Sleep Disturbance (sleep + disturbance)

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Distribution within Medical Sciences

Selected Abstracts

Sleep Disturbances Reported by Refractory Partial-onset Epilepsy Patients Receiving Polytherapy

EPILEPSIA, Issue 7 2006
Xiao Xu
Summary:,Purpose: Although sleep disturbances are common in epilepsy, few studies examined the prevalence and impact of sleep disturbance in epilepsy patients. This study investigates these in a cross-sectional survey. Methods: We surveyed 201 adult partial-onset epilepsy patients taking stable regimens of two or more antiepileptic medications. Community-based U.S. neurologists recorded patient demographic and clinical information. Patients completed the Medical Outcomes Study (MOS) Sleep Scale, the Quality of Life in Epilepsy-10 instrument (QOLIE-10), and the EuroQol-5D (EQ-5D). We evaluated the associations of sleep with health-related quality of life and clinical and demographic characteristics by using correlation coefficients and analysis of variance. Results: Mean (SD) age was 44.2 (12.5); 34% of patients had diagnosed sleep disturbances; 10% received prescription sleep medications. Patients with sleep disturbance reported poorer mean QOLIE-10 (55.2 vs. 63.7; p = 0.006) and EQ-5D (0.49 vs. 0.71; p < 0.001) scores relative to those without sleep disturbances. The mean (SD) MOS Sleep Problems Index score was 36.2 (20.8), worse than the general population mean of 26. Patients with physician-reported anxiety or depression had more sleep problems than did those without these comorbidities. Higher Sleep Problems Index scores were significantly (p < 0.001) correlated with poorer QOLIE-10 (r=,0.49) and EQ-5D (r=,0.56) scores. Patients experiencing a seizure within the past week reported higher MOS Sleep Problems Index scores than did those with a less-recent seizure (41.5 vs. 32.8; p = 0.003). Conclusions: Diagnosed and self-reported sleep disturbances in patients with partial-onset epilepsy are frequently overlooked, but are negatively associated with everyday functioning and well-being, and therefore contribute significantly to the burden of epilepsy. [source]

Patterns and predictors of sleep pattern disturbance after cardiac surgery

Nancy S. Redeker
Abstract The purposes of this study were to examine changes in sleep patterns after cardiac surgery and the contributions of preoperative sleep to postoperative sleep. Seventy-two cardiac surgery patients wore wrist actigraphs for 3 days during the preoperative period (T1) and the 1st (T2), 4th (T3), and 8th (T4) postoperative weeks. They completed the Pittsburgh Sleep Quality Index at T1, T3, and T4. Sleep was most disturbed during the 1st postoperative week and improved at T3 and T4. Overall, sleep pattern disturbance was higher at T3 and T4 than at T1. Age, gender, preoperative New York Heart Association Functional Class, and preoperative sleep variables explained 20%,50% of the variance in sleep at T2, T3, and T4. Sleep disturbance is present preoperatively and continues during the postoperative period. © 2004 Wiley Periodicals, Inc. Res Nurs Health 27:217,224, 2004 [source]

Sleep disturbances among nursing home residents

Arne Fetveit MD
Abstract Study objectives This study assesses the prevalence and characteristics of sleep disturbances among an entire nursing home population, consisting of 29, mainly demented, long-term patients. Design and setting Sleep was evaluated for 14 consecutive days using actigraphic measurements and nursing staff observations. No alterations were made in every-day routines or medications during the observation period. Measurements and results Actigraphy showed a mean sleep onset latency of one hour and a mean wake after sleep onset of more than two hours, while there was no findings of early morning awakening. Mean sleep efficiency was 75%, and more than 13 hours were spent in bed. 72% of the subjects had sleep efficiency below 85%. Nursing staff reported sleep onset latency of more than 30 minutes in 158 of the 203 analysed days, while early morning awakening was reported in only 12 of 203 days. Actigraphical measurements and nursing staff observations gave similar results. The validity of actigraphy in this population is discussed. Conclusion Sleep disturbances were common among the residents in this nursing home. Sleep onset latency was prolonged, and the patients experienced frequent wake bouts after sleep onset. The diminished ability of sustained sleep may have been influenced by the prolonged time in bed. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Sleep disturbances as a predictor of occupational injuries among public sector workers

