Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial

OBJECTIVES: To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. DESIGN: Randomized, controlled trial with allocation to tai chi or exercise control. SETTING: General community. PARTICIPANTS: One hundred eighteen women and men aged 60 to 92. INTERVENTION: Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks. MEASUREMENTS: Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores. RESULTS: Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) (P<.01), PSQI global score (P=.001), and ESS scores (P=.002) in comparison with the low-impact exercise participants. Tai chi participants reported sleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=-28.64 to -7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71-82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores. CONCLUSION: Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.     

Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints

BACKGROUND: This study sought to determine the 12-month effects of exercise increases on objective and subjective sleep quality in initially inactive older persons with mild to moderate sleep complaints. METHODS: A nonclinical sample of underactive adults 55 years old or older (n=66) with mild to moderate chronic sleep complaints were randomly assigned to a 12-month program of primarily moderate-intensity endurance exercise (n=36) or a health education control program (n=30). The main outcome measure was polysomnographic sleep recordings, with additional measures of subjective sleep quality, physical activity, and physical fitness. Directional hypotheses were tested. RESULTS: Using intent-to-treat methods, at 12 months exercisers, relative to controls, spent significantly less time in polysomnographically measured Stage 1 sleep (between-arm difference=2.3, 95% confidence interval [CI], 0.7-4.0; p=003), spent more time in Stage 2 sleep (between-arm difference=3.2, 95% CI, 0.6-5.7; p=.04), and had fewer awakenings during the first third of the sleep period (between-arm difference=1.0, 95% CI, 0.39-1.55; p=.03). Exercisers also reported greater 12-month improvements relative to controls in Pittsburgh Sleep Quality Index (PSQI) sleep disturbance subscale score (p=.009), sleep diary-based minutes to fall asleep (p=.01), and feeling more rested in the morning (p=.02). CONCLUSIONS: Compared with general health education, a 12-month moderate-intensity exercise program that met current physical activity recommendations for older adults improved some objective and subjective dimensions of sleep to a modest degree. The results suggest additional areas for investigation in this understudied area.     

Evaluation of latent links between irritable bowel syndrome and sleep quality

AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this study.Data on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Q...     

Self-reported napping and duration and quality of sleep in the lifestyle interventions and independence for elders pilot study

OBJECTIVES: To determine the prevalence of self‐reported napping and its association with subjective nighttime sleep duration and quality, as measured according to sleep‐onset latency and sleep efficiency. DESIGN: Cross‐sectional study. SETTING: Lifestyle Interventions and Independence for Elders Pilot Study. PARTICIPANTS: Community‐dwelling older adults (N=414) aged 70 to 89. MEASUREMENTS: Self‐report questionnaire on napping and sleep derived from the Pittsburgh Sleep Quality Index (PSQI) scale. RESULTS: Fifty‐four percent of participants reported napping, with mean nap duration of 55.0±41.2 minutes. Nappers were more likely to be male (37.3% vs 23.8%, P=.003) and African American (20.4% vs 14.4%, P=.06) and to have diabetes mellitus (28% vs 14.3%, P=.007) than non‐nappers. Nappers and non‐nappers had similar nighttime sleep duration and quality, but nappers spent approximately 10% of their 24‐hour sleep occupied in napping. In a multivariate model, the odds of napping were higher for subjects with diabetes mellitus (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2–3.0) and men (OR=1.9, 95% CI=1.2–3.0). In nappers, diabetes mellitus (β=12.3 minutes, P=.005), male sex (β=9.0 minutes, P=.04), higher body mass index (β=0.8 minutes, P=.02), and lower Mini‐Mental State Examination score (β=2.2 minutes, P=.03) were independently associated with longer nap duration. CONCLUSION: Napping was a common practice in community‐dwelling older adults and did not detract from nighttime sleep duration or quality. Given its high prevalence and association with diabetes mellitus, napping behavior should be assessed as part of sleep behavior in future research and in clinical practice.     

