Psychometric properties and accuracy of the European Portuguese version of the Pittsburgh Sleep Quality Index in clinical and non-clinical samples

To assess the reliability and validity concerning the formal European Portuguese version of the Pittsburgh Sleep Quality Index [PSQI (EP)], its accuracy, and optimal cut-off point. N = 564 volunteers (18–80 years old) recruited in several settings (e.g., university campuses; work place; home; sleep consultations), agreed to complete the PSQI (EP). Subgroups completed additional measures: Insomnia Severity Index (ISI), STOP-Bang, Glasgow Sleep Effort Scale, or responded to a supplementary question about perceived sleep problems. As to internal consistency, Cronbach’s α = 0.75. Principal component analysis revealed a unidimensional structure. Six PSQI (EP) components and total scores were able to discriminate individuals who did versus did not describe having any sleep problem; all PSQI (EP) scores were significantly higher (denoting poorer quality) in participants suffering from a sleep disorder. Most Cohen’s d values showed large magnitude associations. PSQI (EP) and ISI scores were highly correlated, but no significant correlations were found considering STOP-Bang. ROC analysis confirmed an optimal cut-off point > 5 of the PSQI (EP) to detect self-reported poor/good sleepers in non-clinical settings. To discriminate non-clinical from clinical sleep patients, the optimal cutoff was > 7, and AUC = 0.94. The European Portuguese version of the PSQI performs as a reliable, valid, and accurate measure of overall sleep quality in Portuguese participants. Furthermore, results suggest that PSQI (EP) can discriminate poor sleepers in non-clinical settings, in addition to demonstrating high clinical accuracy in signaling potential sleep-disorder cases. In conclusion, the PSQI (EP) is a suitable tool to assess general sleep quality in Portuguese participants, both for clinical or non-clinical applications.

     

An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary Insomnia

Insomnia is a sleeping disorder, usually studied from a behavioural perspective, with a focus on somatic and cognitive arousal. Recent studies have suggested that an impairment of information processes due to the presence of cortical hyperarousal might interfere with normal sleep onset and/or consolidation. As such, a treatment modality focussing on CNS arousal, and thus influencing information processing, might be of interest. Seventien insomnia patients were randomly assigned to either a tele-neurofeedback (n = 9) or an electromyography tele-biofeedback (n = 8) protocol. Twelve healthy controls were used to compare baseline sleep measures. A polysomnography was performed pre and post treatment. Total Sleep Time (TST), was considered as our primary outcome variable. Sleep latency decreased pre to post treatment in both groups, but a significant improvement in TST was found only after the neurofeedback (NFB) protocol. Furthermore, sleep logs at home showed an overall improvement only in the neurofeedback group, whereas the sleep logs in the lab remained the same pre to post training. Only NFB training resulted in an increase in TST. The mixed results concerning perception of sleep might be related to methodological issues, such as the different locations of the training and sleep measurements.     

Neurofeedback for Insomnia: A Pilot Study of <Emphasis Type="Italic">Z</Emphasis>-Score SMR and Individualized Protocols

Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p < .005), Pittsburgh Sleep Quality Inventory (PSQI p < .0001), PSQI Sleep Efficiency (p < .007), and Quality of Life Inventory (p < .02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p < .001) which were lowered post-treatment (paired z-tests p < .001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.     

Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): Reliability,initial validity and normative scores in higher education students

Based on successive samples totaling more than 5000 higher education students, we scrutinized the reliability, structure, initial validity and normative scores of a brief self-report seven-item scale to screen for the continuum of nighttime insomnia complaints/perceived sleep quality, used by our team for more than a decade, henceforth labeled the Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS). In study/sample 1 (n?=?1654), the items were developed based on part of a larger survey on higher education sleep–wake patterns. The test–retest study was conducted in an independent small group (n?=?33) with a 2–8 week gap. In study/sample 2 (n?=?360), focused mainly on validity, the BaSIQS was completed together with the Pittsburgh Sleep Quality Index (PSQI). In study 3, a large recent sample of students from universities all over the country (n?=?2995) answered the BaSIQS items, based on which normative scores were determined, and an additional question on perceived sleep problems in order to further analyze the scale’s validity. Regarding reliability, Cronbach alpha coefficients were systematically higher than 0.7, and the test–retest correlation coefficient was greater than 0.8. Structure analyses revealed consistently satisfactory two-factor and single-factor solutions. Concerning validity analyses, BaSIQS scores were significantly correlated with PSQI component scores and overall score (r?=?0.652 corresponding to a large association); mean scores were significantly higher in those students classifying themselves as having sleep problems (p?<?0.0001, d?=?0.99 corresponding to a large effect size). In conclusion, the BaSIQS is very easy to administer, and appears to be a reliable and valid scale in higher education students. It might be a convenient short tool in research and applied settings to rapidly assess sleep quality or screen for insomnia complaints, and it may be easily used in other populations with minor adaptations.     

