Prevalencia de trastornos del sueño y factores asociados en pacientes hospitalizados

ObjectiveTo determine the prevalence of insomnia in inpatient in an Internal Medicine Department and to identify risk factors of sleep disorders.MethodA cross-sectional observational study was designed. Inpatients over eighteen years old hospitalized for acute medical conditions were recruited. Insomnia was assessed by the Athens insomnia scale. A nurse administered a questionnaire on risk factors including socio-demographic factors, reason for admission, comorbidities, current medications, functional status, nocturnal symptoms, and environmental factors.ResultsA total of 299 patients were recruited with a mean age of 73.7 years (SD 14.2). Overall prevalence of insomnia was 42.1%, slightly higher in women (48.2%) than in men (37.0%) (P = .052). In those less than 65 years the prevalence was 33.8%, and in patients aged 65 or over it was 44.9% (P = .093). The main factors associated with insomnia were a history of anxiety, depression and stroke, heartburn, pain, fear, and poor functional capacity at admission. Environmental factors such as noise, the sensation of cold or heat, and changing habits involved in hospitalization did not reach statistical significance. In patients 65 years or older, the use of beta-blockers was associated with insomnia. The multivariate analysis showed stroke, heartburn, and pain as independent risk factors for insomnia.ConclusionsInsomnia is highly prevalent among inpatient, and is associated with some treatable or modifiable factors.     

Insomnia,Fatigue, and Depression: Theoretical and Clinical Implications of a Self-reinforcing Feedback Loop in Cancer

Introduction:Insomnia is emerging as a modifiable major risk factor for mental and physical problems, including cancer, and it may contribute to cancer-related fatigue and depression. Since both fatigue and depression may favor insomnia as well, we may hypothesize a self-reinforcing feedback loop among these factors in cancer.Methods:With the aim of discussing this hypothesis, PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA method with several combinations of terms such as “insomnia” and “cancer” and “fatigue” and “depression”. On this basis, we conducted a narrative review about theoretical aspects of insomnia in the context of cancer and about its role in cancer-related fatigue and depression.Results:Twenty-one papers were selected according to inclusion/exclusion criteria. Insomnia is frequent in cancer, and it is associated with cancer-related comorbid conditions such as emotional distress, depressive symptoms, and cancer-related fatigue. The hyperactivation of stress and inflammatory systems, which sustain insomnia, may contribute to cancer-related depression and fatigue. A deleterious feedback loop may be created, and it may perpetuate not only insomnia but also these cancer-related comorbid conditions.Conclusion:Although the understanding of the causal relationship between insomnia/ depression/fatigue in individuals with cancer is limited, we may hypothesize that these symptoms can exacerbate and maintain each other. When insomnia is established in cancer, it may lead to a vicious cycle with fatigue and depression and may contribute to adverse cancer outcomes. Interventions targeting insomnia could provide a promising approach not only for insomnia but also for cancer-related symptoms among cancer patients.     

Insomnia and its associated factors in incarcerated adults: A cross‐sectional study

No evidence exists in the literature concerning the prevalence of insomnia and its associated risk factors among prison inmates in Taiwan. The aim of the present study was to determine the prevalence and factors associated with insomnia among inmates in a large prison in Taiwan. A cross‐sectional anonymous questionnaire survey was conducted at a prison. The participants were 1490 male inmates. Participants completed the self‐reported Insomnia Severity Index–Chinese version questionnaire, and the sociodemographic and psychological distress questionnaires for the study. Multivariate logistic regression was used to analyze and compare the differences between inmates with and without insomnia. The prevalence of insomnia was 26.9%. The study determined that anxiety, self‐rated health status, and religious beliefs were independent predictors of insomnia in male inmates. Given the adverse effect of insomnia and its social consequences, it is crucial to develop prevention programs to mitigate insomnia in inmates.     

Nursing diagnoses of hospitalized infants with physiologic hyperbilirubinemia: A cross sectional study

