Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: A cross-sectional observational study

Objective

The aim of the study was to investigate the association between dialysis shift and subjective sleep quality in chronic haemodialyzed patients.

Design

A cross-sectional observational study.

Participants and methods

A total of 206 haemodialyzed patients aged from 22 to 71 participated in this study. Participants were grouped into the morning-shift and other-shifts groups. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). All participants also completed the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Results

Dialysis shift significantly predicted the PSQI score with patients receiving morning-shift haemodialysis having better sleep quality (β = 0.15, p = 0.01). Other independent predictors of the PSQI score included depression (β = 0.42, p < 0.001), anxiety (β = 0.38, p < 0.001), and tea drinking (β = 0.20, p 0.001). Together these factors explained 48.2% of the variance in the PSQI score.

Conclusion

Morning dialysis shift was significantly associated with better subjective sleep quality in chronic haemodialyzed patients after adjusting for other confounders.     

Music therapy improves sleep quality in acute and chronic sleep disorders: A meta-analysis of 10 randomized studies

Objective

To evaluate the efficacy of music therapy for acute and chronic sleep disorders in adults.

Design

Systematic review and meta-analysis.

Data sources

A systematic search of publications in PubMed, Embase, and the Cochrane Library without language restriction was performed.

Review methods

Studies with randomized controlled design and adult participants were included if music was applied in a passive way to improve sleep quality. Subgroup analysis was conducted to explore the sources of heterogeneity.

Results

Ten studies involving 557 participants were identified. The sleep quality was improved significantly by music (standard mean difference: −0.63; 95% CI: −0.92 to −0.34; p < 0.001), with significant heterogeneity across studies. Subgroup analysis found heterogeneity between subgroups with objective or subjective assessing methods of sleep quality, and between subgroups with difference follow-up durations. No evidence of publication bias was observed.

Conclusion

Music can assist in improving sleep quality of patients with acute and chronic sleep disorders. For chronic sleep disorders, music showed a cumulative dose effect and a follow-up duration more than three weeks is necessary for assessing its efficacy.     

Factors affecting sleep in the critically ill: An observational study

Purpose

The aims of the current study were to describe the extrinsic and intrinsic factors affecting sleep in critically ill patients and to examine potential relationships with sleep quality.

Materials and Methods

Sleep was recorded using polysomnography (PSG) and self-reports collected in adult patients in intensive care. Sound and illuminance levels were recorded during sleep recording. Objective sleep quality was quantified using total sleep time divided by the number of sleep periods (PSG sleep period time ratio). A regression model was specified using the “PSG sleep period time ratio” as a dependent variable.

Results

Sleep was highly fragmented. Patients rated noise and light as the most sleep disruptive. Continuous equivalent sound levels were 56 dB (A). Median daytime illuminance level was 74 lux, and nighttime levels were 1 lux. The regression model explained 25% of the variance in sleep quality (P = .027); the presence of an artificial airway was the only statistically significant predictor in the model (P = .007).

Conclusions

The presence of an artificial airway during sleep monitoring was the only significant predictor in the regression model and may suggest that although potentially uncomfortable, an artificial airway may actually promote sleep. This requires further investigation.     

Effects of Shiatsu in the Management of Fibromyalgia Symptoms: A Controlled Pilot Study

Objectives

This pilot study aimed to evaluate the potential effects of Shiatsu massage on the symptoms of adult patients with primary fibromyalgia, propose a Shiatsu treatment protocol, verify patient acceptability, and evaluate the feasibility for a larger study.

Methods

Thirty-four patients aged 33 to 62 years were divided into a Shiatsu group (SG; n = 17), who received full-body Shiatsu twice a week for 8 weeks, and a control group (n = 17), who received an educational booklet. The patients were assessed at baseline and after 8 weeks. Pain intensity was evaluated by the visual analog scale, pressure pain threshold by dolorimetry, anxiety by the State-Trait Anxiety Inventory, sleep by the Pittsburgh Sleep Quality Index, and symptoms impact on patient's health by the Fibromyalgia Impact Questionnaire. The SG was also questioned about adverse effects and level of satisfaction.