Summary The association between disturbed sleep and increased risk of occupational injury has been observed in several cross-sectional and case,control studies, but prospective evidence is lacking. We examined prospectively whether sleep disturbances predicted occupational injuries in a large population of Finnish public sector employees. A total of 48 598 employees working in 10 municipalities and 21 hospitals in various parts of Finland were included. Sleep disturbances were assessed with the four-item Jenkins Sleep Problems Scale. Records of sickness absence due to occupational injury during the year following the survey were obtained from employers' registers. A proportion (9076; 22%) of participants reported disturbed sleep, and 978 (2.4%) had a recorded occupational injury. After adjustment for socio-demographic characteristics, the odds ratio (OR) for occupational injury was 1.38 [95% confidence interval (CI) 1.02,1.87] times higher for men with experiences of disturbed sleep than for those without sleep disturbances, but not significant for women. Of the sub-dimensions of sleep disturbances, the OR for occupational injury was 1.69 (95% CI 1.26,2.26) for women with difficulties initiating sleep, but not significant for men. These associations remained after additional adjustment for work stress, sleep length, obesity, alcohol use and mental health. This study suggests that sleep disturbances are a significant predictor of occupational injuries even after accounting for a range of covariates. [source]

Disturbances in melatonin and core body temperature circadian rhythms after minimal invasive surgery

I. Gögenur
Background:, Sleep disturbances, fatigue and reduced general well-being frequently occur after minimal invasive surgery. The circadian rhythms of melatonin and core body temperature are central to the regulation of normal sleep. The aim of this study was to assess changes in these circadian rhythms after laparoscopic cholecystectomy. Methods:, Twelve women were studied before and after laparoscopic cholecystectomy. The major urinary melatonin metabolite, 6-sulphatoxymelatonin (aMT6s), and the core body temperature were measured for 1 day before and 1 day after surgery. The basal and maximum secretion of aMT6s were determined, as well as the timing and amplitude of aMT6s and the temperature rhythm. The patients' rest,activity and calculated sleep parameters were assessed by actigraphy. Results:, A significant delay in the timing of aMT6s rhythm was observed after surgery [median (range) peak time of aMT6s: after surgery, 05:49 h (02:57,08:23 h); before surgery, 04:32 h (02:18,06:49 h); P, 0.05]. The amplitude of the aMT6s rhythm was also significantly decreased after surgery [after surgery, 7.1 ng aMT6s/mg creatinine (1,15.9 ng); before surgery, 13.2 ng aMT6s/mg creatinine (2.9,22.7 ng); P, 0.005]. There was almost a12-h phase delay of the core body temperature rhythm after surgery [peak time: before surgery, 17:39 h (15:17,22:06 h); after surgery, 05:14 h (03:24,21:43 h); P, 0.01]. Conclusions:, Following laparoscopic cholecystectomy, there was a delay in the timing of the aMT6s rhythm and a decreased evening decline in the temperature rhythm. [source]

Sleep disturbances in Parkinson's disease,

Matthew Menza MD
Abstract Sleep disturbances are very common in patients with PD and are associated with a variety of negative outcomes. The evaluation of sleep disturbances in these patients is complex, as sleep may be affected by a host of primary sleep disorders, other primary medical or psychiatric conditions, reactions to medications, aging or the neuropathophysiology of PD itself. In this article, we review the evaluation of the common disturbances of sleep seen in PD. This includes the primary sleep disorders, the interaction of depression and insomnia, the impact that medications for PD have on sleep, as well as the role of factors such as nocturia, pain, dystonia, akinesia, difficulty turning in bed, and vivid dreaming. The treatment of sleep disturbances in PD is largely unstudied but recommendations based on clinical experience in PD and research studies in other geriatric populations can be made. Important principles include, diagnosis, treating the specific sleep disorder or co-occurring disorder, and control of the motor aspects of PD. © 2010 Movement Disorder Society [source]

Prevalence of insomnia in Poland , results of the National Health Interview Survey