Background and aimNursing diagnoses are the common language of nurses which indicate the labels given to human responses to health problems/developmental processes. Neonatal physiologic hyperbilirubinemia is a developmental disorder common in neonates. The responses to this health problem need to be identified.This study aimed to find physiologic hyperbilirubinemia related nursing diagnoses in some domains of the NANDA-I classification in hospitalized newborns in a maternal-neonatal educational hospital in Tehran, Iran.MethodsIn this cross-sectional study, a checklist contains labels, defining characteristics and related factors of selected nursing diagnosis of six domains of the NANDA-I classification and a maternal-neonatal information questionnaire were used for conveniently selected 140 hospitalized newborns with physiologic hyperbilirubinemia. The data was analyzed using SPSS software 23 (IBM Corp, Armonk, NY).FindingsRisk for deficient fluid volume, Risk for electrolyte imbalance (hyponatremia/hypocalcemia/hypernatremia), risk for vascular trauma, risk for impaired skin integrity, risk for infection, risk for injury (retinal damage/bilirubin hyperbilirubinemia) and risk for thermal injury were the nursing diagnoses identified for more than 90% of the neonates.ConclusionThe nursing diagnoses identified in this study for physiologic neonatal hyperbilirubinemia can guide clinical neonatal nurses in providing high-quality care in neonatal settings.     

Sleep disorders among nurses and other health care workers in Poland during the COVID-19 pandemic

BackgroundThe profession of nurses involves exposure to harmful agents. Despite numerous international studies on the occurrence of sleep disorders in nurses, most studies lacked an assessment of the dependence on the occurrence of the situation causing fear and anxiety which is a highly contagious.AimDetermining the relationship between the occurrence of sleep disorders and socio-demographic variables of medical personnel during the COVID-19 epidemic.DesignThis is a cross-sectional study conducted online involving 336 health professionals.ResultsInsomnia among staff was determined at the level of Subthreshold insomnia and Clinical insomnia (moderate severity). Suspicion or confirmed COVID-19 had an effect on the occurrence of sleep disorders in the study group of medical personnel.ConclusionTaking into account the statistical error of 6%, the sleep disorders concern about 40% of professionally active nurses and midwives in Poland. Worsening of insomnia was observed in people with the possibility of contact with a patient with COVID-19 in the workplace. Insomnia was more common in respondents over 25 years of age. Psychosocial interventions are needed to help healthcare staff better respond to COVID-19 and future epidemics.     

Sleep disorders: insomnias

An inability to sleep or sleep prematurely ended or interrupted by periods of wakefulness (insomnia) are some of the most frequent complaints heard from patients. Insomnia can be situationally related or persistent in nature. Persistent insomnia may be associated with biological rhythm disturbances, drug dependency, psychophysiologic abnormalities, psychiatric disturbance, sleep apnea syndrome or nocturnal myoclonus. This article describes these pathologies, gives clues toward differential diagnosis, suggests patient subgroups that would benefit from referral for specialized evaluation at a sleep disorder center and describes current treatment options.     

Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment

BackgroundInsomnia is a common health problem, and most people who seek help for insomnia consult primary care. In primary care, insomnia treatment typically consists of hypnotic drugs, although cognitive behavioral therapy for insomnia is the recommended treatment. However, such treatment is currently available to few primary care patients.ObjectivesTo evaluate the effects of a group treatment program for insomnia led by nurses in primary care.Outcomeswere the Insomnia Severity Index, a 2-week sleep diary, and a questionnaire on frequency of hypnotic drug use.DesignA randomized controlled trial with pre- and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group.SettingsRoutine primary health care; 7 primary care centers in Stockholm, Sweden.ParticipantsPatients consulting primary care for insomnia were assessed for eligibility. To be included, patients had to have insomnia disorder and be 18 years or older. Patients were excluded if they if they worked night shifts or had severe untreated somatic and/or mental illness, bipolar disorder, or untreated sleep disorder other than insomnia. One-hundred and sixty-five patients 20 to 90 years were included. Most were women, and many had co-existing somatic and/or mental health problems. The post-treatment dropout rate was 20%.MethodsThe intervention was a nurse-led group treatment for insomnia based on the techniques of cognitive behavioral therapy for insomnia. The nurses had 2 days of training in how to deliver the program. Ninety patients were randomized to the intervention and 75 to the control group (treatment as usual). Data from 82 in the intervention and 71 in the control group were analyzed in accordance with intention-to-treat principles. Fifty-four of the 72 in the intervention group who participated in the group treatment program were followed up after 1 year.ResultsMean Insomnia Severity Index score decreased significantly from 18.4 to 10.7 after group treatment but remained unchanged after treatment as usual (17.0 to 16.6). The effect size was large (1.23). Group treatment also resulted in significant improvements in all sleep diary variables (sleep onset latency, total sleep time, time awake after sleep onset, number of awakenings, and sleep quality). It also reduced hypnotic drug use. Improvements were maintained 1-year post-treatment.ConclusionsPatients with insomnia can be treated successfully with a nurse-led group treatment program in primary health care. The results support implementation of the treatment program, particularly given the need for increased access to non-pharmacological insomnia treatments.     