Results

After treatment, the SG presented statistically significant differences (P < .05) for the change scores of all variables, except state anxiety, compared with the control group. Relative percentage changes were considered clinically relevant for visual analog scale (40.6%), pressure pain threshold (76.4%), Pittsburgh Sleep Quality Index (34.4%), and Fibromyalgia Impact Questionnaire (22.30%). No clinically relevant effects were observed for anxiety after treatment. No adverse effects were reported during the treatment, and about 94% of the patients demonstrated satisfaction with Shiatsu.

Conclusion

This pilot study showed the potential of Shiatsu in the improvement of pain intensity, pressure pain threshold, sleep quality, and symptoms impact on health of patients with fibromyalgia. The proposed Shiatsu treatment protocol was feasible and well accepted by the patients.     

'Appears to have slept well': assessing sleep in an acute care setting

Sleep disturbance is a common occurrence in the hospital environment where the patients' perceptions of their own sleep are rarely considered in the planning of care. This study aims to determine the difference between subjective (Verran/Snyder-Halpern Sleep Scale), objective (Patient's Sleep Behaviour Observational Tool) and physiological (Actigraph) assessments of a patients' single sleep event within an acute care setting by examining the variables Total Sleep, Midsleep Awakening and Sleep Latency. Results indicate no statistically significant difference between instruments for the assessment of total sleep. Midsleep awakening was of questionable value when assessed in the clinical environment. Sleep latency could be useful following further attention to defining the length and time of onset of the nurse observation period.     

Relationship Between Sleep,Pain, and Disability in Patients With Spinal Pathology

Objective

To characterize sleep and its relationship with disability and pain in patients with spine pathology.

Design

A survey study.

Setting

A university-based hospital spine clinic.

Participants

Subjects (N=121) with mixed-etiology spine pathology.

Interventions

Not applicable.

Main Outcome Measures

Self-reported disability (Oswestry Disability Index [ODI]), back and leg pain intensity, the effect of back or leg pain on function, and sleep (Pittsburgh Sleep Quality Index [PSQI]) assessments were completed.

Results

Severe disability was evident with a mean ODI ± SD of 54.9±14, with mean pain intensities ± SD of 50±30mm and 54±27mm of 100mm for the leg and back, respectively. The mean PSQI ± SD was 10.4±5.3, with 87% of participants scoring greater than the sleep-disordered threshold of 5. PSQI was correlated to ODI (r=.53, P<.001), and ODI without the sleep component (r=.47, P<.001). Six of the subscales of PSQI were all also significantly correlated to ODI (.25<r<.42, P<.05). Stepwise regression (ODI dependent variables; PSQI, pain intensity and function, age, body mass index as independent variables) was performed. PSQI was retained in the model along with 2 pain measures (r²=.50, P<.001). Substitution of the 7 subscales for the overall PSQI score revealed 2 subscales (sleep quality, use of sleep medications) as predictors of ODI (r²=.490, P<.001).

Conclusions

Despite its being intuitive that sleep disorders will be present in patients with spinal disorders, it was surprising that sleep quality was an independent predictor of disability along with pain. Furthermore, sleep quality is more closely correlated to disability than leg pain, which is the current focus of medical interventions.     

Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: An experimental crossover trial

Background

The decrease in core body temperature before sleep onset and during sleep is associated with dilation of peripheral blood vessels, which permits heat dissipation from the body core to the periphery. A lower core temperature coupled with a higher distal (hands and feet) temperature before sleep are associated with shorter sleep latency and better sleep quality. A warm foot bath is thought to facilitate heat dissipation to improve sleep outcomes.

Objectives

This study examined the effect of a warm footbath (40 °C water temperature, 20-min duration) on body temperature and sleep in older adults (≥55 years) with good and poor sleep.

Design

Two groups and an experimental crossover design was used.

