A comparison of sleep in rheumatic and non-rheumatic patients

The St. Mary's Hospital Sleep Questionnaire was used to investigate sleep in 439 hospitalized rheumatic and non-rheumatic patients. This questionnaire enabled an evaluation of both the level of sleep disturbance and the causes of such disturbance. The findings from this study indicated that there was little difference in the level of sleep disturbance between rheumatic and non-rheumatic patients. The sleep problem most frequently cited by rheumatic patients was pain. Noise appeared to be the worst environmental sleep problem in these patients. The only significant difference in the sleep problems reported by rheumatic and non-rheumatic patients, was that pain was cited more frequently in the rheumatic group. In order to determine whether sleep varied according to type of rheumatic disease, the rheumatic patients were divided into four diagnostic groups (rheumatoid arthritis; seronegative spondarthritis; osteoarthritis; other conditions). There were no significant differences between these groups in sleep disturbance or reported sleep problems.     

帕金森病睡眠障碍的结构特点及影响因素

目的 探讨帕金森病睡眠障碍的结构特点及影响因素.方法 应用多导睡眠监测仪和匹兹堡睡眠质量指数问卷（PSQI）对15例帕金森病患者（PD组）和18例年龄、性别相匹配的健康成人（对照组）行多导睡眠监测和睡眠质量评估.结果 两组比较,睡眠时间、睡眠效率、3＋4期睡眠时间、3＋4期睡眠比、动眼睡眠期（REM）时间、2期睡眠比.睡眠潜伏期差异均具有统计学意义（P均＜0.05）.睡眠破碎、慢波睡眠缺失发生率PD组分别为73.3％、80.0％,对照组分别为33.3％、22.2％,两组比较差异具有统计学意义（P均＜0.05）.逐步多元回归分析示PD组PSQI得分与左旋多巴剂量和病程呈线性相关（t分别为2.912、2.992,P均＜0.05）.结论 帕金森患者存在多种睡眠结构的改变,睡眠质量与病程、H-Y分级、左旋多巴剂量有关.     

Characteristics of sleep in patients with stable heart failure versus a comparison group

BACKGROUND: Sleep disturbance seems to be common among patients with heart failure (HF). However, little is known about the objective and subjective characteristics of sleep in these patients during daily life or the extent to which the sleep of patients with HF differs from the sleep of other adults. METHODS: We examined the extent to which self-reported and objective characteristics of sleep differ between patients with HF with stable systolic blood pressure (n = 59) and a comparison group of adults who did not have HF (n = 59). RESULTS: The patients with HF had a significantly lower percentage of wake after sleep onset and more frequent wake bouts, as measured with wrist actigraphs. There were no group-related differences in sleep duration. Sixty-seven percent of the patients with HF compared with 51% of the comparison group had poor global sleep quality, and 44% of the patients with HF versus 18.6% of the comparison group reported excessive daytime sleepiness. CONCLUSION: Future research is needed to examine the causes and consequences of disturbed sleep continuity and poor sleep quality and the effects of sleep-promotion strategies designed for patients with HF.     

强直性脊柱炎患者睡眠状态问卷研究

目的研究强直性脊柱炎(AS)患者睡眠状态,探讨睡眠障碍、疼痛之间的性别差异。方法57例男性和23例女性AS患者,进行睡眠状态问卷调查,并与临床资料进行比较。结果74%的女性和46%的男性AS患者有睡眠障碍(P<0.05),造成睡眠障碍的主要原因是疼痛。睡眠障碍和疼痛、晨僵及BathAS活动指数(BASDAI)评分之间存在相关性。结论睡眠障碍是AS的常见问题,与疼痛、病情活动相关,男性女性AS患者之间主观睡眠障碍、疼痛差异存在统计学意义。     