A. Kiejna
Background: Sleep disturbances are one of the most common underdiagnosed and undertreated health problems among the adult population. Objectives: The aim of the study was to assess the prevalence of sleeping problems and their relation to sociodemographic characteristics in the Polish population, based on the results of the National Health Interview Survey carried out by the Central Statistical Office in 1996. Methods: A stratified sampling scheme, involving two steps, was used. Standardized prevalence ratios (SPRs and their 95% confidence intervals) were calculated. Assessment of sleep-related problems was based on six questions. A representative Polish sample (47 924 non-institutionalized, adult respondents) was interviewed. Results: Nearly one-fourth of Polish inhabitants suffered from insomnia. The percentage was significantly higher among women (28.1%) than among men (18.1%). The prevalence of insomnia increased with age and was highest in divorced respondents. Respondents of both sexes with higher educational levels suffered from insomnia less often than individuals with lower levels of education. The problem of insomnia applies in a similar degree to inhabitants of both rural and urban regions. About one-twentieth of inhabitants of Poland experienced recent sleep deterioration related to problems. It was associated positively with age, female gender and lower education. About 20% of the population get up not rested in the morning, women significantly more often than men, urban residents more often than rural ones. Conclusions: Sleep-related problems are common and the results are comparable with those from other countries. The findings have important implications, such as the necessity of better education of the public community about the identification and possibilities of treatment of sleep disturbance. [source]

Seizures and paroxysmal events: symptoms pointing to the diagnosis of pyridoxine-dependent epilepsy and pyridoxine phosphate oxidase deficiency

Aim, We report on seizures, paroxysmal events, and electroencephalogram (EEG) findings in four female infants with pyridoxine-dependent epilepsy (PDE) and in one female with pyridoxine phosphate oxidase deficiency (PNPO). Method, Videos and EEGs were analysed and compared with videos of seizures and paroxysmal events archived from 140 neonates. PDE and PNPO were proven by complete control of seizures once pyridoxine or pyridoxal 5,-phosphate was administered and by recurrence when withdrawn. Mutations in the antiquitin gene were found in three patients and in the PNPO gene in one child. Results, Seizures began within 48 hours after birth in four newborns and at age 3 weeks in one. Frequent multifocal and generalized myoclonic jerks, often intermixed with tonic symptoms, abnormal eye movement, grimacing, or irritability, were observed in all infants with PDE and PNPO, but rarely in the other archived videos of neonates. EEGs were inconstant and frequently no discernable ictal changes were recorded during the seizures and the paroxysmal events. In addition, interictal EEGs were inconclusive, with normal and abnormal recordings. In older children tonic,clonic seizures, abnormal behaviour, inconsolable crying, frightened facial expression, sleep disturbance, loss of consciousness, paraesthesia, or intermittent visual symptoms were described during controlled and uncontrolled withdrawal or insufficient dosage. Interpretation, PDE or PNPO should be considered in infants with prolonged episodes of mixed multifocal myoclonic tonic symptoms, notably when associated with grimacing and abnormal eye movements. [source]

The sleep of co-sleeping infants when they are not co-sleeping: Evidence that co-sleeping is stressful

Melissa Hunsley
Abstract Co-sleeping proponents consider the practice to be "natural" and a potential protection against sudden infant death syndrome (SIDS); others consider the practice of an infant sleeping in the parents' bed for prolonged periods at night to place an infant at risk for harm or death. For this study, co-sleeping was investigated from a different perspective, that is, as a significant early experience to investigate as it may have implications for the infant's development. The sleep of 101 normal, full-term infants was recorded nonintrusively in the home for 24 hr periods when they were 5 weeks and 6 months old. Infants were assigned to three groups: short-term co-sleepers, long-term co-sleepers, and non-co-sleepers. Their sleep states and wakefulness were compared at the two ages and over age. At 5 weeks and 6 months, the long-term co-sleeping infants differed significantly from the non-co-sleepers on a number of measures: At 5 weeks, they showed more quiet sleep and longer bouts of quiet sleep; and at 6 months, they also showed less active sleep, fewer arousals in active sleep, and less wakefulness. Each of these differences indicates a markedly lower arousal level in the long-term co-sleeping infants. This sleep pattern has been repeatedly found to be an indicator of stress. We infer that a major source of stress for these infants is the experience of sleep disturbance documented for infants when they were co-sleeping. Based on extensive evidence for long-term effects of early stress, we conclude that co-sleeping should have significant implications for infants' neurobehavioral development. © 2002 John Wiley & Sons, Inc. Dev Psychobiol 40: 14,22, 2002 [source]

