It is important to provide interventions for insomnia and other sleep disorders based on the same viewpoint as for lifestyle-related diseases, and understand that lifestyle advice, including sleep hygiene, and drug treatment with sleeping pills are also effective for the treatment of lifestyle-related diseases themselves.