Gender differences in motor and non-motor symptoms in early Parkinson disease

Gender differences in motor and non-motor symptoms in Parkinson disease (PD) are still controversial. This study aimed to investigate gender differences in clinical characteristics in patients with early PD.This study included 415 PD patients (201 men and 214 women) with modified Hoehn-Yahr stage 1 to 3 and a disease duration of ≤5 years. Demographic information was obtained by interviews, and motor and non-motor PD symptoms were evaluated with appropriate scales.Women with PD had a shorter duration of formal education than men with PD. No significant differences were found in other demographic variables. Women with PD had significantly lower scores in Unified Parkinson Disease Rating Scale part III and postural tremor compared to men with PD, which was significant after controlling for formal education. No significant gender-related differences were found in scores related to other motor symptoms. Concerning non-motor symptoms, men with PD had higher scores of sexual function on the Non-Motor Symptoms Scale, which means sexual dysfunction was more severe or occurred more frequently in men with PD. Women with PD had significantly higher scores of sleep disturbance in the Pittsburgh Sleep Quality Index, which was not significant after adjustment for multiple comparison.The present study suggests that women with PD had milder motor symptoms compared to men with PD, and gender differences in sexual function can be observed as non-motor symptoms.     

Sleep dysfunction in patients with GERD: erosive versus nonerosive reflux disease

BACKGROUND: Sleep disturbance has been observed in patients with gastroesophageal reflux disease (GERD), but very few studies have further characterized sleep quality in patients with nonerosive esophageal reflux disease (NERD). This study was undertaken to investigate whether there are differences in sleep quality among patients with erosive esophagitis, NERD, and control subjects. METHODS: We performed symptom severity scoring and upper GI endoscopy in 20 healthy control subjects and 35 GERD patients, including 17 with NERD and 18 with erosive esophagitis. Sleep quality was measured by using Pittsburgh Sleep Quality Index (PSQI). RESULTS: Sleep disturbance was noted in 11 of 17 NERD patients and 12 of 18 patients with erosive esophagitis (P = NS) but none of healthy control subjects. The patient groups, erosive esophagitis and NERD, had greater PSQI scores compared with healthy control subjects (both P < 0.05). Both groups had similar median PSQI score (5.5 vs 6.0; NERD vs erosive esophagitis; P = NS). There was no significant correlation between reflux symptom severity score and PSQI score. CONCLUSIONS: Despite no difference in sleep quality between erosive esophagitis and NERD, NERD can have a significant impact on sleep comparable to erosive esophagitis. It is suggested that NERD should be treated aggressively and at least similarly to erosive esophagitis.     

Sleep-related problems of Parkinson's disease

OBJECTIVE: To define the epidemiology, characteristics and aetiology of nocturnal symptoms and sleep disorders in patients with Parkinson's disease (PD) and evaluate the available methods for their diagnosis and management. METHODS: A review of the English-language literature pertaining to sleep disturbances associated with PD, using the Medline database and bibliographies in relevant articles. RESULTS: Sleep-related problems specific to PD may occur early and even predate the diagnosis of the disease but are generally more frequent and more severe in patients with advanced PD. These problems can seriously compromise patients' quality of life and lead to impaired functioning in daily activities. Scales designed specifically for the assessment of sleep problems in patients with PD have recently been developed. Evidence base for the treatment of sleep disturbances in PD is poor, and only nocturnal akinesia, excessive day-time sleepiness and rapid eye movement behaviour disorder have been partially addressed. CONCLUSIONS: Sleep disorders associated with PD are a common and under-recognised problem. The assessment of sleep should be part of the routine evaluation of patients with PD, and large-scale controlled therapeutic trials are necessary.     