A review of the clinical pharmacology of methamphetamine

ADDICTION, Issue 7 2009
Christopher C. Cruickshank
ABSTRACT Aims To examine the literature regarding clinical pharmacokinetics, direct effects and adverse clinical outcomes associated with methamphetamine use. Methods Relevant literature was identified through a PubMed search. Additional literature was obtained from relevant books and monographs. Findings and conclusions The mean elimination half-life for methamphetamine is approximately 10 hours, with considerable inter-individual variability in pharmacokinetics. Direct effects at low-to-moderate methamphetamine doses (5,30 mg) include arousal, positive mood, cardiac stimulation and acute improvement in cognitive domains such as attention and psychomotor coordination. At higher doses used typically by illicit users (,50 mg), methamphetamine can produce psychosis. Its hypertensive effect can produce a number of acute and chronic cardiovascular complications. Repeated use may induce neurotoxicity, associated with prolonged psychiatric symptoms, cognitive impairment and an increased risk of developing Parkinson's disease. Abrupt cessation of repeated methamphetamine use leads to a withdrawal syndrome consisting of depressed mood, anxiety and sleep disturbance. Acute withdrawal lasts typically for 7,10 days, and residual symptoms associated with neurotoxicity may persist for several months. [source]

Sleep Disturbances Reported by Refractory Partial-onset Epilepsy Patients Receiving Polytherapy

EPILEPSIA, Issue 7 2006
Xiao Xu
Summary:,Purpose: Although sleep disturbances are common in epilepsy, few studies examined the prevalence and impact of sleep disturbance in epilepsy patients. This study investigates these in a cross-sectional survey. Methods: We surveyed 201 adult partial-onset epilepsy patients taking stable regimens of two or more antiepileptic medications. Community-based U.S. neurologists recorded patient demographic and clinical information. Patients completed the Medical Outcomes Study (MOS) Sleep Scale, the Quality of Life in Epilepsy-10 instrument (QOLIE-10), and the EuroQol-5D (EQ-5D). We evaluated the associations of sleep with health-related quality of life and clinical and demographic characteristics by using correlation coefficients and analysis of variance. Results: Mean (SD) age was 44.2 (12.5); 34% of patients had diagnosed sleep disturbances; 10% received prescription sleep medications. Patients with sleep disturbance reported poorer mean QOLIE-10 (55.2 vs. 63.7; p = 0.006) and EQ-5D (0.49 vs. 0.71; p < 0.001) scores relative to those without sleep disturbances. The mean (SD) MOS Sleep Problems Index score was 36.2 (20.8), worse than the general population mean of 26. Patients with physician-reported anxiety or depression had more sleep problems than did those without these comorbidities. Higher Sleep Problems Index scores were significantly (p < 0.001) correlated with poorer QOLIE-10 (r=,0.49) and EQ-5D (r=,0.56) scores. Patients experiencing a seizure within the past week reported higher MOS Sleep Problems Index scores than did those with a less-recent seizure (41.5 vs. 32.8; p = 0.003). Conclusions: Diagnosed and self-reported sleep disturbances in patients with partial-onset epilepsy are frequently overlooked, but are negatively associated with everyday functioning and well-being, and therefore contribute significantly to the burden of epilepsy. [source]

Imaging of acetylcholine esterase activity in brainstem nuclei involved in regulation of sleep and wakefulness

C. Eggers
Positron emission tomography with 11C- N -methyl-4-piperidyl-acetate (MP4A) was applied in eight healthy volunteers and two patients with mild Alzheimer's disease (AD) to assess acetylcholine esterase (AChE) activity in magnetic resonance imaging-identified brainstem nuclei. Uptake ratios in lateral dorsal tegmental and pedunculopontine nuclei relative to cerebellum yielded reproducible values for the AChE activity in controls and reduced values in AD, more marked in a patient with complaints of disturbed sleep. Cortical AChE activity was related to the extent of cognitive impairment which was more severe in the AD patient without sleep disturbance. This preliminary observational study demonstrates the feasibility to image and assess AChE activity in small nuclei of the brain stem. This approach may be helpful to investigate the interaction of various nuclei in the complex network regulating sleep and wakefulness in representative patient groups with documented sleep disturbance. [source]