Setting and participants

Forty-three adults responded to our flyer and 25 participants aged 59.8 ± 3.7 years (poor sleeper with a Pittsburgh Sleep Quality Index score ≥ 5 = 17; good sleepers with a Pittsburgh Sleep Quality Index score < 5 = 8) completed this study.

Methods

All participants had body temperatures (core, abdomen, and foot) and polysomnography recorded for 3 consecutive nights. The first night was for adaptation and sleep apnea screening. Participants were then randomly assigned to either the structured foot bathing first (second night) and non-bathing second (third night) condition or the non-bathing first (second night) and foot bathing second (third night) condition.

Results

A footbath before sleep significantly increased and retained foot temperatures in both good and poor sleepers. The pattern of core temperatures during foot bathing was gradually elevated (poor sleepers vs. good sleepers = +0.40 ± 0.58 °C vs. +0.66 ± 0.17 °C). There were no significant changes in polysomnographic sleep and perceived sleep quality between non-bathing and bathing nights for both groups.

Conclusion

A footbath of 40 °C water temperature and 20-min duration before sleep onset increases foot temperatures and distal–proximal skin temperature gradients to facilitate vessel dilatation and elevates core temperature to provide heat load to the body. This footbath does not alter sleep in older adults with good and poor sleep.     

The effects of sleep on the relationship between brain injury severity and recovery of cognitive function: A prospective study

Background

Disturbed sleep pattern is a common symptom after head trauma and its prevalence in acute traumatic brain injury (TBI) is less discussed. Sleep has a profound impact on cognitive function recovery and the mediating effect of disturbed sleep on cognitive function recovery has not been examined after acute TBI.

Objectives

To identify the prevalence of disturbed sleep in mild, moderate, and severe acute TBI patients, and to determine the mediating effects of sleep on the relationship between brain injury severity and the recovery of cognitive function.

Design

A prospective study design.

Setting

Neurosurgical wards in a medical center in northern Taiwan.

Participants

Fifty-two acute TBI patients between the ages of 18 and 65 years who had received a diagnosis of TBI for the first time, and were admitted to the neurosurgical ward.

Method

The severity of brain injury was initially determined using the Glasgow Coma Scale. Each patient wore an actigraphy instrument on a non-paralytic or non-dominated limb for 7 consecutive days. A 7-day sleep diary was used to facilitate data analysis. Cognitive function was assessed on the first and seventh day after admission based on the Rancho Los Amigos Levels of Cognitive Functioning.

Results

The mild (n = 35), moderate (n = 7) and severe (n = 10) TBI patients exhibited poorer sleep efficiency, and longer total sleep time (TST) and waking time after sleep onset, compared with the normative values for the sleep-related variables (P < .05 for all). The severe and moderate TBI patients had longer daytime TST than the mild TBI patients (P < .001), and the severe TBI patients had longer 24-h TST than the mild TBI patients (P = .001). The relationship between the severity of brain injury and the recovery of cognition function was mediated by daytime TST (t = −2.65, P = .004).

Conclusions

Poor sleep efficiency, prolonged periods of daytime sleep, and a high prevalence of hypersomnia are common symptoms in acute TBI patients. The duration of daytime sleep mediates the relationship between the severity of brain injury and the recovery of cognition function.     

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

To describe sleep quality using repeated subjective assessment and the ongoing use of sleep‐promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep‐promoting interventions has not been widely reported. An observational study was conducted in a 58‐bed adult intensive care unit. Sleep quality was assessed using the Richards‐Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep‐promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open‐ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep‐promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards‐Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards‐Campbell Sleep Questionnaire was used on repeated occasions, and sleep‐promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards‐Campbell Sleep Questionnaire for the subjective self‐assessment of sleep quality in intensive care unit patients and the implementation of simple‐promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.     

Negative Affect and Sleep Disturbance May Be Associated With Response to Epidural Steroid Injections for Spine-Related Pain

Objective

To describe whether negative affect and sleep impairment are associated with the clinical effect of epidural steroid injections (ESIs) for low back pain.