血液灌流对老年血液透析患者不安腿综合征和睡眠质量的影响

目的 了解老年维持性血液透析(maintenance hemodialysis,MHD)患者不安腿综合征(restless legs syndrome,RLS)的患病率、危险因素及其对睡眠质量的影响,观察血液灌流改善对老年血液透析患者不安腿症状和睡眠质量的有效性和安全性.方法 以118例因慢性肾衰竭进行MHD治疗的老年患者为研究对象.不安腿综合征的诊断采用国际不安腿综合征研究小组制定的诊断标准量表,以匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)进行睡眠质量评估.对伴有RLS老年MHD患者进行血液灌流治疗,疗程3个月,观察治疗前后患者RLS症状和PSQJ评分情况及不良反应.收集患者的临床和生化资料,进行t检验或x2检验,部分指标间进行相关分析和Logistic回归分析. 结果 (1)118例老年血液透析患者中,并存RLS者31例,患病率为26.3%,其中男性11例,女性20例;(2)RLS组患者透析龄(t=2.332,P=0.021)、性别比(女/男)(X2=15.343,P=0.000)、血磷(t=4.784,P=0.000)、β2-微球蛋白(t=13.124,P-0.000)和甲状旁腺激素水平(t=10.900,P=0.000)明显高于非RLS组,差异均有统计学意义.而在年龄(t=0.341,P=0.734)、干体质量(t=0.008,P=0.994)、透析器膜材料(X2=1.055,P=0.304)、血肌酐(t=0.051,P=0.960)、血尿素(t=0.899,P=0.370)、血红蛋白(t=0.912,P=0.364)、红细胞压积(t=0.601,P=0.549)、血钙(t=0.192,P=0.124)、铁蛋白(t=0.200,P=0.842)、转铁蛋白饱和度(t=1.094,P=0.276)等生化指标方面,两组差异均无统计学意义;Logistic回归分析结果 显示,血甲状旁腺激素和血β2-微球蛋白是老年MHD患者并发RLS的独立危险因素;(3)RLS组PSQI明显高于非RLS组,分别为10.7±2.7和4.9±2.5(t=10.948,P=0.000);睡眠差主要表现在主观睡眠质量、睡眠时间、习惯睡眠效应、日间功能等方面,且RLS严重程度与PSQI总分呈正相关(r=0.839,P<0.05);(4)经血液灌流治疗后,RLS患者血磷,血甲状旁腺激素、血β2-微球蛋白、RLS和PSQI评分均明显下降,与治疗前比较,差异有统计学意义;(5)患者在治疗过程中牛命体征平稳,无不良反应发生. 结论 老年MHD患者RLS的患病率较高,且普遍存在睡眠质量差等问题;血甲状旁腺激素和β2-微球蛋白是老年MHD患者并发RLS的独立危险因素,血液灌流能改善老年MHD患者的RLS和睡眠质量,且安全性好.     

Relationships Between Malnutrition,Inflammation, Sleep Quality,and Restless Legs Syndrome in Hemodialysis Patients

Restless legs syndrome (RLS) is a common neurologic sensorimotor disorder. It is also seen in hemodialysis patients in whom the mechanism is not thoroughly understood. The aim of this study was to evaluate the association between malnutrition‐inflammation score (MIS), sleep quality, and RLS in chronic hemodialysis patients. This cross‐sectional study included 232 adult stable chronic hemodialysis patients (mean age 60.9 ± 14.1 years, 56.5% male). RLS frequency, MIS, Pittsburgh Sleep Quality Index (PSQI), laboratory data of patients as well as severity of RLS were evaluated. Thirty‐seven patients (15.9%) were diagnosed with RLS. Mean MIS of patients with or without RLS were similar. PSQI of patients with RLS was significantly higher than patients without RLS (P = 0.002). There was a significant positive correlation between RLS severity and PSQI (r = 0.445, P = 0.006). A significant positive correlation was also found between PSQI and MIS in patients with RLS (r = 0.419, P = 0.010). RLS severity was positively correlated with some inflammatory parameters such as white blood cell count and C‐reactive protein (r = 0.427, P = 0.008 and r = 0.418 P = 0.010). PSQI was found as an independent significant predictor of RLS (odds ratio [OR] = 1.15 (1.06–1.25), P = 0.001) in multivariate logistic regression analysis. Our study revealed that there was no significant relationship between RLS and MIS in chronic hemodialysis patients. However, RLS severity is correlated with inflammatory parameters. Also, sleep quality in chronic hemodialysis patients with RLS is negatively associated with MIS.     