Ultimate success in epilepsy , the patient's perspective

J. W. Sander
Most people with epilepsy can live outwardly normal lives, but fear about impending seizures, driving restrictions, lack of independence, employment and social problems, medication-related adverse effects and the presence of cognitive or psychiatric complications are all concerns readily identified by affected individuals. While seizure control is the overriding goal of treatment, it is essential to realize the importance that patients place on other aspects of daily functioning. While many of the concerns identified by patients can only be managed by improved social support, others (e.g. neuropsychological impairment, medication-related adverse events, cognitive impairment, sleep disturbance) may be amenable to therapy (if available) or to the selection of a more appropriate antiepileptic drug. Each antiepileptic drug has a unique pharmacodynamic and tolerability profile. Awareness by the treating clinician of the pharmacological profile of each drug may help to minimize unwanted treatment-related effects and possibly improve the outcome of treatment from an epilepsy patient's perspective. Therefore, in order to achieve true treatment success, clinicians need to understand how individuals perceive their disorder and, where possible, address those factors that adversely affect patient quality of life. For the person with epilepsy, successful treatment involves beneficial effects on social, vocational and psychological function. This extends beyond seizure control to freedom from the fear associated with seizures, confidence in pharmacological therapy and improvements in health-related quality of life. [source]

Examination of intravenous and intra-CSF protein delivery for treatment of neurological disease

Kim M. Hemsley
Abstract Mucopolysaccharidosis type IIIA is a neurodegenerative lysosomal storage disorder characterized by progressive loss of learned skills, sleep disturbance and behavioural problems. Absent or greatly reduced activity of sulphamidase, a lysosomal protein, results in intracellular accumulation of heparan sulphate. Subsequent neuroinflammation and neurodegeneration typify this and many other lysosomal storage disorders. We propose that intra-cerebrospinal fluid protein delivery represents a potential therapeutic avenue for treatment of this and other neurodegenerative conditions; however, technical restraints restrict examination of its use prior to adulthood in mice. We have used a naturally-occurring Mucopolysaccharidosis type IIIA mouse model to determine the effectiveness of combining intravenous protein replacement (1 mg/kg) from birth to 6 weeks of age with intra-cerebrospinal fluid sulphamidase delivery (100 ,g, fortnightly from 6 weeks) on behaviour, the level of heparan sulphate-oligosaccharide storage and other neuropathology. Mice receiving combination treatment exhibited similar clinical improvement and reduction in heparan sulphate storage to those only receiving intra-cerebrospinal fluid enzyme. Reductions in micro- and astrogliosis and delayed development of ubiquitin-positive lesions were seen in both groups. A third group of intravenous-only treated mice did not exhibit clinical or neuropathological improvements. Intra-cerebrospinal fluid injection of sulphamidase effectively, but dose-dependently, treats neurological pathology in Mucopolysaccharidosis type IIIA, even when treatment begins in mice with established disease. [source]

Yoga reduces sleep disturbance in cancer patients

Article first published online: 14 JUN 2010

Quantifying subjective assessment of sleep and life-quality in antidepressant-treated depressed patients

Andrew G. Mayers
Abstract This study sought to establish a method of quantifying subjective perceptions of sleep against perceptions of life-quality and mood, using amended versions of the Pittsburgh sleep diary (PghSD) and quality of life of insomniacs (QOLI) questionnaire. Diaries and questionnaires were self-completed in participants' homes. Outpatients with a DSM-IV diagnosis of major depressive disorder were compared with a healthy control group (with no history, or family history, of depression). Poorer sleepers, as determined by the sleep diary, were significantly more likely to report poorer life-quality and mood perceptions on the subsequent questionnaire. Furthermore, the depressed group reported significantly poorer perceptions of sleep quality and poorer perceptions of life-quality and mood than the control group, even though estimates of sleep disturbance were similar. This may indicate that depressed individuals experience more ,sleep distress' than healthy individuals. These results confirm the extent of subjectively reported sleep disruption in depression and demonstrate the merit of combining the amended PghSD and QOLI to quantify sleep perceptions. Copyright © 2002 John Wiley & Sons, Ltd. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Self-report of memory and affective dysfunction in association with medication use in a sample of individuals with chronic sleep disturbance