Design

Observational study; patients were evaluated before ESI and 1 and 3 months after ESI.

Setting

Spine center and related treatment sites.

Participants

Participants (N=158) seeking treatment for low back pain with or without radiculopathy.

Intervention

ESI for low back pain with or without radiculopathy.

Main Outcome Measures

We assessed the dependent (global pain severity for back and leg pain, pain behavior, pain interference) and independent variables (depression, sleep disturbance, and covariates of back pain response) with the Patient-Reported Outcome Measurement Information System (PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple regression and longitudinally with path analysis.

Results

After 1 month, sleep disturbance was the only predictor for the global ratings of improvement in back pain (R²=16.8%) and leg pain (R²=11.4%). The proportions of variance explained by sleep disturbance and negative affect for all dependent variables were greater at 3 months than 1 month. Mediation analysis was significant for negative affect for the 3-month outcomes on PROMIS pain behavior (β=.87, P<.01) and pain interference (β=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome.

Conclusions

Negative affect and sleep disturbance are associated with worse outcomes after ESI. Further research is needed to determine if treatment of negative affect and sleep disturbance prior to or concurrently with ESI will improve outcomes.     

Physiotherapy for Sleep Disturbance in People With Chronic Low Back Pain: Results of a Feasibility Randomized Controlled Trial

Objective

To determine the feasibility of a randomized controlled trial investigating the effectiveness of physiotherapy for sleep disturbance in chronic low back pain (CLBP) (≥12wks).

Design

Randomized controlled trial with evaluations at baseline, 3 months, and 6 months.

Setting

Outpatient physiotherapy department in an academic teaching hospital.

Participants

Participants with CLBP were randomly assigned to a walking program (n=20; mean age ± SD, 46.4±13.8y), supervised exercise class (n=20; mean age ± SD, 41.3±11.9y), or usual physiotherapy (n=20; mean age ± SD, 47.1±14.3y). The 3-month evaluation was completed by 44 participants (73%), and 42 (70%) participants completed the 6-month evaluation.

Interventions

Participants received a physiotherapy-delivered 8-week walking program, an 8-week group supervised exercise class (1 class/wk), or 1-to-1 usual physiotherapy (advice, manual therapy, and exercise).

Main Outcome Measures

Sleep was assessed by the self-reported Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, and objective actigraphy.

Results

Groups were comparable at baseline. Most (95%, n=57) of the participants had sleep disturbance. The acceptability of actigraphy was excellent at baseline (58 of 60 participants), but dropped at 3 months (26 of 44 participants). There were improvements on the PSQI and ISI in all groups at 3 and 6 months, with predominantly medium effect sizes (Cohen d=0.2–0.5).

Conclusions

The high prevalence of sleep disturbance indicated the feasibility of good recruitment in future trials. The PSQI would be a suitable screening tool and outcome measure alongside an objective nonobtrusive sleep outcome measure. The effectiveness of physiotherapy for sleep disturbance in CLBP warrants investigation in a fully powered randomized controlled trial.     

Sleep during and following critical illness: A narrative review

Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.     

Development and Assessment of a Community Follow-Up Questionnaire for the Rick Hansen Spinal Cord Injury Registry

Objective

To develop a comprehensive community follow-up questionnaire for participants enrolled in the Rick Hansen Spinal Cord Injury Registry (RHSCIR).

Design

Development and preliminary assessment of measurement properties (reliability and validity) of instruments used during a community follow-up and aligned with the International Classification of Functioning, Disability and Health (ICF).

Setting

General community setting.

Participants

People with spinal cord injury (N=50) living in the community.

Intervention

Not applicable.

Main Outcome Measures

A comprehensive follow-up questionnaire, referred to as the RHSCIR Community Follow-up Questionnaire Version 2.0 (CFQ-V2.0), includes 8 instruments. Four new instruments were developed, 2 existing instruments were modified, and 2 previously published instruments were included.