Sleep quality among patients treated with implantable atrial defibrillation therapy: effect of nocturnal shock delivery and psychological distress

INTRODUCTION: The Medtronic ICD-AT has atrial/ventricular therapies, which can be programmed to deliver atrial defibrillation during sleep, intended to potentially decrease shock anxiety/pain and lifestyle disruption. However, these shocks may diminish sleep quality. This study examined atrial shock characteristics (i.e., mode, frequency), AF symptoms, and psychological factors as determinants of sleep quality. METHODS AND RESULTS: The 96 ICD-AT patients were mostly men (72%; M age 65 +/- 12 years) and implanted for 1.6 years (SD = 0.8 years). Patients were divided into shock groups based on the proportion of mode (> or =90%) of total atrial shocks received. Patients were grouped into either automatic-nocturnal shock group (8 P.M.-8 A.M.; n = 35) or manual-awake shock group (n = 42). Psychological measures included Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiology Studies-Depression Scale, State-Trait Anxiety Inventory, and Illness Intrusiveness Rating Scale. Atrial fibrillation disease burden was assessed via atrial symptom score and atrial shock use. PSQI global scores were similar between manual (7.67 +/- 2.53) and automatic shock (8.20 +/- 2.93) groups. A multiple hierarchical regression analysis indicated that no atrial shock variables were predictive of sleep quality; yet, both AF symptom (B = 0.226, P = 0.040) and depression (B = 0.392, P = 0.034) scores predicted diminished sleep quality, accounting for 42% of the variance in global sleep quality (P < 0.001). CONCLUSION: These results suggest that atrial defibrillation therapy does not have a deleterious impact on sleep. However, the significance of AF symptoms and depression indicate that comprehensive care of both physical and psychological symptomatology may improve sleep quality in ICD-AT patients.     

Prevalence of Restless Legs Syndrome and Its Effects on Sleep and Health-Related Quality of Life in Patients With Heart Failure

BackgroundRestless legs syndrome (RLS) is a neurological disorder characterized by leg restlessness and dysesthesia. Although the relationship between RLS and heart failure (HF) has been reported, the prevalence and clinical significance of RLS in patients with HF remain to be elucidated.Methods and ResultsWe enrolled consecutive patients with HF who were admitted to our institutions. RLS was diagnosed using the International Restless Legs Syndrome Study Group criteria. Subjective sleepiness, sleep quality, and quality of life (QoL) were assessed using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and 8-item Short Form (SF-8), respectively. Among the 133 patients, 18 (13.6%) had RLS and were younger than those without RLS (62.4±13.4 vs 70.0±12.2, P = .017). The RLS group had significantly disrupted sleep quality and QoL, with greater PSQI score (8.0±3.2 vs 5.9±3.3, P = .015) and lower SF-8 physical component summary (PCS) score (35.6±6.5 vs 40.7±9.5, P = .031), despite similar ESS and SF-8 mental component summary scores. In the multivariable regression analysis, RLS was associated with greater PSQI (β=0.211; P = .014) and lower PCS score (β=?0.177; P = .045).ConclusionIn the patients with HF, RLS was prevalent, and sleep quality and QoL may be disrupted by RLS.     

Sleep disorders in patients with psoriasis: a cross-sectional study using non-polysomnographical methods

Background

Psoriasis is a chronic inflammatory skin disease which can cause sleep disturbances due to the disease itself or due to its complications. In this study, we aimed to analyze the array of sleep disturbances caused by psoriasis and to evaluate the interaction between the quality of sleep and the duration and severity of psoriasis.