Mary Pat McAndrews
Abstract Benzodiazepines produce memory disturbance after acute administration. It is not clear whether chronic use of benzodiazepines is hazardous to memory processes. Epidemiological data indicate that a large proportion (10,30 per cent) of individuals with sleep dysfunction take hypnotic aids for a year or longer. The purpose of the present study was to evaluate self-reported memory dysfunction in a sample of individuals who considered their sleep disturbance sufficiently severe to seek investigation in sleep clinics. It was hypothesized that individuals taking benzodiazepines for sleep would report greater perceived everyday memory failures than individuals taking other sleep aids or no medication. Questionnaires were given to 368 individuals referred into the study by investigators in six sleep disorders clinics. All respondents completed a lengthy (700-item) questionnaire, which included scales assessing memory difficulties, affective status and sleep disturbance. Respondents also reported any medication use for sleep problems and duration of use of the current drug. Information on medication use was reported by 289 participants. Fifty-six per cent of respondents reported using some form of psychoactive medication (antidepressants, benzodiazepines, Zopiclone). Twenty-two per cent reported using no medication. Analysis of covariance showed that these medications had no detectable effect on subjective memory difficulties during chronic use, F(4,226)=1·34, p=0·25. Copyright © 2000 John Wiley & Sons, Ltd. [source]

Maternal Psychosocial Adversity and the Longitudinal Development of Infant Sleep

INFANCY, Issue 5 2008
Alison Cronin
Research has identified associations between indicators of social disadvantage and the presence of child sleep problems. We examined the longitudinal development of infant sleep in families experiencing high (n = 58) or low (n = 64) levels of psychosocial adversity, and the contributions of neonatal self-regulatory capacities and maternal settling strategies to this development. Assessments of infant sleep at 4-, 7-, and 12-weeks postpartum indicated no differences in sleeping difficulties between high- and low-adversity groups. However, more infant sleep difficulties were reported in the high- versus low-adversity groups at 12- and 18-month follow-ups. Neonatal self-regulatory capacities were not related to the presence or absence of adversity, or to subsequent infant sleep quality. However, there were group differences in maternal settling strategies that did predict subsequent infant sleep difficulties. The pattern of sleep disturbance observed in association with maternal psychosocial adversity at 18-months was consistent with risk for broader impairments in child functioning. [source]

Neck pain and disability: A cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinic

A.O. Frank
Summary This hospital-based cross-sectional cohort study examines the clinical and demographic features of neck pain, disability (using the Northwick Park neck pain questionnaire) and relationships to handicap in employment. Of 173 consecutive referrals to a rheumatology clinic with neck pain, 70% had neck/arm pain without neurological involvement, 13% other conditions, 11% nerve involvement and 5% other spinal pain. 141 patients (mean age 50 years) had mechanical or degenerative neck pain, of which 13% was probably work-related and 13% was trauma-related. 44 had taken sickness absence for an average of 30 weeks. Comorbidities were frequent (lumbar pain 51%). Those in work were significantly less disabled than those not working (p = 0.001) and those off sick (p < 0.01). Those reporting sleep disturbance, tearfulness and crying were significantly more disabled (p = 0.0001) than those who did not. Neck pain in secondary care is complicated by physical and emotional comorbidities. Comprehensive management requires a biopsychosocial model of care. [source]

Lesson from performing SCORADs in children with atopic dermatitis: Subjective symptoms do not correlate well with disease extent or intensity

K. L. E. Hon MBBS
Background, Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Method, Patients with AD younger than 18 years old were recruited from the pediatric dermatology clinic of a university teaching hospital, and AD severity was evaluated by the SCORAD index. Results, One hundred and eighty-two Chinese children with AD (107 boys and 75 girls) [mean (SD) age of 9.6 (4.2) years] were recruited. Their mean (SD) overall SCORAD was 30.1 (19.2). Sleep loss was strongly correlated with pruritus (r = 0.57, P < 0.001). However, the two subjective symptoms were only weakly correlated with the objective signs (extent and intensity) of AD. The correlations between pruritus and extent and intensity were 0.42 (P < 0.001) and 0.38 (P < 0.001), respectively, and the correlations between sleep loss and extent and intensity were 0.38 (P < 0.001) and 0.34 (P < 0.001), respectively. Conclusion, We speculate that the lack of a better correlation was either because pruritus and sleep loss as reported by parents were imprecise, or that mechanisms other than disease extent or severity are responsible for the pathogenesis of these subjective symptoms. [source]

Development of a Korean version of the behavior rating scale for dementia (BRSD-K)

