Periodic leg movements during sleep in PLMD and RLS patients with and without pramipexole treatment

Objective

Pharmacological treatment of restless legs syndrome (RLS) patients with pramipexole (PPX) is common and evidence based, whereas the effect of pramipexole on periodic leg movements (PLM) in periodic limb movement disorder (PLMD) patients is unknown. The aim of this study was to investigate the effect of pramipexole on sleep parameters and PLM indices in RLS and in PLMD patients.

Material and methods

Retrospectively, data of two consecutive polysomnographies of 47 patients (20 women, 27 men; mean age 59.8?±?13.6 years; range 23–87 years) with RLS (n?=?29) or PLMD (n?=?18) were analyzed. Of these, 15 patients with RLS and 9 patients with PLMD were treated with 0.18 mg pramipexole directly before the second polysomnographic night.

Results

The PLMS (total PML during sleep) index of PLMD patients was significantly higher (p?=?0.007) in untreated as well in treated patients (p?=?0.007) as compared to RLS. It was significantly reduced (p?<?0.03) in both groups under PPX. In RLS + PPX as well as in PLMD + PPX, light sleep significantly increased and deep sleep significantly decreased. The parameters total sleep time (TST) and sleep efficiency showed no significant changes as compared to the first polysomnographic night.

Conclusion

Results of this retrospective study indicate that a single treatment with 0.18 mg pramipexole leads, on the one hand, to a reduction of PLM indices in sleep both in RLS and in PLMD patients but, on the other hand, to an increase of sleep stages 1 and 2 and to a decrease of deep sleep.     

Poor Sleep Quality is Associated with Depressive Symptoms in Patients with Heart Disease

Background

Depression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression.

Purpose

This cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients.

Methods

Two hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3?±?14.3?years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6?±?13.0?years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms.

Results

Poor sleep quality (PSQI?>?5) was reported in all comorbid DCP (PSQI 12.00?±?3.53, BDI 17.86?±?4.28), in 60% of the 80 non-DCP (PSQI 5.59?±?3.73, BDI 4.47?±?3.07), and in 86.4% of the DP (PSQI 11.76?±?4.77, BDI 27.11?±?10.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (r?=?0.40) and daytime dysfunction (r?=?0.34). Both sleep components were significant predictors of self-rated depression (R2?=?0.404).

Conclusions

Most cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.     

Schlafbezogene Atmungsstörungen bei Parkinsonsyndromen: Häufigkeit, Art und Behandlungsansätze

Objective

In recent literature the contribution of sleep related breathing disorders [SRBD] to the complex sleep disorder of Parkinson's disease [PD] patients is controversely discussed. In our study we discovered the frequency and kind of SRBD in a group of PD patients with sleep complaints.

Patients and methods

83 patients with different types of parkinsonism were studied polysomnographically. Respiration was measured by means of inductance plethysmography, capnography, and pulse oximetry. Different analysing techniques were used. Besides the evaluation of apneas and hypopneas a visual classification of the respiratory pattern and a breath-to-breath calculation of the laboured breathing index [LBI] was carried out.

Results

More than 50% of the patients showed sleep disordered breathing. Most of them had upper airway obstructions. Central apnea was observed in 5 cases, three of those suffered from a heart disease. In 25% the SRBD should be treated. The LBI calculation revealed hints for short pharyngeal obstructions in each patient. This parameter turned out to be highly sensitive to detect changes in upper airway mechanics and was therefore considered to be useful in testing dopaminergic influences on respiratory movements.

Conclusion

Disturbances of the extrapyramidal motor system may lead to long lasting obstructive hypoventilation of different clinical importance. Specific measurement techniques should be used to identify these disturbances. The laboured breathing index may be useful to detect dopaminergic deficits in respiratory motion. As more than 50% of severe SRBD patients are not able to handle nCPAP it is necessary to develop pharmacological options. Dopaminergic medication as a possible therapeutical alternative to nCPAP should be tested in further studies.     

