Disturbed sleep and somatic complaints

We investigated sleep patterns in 20 patients with multiple vague but persistent somatic complaints, not due to any identifiable medical or neurologic disorder, and in whom psychiatric consultations had failed to identify a psychiatric diagnosis. Afternoon naps were recorded in 20 patients and in 10 controls without medical or psychiatric problems. Three-hour postprandial nap recordings were made of submental electromyogram, electrooculogram, and EEG with drowsiness, stages 1-4 NREM, and REM sleep, sleep latency (minutes), sleep efficiency (percent), and number of arousals with return of alpha activity compared in patients and controls by one-tailed t-test. No stage IV or REM sleep occurred in naps. Patients with multiple somatic complaints had less stage III and stage II sleep, and more wakefulness. Arousals were more frequent in the patient group; sleep latency was shorter but sleep efficiency was reduced in patients with multiple somatic complaints compared with controls. The findings suggest that patients with multiple somatic complaints not otherwise explicable by medical or psychiatric problems may have disturbed sleep, improvement of which may ameliorate somatic complaints. Sleep histories should be elicited in such patients, and sleep recordings may be of value in their evaluation; afternoon naps may be a cost-effective way of screening for remediable sleep disturbances in patients with persistent physical complaints of undeterminable cause.     

Disturbed sleep and worries among learning disabled adolescents

This study tested the clinical assumption that sleep problems reflect underlying emotional concerns. The hypothesis that worry-correlates of disturbed sleep for learning disabled adolescents would be related to their disability was borne out by findings of sleep problems associated with concerns about intellectual and academic adequacy. Other significant correlates suggested the effect of social anxiety which may be age-appropriate.     

Disturbed dreaming and sleep quality: altered sleep architecture in subjects with frequent nightmares

Nightmares are intense, emotionally negative mental experiences that usually occur during late-night sleep and result in abrupt awakenings. Questionnaire-based studies have shown that nightmares are related to impaired sleep quality; however, the polysomnographic profile of nightmare subjects has been only scarcely investigated. We investigated the sleep architecture of 17 individuals with frequent nightmares and 23 control subjects based on polysomnographic recordings of a second night spent in the laboratory after an adaptation night. Nightmare subjects in comparison with control subjects were characterized by impaired sleep architecture, as reflected by reduced sleep efficiency, increased wakefulness, a reduced amount of slow wave sleep, and increased nocturnal awakenings, especially from Stage 2 sleep. While these differences were independent of the effects of waking psychopathology, nightmare subjects also exhibited longer durations of REM sleep that was mediated by heightened negative affect. Our results support that nightmares are related to altered sleep architecture, showing impaired sleep continuity and emotion-related increase in REM propensity.     

Disturbed sleep and musculoskeletal pain in the bed partner of patients with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) has been recognized as a distressing experience to the female partner, but a causal association remains controversial. Furthermore, a growing body of evidence supports a relationship of distress and sleep disruptions with musculoskeletal pain, also prevalent in middle-aged women. To test the hypothesis that sharing a bed with an OSA man may contribute to manifestations of distress and impaired sleep, we conducted a case-control study of 17 OSA wives and 17 wives of healthy sleepers.MethodsClinical outcome variables were scores of the Fibromyalgia Impact Questionnaire (FIQ) and visual analog scales (VAS), tender point (TP) count and algometric index. Sleep outcome parameters were VAS scores for sleep quality and polysomnographic (PSG) parameters. Secondary outcomes were VAS scores for distress and marital relationship and coping strategies adopted by OSA wives. Clinical assessment and PSG scoring were conducted blindly.ResultsAfter controlling for age and menopausal status, OSA wives exhibited lower sleep quality and higher distress scores than controls (p < 0.05, all). Increase in pain threshold (TP count and algometric index) and in FIQ score were also observed, and in their PSG, there was an increase in awaken period and stage 1 amount during sleep, as well as in alpha power during slow wave sleep (p < 0.05, all). These sleep parameters had substantial correlation with tiredness and poor sleep quality and were moderately correlated to pain assessments and distress scores.ConclusionThus, independently of age and menopausal status of the group, wives of OSA patients exhibited an increase in pain threshold, distress and impaired sleep in comparison to controls.     