Insomnia and Relationship with Anxiety in University Students: A Cross-Sectional Designed Study

Purpose

Sleep disorders (SDs) are now recognized as a public health concern with considerable psychiatric and societal consequences specifically on the academic life of students. The aims of this study were to assess SDs in a group of university students in Lebanon and to examine the relationship between SDs and anxiety.

Methods

An observational cross-sectional study was conducted at Saint-Joseph University, Lebanon, during the academic year 2013–2014. Four questionnaires were face-to-face administered to 462 students after obtaining their written consent: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Generalized Anxiety Disorder 7-item scale (GAD-7).

Results

The prevalence of clinically significant insomnia was 10.6% (95% CI: 7.8–13.4%), more frequent in first year students. ISI mean score was 10.06 (SD = 3.76). 37.1% of the participants were poor sleepers. Excessive daytime sleepiness (EDS) and poor sleep were significantly more frequent among participants with clinical insomnia (p = 0.031 and 0.001 respectively). Clinically significant anxiety was more frequent in students suffering from clinical insomnia (p = 0.006) and in poor sleepers (p = 0.003). 50.8% of the participants with clinically significant anxiety presented EDS versus 30.9% of those with no clinically significant anxiety (p<0.0001).

Conclusions

The magnitude of SDs in this sample of Lebanese university students demonstrate the importance of examining sleep health in this population. Moreover, the link between SD and anxiety reminds us of the importance of treating anxiety as soon as detected and not simply targeting the reduction of sleep problems.     

BaSIQS - basic scale on insomnia complaints and quality of sleep: reliability,norms, validity,and accuracy studies,based on clinical and community samples

This research focused on the Basic Scale on Insomnia Symptoms and Quality of Sleep (BaSIQS), formerly validated in undergraduates using the Pittsburgh Sleep Quality Index (PSQI), and aimed to expand internal consistency analysis, examine thoroughly its validity, and determine its clinical accuracy. Considering objective and subjective measures, recruiting non-clinical and clinical samples, this research implemented a comprehensive approach to examine convergent and discriminant validity, confirmatory factor analyses, and the BaSIQS sensitivity and specificity. The BaSIQS was filled out along with the Insomnia Severity Index (ISI), questions on sleep-wake schedules, Composite Scale of Morningness (CSM) and Brief Symptom Inventory-18 (BSI-18) by 1198 adults, 18–64 years old, plus another 30 who wore actimeters, recruited in community settings. A clinical group of 30 chronic insomnia disorder patients also participated. Cronbach alpha coefficient was 0.80. A two-factor structure was confirmed. The association between BaSIQS and ISI was large, whereas actigraphy correlations were medium or small. Medium to non-significant correlations were found concerning conceptually different self-report measures. Comparing the clinic and control groups, the former showed poorer sleep, with a large effect size. Receiver operating characteristic analysis revealed an area under curve = 0.9, and an optimal cut-off score >15. In conclusion, results on reliability, validity, and accuracy provide support to the utility of the BaSIQS both in community and clinical settings, for research and practical purposes.     

Short and long-term effects of unguided internet-based cognitive behavioral therapy for chronic insomnia in morning and evening persons: a post-hoc analysis