Transverse myelitis associated with restless legs syndrome and periodic movements of sleep responsive to an oral dopaminergic agent but not to intrathecal baclofen

Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are related sleep disorders that occur with increased frequency in spinal cord disease. Effective treatment may be obtained with dopaminergic or opioid drugs, while anticonvulsants, benzodiazepines, and possibly baclofen may be helpful. This report describes a patient who developed RLS and PLMD after acute transverse myelitis associated with infectious mononucleosis, and failed to respond to intrathecal baclofen. All symptoms of RLS/PLMD resolved after treatment with pergolide.     

Low Resistance Thought Induction Sleep-regulating Technique (TIP3-2) Combined with Medication for Primary Insomnia: A Randomized Controlled Trial

Background

Cognitive behavioral therapy for insomnia (CBT-I) is well-validated in the western countries. However, it has not been widely adopted or disseminated in China. One possibility is that therapeutic approaches drawn from traditional Chinese medicine (TCM) will be more widely accepted.

Purpose

This study aimed to evaluate the efficacy of medication in combination with a therapeutic approach drawn from TCM, Low Resistance Thought Induction Sleep-regulating Technique (TIP3-2), for acute treatment of insomnia.

Method

A randomized controlled trial was conducted. Ninety primary insomnia patients were randomly assigned to receive TIP3-2 combined with medication (n?=?45) or medication only (n?=?45) for 4 weeks. Medication consisted of 1–2 mg Estazolam nightly. On the basis of taking Estazolam, TIP3-2 combined with medication group was given Low Resistance Thought Induction Sleep-regulating Technique (TIP3-2) treatment twice a week. Outcomes were assessed with the Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) before and after treatment.

Results

Both groups demonstrated significant improvements in the PSQI and polysomnography indices. The TIP3-2+ medication group demonstrated a significant difference between the two groups in PSQI total score, sleep medication use, daytime dysfunction, subjective sleep quality, as well as polysomnography indices of sleep efficiency and awakening times (P?<?0.05).

Conclusion

Among patients with primary insomnia, the addition of TIP3-2 provided benefits above and beyond the role of medication alone.     

Interpreting Wrist Actigraphic Indices of Sleep in Epidemiologic Studies of the Elderly: The Study of Osteoporotic Fractures

Introduction:

Although wrist actigraphy-derived sleep indices correlate with adverse health outcomes, it is unclear whether these indices identify specific sleep disorders.

Methods:

Overnight polysomnography and ≥ three 24-h periods of wrist actigraphy were performed in the Study of Osteoporotic Fractures (SOF) (n = 455, age: 73–96 y). Actigraphy identified those with reduced sleep efficiency (SE, < 70%) and decreased sleep duration (≤ 5 h). Sleep disorders considered were: (1) sleep-disordered breathing (SDB): respiratory disturbance index ≥ 15 and (2) periodic limb movement disorder (PLMD): periodic limb movement-arousal index ≥ 5. Multivariable logistic regression analyses modeled each sleep disorder as the dependent variable with wrist actigraphy measures, age, race, medication use, depression, body mass index, activity, mental status, and comorbidity as independent variables.

Results:

In multivariable models, poor SE derived from wrist actigraphy was associated with 2.4-fold higher odds of SDB (OR = 2.43, 95% CI: 1.43–4.14) and PLMD (OR = 2.36, 95% CI: 1.34–4.15). Reduced sleep duration was associated with 3.2-fold higher odds of SDB (OR = 3.18, 95% CI: 1.51–6.68), and a 3.8-fold higher odds of PLMD (OR = 3.77, 95% CI: 1.78–17.95).

Conclusions:

In elderly women, wrist actigraphy-ascertained reduced SE and sleep duration are associated with objective measures of SDB and PLMD. Thus, although not able to discriminate between the different sleep disorders, variations in wrist actigraphy measures collected in epidemiologic studies may identify individuals at higher risk of SDB or PLMD.