Methods

Study subjects included 60 patients with plaque psoriasis and 60 sex- and age-matched controls. The Psoriasis Area and Severity Index (PASI) was used to evaluate severity of disease. Body mass index (BMI), medication usage, and duration of disease were recorded. All subjects completed the Epworth Sleepiness Scale (EES), Pittsburgh Sleep Quality Index (PSQI), insomnia severity index (ISI), Berlin-sleep apnea questionnaire, and questions based on criteria of the International Restless Legs Syndrome Study Group indicating the presence of restless legs syndrome (RLS).

Results

There were statistically significant and clinically relevant differences between the patients and controls regarding day-time sleepiness (ESS 5.3 vs 4.1, p?=?0.037), sleep quality (PSQI 14.4 vs 4.9, p?<?0.001), insomnia (ISI 19.7 vs 14.4, p?<?0.001), sleep apnea (high risk 30% vs 7%, p?=?0.01), and RLS (high risk 32% vs 0%, p?<?0.001).

Conclusions

Patients with psoriasis experience poor sleep quality and are at markedly increased risk for insomnia, obstructive sleep apnea, and restless legs syndrome. These findings suggest the importance of evaluating patients with psoriasis for conditions that affect sleep. The study results further suggest that simple screening tools may be useful for this task.

     

Association between depressive symptoms and sleep disturbances in community-dwelling older men

OBJECTIVES: To examine the association between depressive symptoms and subjective and objective measures of sleep in community-dwelling older men.
DESIGN: Cross-sectional.
SETTING: Six U.S. clinical centers.
PARTICIPANTS: Three thousand fifty-one men aged 67 and older.
MEASUREMENTS: Depressive symptoms assessed using the 15-item Geriatric Depression Scale and categorized as 0 to 2 (normal, referent group), 3 to 5 (some depressive symptoms), and 6 to 15 (depressed); objective sleep measures ascertained using wrist actigraphy (mean duration 5.2 nights); and subjective sleep measures assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale.
RESULTS: There was a strong multivariable-adjusted association between level of depressive symptoms and subjective sleep disturbances ( P -trend <.001). For example, the odds of reporting poor sleep quality were 3.7 times (95% confidence interval (CI)=2.5–5.3) higher for depressed men as for normal men, and 2.1 times (95% CI=1.7–2.6) higher for men with some depressive symptoms. For objectively measured sleep disturbances, men with more depressive symptoms had greater odds of sleep latency of 1 hour or more ( P -trend=.006). There was no association between level of depressive symptoms and sleep efficiency, awakening after sleep onset, multiple long-wake episodes, or total sleep time. Excluding 384 men taking antidepressants, benzodiazepines, or other anxiolytic or hypnotics did not alter the results.
CONCLUSION: Depressive symptoms have a strong, graded association with subjective sleep disturbances and are moderately associated with objectively measured prolonged sleep latency. Future studies should address temporality of depression and sleep disturbances.     

Restless legs syndrome and sleep quality among adult sickle cell disease patients

Objective

The purpose of this study is to determine and compare the prevalence of restless legs syndrome (RLS) between adult patients with sickle cell disease (SCD) and non-SCD anemia.

Methods

This cross-sectional study was conducted from December 2013 to July 2014. Patients with SCD and non-SCD anemia were recruited from a hematology clinic at a large university hospital. Patients with secondary RLS were excluded. Data were collected on demographic features, clinical evaluations, laboratory tests, sleep quality using the Pittsburgh Sleep Quality Index, RLS symptoms using the International Restless Legs Syndrome Study Group Criteria, severity of RLS using the International Restless Leg Syndrome Rating Scale, and daytime sleepiness using the Epworth Sleepiness Scale.

Results

The study sample consisted of 44 patients with SCD and 45 with non-SCD anemia. The two groups were comparable in age, gender, body mass index, smoking habit, and comorbidities. Poor sleep quality was found in 63% of the SCD group compared to 53% of the non-SCD group. The prevalence of RLS among SCD group and non-SCD group was 13.6% (6/44) and 8.8% (4/45), respectively. These differences, however, were not statistically significant, p?>?0.05. Excessive daytime sleepiness was also similar in both groups, with the rate being 20.5 and 17.8% in the SCD and non-SCD groups, respectively.