帕金森病患者睡眠障碍多导睡眠图分析

目的探讨帕金森病(Parkinson’s disease,PD)患者睡眠结构和睡眠障碍的临床特征。方法对30例PD患者(PD组)和32例年龄、性别相匹配的患者(对照组)进行多导睡眠图(polysomnographic,PSG)监测。结果两组患者总睡眠时间无明显差异,深睡眠均较少;PD组患者比对照组患者总觉醒时间长、睡眠潜伏期长,睡眠效率下降,总非快速眼动睡眠比例下降,觉醒比例增加(P<0.05)。PD组患者睡眠障碍的主要类型有入睡困难、片断睡眠、快速眼动睡眠行为障碍,但PD组患者快速眼动睡眠行为障碍、周期性腿动及睡眠呼吸暂停低通气综合征与对照组比较无明显差异。结论PD组患者总体睡眠质量差,伴发睡眠障碍较对照组常见。提示PSG对了解PD患者睡眠结构和睡眠障碍有着重要意义。     

Sleep disturbances in caregivers of patients with end-stage congestive heart failure: Part II--assess and intervene

Sleep disturbances in caregivers of patients with congestive heart failure is common. The consequences of sleep disturbances are dire and have potential to seriously impact caregiver health and patient outcomes. Therefore, it is imperative that the health care team, especially nurses, assess and intervene. Basic assessment of caregiver sleep disturbance can be quick and simple and can be performed while assessing the congestive heart failure patient's health. If a more complex sleep disorder is suspected, other assessments can be conducted if time and money permit. The benefits to properly assessing sleep disturbance and subsequent treatment far outweigh the minimal time spent by the health care team or caregiver.     

Sleep disturbance in Moroccan patients with ankylosing spondylitis: Prevalence and relationships with disease-specific variables, psychological status and quality of life

Sleep disturbance is often reported by the patients with ankylosing spondylitis (AS), with awakenings produced by inflammatory pain. There are limited studies about sleep disturbance on these patients, and especially its association with psychological state and quality of life to examine the prevalence of sleep disturbance and to assess its association with disease-specific variables, psychological status and quality of life. One hundred and ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Clinical and biological parameters were evaluated. Sleep disturbance was assessed by the fourth item of Hamilton Anxiety Scale. Psychological status was assessed by The Hospital Anxiety and Depression Scale including depression subscale and anxiety subscale. The quality of life was evaluated by the short form-36 (SF-36). Sleep disturbance was found in 64.5 %, depression in 55.5 % and anxiety in 60.9 % amongst our patients. Significantly, worse pain, higher disease activity and functional disability were present in patients with sleep disturbance. Likewise, sleep problems were significantly higher in patients with depression, anxiety and in patients with low scores of the SF36. Multivariate logistic regression analysis revealed that the pain (OR = 1.019) and depression (OR = 1.304) were independent risk factors that influenced sleep disturbance. Sleep problems are prevalent amongst Moroccan patients with AS. Our findings suggest that pain and depression were the independent risk factors that influenced the sleep disturbance and hence, the need for evaluation and optimal management of pain and depression to improve sleep quality in AS patients.     

帕金森病患者睡眠障碍相关因素的分析

目的探讨帕金森病(Parkinson’s disease,PD)患者睡眠障碍的相关因素。方法对96例PD患者(PD组)和98例年龄、性别相匹配对照者(对照组)进行匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PQSI)、爱泼沃斯思睡量表的问卷调查。结果有63.54%的PD患者总体睡眠质量差,睡眠质量差者病程长、Hoehn和Yahr(H&Y)分期高、统一PD评定量表-运动检查(UPDRS-Ⅲ)指数高、左旋多巴的应用和剂量大以及抑郁发生率高;多因素logistic回归显示睡眠质量与H&Y分期、UPDRS-Ⅲ评分、左旋多巴的应用和剂量显著相关。有梦魇的PD患者H&Y分期高、UPDRS-Ⅲ评分高以及服用苯海索剂量大。PD患者有日间过度思睡者年龄大、病程长、H&Y分期高、UPDRS-Ⅲ指数高、PQSI分值高以及左旋多巴的剂量大;多因素logistic回归显示日间过度思睡与H&Y分期、UPDRS-Ⅲ评分以及PQSI分值显著相关。结论PD患者的睡眠状况与年龄、疾病的严重程度以及抗PD药物的使用和剂量相关。     