Disturbed sleep in children with Tourette syndrome: a polysomnographic study

OBJECTIVE: To evaluate objective data on sleep quantity/quality and motor activity during night sleep in children with Tourette syndrome (TS). METHOD: Polysomnography of 17 unmedicated TS children (ages: 7;11-15;5, mean: 11;10 years) without comorbid attention-deficit hyperactivity disorder (ADHD) was compared with 16 age-, sex- and IQ-matched healthy controls. Sleep analyses according to the procedure of Rechtschaffen and Kales were supplemented by counting epochs with short arousal-related movements (相似文献   

Disturbed sleep is associated with increased C-reactive protein in young women

Evidence links disturbed sleep with an exaggerated inflammatory response and increased risk of adverse health outcomes. An emerging risk factor for many adverse health outcomes is chronic, low-grade inflammation. An exaggerated inflammatory response could provide a biological link between disturbed sleep and adverse health outcomes. The relationship between sleep and chronic, low-grade inflammation has been sparsely examined in otherwise healthy, young women. We evaluated cross-sectional relationships between self-reported sleep and three inflammatory markers. Participants were community dwelling nonpregnant women (N = 43, 28.2 ± 5.2 years of age). Measures included the Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and serum levels of IL-6, TNF-α and C-reactive protein. Poor sleep quality and continuity were associated with higher CRP levels after controlling for covariates. No significant relationships were observed between PSQI scores and IL-6 or TNF-α; sleep duration was not related to any of the inflammatory markers. Poor sleep, in young adulthood, may contribute to the chronic, low-grade inflammation associated with an increased risk for future adverse health outcomes. Future work should longitudinally evaluate how these relationships may affect development of gender-specific diseases in apparently healthy young women.     

The hypnotic effects of melatonin treatment on diurnal sleep in humans

This study investigated the hypnotic effects of 10 mg melatonin and placebo, which were administered at 10.00 h, according to a single-blind crossover design, on an 8-h diurnal sleep from 11.00 to 19.00 h, following a full night of sleep. The subjects were six healthy male students, each of whom underwent polysomnography and rectal temperature monitoring. Melatonin treatment significantly increased total sleep time in diurnal sleep (403.2+/-SD 72.8 min and 258.5+/-118.3 min, P<0.001). As to changes in rectal temperature during diurnal sleep, however, there were no significant differences between the melatonin and placebo conditions. Thus, these results indicated that melatonin administered at 10.00 h had direct hypnotic effects on diurnal sleep.     

A hypnotic drug for sleep disturbances in patients with Parkinson's disease]

Patients with Parkinson's disease have been known to have sleep disturbances of various types. Zolpidem tartrate, an imidazopyrimidine short-acting hypnotic drug used treat insominia and several patients with PD have described a significant improvement of parkinsonian symptoms after administration of zolpidem tartrate. We tried to evaluate effect of zolpidem tartrate for sleep disturbances in patients with PD by a Japanese version of Chaudhuri's Parkinson's disease Sleep Scale (PDSS) and Unified Parkinson's disease rating Scale (UPDRS) motor scale. Twelve patients with PD (mean age 67.4 years old, range 40-77 years old) were evaluated by PDSS and UPDRS before and two weeks after prescribed zolpidem tartrate 5 mg per day. Patients showed improvement in items relating overall sleep disturbances, sleep refreshment and morning stiffness. Disabilities remained unchanged before and two weeks after prescribing zolipdem tartrate. Zolpidem tartrate may be useful for sleep disturbances in patients with PD and for improving their quality of daily livings.     

A meta-analysis of sleep changes associated with placebo in hypnotic clinical trials