Citation:

Mehra R; Stone KL; Ancoli-Israel S; Litwack-Harrison S; Ensrud KE; Redline S. Interpreting wrist actigraphic indices of sleep in epidemiologic studies of the elderly: the study of osteoporotic fractures. SLEEP 2008;31(11):1569–1576.     

Comparison of prevalence of obstructive sleep apnea,restless legs syndrome,and poor sleep quality in patients with coronary artery disease and depression

Background

This study was designed to compare the prevalence of restless leg syndrome (RLS), obstructive sleep apnea (OSA), and poor sleep quality between patients with coronary artery disease (CAD) and those with major depressive disorder (MDD)/somatic symptom disorder (SSD).

Methods

In this study, subjects with CAD were included. The comparison group consisted of subjects with MDD or SSD. After screening for exclusion criteria, a total of 100 subjects from each group were screened for OSA, RLS, and sleep quality. Hindi versions of the Berlin questionnaire, the Cambridge–Hopkins RLS diagnostic questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) were used for screening, respectively. The groups were compared using statistical tests.

Results

Due to missing data, 33 subjects were excluded from final analysis. Final analysis was performed on 167 subjects—82 with CAD and 85 with MDD/SSD. Males outnumbered females in this sample (79?% men and 21?% women) and patients with CAD were older (56.1 ± 10.4 years in CAD vs. 35.5 ± 10.9 years in MDD/SSD). Prevalence of “high risk for OSA” was higher among CAD (34?%) as compared to MDD/SSD subjects (12.9?%), even after controlling for age and gender. The prevalence of RLS was comparable (13.4?% in CAD vs. 9.4?% in MDD/SSD). Daytime dysfunction, sleep quality, use of medication to induce sleep, and sleep latency were worse in the MDD/SSD group as compared to the CAD group.

Conclusion

In conclusion, this study shows that CAD patients are at a higher risk of OSA, while sleep-related parameters are worse in MDD/SSD patients. RLS was comparable between groups. On the whole, the prevalence of OSA, RLS, and poor sleep quality in both groups was higher as compared to the general population.

     

Subtypes of ADHD and their association with sleep disturbances in children

Objective

So far, little is known about potential links between subtypes of attention deficit hyperactivity disorder (ADHD) and sleep disturbances in childhood. Therefore, this study examined the association between sleep disorders and all three subtypes of ADHD.

Methods

A total of 60 children showing attention deficit symptoms (aged 6?C13 years; 88.3% boys) were diagnosed with regard to ADHD according to the DSM-IV-TR. The subtypes of ADHD diagnosed were then related to potential sleep disturbances as measured using a standardized parent-rated questionnaire (Children??s Sleep Habits Questionnaire, CSHQ-DE).

Results

Clinically significant elevated scores in the CSHQ-DE??s Sleep Disturbance Scale were exhibited in all 60?children. Parents of the children with primarily hyperactive?Cimpulsive subtype reported the highest scores. Children with this subtype displayed the highest rate of specific sleep disorders, e.g., increased daytime sleepiness and higher bedtime resistance.

Conclusion

The assumption that children with ADHD show elevated scores of sleep disturbances was verified. In addition, it was possible to identify a unique pattern of sleep disturbances corresponding to the respective ADHD subtypes.     

Is a polysomnographic recording prior to MSLT worth the effort?

Objective

It was recently proposed that polysomnography (PSG) may be replaced by actigraphy in order to obtain long-term sleep time prior to the multiple sleep latency test (MSLT). Polysomnography is used to assess sleep time and to detect and classify underlying sleep pathology. In the following article, the contribution of PSG to the diagnostic outcome of the MSLT is discussed.

Methods

MSLT referrals (n?=?81) with in-home polysomnography from the neurology (n?=?39, 23 women, 37 (±13) years) and pulmonary medicine (n?=?42, 20 women, 41 (±14) years) departments were analyzed. The diagnostic outcomes of the PSG and MSLT were examined.