Sleep, hypnotics and chronic obstructive pulmonary disease

The quality of sleep is significantly compromised in many patients with chronic obstructive pulmonary disease (COPD) and may be further diminished when certain comorbidities are present. A reduced sleep quality is associated with daytime consequences like fatigue, psychiatric problems and an impaired quality of life. Sleep induces physiologic alterations in respiratory function, which can become pathologic and may provoke or worsen hypoxemia and hypercapnia in COPD. Dyspnea, cough and excessive mucus production should be optimised to minimise causes for sleep disturbance. Pharmacological therapy may be helpful; sedatives like benzodiazepines and non-benzodiazepine benzodiazepine-receptor agonists (NBBRAs) are (equally) effective in improving sleep quality. Whether or not these hypnotics produce serious adverse respiratory effects during sleep, remains unclear due to opposing studies. Therefore, their use should be as short as possible.     

Sleep patterns and mortality among elderly patients in a geriatric hospital

BACKGROUND: Sleep disturbance is one of the major and unsolved problems in older people. Most of the previous sleep studies rely on self-reported documents, and memory disturbance in older people might bias sleep complaints and health status. OBJECTIVE: Sleep disturbances were studied as a mortality risk. METHODS: In 272 patients who were aged, infirmed and chronically institutionalized in a skilled-care geriatric hospital, the presence or absence of sleep disturbances were examined by hourly observations of patients over 2 weeks at baseline, and they were prospectively followed up for 2 years to assess mortality. RESULTS: Mortality after 2 years was significantly higher in the nighttime insomnia, daytime sleepiness, and sleep-onset delay groups. Further, adjusted for age, gender and activities of daily living status, the presence of nighttime insomnia and sleep-onset delay remained associated with a higher risk of mortality. CONCLUSION: Sleep disturbance may be one of the symptoms indicating poor health or functional deficits, and be an independent risk factor for survival.     

Respiration and heart rate variability during sleep in untreated Parkinson patients.

Twenty-six patients with untreated mild to moderate Parkinson's disease (PD) lasting 5 years or less, were investigated in the sleep laboratory. Sleep architecture and respiration during sleep did not significantly differ from age-matched controls. PD patients showed defective cardiac autonomic control during sleep, mainly parasympathetic but also sympathetic in nature, although they had normal results in conventional autonomic tests during wakefulness. Therefore, autonomic cardiac involvement seems to be an early sign of PD.     

Relevance of sleep disturbance to the integrity and characteristics of secondary peristalsis in patients with gastroesophageal reflux disease

Objective: Sleep disturbance is common in patients with gastroesophageal reflux disease (GERD). Secondary peristalsis is important for clearance of the refluxate from the esophagus. We aimed to test the hypothesis whether secondary peristalsis is impaired in GERD patients with sleep disturbance.

Methods: Secondary peristalsis was stimulated with slow and rapid air injections into mid-esophagus in 8 age-matched health controls and 41 patients with GERD. Sleep disturbance was assessed by the Pittsburg Sleep Quality Index (PSQI). Objective sleep measures were assessed by ambulatory actigraphy.

Results: The threshold volume for inducing secondary peristalsis during slow air injection was significantly higher in GERD patients with sleep disturbance than healthy controls (14.3?±?1.2 vs. 8.9?±?0.5?mL, p?<?.05). GERD patients with sleep disturbance had higher threshold volume of secondary peristalsis during rapid air injection than GERD patients without sleep disturbance (5.1?±?0.4 vs. 3.9?±?0.2?mL, p?<?.05) and healthy controls (5.1?±?0.4 vs. 3.6?±?0.2?mL, p?<?.05). There was a negative correlation between PSQI score and peristaltic frequency during rapid air injection (r?=??.39, p?=?.01). Secondary peristaltic amplitude during rapid air injection was negatively correlated with wake after sleep onset (r?=??.34, p?=?.04).

