Presleep Arousal and Sleep Disturbances in Children

Study Objectives:

To determine if associations between presleep arousal and sleep disturbance reported in adults are also characteristic of children.

Design:

Linear regression analyses examined whether somatic and cognitive presleep arousal predicted sleep disturbances.

Setting:

Two inner city schools, London, UK.

Participants:

One hundred twenty-three children aged 8 to 10 years, 49% boys, from ethnically diverse backgrounds.

Interventions:

N/A

Measurements and Results:

Children completed the Sleep Self-Report and the Pre-sleep Arousal Scale (comprising somatic and cognitive subscales). Parents completed the Child Sleep Habits Questionnaire. In separate models, both somatic (~ = 0.44, P < 0.001, R² = 0.19) and cognitive (~ = 0.48, P < 0.001, R² = 0.23) presleep arousal predicted the Sleep Self-Report total score. Somatic (~ = 0.28, P <.01, R² = 0.08) and cognitive (~ = 0.37, P < 0.001, R² = 0.14) arousal also predicted Sleep Self-Report insomnia items in separate models. These results were partially replicated when using the parent report of the Child Sleep Habits Questionnaire. When somatic and cognitive items were included in the same models, cognitive but not somatic arousal significantly predicted (most definitions of) sleep disturbance.

Conclusions:

Cognitive, and to a lesser extent somatic, presleep arousal appears to be associated with sleep disturbances in children. This suggests that further research into cognitive aspects of sleep disturbance in children is warranted—as incorporating this information into treatments may eventually prove fruitful.

Citation:

Gregory AM; Willis TA; Wiggs L; Harvey AG. Presleep arousal and sleep disturbances in children. SLEEP 2008;31(12):1745–1747.     

EEG Spectral Analysis in Primary Insomnia: NREM Period Effects and Sex Differences

Study Objectives:

To compare NREM EEG power in primary insomnia (PI) and good sleeper controls (GSC), examining both sex and NREM period effects; to examine relationships between EEG power, clinical characteristics, and self-reports of sleep.

Design:

Overnight polysomnographic study.

Setting:

Sleep laboratory.

Participants:

PI (n = 48; 29 women) and GSC (n = 25; 15 women).

Interventions:

None.

Measurements:

EEG power from 1–50 Hz was computed for artifactfree sleep epochs across four NREM periods. Repeated measures mixed effect models contrasted differences between groups, EEG frequency bands, and NREM periods. EEG power-frequency curves were modeled using regressions with fixed knot splines.

Results:

Mixed models showed no significant group (PI vs. GSC) differences; marginal sex differences (delta and theta bands); significant differences across NREM periods; and group*sex and group*NREM period interactions, particularly in beta and gamma bands. Modeled power-frequency curves showed no group difference in whole-night NREM, but PI had higher power than GSC from 18–40 Hz in the first NREM period. Among women, PI had higher 16 to 44-Hz power than GSC in the first 3 NREM periods, and higher 3 to 5-Hz power across all NREM periods. PI and GSC men showed no consistent differences in EEG power. High-frequency EEG power was not related to clinical or subjective sleep ratings in PI.

Conclusions:

Women with PI, but not men, showed increased high-frequency and low-frequency EEG activity during NREM sleep compared to GSC, particularly in early NREM periods. Sex and NREM period may moderate quantitative EEG differences between PI and GSC.

Citation:

Buysse DJ; Germain A; Hall ML; Moul DE; Nofzinger EA; Begley A; Ehlers CL; Thompson W; Kupfer DJ. EEG spectral analysis in primary insomnia: NREM period effects and sex differences. SLEEP 2008;31(12):1673–1682.     

Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients

Primary insomnia (PI) is characterized by low subjective sleep quality which cannot always be verified using polysomnography (PSG). To shed light on this discrepancy, subjective estimates of sleep and PSG variables were compared in patients with PI and good sleeper controls (GSC). 100 patients with PI (age: 42.57 +/- 12.50 years, medication free for at least 14 days) and 100 GSC (41.12 +/- 13.99 years) with a sex distribution of 46 men and 54 women in each group were included. Both PSG and questionnaire variables showed clear impairments of sleep quality in PI compared with GSC. The arousal index within total sleep time was increased, which was mainly because of a strong increase within rapid eye movement (REM) sleep. Subjectively, more PI than GSC subjects estimated wake times longer than obtained from PSG. Linear modeling analysis of subjective wake time in terms of PSG parameters revealed that in addition to PSG defined wake time, REM sleep time contributed significantly to subjective wake time. This REM sleep contribution was larger for PI than for GSC subjects. The findings suggest that REM sleep-related processes might contribute to subjectively disturbed sleep and the perception of waking time in patients with PI.     