Results

Median total sleep time prior to MSLT was 362 (range, 156–530) min. Sleep apnea (respiratory disturbance index >?15/h and >?30/h) was diagnosed in 21 and 19 patients, respectively. Periodic limb movements (PLM) were identified in 5 patients; 3 of these had a PLM arousal index >?5/h. Sleep onset REM (SOREM) was detected during PSG in 5 patients; 4 of these also had SOREM in the MSLT.

Conclusion

PSG combined with MSLT was found to improve diagnostic outcome and is highly useful for recognition of sleep-related pathology. Various sleep disorders remain undetected if ACT alone is used prior to MSLT procedures.     

Die Schlafgewohnheiten der Österreicher

Background

Sleep disturbances and lack of sleep are prevalent in modern society. Although there is a growing public interest in sleep-related topics, it is still unclear, how this knowledge of adequate sleep affects individual sleeping behavior.

Methods

In a survey representative for the Austrian population (n= 1000, 478 men, 522 women), questions concerning common sleep traits, sleep quality, sleep disturbances, and sleep habits were sampled in association with demographic and health status.

Results

Of the population interviewed, 76%reported an average sleep duration between 6 and 8 h as well as normal sleep latency; 90% were satisfied with their subjective sleep quality. On weekends, 54% reported longer sleep periods, and 23% took a nap during the day. Here, the percentage of retirees proved to be comparably high. Of the persons sampled, 87% always slept in the same bed, 31% slept alone, while 46% shared their bed with a partner. Interestingly, 18% of the sample disclosed frequent sleep disturbances, but 70% never did anything about it. Of the subpopulation who actively dealt with its problems, 45% resorted to hypnotics. Lower education and professional qualification correlated with reduced sleep quality. Similarly, obesity and lack of physical activity were associated with sleep problems. Despite the wide range of knowledge available in the media, most Austrians used their physicians or pharmacies as their primary source of information concerning questions on sleep and sleep disturbances.

Conclusion

The present study on sleep habits and sleep disorders of the Austrian population gives first insight into the complexity of sleep and the influence of potential interference factors.     

Restless legs syndrome in patients with depressive disorders

Aim

Recent community-based studies have shown strong associations between restless legs syndrome (RLS) and major depressive disorder and panic disorder. The aim of the study was to investigate whether patients with a manifest depressive disorder have an increased prevalence of RLS and whether there is an association with different depressive disorders.

Methods

Three psychiatry departments in two countries (Germany and Australia) each recruited 100?consecutive patients with current depression. All patients completed a standardized questionnaire including diagnostic questions for RLS, the Center for Epidemiologic Studies Depression Scale (CES-D), and the International RLS Severity Scale (IRLS), if RLS was present. The treating doctors completed a second standardized questionnaire including RLS diagnostic questions and comorbidities.

Results

A total of 277?questionnaires could be evaluated, 184 in Germany (96 in Bremen, 88 in Freiburg) and 93 in Australia. The Australian patients were younger than the German patients (45.4?±?13.8 vs. 49.7?±?15.0?years, p?=?0.02); the gender distribution was not different (p?=?0.71). The minimal diagnosis criteria for RLS were fulfilled by 8.3% of the German and 17.0% of the Australian patients (p?=?0.02). The treating physicians rated 4.3% of the German and 12.4% of the Australian patients as RLS cases. RLS prevalence was similar across all subtypes of depression.

Conclusion

RLS is not more frequent in patients with manifest depression in Germany as compared to the general population. Possible reasons for the higher prevalence of RLS in depressive patients in Australia are discussed.     

Bispectral index monitoring of sleep in palliative care patients

Purpose

In patients receiving palliative care (PC), sleep is often negatively influenced by pain, anxiety and medication. Because these patients are often too sick to be investigated in a sleep laboratory, it is difficult to obtain objective information concerning their sleep. This study investigates whether bispectral index (BIS) monitoring reflects wakefulness, sleep and the effect of medication and whether it is tolerable for patients.