Conclusions: Sleep disturbance is associated with secondary peristaltic response to distension-induced esophageal stimulation in patients with GERD. Our study suggests that sleep disturbance per se may adversely influence the effectiveness of esophageal peristalsis and bolus clearance during sleep in patients with GERD.     

Impact of sleep disturbances in inflammatory bowel disease

BACKGROUND: Normal sleep is paramount for a healthy lifestyle and high quality of life. Sleep modulates the immune system and thus affects the course of several chronic inflammatory conditions. There are no reported studies that address the role of sleep disturbance in the course of inflammatory bowel disease (IBD). The aim of this study was to characterize sleep disturbance in IBD using validated measures of sleep and quality of life. METHODS: A self-administered, mail-in questionnaire package was sent to 205 subjects after a brief instruction. The questionnaire package was composed of the Pittsburgh Sleep Quality Index (PSQI), a measure of disease severity and the IBD-Quality of Life Questionnaire. A total of 119 subjects were recruited (58% response rate): 80 with inactive IBD, 24 with irritable bowel syndrome (IBS) and 15 healthy controls. RESULTS: The IBD subjects reported significantly prolonged sleep latency, frequent sleep fragmentation, higher rate of using sleeping pills, decreased day-time energy, increased tiredness and poor overall sleep quality compared to healthy controls. The abnormal sleep patterns in IBD subjects were similar to IBS subjects. The reported sleep quality was correlated with IBD disease severity score (r(2) = 0.55, P = 0.02). Both IBD and IBS subjects thought that sleep and their disease status were correlated. CONCLUSION: The results show that IBD patients have significant sleep disturbance even when their disease is not active. This problem might affect quality of life, gastrointestinal symptoms and coping ability, and might potentially modify disease severity or increase risk of flare-up. Regardless of the primary or secondary origin of this problem, sleep disturbance should be addressed in the clinical management of patients with IBD.     

Sleep disturbance in palliative care

Sleep disturbance in palliative medicine is a common and challenging condition that significantly adds to the burden of suffering experienced by patients with advanced stage diseases. Sleep disorders may be primary or, more commonly, a secondary symptom of the advancing disease process. The diverse nature of patients under palliative care makes management of sleep disorders particularly challenging and highly individualized. Multiple pharmacologic and nonpharmacologic interventions have been successfully used for the management of sleep disturbances in palliative medicine. Yet, despite these measures, many patients do not seek medical attention for sleep disturbances, and health care providers tend to under-diagnose this condition and under-treat it when diagnosed, thus missing an opportunity to improve the quality of life of patients already suffering from the burden of terminal disease.     

Melatonin secretion after surgery

Sleep disturbance is common postoperatively. We examined whether melatonin concentrations were related to this disturbance in seven postoperative patients. Nocturnal concentrations of melatonin were significantly (p=0.005) lower on the first than on the second or third nights after surgery. This finding raises the possibility that melatonin suppression and associated sleep disturbance might be prevented by melatonin replacement.     

Sleep disturbance in menopause

Sleep disturbance during menopause is a common and important complaint faced by many women. There are many factors that may play a role in this problem, including vasomotor symptoms and changing hormone levels, circadian rhythm abnormalities, exacerbation of primary insomnia, mood disorders, coexistent medical conditions as well as lifestyle factors. Sleep can be measured both objectively and subjectively; however, correlation between the two measures is not high. Most of the menopause-related sleep disturbances have been reported as qualitative in nature; however, there have also been studies showing changes in objective measures. This discrepancy has implications with regard to evaluation of research in sleep and menopause, as well as application in the clinical setting. Investigations of inadequate sleep and sleep problems during the menopausal period and obtaining a thorough understanding of the factors contributing to these problems are essential in formulating treatment strategies. Such strategies can vary from hormonal treatment and medications to lifestyle and behavioural modification.