OBJECTIVES: The effects associated with placebo (EAP) have been incompletely described in clinical trials of insomnia treatment. We conducted a meta-analysis of insomnia medication trials for the purpose of estimating the magnitude of sleep EAP. METHOD: We reviewed Medline for 1966 through 2000 for the meta-analysis. The subject heading of insomnia restricted to the subheading of drug therapy was crossed against the results of a search on the subjects heading placebo and text word placebo. We selected only papers that examined primary insomnia, incorporating both placebo and active medication therapies in a randomized, double-blind, parallel-group design. We required that results be reported for 1, 2, 3, or 4 weeks of treatment, and that outcomes be reported in hours/minutes. RESULTS: Five papers satisfied our requirements for eligibility, comprising 213 patients receiving placebo for a 2-week interval. Subjective sleep latency demonstrated a significant reduction (mean+/-S.E.) of 13.1+/-2.0 min (95% confidence interval (CI) 9.2, 17.0) for the placebo group after combining the data across studies. Subjective total sleep time demonstrated a significant increase of 13.5+/-5.4 min (95% CI 2.9, 24.0). Polysomnographic (PSG) sleep latency demonstrated a non-significant reduction of 2.5+/-4.3 min (95% CI -5.9, 10.9). CONCLUSIONS: The confirmation of EAP in insomnia clinical trials argues for the retention of a placebo control in future insomnia clinical trials.     

Dexamethasone nonsuppression predicts the antidepressant effects of sleep deprivation

Twenty-two patients with major depression underwent a dexamethasone suppression test followed by 1 night of sleep deprivation. Clinical improvement occurred significantly more frequently in patients with dexamethasone nonsuppression than in those with normal dexamethasone suppression before sleep deprivation.     

Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes

ObjectiveTo investigate the cross-sectional association between COPD severity and disturbed sleep and the longitudinal association between disturbed sleep and poor health outcomes.MethodsNinety eight adults with spirometrically-confirmed COPD were recruited through population-based, random-digit telephone dialing. Sleep disturbance was evaluated using a 4-item scale assessing insomnia symptoms as: difficulty falling asleep, nocturnal awakening, morning tiredness, and sleep duration adequacy. COPD severity was quantified by: FEV₁ and COPD Severity Score, which incorporates COPD symptoms, requirement for COPD medications and oxygen, and hospital-based utilization. Subjects were assessed one year after baseline to determine longitudinal COPD exacerbations and emergency utilization and were followed for a median 2.4 years to assess all-cause mortality.ResultsSleep disturbance was cross-sectionally associated with cough, dyspnea, and COPD Severity Score, but not FEV₁. In multivariable logistic regression, controlling for sociodemographics and body-mass index, sleep disturbance longitudinally predicted both incident COPD exacerbations (OR = 4.7; p = 0.018) and respiratory-related emergency utilization (OR = 11.5; p = 0.004). In Cox proportional hazards analysis, controlling for the same covariates, sleep disturbance predicted poorer survival (HR = 5.0; p = 0.013). For all outcomes, these relationships persisted after also controlling for baseline FEV₁ and COPD Severity Score.ConclusionsDisturbed sleep is cross-sectionally associated with worse COPD and is longitudinally predictive of COPD exacerbations, emergency health care utilization, and mortality.     

Disturbed sleep in children born extremely preterm is associated with behavioural and emotional symptoms

AimTo determine whether children born extremely preterm are at increased risk for sleep disturbances and to explore relationships between extremely preterm birth, sleep and attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional symptoms.MethodEPICure2 cohort study. Parents of 165 children born ≤26 weeks' gestation (53% male) and 121 children born at term (43% male) completed the Children's Sleep Habits Questionnaire, sleep disordered breathing subscale of the Pediatric Sleep Questionnaire, the emotional problems scale of the Strengths and Difficulties Questionnaire and the ADHD Rating Scale-5 at 11 years of age.ResultsExtremely preterm children had greater habitual snoring (adjusted odds ratio 6.8; 95% confidence interval 2.3, 20.3), less frequently fell asleep within 20 minutes (Cohen's d 0.33), higher night wakings (d 0.44) and daytime sleepiness scores (d 0.40) than term-born children; there was no between-group difference in sleep duration scores. Among children without severe disability, night wakings scores partially mediated the relationship between preterm birth and inattention (additional 5% of variance explained), hyperactivity/impulsivity (13%) and emotional problems (9%). Snoring partially mediated the relationship between preterm birth, hyperactivity/impulsivity and inattention (additional 1–5% of variance).ConclusionChildren born extremely preterm are at increased risk of disturbed sleep compared to term-born children. As night wakings partially mediated the relationship between preterm birth and ADHD symptoms and emotional problems, reducing sleep disturbance may improve sleep and reduce attention and emotional problems in this population.