Jong Chul Youn
Abstract Objective The purpose of this study was to develop a Korean version of the behavior rating scale for dementia (BRSD-K) for evaluating behavioral and psychological symptoms of dementia. Methods The BRSD-K was administered to the informants of 268 subjects with dementia. Internal, inter-rater and test,retest reliabilities were tested. To evaluate construct validity, exploratory factor analysis was performed. To evaluate concurrent validity, Pearson correlation coefficients between BRSD-K scores and the corresponding scores of the Korean version of the neuropsychiatric inventory (NPI-K) were calculated. Results BRSD-K demonstrated substantially high levels of reliabilities. Factor analysis identified seven factors, i.e. depressive symptoms, irritability/aggression, psychotic symptoms, behavioral dysregulations, sleep disturbance, inertia, and appetite. Correlations between BRSD-K and corresponding NPI-K scores were statistically significant (p,<,0.05). Conclusions BRSD-K was found to be a reliable and valid instrument for evaluating BPSD. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Behavioural and psychological syndromes in Alzheimer's disease

A. Mirakhur
Abstract Objectives The origins of behavioural and psychological symptoms of dementia are still poorly understood. By focusing on piecemeal behaviours as opposed to more robust syndrome change valid biological correlates may be overlooked. Our understanding of BPSD via the identification of neuropsychiatric syndromes. Methods We recruited 435 subjects from old age psychiatry and elderly care memory outpatient clinics fulfilling the criteria for diagnosis of probable Alzheimer's disease. Behavioural and psychological symptoms were assessed using the Neuropsychiatric Inventory. Principal components factor analysis was carried out on the composite scores of the 12 symptom domains to identify behavioural syndromes (factors). Results were confirmed by performing three different rotations: Varimax, Equamax and Quartimax. Results Four factors were identified (which accounted for 57% of the variance): ,affect' factor,depression/dysphoria, anxiety, irritability/lability and agitation/aggression; ,physical behaviour' factor,apathy, aberrant motor behaviour, sleep disturbance and appetite/eating disturbance; ,psychosis' factor,delusions and hallucinations; ,hypomania' factor,disinhibition and elation/euphoria. These groups were unchanged when different methods of rotation were used. Conclusions We report novel observations that agitation/aggression/irritability cluster within a depressive symptom factor and apathy is found within a physical behaviour factor. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Behavioral profile of Alzheimer's disease in Chinese elderly , a validation study of the Chinese version of the Alzheimer's disease behavioral pathology rating scale

Linda C. W. Lam
Abstract Objectives This study aims to examine the psychometric properties of the Chinese version of the Alzheimer's disease behavioral pathology rating scale (CBehave-AD) and the behavioral profile of Chinese patients with AD. Methods Seventy-one subjects with NINCDS-ADRDA diagnosis of probable and possible AD were assessed for validation of the CBehave-AD. A behavioral symptom frequency checklist, the Chinese version of the Blessed Roth dementia scale (CDS) and the Cantonese version of the Mini-Mental State Examination (CMMSE) were used for comparison. An extended sample of 120 AD patients was then evaluated with the CBehave-AD. Results High correlations between the CBehave-AD and checklist scores were found (paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness and diurnal rhythm disturbances). The scale also demonstrated satisfactory inter-rater and test-retest reliabilities. The mean (SD) CMMSE score of the 120 patients was 9.4 (7.1). Among them, 32% have delusions, 15% had hallucinations, 54% had activity disturbances, 61% had aggressive behavior, 44% had sleep disturbance, 24% had affective disturbances, 19% had anxiety and phobias. Delusional ideation was significantly associated with hallucinations, aggressiveness, and affective disturbances. Diurnal rhythm disturbances were associated with activity disturbances and aggressiveness. CBehave-AD total scores were not significantly correlated with severity of AD, but individual symptom categories showed different pattern of correlation. Delusions, hallucinations, anxiety and phobias were significantly correlated with dementia staging. Conclusion The findings suggest that the CBehave-AD is a valid assessment tool for behavioral disturbances in patients with AD. Variable associations between different symptom categories and dementia staging suggest a need for further exploration of the complex interactions between behavioral and cognitive disturbances in dementia. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Patient Response to the Fast-Track Experience