Conclusion

Our study revealed that poor sleep quality and RLS were both common among adult patients with SCD; however, they did not differ significantly from patients with non-SCD anemia.

     

Sleep quality, daytime sleepiness and fasting insulin levels in women with chronic obstructive pulmonary disease

STUDY OBJECTIVES: To test the clinical observations that patients with chronic obstructive pulmonary disease (COPD) have impaired sleep quality without excessive daytime sleepiness (EDS), and to analyse the aetiological factors. PARTICIPANTS: Fifteen non-diabetic postmenopausal women with moderate to severe COPD and 20 community dwelling age-matched control women. MEASUREMENTS AND RESULTS: Patients completed questionnaires, had a polysomnography and blood tests. Controls filled in the questionnaires. In the Basic Nordic Sleep Questionnaire, the average (+/-sd) scores for sleepiness (9.9+/-3.0 in patients vs. 7.6+/-3.2 in controls, P = 0.025, test range 4-20) and insomnia (18.3+/-3.4 vs. 16.6+/-4.4, P = 123, test range 7-35) were low. Although 53% had a good night's sleep seldom or never and 70% slept restlessly, only 33% felt tired in the mornings. Controls reported better sleep quality, less tiredness and sleepiness. With polysomnography, the total sleep time was 4h 41 min +/-1h 20 min in patients. Sleep was fragmented, the proportion of stage 1 sleep high and rapid eye movement (REM) latency delayed. Sleepiness correlated with fasting serum insulin levels (r = 0.59, P = 0.027) and body movements (r = 0.52, P = 0.047). In stepwise linear regression analyses, sleepiness was positively associated with insulin levels (P = 0.025) but not with body movements. Insulin explained 38.0% of the variance in the sleepiness score, when adjusted for body mass index (BMI). Conclusions: Despite short and fragmented sleep, non-diabetic patients with COPD did not have marked EDS. An association between fasting insulin and sleepiness suggests that insulin resistance is involved in EDS.     

The relationship between sleep disorders,anxiety, depression,and cognitive function with restless legs syndrome (RLS) in the elderly

Objectives

Restless legs syndrome (RLS) has a significant effect on sleep and quality of life. Delays in diagnosis and treatment are frequent due to a lack of awareness. In this study, a clinical analysis was performed to examine the relationship between sleep, mood, and cognitive function in RLS.

Methods

According to the Pittsburgh Sleep Quality Index score (PSQI), patients with RLS were divided into a sleep disorders group (SD, PSQI?>?7) and non-sleep disorders group (NSD, PSQI?≤?7). Healthy controls were selected as a control group matched for age, cultural background, and marital status. We compared differences between the three groups using the Hamilton Anxiety Scale (HAMA), Hamilton Depression (HAMD), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). The SD and NSD groups were also assessed with the Restless Leg Syndrome Rating Scale (RLSRS) and the severity of RLS between the two groups was compared. The analysis used t-test, ANOVA, and Pearson correlation.

Results

(1) Among the 54 RLS patients, 30 people in the control group, 35 patients with sleep disorders (SD, 65%), and 19 patients without sleep disorders (NSD, 35%), there were no significant differences in age, educational level, marital status, or trauma history. (2) The comparison results of the case group (SD and NSD) and the control group showed highly significant differences (P?<?0.01) in the PSQI–HAMA–HAMD score but no significant differences between the NSD group, the SD group, and the control group in MMSE score. There was no difference between the NSD group and the control group in the MoCA, but a significant difference (P?<?0.05) between the SD group and the control group was found. (3) The comparison between the NSD and the SD groups revealed significant differences in the RLSRS, HAMA, and HAMD scores (P?<?0.05), but there were no statistical differences (P?>?0.05) between two groups on MMSE and MoCA score. (4) Correlation and regression showed that there was a linear correlation between PSQI scores and RLSRS and HAMD scores in patients with RLS (P?<?0.05). The regression equation was PSQI?=????2.393?+?0.494 RLSRS?+?0.170 HAMD.