The correlation between shoulder pathologies and sleep disorders

ObjectiveTo assess and characterize the correlation between shoulder pathologies and sleep disturbances.MethodsParticipants enrolled into this case–control study were divided into two groups: patients with an established clinical diagnosis of active shoulder pathology (study group), and patients without any shoulder pathology (control group). All patients completed the Insomnia Severity Index (ISI) questionnaire, in addition to questions related to participant demographics, health status, medication, and other known insomnia risk factors.ResultsA total of 98 patients were included (46 in the study group and 52 controls). Mean ISI score was significantly higher (indicating more severe insomnia) in the study group versus control group (t[96] = –9.67), even after correcting for confounders (t[53.1] = –8.61). Additionally, in patients with shoulder pathology, those with comorbidities experienced more sleep disturbances than those without comorbidities (β = 0.36). Lastly, the shoulder pathology group was at a higher risk of having sleep disturbances compared with controls (relative risk 4.86, 95% confidence interval 2.24, 10.55).ConclusionsSleep disturbances are more common among patients with shoulder pathologies. Comorbidities and a shorter duration of pathology may predict more severe sleep disturbances.     

Gender differences in the relationships between sleep disturbances and academic performance among nursing students: A cross-sectional study

BackgroundSleep disturbances, such as insomnia, excessive daytime sleepiness, and poor-quality sleep, are common among nursing students and are closely linked with academic performance.ObjectivesTo examine the prevalence of sleep disturbances and academic performances in male and female nursing students and to determine gender-specific effects on the relationship between sleep disturbances and academic performance.DesignA cross-sectional study design was adopted.SettingsThis study was conducted in a school of nursing in Indonesia.ParticipantsA total of 492 undergraduate students (103 males and 389 females) were included.MethodsData pertaining to the biosociodemographic characteristics, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Morningness-Eveningness Questionnaire, and Beck Depression Inventory were collected from July 1, 2018 to September 30, 2018. Academic performance was measured using grade point average of the academic year 2017–2018. A multivariate logistic regression model was used for data analyses.ResultsThe prevalence of poor sleep quality, insomnia, and daytime sleepiness was 66.0%, 45.6%, and 24.3%, respectively, in male nursing students and 71.5%, 52.4%, and 28.8%, respectively, in female nursing students. For circadian rhythm preferences, 66% male and 51.7% female nursing students were categorized as intermediate- and morning-type people, respectively. Insomnia was the only variable among sleep disturbances that significantly correlated with the risk of poor academic performance in female nursing students even after adjustment of covariates.ConclusionsSleep disturbances were highly prevalent among female and male nursing students, and insomnia was substantially associated with poor academic performance in female nursing students. Identifying sleep disturbances among nursing students and designing effective interventions to specifically target them are required to improve academic performance of female nursing students.     

Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors

Purpose

Insomnia is increasingly recognized as a major symptom outcome in breast cancer; however, little is known about its prevalence and risk factors among women receiving aromatase inhibitors (AIs), a standard treatment to increase disease-free survival among breast cancer patients.

Methods

A cross-sectional survey study was conducted among postmenopausal women with stage 0?CIII breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic of a large university hospital. The insomnia severity index (ISI) was used as the primary outcome. Multivariate logistic regression analyses were performed to evaluate risk factors.

Results

Among 413 participants, 130 (31.5?%) had subthreshold insomnia on the ISI, and 77 (18.64?%) exceeded the threshold for clinically significant insomnia. In a multivariate logistic regression model, clinically significant insomnia was independently associated with severe joint pain (adjusted odds ratio (AOR) 4.84, 95?% confidence interval (CI) 1.71?C13.69, P?=?0.003), mild/moderate hot flashes (AOR 2.28, 95?% CI 1.13?C4.60, P?=?0.02), severe hot flashes (AOR 2.29, 95?% CI 1.23?C6.81, P?=?0.015), anxiety (AOR 1.99, 95?% CI 1.08?C3.65, P?=?0.027), and depression (AOR 3.57, 95?% CI 1.48?C8.52, P?=?0.004). Age (>65 vs. <55?years; AOR 2.31; 95?% CI 1.11?C4.81; P?=?0.026) and time since breast cancer diagnosis (<2 vs. 2?C5?years; AOR 1.94; 95?% CI 1.02?C3.69; P?=?0.045) were also found to be significant risk factors. Clinical insomnia was more common among those who used medication for treating insomnia and pain.