Results

Intra- and interrater reliability statistics (Gwet's AC1) support the measurement properties of the new and modified instruments. Correlations between new and existing instruments and between groups based on the severity of injury support the construct validity of the secondary complications and person-perceived participation instruments.

Conclusions

The RHSCIR CFQ-V2.0 is a comprehensive community follow-up questionnaire that aligns to the ICF. Initial study results suggest that it covers all relevant aspects of community living, and the measurement properties are promising.     

24 bp duplication of CHIT1 gene and determinants of human chitotriosidase activity among participants of EPISONO,a population-based cross-sectional study,São Paulo,Brazil

Objectives

We investigated whether plasma chitotriosidase activity is related to Obstructive Sleep Apnea (OSA) conditions and is correlated with biochemical variables present in the EPISONO database. This is the first study conducted in an epidemiological and nutritional transition country using subjects from the EPISONO population-based cross-sectional study.

Design and methods

Chitotriosidase (CHIT) activity was determined by fluorimetric assay. OSA classification was defined as an apnea–hypopnea index. The correlations were investigated using a multiple regression linear model and statistical criteria, with CHIT as the dependent variable and correlated variables (from the EPISONO database) as independent variables, to access the contribution of each one to the variation in CHIT activity.

Results

No significant difference was observed when comparing the mean CHIT activities of different apnea groups. The prevalence of the CHIT1 24-bp duplication from patients with severe apnea was higher than in controls. In a multiple regression linear model, CHIT concentration was positively associated with age, creatine and testosterone. Age was the strongest predictor of CHIT variation, followed by gender, waist circumference and TNFα levels. The whole regression model explained 14% of the CHIT variation.

Conclusion

Many variables are related to CHIT activity and show evidence of the multifactor and potentially synergistic character of this enzyme. In this study, we found that age, gender, TNFα, Hcy, sleep efficiency and waist circumference were responsible for approximately 14% of CHIT variation. Further studies are needed to elucidate additional parameters that may be related to CHIT activity.     

Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: a preliminary study

Parcell DL, Ponsford JL, Redman JR, Rajaratnam SM. Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: a preliminary study.

Objectives

To evaluate changes in sleep quality and objectively assessed sleep parameters after traumatic brain injury (TBI) and to investigate the relationship between such changes and mood state and injury characteristics.

Design

Survey and laboratory-based nocturnal polysomnography.

Setting

Sleep laboratory.

Participants

Ten community-based subjects with moderate to very severe TBI and 10 age- and sex-matched controls from the general community.

Interventions

Not applicable.

Main Outcome Measures

Pittsburgh Sleep Quality Index for self-report sleep quality, nocturnal polysomnography for objective sleep recording, and Hospital Anxiety and Depression Scales.

Results

Compared with controls, TBI patients reported significantly poorer sleep quality and higher levels of anxiety and depression. Objective sleep recording showed that TBI patients showed an increase in deep (slow wave) sleep, a reduction in rapid eye movement sleep, and more frequent nighttime awakenings. No significant relationship was observed between these changes in sleep and injury severity or time since injury. Anxiety and depression covaried with the observed changes in sleep.

Conclusions

The findings contribute to the growing body of evidence that sleep is involved in the physiologic processes underlying neural recovery. The association between anxiety and depression and the observed changes in sleep in TBI patients warrants further examination to determine whether a causative relationship exists.     

The quality and duration of sleep in the intensive care setting: An integrative review

Background

Sleep is essential for well-being and recovery from illness. The critically ill are in significant need of sleep but at increased risk of sleep loss and disruption.

Objectives

To determine the quality and duration of sleep experienced by adults who are patients in intensive care units and factors affecting their sleep.

Design

An integrative approach was used for this literature review in order to explore the available evidence on this topic, which has yet to be fully investigated.

Data sources

PubMed, CINAHL, Psychinfo, the Australian Digital Theses Program and ProQuest Dissertations and Theses (Interdisciplinary) databases were searched for studies conducted about sleep in adult intensive care units. Manual searches of papers identified from this search were performed to find additional studies.