Methods

In all, 10 patients from an inpatient PC unit participated in the study. They were monitored using a BIS system for one night, while each event was carefully documented by patient care attendants. In addition, participants completed a questionnaire on the evening prior to and on the morning following the recording about their subjective wellbeing and sleep.

Results

On a scale from 0 to 100, BIS measurements covered values ranging from a minimum of 29–40 to a maximum of 74–98. Individual differences between minimum and maximum ranged between 38 and 68. High BIS values are associated with wakefulness, low BIS values with sleep. The administration of sedative and analgesic medication was followed by a long-lasting decrease in BIS measurements. In 3 patients, the measurements were discontinued due to the patient being disturbed or irritation of the skin.

Conclusion

BIS monitoring was well tolerated by most but not all patients. It can be useful in complementing patients’ reports in questionable cases. This might be of special interest in outpatient settings where continuous objective professional observation is not available.     

Elevated Estradiol Plasma Levels in Women with Restless Legs during Pregnancy

Study Objectives:

Pregnant women have an increased risk of experiencing restless legs syndrome (RLS). Aim of this study was to elucidate the relationship between pregnancy-related hormonal and metabolic changes and RLS symptomatology.

Design:

Blood measurements and overnight polysomnography were performed during the third trimester of pregnancy and again 3 months after delivery. We investigated blood hormonal levels (estradiol, prolactin, progesterone, testosterone, follicle-stimulating hormone [FSH], luteinizing hormone [LH], iron, ferritin, hemoglobin) and polysomnographic sleep parameters. Subjective sleep quality and RLS symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the International RLS study group (IRLSSG) rating scale.

Setting:

Sleep laboratory.

Participants:

Ten pregnant women fulfilling the IRLSSG criteria for RLS diagnosis and 9 pregnant healthy controls underwent the protocol.

Interventions:

N/A.

Results:

Women with RLS showed higher levels of estradiol during pregnancy compared to controls (34,211 ± 6,397 pg/mL vs. 25,475 ± 7,990 pg/mL, P < 0.05). Patients also showed more periodic limb movements (PLMs) before and after delivery, particularly during sleep stage 1 and wakefulness (P < 0.05). PLMs decreased postpartum in subjects with RLS only (P < 0.05); sleep efficiency increased in women without RLS and remained unchanged in patients (P < 0.05). No significant differences were found between groups before or after delivery in plasma concentrations of prolactin, progesterone, testosterone, FSH, LH, iron, ferritin or hemoglobin.

Conclusions:

RLS in pregnant women goes along with transiently increased estradiol levels and PLM indices suggesting that estrogens play a pathophysiological role for triggering RLS symptoms during pregnancy.

Citation:

Dzaja A; Wehrle R; Lancel M; Pollmächer T. Elevated estradiol plasma levels in women with restless legs during pregnancy. SLEEP 2009;32(2):169-174.     

Dream recall frequency and nightmare frequency in patients with sleep-disordered breathing

Question of the study

There are conflicting findings regarding dream recall frequency (DRF) in patients with sleep-disordered breathing: Various studies have reported less, equal, or higher DRF in comparison with healthy controls. Although more negatively toned dreams were found in these patients, nightmare frequency had not been found to be increased in a previous study. This study concerned whether DRF or nightmare frequency was altered in patients with sleep-disordered breathing without other comorbid diagnoses and whether disorder-related parameters, comorbidity, or drug intake was associated with DRF and nightmare frequency.

Patients and methods

The present study assessed home DRF and nightmare frequency via two rating scales in 1,706 patients with sleep-disordered breathing. These data were compared with those of healthy control samples from other studies.

Results

In comparison with the control group, a reduced DRF was found that was not associated with respiratory parameters or comorbidity. Similarly, nightmare frequency was reduced, and one might speculate whether these findings can be explained by cognitive dysfunction, which is often found in patients with sleep-disordered breathing. Use of antidepressants and psychiatric comorbidity were associated with heightened nightmare frequency.