Conclusions

Insomnia complaints exceed 50?% among AI users. Clinically significant insomnia is highly associated with joint pain, hot flashes, anxiety and depression, age, and time since diagnosis.     

Satisfacción vital y factores sociodemográficos en mujeres de mediana edad

ObjectiveTo assess life satisfaction and related factors in middle-aged Spanish women.MethodThis was a cross-sectional study including 235 women aged 40 to 65, living in Granada (Spain), healthy companions of patients visiting the obstetrics and gynecology clinics. They completed the Diener Satisfaction with Life Scale, the Menopause Rating Scale, the Perceived Stress Scale, the Insomnia Severity Index and a sociodemographic questionnaire containing personal and partner data. Internal consistency of each tool was also calculated.ResultsAlmost two-thirds (61.3%) of the women were postmenopausal, and 43.8% had abdominal obesity, 36.6% had insomnia, 18.7% had poor menopause-related quality of life, 31.9% performed regular exercise, and 5.1% had severe financial problems. Life satisfaction showed significant positive correlations (Spearman's test) with female and male age, and inverse correlations with menopause-related quality of life, perceived stress and insomnia. In the multiple linear regression analysis, high life satisfaction is positively correlated with having a partner who performed exercise, and inversely with having work problems, perceived stress and the suspicion of partner infidelity. These factors explained 40% of the variance of the multiple regression analysis for life satisfaction in middle-aged women.ConclusionLife satisfaction is a construct related to perceived stress, work problems, and having a partner, while aspects of menopause and general health had no significant influence.     

失眠相关的心理因素研究

目的:探讨失眠与睡眠的过度要求、对睡眠的控制、失眠的外归因以及睡眠依赖等心理因素的关系。方法:用汪氏失眠综合问卷(WIIQ)对150例失眠患者以及150例正常睡眠者进行横断性的问卷调查,用SPSS 22.0进行分析。结果:失眠症组心理因素总分及各分量表分相较于对照组更高(P0.01)。心理因素总分以及每个分量表的总分与WIIQ的失眠严重性指数之间有显著相关性(P0.01),相关系数在0.571与0.746之间。在对照组中,曾经有过失眠的受试者的心理因素比从未失眠的受试者更多(P0.01)。临床试验患者中,治疗后比治疗前心理因素更少(P0.01);心理因素总分与匹兹堡睡眠质量指数治疗前后差值之间有显著的相关性(P0.01),相关系数为0.461。结论:失眠与睡眠的过度要求、对睡眠的控制、失眠的外归因以及睡眠依赖等不良的认知和行为相关,因素越多失眠越严重。失眠与相关的心理因素的因果关系可能是双向,即失眠带来心理因素,心理因素维持、加重失眠。通过心理治疗可以减少这些心理因素,进而缓解失眠。     

Modifiable factors associated with anxiety in persons with dementia: An integrative review

ObjectivesThe purpose of this integrative review was to examine factors related to the presence of anxiety in person with dementia (PWD) and to identify potentially modifiable factors among them.MethodsAn integrative review was conducted using PsycINFO, CINAHL, AgeLine, PubMed, Embase, Web of Science, and Scopus. Among 1856 studies identified, 27 studies were included.ResultsA number of modifiable factors associated with anxiety were identified. Individual level factors included pain, physical health, physical functioning, fatigue, sleep disturbance, disclosure of diagnosis, embarrassment about memory problems, separation from caregivers, views about oneself and others, social rejection, social isolation, and interactions with others. Caregiver factors associated with anxiety in PWD included caregiver stress, caregiver's negative reactions towards the behavioral problems of PWD, and competence about caregiving.ConclusionThe results of this review can be used to identify potential targets for interventions to reduce for anxiety in persons with dementia.     

Solving insomnia electronically: Sleep treatment for asthma (SIESTA): A study protocol for a randomized controlled trial