Review methods

Data related to the quality and duration of sleep along with study design, sample size and intensive care context were extracted, evaluated and summarised.

Results

Total sleep time is normal or reduced with significant fragmentation. Light sleep is prolonged and deep and rapid eye movement sleep are reduced. The most likely factors affecting sleep quality are high sound levels, frequent interventions and medications. Data obtained from polysomnography are supported by patient self reports. Considerable variation in data exists between patients and studies affecting generalizability. Existing criteria for staging sleep may be inadequate for quantifying sleep in intensive care patients.

Conclusions

There is evidence that intensive care patients’ sleep is significantly disrupted. Alternative methods of quantifying sleep for intensive care patients may be required. Few large observational or interventional studies have used polysomnography and simultaneous recordings of intrinsic and extrinsic disruptive factors. These studies are required in order to improve sleep for intensive care patients.     

Subjective Sleep Complaints Are Associated With Insulin Resistance in Individuals Without Diabetes: The PPP-Botnia Study

OBJECTIVE

Sleep disorders and subjective sleep complaints have been associated with increased risk of type 2 diabetes. The evidence with respect to insulin resistance (IR) and insulin secretion in individuals without type 2 diabetes has been scarce and elusive. We examined if subjective sleep complaints and their co-occurrence were associated with IR and insulin secretion in adult women and men without diabetes.

RESEARCH DESIGN AND METHODS

Women (n = 442) and men (n = 354) 18–75 years of age without type 2 diabetes underwent an oral glucose tolerance test (OGTT), with insulin and glucose measured at fasting and at 30 and 120 min. Complaints related to sleep apnea, insomnia, and daytime sleepiness were self-rated with the Basic Nordic Sleep Questionnaire.

RESULTS

In comparison with individuals with no or minor sleep complaints, those with more frequent complaints of sleep apnea, insomnia, and daytime sleepiness were more insulin resistant, as evidenced by higher fasting insulin concentrations and insulin and glucose responses to OGTT, and more frequently had high homeostasis model assessment of IR and low insulin sensitivity index values. The likelihood of being insulin resistant increased significantly and linearly according to the accumulation of co-occurring sleep complaints. These associations changed only a little when adjusted for mediating and confounding factors and for depressive symptoms. Sleep complaints were not associated with indices of deficiency in insulin secretion.

CONCLUSIONS

Subjective sleep complaints were associated with IR. The likelihood of being insulin resistant increased according to accumulation of co-occurring sleep complaints. Sleep complaints were not associated with deficiency in insulin secretion.In several cross-sectional and prospective studies, sleep apnea, sleep disordered breathing, habitual snoring, insomnia, difficulties in initiating and maintaining sleep, and daytime sleepiness have been associated with the prevalence and the incidence of type 2 diabetes (1–6). Although these findings suggest that sleep disorders and subjective sleep complaints may carry an increased risk for type 2 diabetes, the evidence with respect to insulin resistance (IR) and insulin secretion, two major features of type 2 diabetes, in individuals without type 2 diabetes has been scarce and elusive.In individuals without a history of or concurrently diagnosed type 2 diabetes, polysomnography-based sleep disordered breathing was associated with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) (2), a higher degree of IR (7,8), and a decreased degree of insulin sensitivity and pancreatic β-cell function during a frequently sampled intravenous glucose tolerance test (9). However, subjective complaints of sleep apnea, habitual snoring, and daytime sleepiness were not associated with IFG, IGT, and IR (10). Finally, a recent study has reported that subjective complaints of frequent snoring were not associated with fasting insulin, glucose, and IR, whereas insomnia, a combined measure of actigraphy-based sleep latency and fragmentation, and subjective complaints were associated with lower fasting insulin values and a lower likelihood of being insulin resistant (4).We studied whether subjective complaints of sleep apnea (habitual snoring and sleep disordered breathing), insomnia (difficulties in initiating and/or maintaining sleep), and daytime sleepiness were associated with IR and insulin secretion in a population-based sample of 18–75-year-old Finnish women and men without a history of or concurrently diagnosed type 2 diabetes. Our study contributes to previous studies in two ways. First, we tested if the degree of glycemia and IR increased according to accumulation of subjective sleep complaints that often co-occur together (11,12). Second, we tested if symptoms of depression accounted for the associations. The latter was seen as relevant since sleep complaints may indicate the presence of depression (13), and symptoms of depression have been linked with the prevalence and the incidence of type 2 diabetes (14,15), and with IR in populations without type 2 diabetes (16).     