ABSTRACT

A post-hoc analysis comparing morning and evening persons with insomnia on sleep and mental health characteristics was conducted in order to investigate whether an Internet-based cognitive behavioral therapy for insomnia (ICBTi) was effective both for morning and evening persons. Adult patients (N = 178, mean age = 44.8, 67% females) with insomnia were randomized to either ICBTi (N = 92; morning persons = 41; evening persons = 51) or a web-based patient education condition (N = 86; morning persons = 44; evening persons = 42). All patients were assessed with sleep diaries, the Insomnia Severity Index (ISI), the Bergen Insomnia Scale (BIS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Hospital Anxiety and Depression Scale (HADS) and the Chalder Fatigue Scale (CFQ). Patients were characterized as morning or evening persons based on a median split on the Horne-Östberg Morningness Eveningness Questionnaire. Short and long-term effects of treatment were examined with mixed-model repeated-measures analyses. Morning and evening persons did not differ in terms of age, gender or educational status. At baseline, morning persons had more wake time after sleep onset (d= 0.54, p < .001) and more early morning awakening (d= 0.38, p < .05) compared to evening persons, while evening persons reported longer sleep onset latency (d= 0.60, p < .001), more time in bed (d= 0.56, p < .001), longer total sleep time (d= 0.45, p < .01), more fatigue (d= 0.31, p < .05) and more dysfunctional beliefs and attitudes about sleep (d= 0.47, p < .01). Despite these differences at baseline, both morning and evening persons receiving ICBTi benefitted more across most measures compared to morning and evening persons who received patient education. For morning persons in the ICBTi group, ISI scores were reduced from 17.3 at baseline to 8.8 (d_pre-post = 2.48, p < .001) at post-assessment, and to 10.0 at 18-month follow up (d_pre-post18m = 2.13, p < .001). Comparable results were found for evening persons in the ICBTi group, with a reduction in ISI scores from 17.4 at baseline to 8.6 (d_pre-post = 2.24, p < .001) at post-assessment, and to 8.7 at 18-month follow up (d_pre-post18m = 2.19, p < .001). Similar results were found on the BIS, DBAS, HADS, CFQ and sleep diary data. Despite different insomnia symptomatology between the two groups, the current study suggests that ICBTi is effective across scores on the morningness-eveningness dimension. The study was pre-registered at: ClinicalTrials.gov Identifier: NCT02261272.     

酸枣仁汤合百合地黄汤加减联合针刺对脑卒中后阴虚火旺型失眠患者睡眠质量及血清神经递质水平的影响

摘要 目的：观察酸枣仁汤合百合地黄汤加减联合针刺对脑卒中后阴虚火旺型失眠患者睡眠质量及血清神经递质水平的影响。方法：所选病例均来自于我院2018年3月~2023年2月期间收治的脑卒中后阴虚火旺型失眠患者,共计126例。按照随机数字表法将患者分为对照组（常规西医治疗+针刺治疗,63例）和观察组（对照组的基础上接受酸枣仁汤合百合地黄汤加减治疗,63例）。对比两组疗效、中医证候积分、量表评分[匹兹堡睡眠质量指数量表（PSQI）、睡眠状况自评量表（SRSS）]、血清神经递质[5-羟色胺（5-HT）和多巴胺（DA）]。结果：观察组的临床总有效率高于对照组,比较有统计学差异（P<0.05）。两组治疗后入睡困难、易醒早醒、心悸易惊、手足心热、头晕耳鸣、口干咽燥评分下降,且观察组低于对照组,比较均有统计学差异（P<0.05）。两组治疗后PSQI评分、SRSS评分下降,且观察组低于对照组,比较均有统计学差异（P<0.05）。两组治疗后DA下降,5-HT升高,且观察组的改善幅度大于对照组,比较均有统计学差异（P<0.05）。结论：酸枣仁汤合百合地黄汤加减联合针刺治疗脑卒中后阴虚火旺型失眠,可有效改善失眠症状,调节血清5-HT、DA水平。     

益气安神膏对心脾两虚型失眠患者睡眠质量及中医证候疗效的影响

目的:观察益气安神膏对心脾两虚型失眠患者睡眠质量及中医症候疗效的影响,为膏方应用于失眠调理提供理论依据。方法:选取2016年10月至2017年10月来广州中医药大学第一附属医院就诊的70例心脾两虚型失眠患者作为研究对象,按照就诊顺序,由电脑产生随机数字,根据数字奇偶性分为对照组(35例)和试验组(35例)。在认知行为治疗(CBT-I)干预基础上,试验组予口服益气安神膏1匙(约15g)/次,每日2次,对照组予口服归脾丸10丸/次,每日3次,4周为1疗程,两组均连续服用8周2疗程。采用匹兹堡睡眠质量指数量表(PSQI)、中医证候评分量表评分评估睡眠质量及中医证候疗效。结果:试验组总有效率为94.3%(治愈2例,有效31例),高于对照组的77.1%(治愈1例,有效26例),差异有统计学意义(P0.05)。治疗前,两组PSQI评分差异无统计学意义(P0.05);治疗后,试验组得分(8.1±2.8)分,对照组得分(10.4±3.8)分,前者明显低于后者,差异具有统计学意义(P0.05)。中医证候疗效方面,相较于对照组,试验组疗效更佳,差异有统计学意义(P0.05)。结论:益气安神膏在改善睡眠质量及中医证候疗效方面均优于归脾丸,其临床疗效明显,服用方便,可适用于临床慢性失眠患者的调理。     