Conclusions

Future studies should include current medication intake, measures of cognitive functioning, and sleep parameters in order to explain reduced DRF and reduced nightmare frequency in patients with sleep-disordered breathing.     

The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616]

Background

Stopping antipsychotic treatment can interrupt improvement and exacerbate the illness. The reasons for discontinuing treatment during controlled clinical trials were analyzed to explore this phenomenon.

Methods

A post-hoc, pooled analysis was made of 4 randomized, double-blind clinical trials, 24–28 weeks in duration, involving 1627 patients with schizophrenia or a related disorder. Analyses combined all the atypical antipsychotic treatment groups in the studies.

Results

The majority of patients (53%) stopped their treatment at an early stage. Poor psychiatric response along with worsening symptoms was the most frequently given reason for discontinuing the course (36%), which was substantially more common than discontinuation due to poor tolerability of the medication (12%). This phenomenon was corroborated by less improvement in patients who discontinued treatment compared with those who completed, based on the PANSS total scores. Discontinuation due to poor response was, apparently, more predominantly linked to patient perception than to physicians' conclusions alone (80% vs. 20%). Discontinuation due to patient perception of poor response appeared to occur particularly early in the course of treatment. Patients who discontinued due to poor toleration of the medication responded in a more comparable manner with completers.

Conclusion

Discontinuing treatment may lead to exacerbation of symptoms, undermining therapeutic progress. In these studies, poor response to treatment and worsening of underlying psychiatric symptoms, and to a lesser extent, intolerability to medication were the primary contributors to treatment being discontinued. Our findings suggest that adherence may be enhanced by effective symptom control, as objectively measured and as subjectively perceived. Such strategies may improve patients' willingness to undertake long-term therapy and increase the likelihood of a better prognosis.     

Hat die Ausschreibung von CPAP-Geräten einen Einfluss auf die Compliance und Abbruchrate bei Patienten mit obstruktivem Schlafapnoesyndrom?

Background and objectives

The compliance of CPAP therapy in patients with obstructive sleep apnea syndrome is variable. Many factors have a significant influence. The new bidding procedure of CPAP devices by insurance companies is a new factor in this area. The goal of this study was to investigate what influence this additional factor has on the compliance and drop-out rate.

Patients and methods

All patients who received a CPAP device in our sleep laboratory in 2009 were included in the study. Two groups were formed: patients with bidding procedure (group A) and patients without (group B). All patients received a questionnaire and an appointment in the sleep laboratory. Patients were compared regarding epidemiological and sleep medicine aspects while using the device.

Results

A total of 87 (group A) and 93 (group B) patients were included. The observation time required 622–966 days (mean 692.6 days). The data at the beginning of the study were comparable. The drop-out rate in group A was higher than in group B (29.9?% vs 22.6?%). Statistical significance was not accomplished (p?=?0.072).

Conclusions

The bidding procedure for CPAP devices might have negative effects for the drop-out rate of the therapy; however, further investigations are needed.     

Validation of the restless legs syndrome screening questionnaire (RLSSQ)

Background

Although the diagnosis of restless legs syndrome (RLS) is largely based on the presence of the four essential criteria, no validated diagnostic questionnaire exists for use in epidemiological studies or clinical practice.

Methods

For this purpose we validated a 10-item patient self-rating questionnaire (maximum total score 10 points) covering the clinical features of RLS and including the essential criteria (items 1–5). The essential criterion 1 was divided into two questions to separately address the unpleasant sensations (item 1) and the urge to move (item 2). The RLS screening questionnaire (RLSSQ) was administered to 329 patients with RLS (213 female; mean age 62.6±11.8 years), 187 control subjects from the general population (113 female; mean age 50.0±13.3 years), and 118 patients with Parkinson’s disease (44 female; mean age 65.1±9.8 years) in whom RLS was excluded.