补阴泻阳穴位按摩法对失眠症患者睡眠质量及心理状态的影响

目的观察补阴泻阳穴位按摩法对失眠症患者睡眠质量及心理状态的影响。方法选取2018年2月至2019年2月于我院门诊就诊的90例失眠症患者,根据入院顺序将其随机分为常规组(45例,常规干预)和按摩组(45例,常规干预基础上进行补阴泻阳穴位按摩法)。比较两组临床疗效、睡眠质量及心理状态评分。结果按摩组治疗总有效率高于常规组(P<0.05)。治疗后,两组睡眠效率较治疗前升高,ISI评分较治疗前降低,且按摩组优于常规组(P<0.05)。治疗后,两组SAI、TAI评分均较治疗前降低,且按摩组低于常规组(P<0.05)。结论补阴泻阳穴位按摩法治疗失眠症能够显著改善患者睡眠质量,缓解患者焦虑状态,提高临床疗效。     

Tuina for perimenopausal insomnia: A protocol for systematic review and meta-analysis

Background:Insomnia in perimenopausal women has a negative impact on quality of life and increases health care costs. With the increasing incidence of the disease, Tuina has been accepted by perimenopausal women. The purpose of this study is to explore the effectiveness and safety of Tuina for perimenopausal insomnia.Methods:We will search 9 electronic databases: Chinese Biomedical Literature Database, Cochrane Library, China National Knowledge Infrastructure, EMBASE, MEDLINE, Web of Science, PubMed, Wan fang, Chinese Scientific Journal Database, and 1 clinical trials register platform: WHO International Clinical Trials Registry Platform. All relevant randomized controlled trial using Tuina for perimenopausal insomnia will be included. Two reviewers will independently screen date, and meta-analysis will be performed with RevMan (V5.3.5) software.Results:This study will provide an evidence of Tuina for perimenopausal insomnia.Conclusion:This study will provide a reliable evidence for the evaluation of the efficacy and side effects of Tuina in the treatment of perimenopausal insomnia.PROSPERO registration number:CRD42021259017.Ethics and dissemination:This systematics review will evaluate the efficacy and safety of tuina in the treatment of perimenopausal insomnia. Since all the data included were published, the systematic review did not require ethical approval.     

彭筱平教授从火热论治失眠经验举隅

睡眠占据人一生中1/3的时间,拥有良好的睡眠是所有人的需要,而失眠作为临床中常见病、多发病,严重影响人们的身心健康,如何有效治疗失眠一直是关注的焦点。彭筱平教授认为火热之邪是失眠的重要发病因素,火热之邪上扰心神是失眠的重要发病病机,本文介绍了彭教授从火热论治失眠,以清热泻火,滋阴安神为基本治法治疗失眠的临证经验。     

张斌霞调治慢性失眠经验

张斌霞教授治疗慢性失眠遵循平调阴阳,补虚泻实的总治法,认为慢性失眠发病多与心、肝、脾、肾四脏密切相关,以心肾为根本,肝胆为枢机,脾胃为通路,在治疗过程中根据辨证,侧重有所不同。张教授治疗失眠强调以阴阳为纲,认为不论采用何种治疗都应遵循"平调阴阳,引阳入阴"的治疗大法,不可忽视阴阳变化,而一味安神。张教授治疗慢性失眠,以疏利肝胆为法,方用柴胡加龙骨牡蛎汤加减,尤爱甘松一药,因其性甘温,除醒脾健胃外,还可理气开郁,有肝脾同调之功。张教授治疗慢性失眠避用破气消积药物,取厚朴花而非厚朴,因厚朴花理气化湿无厚朴燥湿下气之力,花类药物质轻升散,可更好助脾胃升发清阳。张教授认为,慢性失眠病程较长,具有久病多虚、久病及肾、久病入络、久病致郁、久郁生痰特点,补虚多从肾入手,根据病邪性质,选择性配伍化瘀通络、疏肝解郁、理气化痰之品,常有良效。     