Conclusions

RLS patients were prone to sleep disorders, anxiety, and depression. Sleep disorders increased with the severity of the RLS and had some influence on the patient’s cognitive function. Sleep disorders were closely related to RLSRS and HAMD.

     

Determinants of sleep quality in women with systemic lupus erythematosus

OBJECTIVE: To characterize sleep complaints in women with systemic lupus erythematosus (SLE) and to identify correlates of sleep quality. METHODS: Sleep quality in 100 women with SLE was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants completed standardized questionnaires assessing depressed mood, leisure time physical activity, functional disability, and pain severity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled the American College of Rheumatology criteria for fibromyalgia. A series of hierarchical multiple regressions were computed. RESULTS: The mean +/- SD global PSQI score was 6.98 +/- 4.03, with moderate to severe sleep impairment reported by 56% of the sample. The first model testing the importance of demographic factors was not statistically significant. In the disease-related model, the use of prednisone and functional disability both contributed to poor sleep quality (P < 0.001). The addition of level of exercise participation to the demographic set significantly added to the model (P = 0.001). Depression significantly added to the demographic set, explaining 29% of the variance (P < 0.0001). When these variables, along with disease related variables, were simultaneously regressed on the PSQI Global Score, only depressed mood appeared as a significant independent determinant of global sleep quality (P < 0.001). However, the point estimates for the Beta coefficients were consistent with effects for lack of exercise and prednisone use. CONCLUSION: A significant proportion of women with SLE suffer from poor sleep quality. The findings suggest that depressed mood, prednisone use, and lack of exercise contribute to decreased overall sleep quality.     

Sequential compression devices for treatment of restless legs syndrome

Restless legs syndrome (RLS) is a common disorder that presents with irresistible urges to move the legs and motor restlessness, worsening in the evening. RLS commonly causes insomnia and associated daytime symptoms. Treatment of first choice for RLS is usually medication, but medications are often ineffective or poorly tolerated. An effective nonpharmacologic therapy would be highly desirable. Here we review RLS and its treatment and present data from a pilot study on the effect of a novel treatment for this condition. The objective of this study was to determine the therapeutic effect of pneumatic sequential compression devices (SCDs) on RLS symptoms.We performed an uncontrolled, prospective interventional study using SCDs on a convenience sample of adults reliably diagnosed with RLS. Patients were asked to wear the SCD for an hour each evening before the usual time of onset of restless legs symptoms. Before and after 1-3 months of SCD therapy, patients completed validated questionnaires to assess RLS severity, daytime sleepiness, and impact of RLS on quality of life in the domains of social function, daily task function, sleep quality, and emotional well-being. Compliance with SCD therapy was measured using patient-recorded logs.Of 10 patients (7 women; age range, 37-80 yr; mean age, 56 yr), symptomatic for a mean of 68 months (range, 12-360 mo), 1 could not tolerate wearing the SCD and withdrew from the protocol after 3 days. The remaining 9 patients complied with therapy 58%-100% of nights (mean, 82%). Three patients experienced complete resolution of RLS and 6 patients had improvement of symptoms. Group severity score improved from 24/40 to 8/40 (p = 0.001). Epworth Sleepiness Scale score improved from 12/24 to 8/24 (p = 0.05). Every quality of life score improved: social function from 74% to 96% (p = 0.04), daily task function 63% to 80% (p = 0.05), sleep quality 27% to 63% (p = 0.003), and emotional well-being from 49% to 83% (p = 0.02). In this group of patients, wearing the SCD in the evening for an hour improved symptoms of RLS and improved quality of life, with complete resolution of symptoms in 3 of 10 patients.     