Healthcare-Related Regret among Nurses and Physicians Is Associated with Self-Rated Insomnia Severity: A Cross-Sectional Study

To examine the association between healthcare-related regrets and sleep difficulties among nurses and physicians, we surveyed 240 nurses and 220 physicians at the University Hospitals of Geneva. Regret intensity and regret coping were measured using validated scales. Sleep difficulties were measured using the Insomnia Severity Index (ISI), and an additional question assessed the frequency of sleeping pill use. After controlling for sex, profession, years of experience, rate of employment, and depression as well as for all other regret-related variables, the following variables remained significantly associated with self-rated severity of insomnia: regret intensity (slope = 1.32, p = 0.007, 95%CI: [0.36; 2.29], std. coefficient = 0.16) and maladaptive (e.g., rumination) emotion-focused coping (slope = 1.57, p = 0.002, 95%CI: [0.60; 2.55], std. coefficient = 0.17) remained significant predictors of self-rated insomnia severity. If these cross-sectional associations represent causal effects, the development of regret-management programs may represent a promising approach to mitigating sleep difficulties of healthcare professionals.     

3111T/C CLOCK GENE POLYMORPHISM IS NOT ASSOCIATED WITH SLEEP DISTURBANCES IN UNTREATED DEPRESSED PATIENTS

Sleep patterns, frequently altered in depression, have been hypothesized to be under genetic control. The circadian locomotor output cycles kaput (CLOCK) T3111C variant has been studied in association with sleep disturbances in depressed patients. The aim of this study was to investigate possible effects of T3111C CLOCK on insomnia, daytime sleepiness, sleep quality, and depression severity in a sample of 100 major depressive disorder patients. Inclusion criteria were: major depressive disorder, drug-free for any antidepressant and/or benzodiazepines for at least four weeks previously to the study, and a minimum score of >17 on the Hamilton Rating Scale for Depression. The Morningness–Eveningness Questionnaire, Epworth Sleepiness Scale, Athens Insomnia Scale, and Pittsburgh Sleep Quality Index were applied. No significant difference was found concerning genotype or allele groups and Hamilton Rating Scale for Depression items or clusters. No difference was found between genotypes and comorbidity, chronotype distribution, Epworth Sleepiness Scale, Athens Insomnia Scale, or Pittsburgh Sleep Quality Index total scores. Overall, the present findings did not support the hypothesis of an effect of the T3111C CLOCK variant on sleep disturbances in major depressive disorder. Further analysis of clock machinery will clarify the contribution of clock genes to the maintenance of mental health. (Author correspondence: alessandro.serretti@unibo.it)     

A Pilot Study of Audio–Visual Stimulation as a Self-Care Treatment for Insomnia in Adults with Insomnia and Chronic Pain

This pilot study tested the efficacy of an audio–visual stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre–post design. Participants self-administered a 30-min AVS program nightly at bedtime for 1 month. Sleep and pain were assessed at baseline and at the conclusion of the 4-week intervention phase. Nine adults (mean age 33 ± 15.8 years; female, 89 %) completed the study. After using the AVS device for 4 weeks, significant improvement was seen in reported insomnia (ISI, p = 0.003), pain severity (BPI, p = 0.005), and pain interference with functioning (BPI, p = 0.001). Large effect sizes (Partial η² 0.20–0.94) (Cohen’s d 0.44–1.45) were observed. The results of this pilot study suggest that the AVS program may be efficacious in decreasing both insomnia and pain symptoms. In order to better assess the efficacy of AVS for sleep promotion and possible pain reduction, more definitive randomized controlled trials will be needed. These should include appropriate sample sizes, objective measures of sleep and pain, and longitudinal follow-up.     