枣仁安神胶囊治疗失眠症有效性及安全性的Meta分析

目的系统评价枣仁安神胶囊治疗失眠症的有效性及安全性。方法通过检索Pub Med、EBSCO、theCochrane Library、中国知网(CNKI)、维普中文科技期刊(VIP)、万方数字化期刊(Wanfang Data)等数据库,收集枣仁安神胶囊治疗失眠症的随机对照试验(RCT),检索时间均为建库时间至2019年6月。对符合纳入标准的研究进行质量评价,提取数据,并用Rev Man 5.3软件进行Meta分析。结果共纳入10项RCT,涉及935例患者。枣仁安神胶囊治疗失眠症的临床疗效[RR=1.04,95%CI(0.97,1.10),P=0.26]、匹兹堡睡眠质量指数(PSQI)评分[MD=-0.40,95%CI(-1.94,1.14),P=0.61]相当于苯二氮受体激动剂,二者比较无统计学意义,但在头晕头痛[RR=0.07,95%CI(0.02,0.18),P<0.000 01]、嗜睡[RR=0.13,95%CI(0.05,0.31),P<0.000 01]、宿醉[RR=0.14,95%CI(0.03,0.62),P=0.009]、疲乏[RR=0.47,95%CI(0.31,0.70),P=0.000 2]等不良反应发生率远低于苯二氮受体激动剂。结论枣仁安神胶囊治疗失眠症疗效确切,不良反应少而轻。基于纳入研究数量和质量的限制,结论仍需更多的多中心、高质量的随机对照试验加以验证。     

清心汤合枕中丹加减治疗心肾不交型失眠的临床观察

目的:观察清心汤合枕中丹加减治疗心肾不交型失眠的临床疗效。方法:将100例患者根据入组先后顺序,按随机数字表法随机分为对照组和治疗组,各50例。对照组口服艾司唑仑,1. 0 mg/次,睡前服用;观察组口服清心汤合枕中丹加减,1日/剂,2次/日,连续服用6日,休息1日。疗程均为8周。比较两组患者匹兹堡睡眠质量指数(PSQI),监测多导睡眠图[觉醒时间(AWT),睡眠总时间(TST),睡眠维持率(SE),睡眠潜伏期(SL),快动眼睡眠相潜伏期(RL),觉醒次数(AT)],检测血清单胺类神经递质[5-羟吲哚乙酸(5-HIAA),5-羟色胺(5-HT),去甲肾上腺素(NE)和β-内啡肽(β-EP)]的含量,观察两组治疗后及随访(治疗后30 d)临床疗效,研究期间不良反应发生率。结果:研究期间脱落7例。治疗组总有效率89. 6%(43/48),高于对照组的71. 1%(32/45)(P 0. 05);治疗组患者PSQI评分明显低于对照组(P 0. 05);治疗组患者TST,SE和RL较对照组升高(P 0. 05),AWT,SL,AT较对照组降低(P 0. 05);治疗组患者5-HIAA,5-HT和β-EP含量高于对照组(P 0. 05),NE含量低于对照组(P 0. 05);对照组不良反应发生率22. 2%(10/45),治疗组未见明显不良反应。结论:清心汤合枕中丹加减可明显改善心肾不交型失眠的临床症状,单胺类神经递质,不良反应发生率低,值得临床推广应用。     

围绝经期失眠症肝郁患者的常见症状及证素特点研究

目的探讨围绝经期失眠症肝郁患者的常见症状及证素特点,为围绝经期失眠症的临床治疗提供思路。方法选择100例围绝经期失眠症肝郁患者,采用证素积分的方法,通过四诊资料规范化采集,分析围绝经期失眠症肝郁患者的症状分布情况及不同肝郁分级患者的病位、病性证素特点。结果围绝经期失眠肝郁患者症状发生频率较高的依次为易激动、潮热汗出、眩晕、骨关节肌肉痛、感觉异常等;主要病位证素为肾、脾、胞宫和心神;主要实证病性证素为痰、湿、血瘀和热;虚证病性证素为阴虚、气虚、血虚与阳虚。结论围绝经期失眠肝郁患者多兼肾、脾、胞宫和心神等脏腑的病理改变,虚实夹杂为本病的基本病机特点。