卒中高危人群的睡眠质量:基于社区的调查

目的 调查卒中高危人群的睡眠质量并探讨睡眠障碍的危险因素.方法 2016年3月对天津市南开区水上公园及王顶堤社区的卒中高危人群进行横断面调查,根据匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)将研究对象分为睡眠良好组和睡眠障碍组,采用多变量logistic回归分析确定影响睡眠质量的危险因素;根据高危人群既往有无卒中史分为有卒中史组和无卒中史组,比较2组睡眠质量,并分析睡眠障碍与卒中转归的相关性.结果 共纳入565例卒中高危人群,睡眠障碍者178例(31.5％).睡眠障碍组年龄显著大于睡眠良好组[(66.70±8.97)岁对(62.87±9.46)岁;t=-4.540,P＜0.001],女性(68.0％对49.1％;x2=16.190,P＜ 0.001)、高血压(69.7％对57.9％;x2=7.154,P=0.005)、缺血性心脏病(48.9对35.4％;x2=9.253,P=0.002)、既往卒中或短暂性脑缺血发作(transient ischemic attack,TIA)史(30.9％对18.9％;x2=10.080,P=0.001)、颈动脉斑块(71.9％对53.7％;x2=16.688,P＜0.001)构成比显著高于睡眠良好组.多变量logistic分析表明,在校正年龄和性别后,既往卒中或TIA史[优势比(odds ratio,OR)1.712,95％可信区间(confidence interval,CI)1.105～2.653;P=0.016]、颈动脉斑块(OR1.583,95％ CI 1.003～2.498;P =0.048)是睡眠障碍的独立危险因素.既往有卒中史者PSQI总分显著高于无卒中史者[(7.25±4.71)分对(6.13±4.20)分;t=-2.578,P=0.010];既往有卒中史者入睡时间评分[(1.24±1.06)分对(0.95±1.02)分;t=-2.868,P=0.004]和睡眠障碍评分[(1.23±0.63)分对(1.07±0.61)分;t=-2.622,P=0.009]显著高于无卒中史者.根据改良Rankin量表评分将有卒中史者分为转归良好组(0～2分)和转归不良组(＞2分),分别包括105例(82.0％)和23例(18.0％).转归不良组睡眠障碍患者比例(78.3％对35.2％;x2=14.251,P＜0.001)和PSQi评分[中位数和四分位数间距:6(3 ～8)分对12(8～18)分;Z=-4.392,P＜0.001]均显著高于转归良好组.结论 卒中高危人群睡眠障碍发生率高,既往卒中或TIA史、颈动脉斑块是卒中高危人群睡眠障碍的独立危险因素,而且睡眠障碍与卒中转归不良相关.因此,应积极关注卒中高危人群的睡眠质量,控制导致其睡眠障碍的危险因素,特别是对于既往有卒中史者,将有助于降低卒中的发病风险.     

Subjective sleep quality and daytime sleepiness in a large sample of patients with chronic fatigue syndrome (CFS)

Chronic fatigue syndrome (CFS) is characterised by incapacitating fatigue in combination with a number of minor criteria, including unrefreshing sleep without further specifications, in the absence of psychiatric and internal disease. As little data exist on subjective sleep quality and daytime sleepiness, these parameters were assessed in a large sample of CFS patients. Consecutive patients with a diagnosis of CFS in a tertiary referral centre filled out the Fatigue Questionnaire (FQ), Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Inclusion comprised 415 individuals (mean age 40.5 yr, SD 7.9, range 18-64; 86% female). Mean FQ (26.90; SD 4.04), mean Global Physical Health from the MOS SF-36 (29.30; SD 12.25) and Global Mental Health from the MOS SF-36 (49.62; SD 18.31) scores corresponded with literature data for similar CFS samples. High mean ESS (10.51; SD 5.52) and global PSQI (10.17; SD 4.02) were observed. No significant relationship was found between ESS and global PSQI. In contrast, regression analysis demonstrated a significant cubic relation between ESS and 'PSQI without daytime dysfunction'. A subgroup (n=69) with an insomnia-like phenotype low ESS (<5), high PSQI (mean 11.51; SD 3.86) was observed. The assessment of subjective sleep quality and daytime sleepiness in a large sample of CFS patients indicated high mean PSQI and ESS values. ESS and 'PSQI without daytime dysfunction' were inversely related at the spectral ends of ESS. A distinct subgroup with clinical features of insomnia was identified.     