The Interplay of Stress and Sleep Impacts BDNF Level

Background

Sleep plays a pivotal role in normal biological functions. Sleep loss results in higher stress vulnerability and is often found in mental disorders. There is evidence that brain-derived neurotrophic factor (BDNF) could be a central player in this relationship. Recently, we could demonstrate that subjects suffering from current symptoms of insomnia exhibited significantly decreased serum BDNF levels compared with sleep-healthy controls. In accordance with the paradigm indicating a link between sleep and BDNF, we aimed to investigate if the stress system influences the association between sleep and BDNF.

Methodology/Principal Findings

Participants with current symptoms of insomnia plus a former diagnosis of Restless Legs Syndrome (RLS) and/or Periodic Limb Movement (PLM) and sleep healthy controls were included in the study. They completed questionnaires on sleep (ISI, Insomnia Severity Index) and stress (PSS, Perceived Stress Scale) and provided a blood sample for determination of serum BDNF. We found a significant interaction between stress and insomnia with an impact on serum BDNF levels. Moreover, insomnia severity groups and score on the PSS each revealed a significant main effect on serum BDNF levels. Insomnia severity was associated with increased stress experience affecting serum BDNF levels. Of note, the association between stress and BDNF was only observed in subjects without insomnia. Using a mediation model, sleep was revealed as a mediator of the association between stress experience and serum BDNF levels.

Conclusions

This is the first study to show that the interplay between stress and sleep impacts BDNF levels, suggesting an important role of this relationship in the pathogenesis of stress-associated mental disorders. Hence, we suggest sleep as a key mediator at the connection between stress and BDNF. Whether sleep is maintained or disturbed might explain why some individuals are able to handle a certain stress load while others develop a mental disorder.     

Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal,Population-Based Study

Background

Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.

Methods

A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.

Results

After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.

Limitations

Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.

Conclusions

Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.     

Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep–Wake Diaries

There is good evidence for cognitive and physiological arousal in chronic insomnia. Accordingly, clinical trial studies of insomnia treatments aimed at reducing arousal, including relaxation and meditation, have reported positive results. Yoga is a multicomponent practice that is also known to be effective in reducing arousal, although it has not been well evaluated as a treatment for insomnia. In this preliminary study, a simple daily yoga treatment was evaluated in a chronic insomnia population consisting of sleep-onset and/or sleep-maintenance insomnia and primary or secondary insomnia. Participants maintained sleep–wake diaries during a pretreatment 2-week baseline and a subsequent 8-week intervention, in which they practiced the treatment on their own following a single in-person training session with subsequent brief in-person and telephone follow-ups. Sleep efficiency (SE), total sleep time (TST), total wake time (TWT), sleep onset latency (SOL), wake time after sleep onset (WASO), number of awakenings, and sleep quality measures were derived from sleep–wake diary entries and were averaged in 2-week intervals. For 20 participants completing the protocol, statistically significant improvements were observed in SE, TST, TWT, SOL, and WASO at end-treatment as compared with pretreatment values.     

Dietary Patterns,Metabolic Markers and Subjective Sleep Measures in Resident Physicians

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p?=?0.004). Men displayed significantly greater body mass index (BMI) values (p?=?0.002) and self-reported weight gain after the beginning of residency (p?=?0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p?=?0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p?<?0.005), hs-CRP (p?=?0.04), and cortisol (p?=?0.009) values than men. The elevated prevalence of hypertriglyceridemia and abnormal values of low-density lipoprotein cholesterol (LDL-C; >100?mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the examined resident physicians. Based on current recommendations, a high prevalence of low sleep quality and excessive daytime sleepiness was identified. These observations indicate the need to monitor health status and develop actions to reassess the workload of medical residency and the need for permission to perform extra night shifts for medical residents to avoid worsening health problems in these individuals.     

Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

Patients with attention-deficit/hyperactivity disorder (ADHD) often exhibit disrupted sleep and circadian rhythms. Determination of whether sleep disturbance and/or circadian disruption are differentially associated with symptom severity is necessary to guide development of future treatment strategies. Therefore, we measured sleep and ADHD symptoms in participants aged 19–65 who met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria for ADHD and insomnia without psychiatric comorbidities by monitoring actigraphy and daily sleep logs for 2 wks, as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), the ADHD Rating Scale (ADHD-RS), and a clinic-designed sleep behavior questionnaire. Principal components analysis identified correlated circadian- and sleep-related variables in all participants with ADHD who completed the study (n?=?24). The identified components were entered into a backwards stepwise linear regression analysis, which indicated that delayed sleep timing and increased sleepiness (ESS) (but not sleep duration or sleep efficiency) significantly predicted greater severity of both hyperactive-impulsive and inattentive ADHD symptoms (p <?.05 for partial regression coefficients). In addition, combined subtypes had the most impaired age-adjusted sleep quality (PSQI scores; p?<?.05 compared with healthy controls; n?=?13), and 91.7% of them reported going to bed late due to being “not tired/too keyed up to sleep” compared with 57.2% and 50% of inattentive and symptom-controlled participants, respectively (p?<?.05). In conclusion, the results of this study suggest that ADHD symptom severity correlates with delayed sleep timing and daytime sleepiness, suggesting that treatment interventions aimed at advancing circadian phase may improve daytime sleepiness. In addition, ADHD adults with combined hyperactive-impulsive and inattentive symptoms have decreased sleep quality as well as the delayed sleep timing of predominately inattentive subtypes. (Author correspondence: rfargason@uab.edu)     

Serum melatonin levels and insomnia in patients with Machado-Joseph Disease

We previously reported a patient with Machado-Joseph Disease (MJD) who had severe insomnia and a low serum melatonin (MLT) level, and whose insomnia was alleviated by oral MLT replacement therapy. The aims of this study were to examine whether patients with MJD are likely to have insomnia, and whether there is a relationship between the degree of insomnia and the serum MLT level among patients with MJD. This study included 8 patients with MJD. A 58-year-old-patient with cervical spondylosis was also included in this study to check the condition of the test room for sleeping. All patients filled out the Japanese version of Pittsburgh Sleep Quality Index (PSQI-J) questionnaire. We obtained blood samples at 12:00 and 24:00 hours to measure the MLT level. We checked the sleep condition of the patient once an hour and recorded the grade in sleep-logs: the grades of sleep condition were asleep, sleepy, or awake. Statistical analyses were performed to search for correlations between the PSQI score and the serum MLT level or actual sleep time using Spearman’s rank correlation coefficient. Seven of the 8 MJD patients had a total PSQI score of above 5.5 (cut-off level). The daytime MLT level (at 12:00 hours) was below 2.8 pg/mL in all 8 patients, whereas the mean night-time MLT level (at 24:00 hours) of the MJD patients (23.6 ± 17.5 pg/mL) was lower than that of the control patient (43.0 pg/mL) and also lower than the reported cut-off level among healthy people aged 30–50 years (55.5 pg/mL). There was a negative correlation between the total PSQI score and the serum MLT level among the MJD patients (P < 0.05). Our results show that a low serum MLT level may contribute to insomnia in patients with MJD.

     

Block the light and sleep well: Evening blue light filtration as a part of cognitive behavioral therapy for insomnia

ABSTRACT

The objective of the present study was to assess the effect of combining CBT-I with wearing blue-light blocking glasses 90 min prior to bedtime on subjective and objective sleep parameters and daily symptoms (anxiety, depression, hyperarousal). Thirty patients (mean age 48.1 ± 16.13 years, range 21–71, 15 men/15 women) completed a CBT-I group therapy program, with groups randomly assigned to either “active” (blue-light filtering glasses) condition or “placebo” (glasses without filtering properties) condition. Patients were continually monitored by wristwatch actigraphy, kept their sleep diaries and completed a standard questionnaire battery at admission and after the end of the program. Statistical analyses showed a greater reduction of BAI score in “active” (4.33 ± 4.58) versus “placebo” (?0.92 ± 3.68) groups of patients [F = 6.389, p = .019, Cohen’s d = 1.26] and significant prolongation of subjective total sleep time in “active” (?36.88 ± 48.68 min.) versus “placebo” (7.04 ± 47.50 min.) [F = 8.56, p < .01, d = 0.91] group. When pre- and post-treatment results were compared in both groups separately, using paired-samples t-tests, significant differences were observed also in the active group for BDI-II score (t = 3.66, p = .003, Cohen’s d = 0.95) and HAS score (t = 2.90, p = .012, Cohen’s d = 0.75). No significant differences were found in the placebo group. In active group, there was also a significant reduction of subjective sleep latency (t = 2.65, p = .021, d = 0.73) and an increase of subjective total sleep time (t = ?2.73, p = .018, d = ?0.76) without change in objective sleep duration which was significantly shortened in the placebo group. We provide further evidence that blocking short-wavelength light in the evening hours may be beneficial for patients suffering from insomnia.