BackgroundChronic insomnia is associated with poor asthma control. Cognitive-behavioral treatment for insomnia (CBT-I) is an efficacious and durable treatment for comorbid insomnia in medical and psychiatric disorders. However, the efficacy and potential accompanying mechanisms of CBT-I have not been examined in asthma. The purpose of this study is to test the efficacy of a CBT-I intervention on sleep and asthma control in adults with insomnia and asthma. We will also explore airway inflammation (i.e., exhaled nitric oxide, blood eosinophils) as a potential biological mechanism linking improvements in sleep with improvements in asthma control.MethodsThe study is a single center, parallel group, randomized controlled trial. Two hundred and ten adults with insomnia and asthma that is not well-controlled will be randomized to either a 9-week Internet-based CBT-I program (Sleep Healthy Using the Internet (SHUTi)) or an enhanced usual care condition which utilizes an online educational video about insomnia. The primary sleep outcome is insomnia severity measured by the Insomnia Severity Index. Secondary sleep outcomes are sleep quality and wrist actigraph-recorded sleep parameters. Asthma control will be assessed by the Asthma Control Test, Asthma Quality of Life Questionnaire, pulmonary function testing, and self-report of asthma exacerbations and asthma-related healthcare utilization. Treatment outcomes will be measured at baseline, 9 weeks, and 6 months.DiscussionThis trial has the potential to identify a novel strategy for improving asthma control. Findings may advocate for the inclusion of treatment of comorbid insomnia into current asthma management practice guidelines.     

Benefit finding in cancer: A review of influencing factors and health outcomes

PurposeEmerging research is revealing that the use of positively-oriented coping efforts may be beneficial to people living with and beyond cancer treatments. Benefit finding is such a positively-oriented coping strategy suggested to influence psychological and physical health outcomes, but the empirical evidence for these suggestions is unclear. This study aimed to review the existing evidence on factors that influence the use of benefit finding, and the associated health outcomes in cancer.MethodsSearches were undertaken in established databases. Studies were reviewed if published between January 1980 and June 2012. The search terms ‘benefit finding’, ‘coping’, ‘positive emotions’, and ‘neoplasms’ were used in various combinations. Ten studies were included in the Review.ResultsOptimism was the only influencing factor that was consistently supported by evidence in the literature (n = 5/10). For health outcomes, physiological stress-response biomarkers of enhanced immune function were associated with benefit finding (n = 2/10). Inconsistent evidence were found between benefit finding and social support, and between benefit finding and psychological outcomes.ConclusionsThere is inconclusive evidence to date to conclude that certain factors influence the use of benefit finding in cancer populations, or that benefit finding is clearly associated with any particular health outcomes. There is beginning evidence to conclude that optimism is related to benefit finding, and that benefit finding is associated with reduced physiological stress-response biomarkers. Further research is needed to explore predictors, co-variates, associations and clinical outcomes of benefit finding in cancer populations.     

Prevalencia de factores de riesgo modificables en el diagnóstico de enfermería: riesgo del síndrome de la muerte súbita del lactante

ObjectiveTo measure the prevalence of modifiable risk factors for the nursing diagnosis of risk of sudden infant death syndrome (RSIDS), and to establish the association between the prevalence found and the sociodemographic characteristics of the sample.Material and methodsThe sample was composed of 384 mothers (Spaniards, Moroccans and Ecuadorians). Data were collected in the maternity ward of Sta. M^a del Rosell Hospital in Cartagena (Murcia) from June to November 2007 through a questionnaire containing items on sociodemographic variables and questions about upbringing habits and practices, which are defined as modifiable risk factors by the NANDA-I taxonomy. In the statistical analysis, the Chi-square test was used for qualitative variables and Student's t-test and analysis of variance were used for quantitative variables.ResultsA total of 77.1% of newborns were diagnosed with RSIDS related to modifiable risk factors. Notable was the high prevalence of risk factors such as the choice of side-lying position to put the newborn to bed in 39.8% (153) and smoking during pregnancy in 25.7% (99). Statistically significant associations were found (p<0.001) between the diagnosis of RSIDS and the mother's nationality, educational level and household income.ConclusionThe high prevalence of some modifiable risk factors among newborns raises the need to provide more information about upbringing habits and practices for SIDS prevention, not only in Infant Nursing Consulting Rooms but also throughout pregnancy and in the first days of life of the newborn.     

Insomnia in women

Insomnia is a highly prevalent disorder that can lead to substantial impairments in quality of life and functional capacity. This condition occurs significantly more frequently in women than men. An important contributing factor is that insomnia can occur in association with hormonal changes that are unique to women, such as those of menopause or the late-luteal phase of the menstrual cycle. Another consideration is that women are more likely to suffer from major depression and anxiety disorders, which are also associated with insomnia. The reasons are unclear as are the reasons why women are at increased risk of primary insomnia. These conditions are frequently encountered in clinical practice and present a challenge to the practitioner because there is a striking lack of research data to serve as a guide. For example, there are no published studies to indicate how to safely and effectively manage insomnia that often occurs late in pregnancy. This article reviews the available literature related to these conditions with a focus on the epidemiologic data and diagnosis and treatment of insomnia and highlights the need for further research.