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.     

Management of restless legs syndrome in chronic liver disease: A challenge for the correct diagnosis and therapy

AIM To investigate the association between restless legs syndrome(RLS) and well-defined chronic liver disease, and the possible therapeutic options. METHODS Two hundred and eleven patients with chronic liver disease, complaining of sleep disturbances, painful leg sensation and daily sleepiness, were included. Patients with persistent alcohol intake, recent worsening of clinical conditions, or hepatitis C virus were excluded. Diagnosis of RLS was suggested by the Johns Hopkins questionnaire and verified by fulfilling the diagnostic criteria by Allen. All patients were tested, both at baseline and during follow-up, with the Hamilton rating scale for depression, sleep quality assessment(PSQI), Epworth sleepiness scale(ESS), International Restless Legs Syndrome Study Group evaluation, and international RLS severity(IRLS) scoring system. Ironfree level, ferritin, folate, vitamin B12 and D-OH25 were detected. Neurological examinations and blood testoccurred at the beginning of the therapy, after 2 wk, and at the 28~(th), 75 th, 105 th, 135 th, 165 th and 205 th day. Regarding therapy, pramipexole or gabapentin were used.RESULTS Patients were moderately depressed, with evident nocturnal sleep problems and concomitant daily sleepiness. Sleep problems and involuntary leg movements had been underestimated, and RLS s yndrome had not be e n c ons ide re d be fore t he neurological visit. All(211/211) patients fulfilled the RLS diagnostic criteria. Twenty-two patients considered their symptoms as mild, according to IRSL, but 189 found them moderate to very severe. No correlation was found between ammonium level and ESS or PSQI. Augmentation was rather precocious in our patients(135 th day), and more frequent(35%) than previous data(8.3%-9.1%). The dosage of dopamine agonists was found to be associated with augmentation and appears in range with the literature. Previous intake of alcohol and lower levels of vitamins have been related to the phenomenon in our study.CONCLUSION RLS is a common disorder, requiring rapid diagnosis and treatment. Further research is therefore fundamental.     

Characteristics of chronic pain associated with sleep difficulty in older adults: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study

OBJECTIVES: To evaluate pain severity and distribution in relation to sleep difficulty in older adults. DESIGN: Population‐based cross‐sectional study. SETTING: Community within a 5‐mile radius of the study center at the Institute for Aging Research, Hebrew SeniorLife (HSL), Boston. PARTICIPANTS: Seven hundred sixty‐five participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study aged 64 and older. MEASUREMENTS: Pain severity was measured using the Brief Pain Inventory (BPI) Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, two or more sites, and widespread pain (upper and lower extremities and back pain). Three aspects of sleep difficulty were measured using items from the Center for Epidemiologic Studies Depression Scale, Revised (trouble getting to sleep, sleep more than usual, and restless sleep). RESULTS: Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32.0%, and 37.0% for the lowest to highest pain severity quartiles, respectively. Similar relationships between pain and sleep were observed across sleep measures according to pain severity and distribution. Adjusted for sociodemographic characteristics, chronic conditions, and health behaviors, chronic pain was strongly associated with trouble sleeping (≥1 d/wk) (single‐site pain, odds ratio (OR)=1.77, 95% confidence interval (CI)=1.10–2.87; multisite pain, OR=2.38, 95% CI=1.48–3.83; widespread pain, OR=2.55, 95% CI=1.43–4.54, each compared with no pain). Similar associations were observed for restless sleep and sleeping more than usual. For specific pain sites alone or in combination with other sites of pain, only modest associations were observed with sleep problems. CONCLUSION: Widespread or other multisite pain and moderate to severe pain are strongly associated with sleep difficulty in older adults. Further research is needed to better understand the burden and consequences of pain‐related sleep problems in older adults.