Development of an Instrument to Measure Behavioral Health Function for Work Disability: Item Pool Construction and Factor Analysis

Objectives

To develop a broad set of claimant-reported items to assess behavioral health functioning relevant to the Social Security disability determination processes, and to evaluate the underlying structure of behavioral health functioning for use in development of a new functional assessment instrument.

Design

Cross-sectional.

Setting

Community.

Participants

Item pools of behavioral health functioning were developed, refined, and field tested in a sample of persons applying for Social Security disability benefits (N=1015) who reported difficulties working because of mental or both mental and physical conditions.

Interventions

None.

Main Outcome Measure

Social Security Administration Behavioral Health (SSA-BH) measurement instrument.

Results

Confirmatory factor analysis (CFA) specified that a 4-factor model (self-efficacy, mood and emotions, behavioral control, social interactions) had the optimal fit with the data and was also consistent with our hypothesized conceptual framework for characterizing behavioral health functioning. When the items within each of the 4 scales were tested in CFA, the fit statistics indicated adequate support for characterizing behavioral health as a unidimensional construct along these 4 distinct scales of function.

Conclusions

This work represents a significant advance both conceptually and psychometrically in assessment methodologies for work-related behavioral health. The measurement of behavioral health functioning relevant to the context of work requires the assessment of multiple dimensions of behavioral health functioning. Specifically, we identified a 4-factor model solution that represented key domains of work-related behavioral health functioning. These results guided the development and scale formation of a new SSA-BH instrument.     

Can a Prediction Model Combining Self-Reported Symptoms,Sociodemographic and Clinical Features Serve as a Reliable First Screening Method for Sleep Apnea Syndrome in Patients With Stroke?

Objective

To determine whether a prediction model combining self-reported symptoms, sociodemographic and clinical parameters could serve as a reliable first screening method in a step-by-step diagnostic approach to sleep apnea syndrome (SAS) in stroke rehabilitation.

Design

Retrospective study.

Setting

Rehabilitation center.

Participants

Consecutive sample of patients with stroke (N=620) admitted between May 2007 and July 2012. Of these, 533 patients underwent SAS screening. In total, 438 patients met the inclusion and exclusion criteria.

Interventions

Not applicable.

Main Outcome Measures

We administered an SAS questionnaire consisting of self-reported symptoms and sociodemographic and clinical parameters. We performed nocturnal oximetry to determine the oxygen desaturation index (ODI). We classified patients with an ODI ≥15 as having a high likelihood of SAS. We built a prediction model using backward multivariate logistic regression and evaluated diagnostic accuracy using receiver operating characteristic analysis. We calculated sensitivity, specificity, and predictive values for different probability cutoffs.

Results

Thirty-one percent of patients had a high likelihood of SAS. The prediction model consisted of the following variables: sex, age, body mass index, and self-reported apneas and falling asleep during daytime. The diagnostic accuracy was .76. Using a low probability cutoff (0.1), the model was very sensitive (95%) but not specific (21%). At a high cutoff (0.6), the specificity increased to 97%, but the sensitivity dropped to 24%. A cutoff of 0.3 yielded almost equal sensitivity and specificity of 72% and 69%, respectively. Depending on the cutoff, positive predictive values ranged from 35% to 75%.

Conclusions

The prediction model shows acceptable diagnostic accuracy for a high likelihood of SAS. Therefore, we conclude that the prediction model can serve as a reasonable first screening method in a stepped diagnostic approach to SAS in stroke rehabilitation.