Results

The mean RLSSQ score in the RLS group was 8.5±1.0 points, compared with 2.2±2.1 points in the general population control group (p<0.0005). Considering an RLSSQ score of 7 points as a positive test result, we found a sensitivity of 97.9% and a specificity of 96.2%. In the Parkinson’s disease control group, the mean RLSSQ score (3.72±2.04) was also significantly lower than in the RLS group (p<0.0005), revealing a specificity of 93.2%.

Conclusion

Because of its high sensitivity and specificity, the RLSSQ proved to be a useful diagnostic instrument.     

Maternal smoking during pregnancy and sleep problems in 2-month-old infants

Objective

The study aimed to assess possible association between maternal smoking during pregnancy and sleep disturbances in 2-month-old infants.

Subjects and methods

The study comprised 200 apparently healthy infants from community settings selected by chance (88 boys, 112 girls), aged 2 months, who were singletons born in St. Petersburg in 2007. The mothers were asked to complete the questionnaires addressing major infant, maternal and demographic characteristics with particular emphasis on maternal smoking during pregnancy. As a part of the interview, the mothers were requested to describe possible sleep disturbances in their infants, divided into five major sleep domains: bedtime problems, excessive daytime sleepiness, awakenings, regularity and duration of sleep as well as snoring.

Results

Of 200 mothers, 63 (31.5%) smoked during pregnancy. The babies born to smoking mothers more commonly were reported as having bedtime problems [odds ratio (OR)=2.75; 95% confidence interval (CI)=1.15–6.58], and this association remained significant after adjustment was made for major potential confounders. Maternal smoking after delivery did not significantly add to the risk. Babies born to smoking mothers more often had irregular sleep, but this association was markedly influenced by the confounding effect of maternal education. No statistically significant differences were found for total night time sleep duration, the frequency of night time awakenings, excessive night time waking and daytime sleepiness as well as for snoring and noisy breathing during sleep.

Conclusion

Maternal smoking during pregnancy should be considered as a risk factor for infant bedtime problems, emerging as early as 2 months of age.     

Sleep problems among family members of a universal parent-training

Objective

Being a parent is often associated with less sleep and sleep problems. In addition, young children often suffer from sleep problems. Hence, children’s sleep problems can evoke sleep problems in their parents. However, little is known about sleep of family members.

Method

A total of 54 parents with their children between 4 and 12 years of age (mean 7.04 years) participated in this study prior to a universal parent-training. Sleep problems were assessed by the Child Behavior Checklist (CBCL) and the Symptom Checklist 90-R (SCL-90-R). Psychological problems of the children and parental burden were further evaluated with the Eyberg Child Behavior Inventory (ECBI). In addition, parental behavior was assessed with the short form of the Parenting Scale of Arnold (“Erziehungsfragebogen für Eltern”, EFB-K).

Results

In sum, 13?% of the children showed shorter overall sleep duration than other children, whereas 5.6?% slept more. None of the parents reported daytime sleepiness in their children, but 3.9?% reported that their children do often have nightmares and also 3.9?% often talk during sleep. Altogether 15.4?% of the parents thought that their child suffered from sleep problems. Problems falling asleep were reported by 19.6?% of mothers and 10.5?% of fathers and disturbed sleep was reported by 33.3?% of mothers and 12.6?% of fathers, whereas 15.8?% of mothers and 8.4?% of fathers were suffering from waking up too early in the morning. Children with sleep disturbances did not differ significantly from children without sleep problems regarding their psychological disturbances. However, parents differed with regard to parental burden, depression, anxieties, and sleep problems. The main limitations are the small sample size and the lack of a healthy control group.

Conclusion

In contrast to their parents, children with or without sleep problems did not differ concerning psychological disturbances. Consequently, even if the child is not affected by sleep problems these issues need to be considered for parents participating in a universal parent-training. Furthermore, fathers also need to be integrated into diagnostics, not only mothers, because sleep problems and other psychological problems are often experienced by both parents.