Jane Flanagan
PURPOSE To describe patients' functional health, symptom distress, and recovery at home across a fasttrack perioperative experience. METHODS A nonexperimental, descriptive, correlational design using pre/post test measures and openended questions captured the fast-tracking experience. A convenience sample included 77 patients entering the same-day surgery unit to undergo arthroscopy with general anesthesia and planned fast-track recovery. In the preadmission test area, patients were asked by a nurse to participate in the study. If they agreed and met selection criteria, a nurse completed a demographic sheet, the Foster and Jones Functional Health Pattern Assessment Screeing Tool (FHPAST), and the Symptom Distress Scale (SDS). On the evening of surgery, a nurse called the patient to review the SDS to be completed by phone. At 72 hours after surgery, the FHPAST, the SDS, and a 72-hour open-ended questionnaire were administered to understand the patient experience of fast-tracking. FINDINGS At 12 hours nurses reported patients were "euphoric" and it was difficult to imagine pain or other symptoms. Some patients complained of nausea and fatigue. Most patients had family present. At 72 hours patients described unmet expectations, fatigue, immobility, ineffective pain management, sleep disturbance, and nausea. Interventions included teaching, coaching, and reassurance. Some patients continued to have nursing problems at 72 hours and benefited from a telephone follow-up call. CONCLUSIONS Preliminary results suggest that nursing diagnoses, interventions, and outcomes can be used to describe patient responses to the fast-track experience. Results indicate a need for practice changes to include innovative models and further research to measure outcomes. Fast-tracking can be effective, but requires clinical reasoning by nurses to guide the individual's healing. A coaching intervention seems to enhance patient satisfaction and a sense of being cared for. [source]

Night-time frequency, sleep disturbance and general health-related quality of life: Is there a relation?

Koji Yoshimura
Objectives: We conducted a community-based study to determine the relationship among night-time frequency, sleep disturbance and general health-related quality of life (GHQL). Methods: A total of 2271 participants, men and women, aged 41,70 and randomly selected in three Japanese towns completed a postal questionnaire survey. This questionnaire included: the International Prostate Symptom Score, the overall incontinence score of the International Consultation of Incontinence Questionnaire Short Form for lower urinary tract symptoms, the Pittsburg Sleep Quality Index for sleep problems, the Medical Outcome Study Short Form-8 for GHQL, and medical history of disease, cigarette smoking, and alcohol consumption. A multiple regression model was used for statistical analysis, and P < 0.05 was considered significant. Results: Although night-time frequency by itself was closely associated with most aspects of GHQL, this association disappeared in four domains (general health perception, vitality, mental health and emotional role) and in the two summary scores of the Medical Outcome Study Short Form-8 after inclusion of the influence of sleep problems represented by the total score on the Pittsburg Sleep Quality Index. However, three domains (physical function, physical role, and social function) remained significantly associated with night-time frequency. Sleep problems were by far the worst risk factor for the deterioration of GHQL. Conclusions: Night-time frequency appeared to be associated with GHQL mainly by affecting sleep conditions, a symptom that independently influenced some aspects of GHQL. [source]

Burnout and physical and mental health among Swedish healthcare workers

Ulla Peterson
Abstract Title.,Burnout and physical and mental health among Swedish healthcare workers Aim., This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors. Background., Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes. Method., A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout). Results., Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group. Conclusion., Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout. [source]

Cardiovascular Exercise Training Extends Influenza Vaccine Seroprotection in Sedentary Older Adults: The Immune Function Intervention Trial

Jeffrey A. Woods PhD
OBJECTIVES: To determine whether cardiovascular exercise training resulted in improved antibody responses to influenza vaccination in sedentary elderly people who exhibited poor vaccine responses. DESIGN: Single-site randomized parallel-arm 10-month controlled trial. SETTING: University of Illinois at Urbana-Champaign. PARTICIPANTS: One hundred forty-four sedentary, healthy older (69.9 ± 0.4) adults. INTERVENTIONS: Moderate (60,70% maximal oxygen uptake) cardiovascular exercise was compared with flexibility and balance training. MEASUREMENTS: The primary outcome was influenza vaccine response, as measured according to hemagglutination inhibition (HI) anti-influenza antibody titer and seroprotective responses (HI titer ,40). Secondary measures included cardiovascular fitness and body composition. RESULTS: Of the 160 participants enrolled, 144 (90%) completed the 10-month intervention with excellent compliance (,83%). Cardiovascular, but not flexibility, exercise intervention resulted in improvements in indices of cardiovascular fitness, including maximal oxygen uptake. Although not affecting peak (e.g., 3 and 6 weeks) postvaccine anti-influenza HI titers, cardiovascular exercise resulted in a significant increase in seroprotection 24 weeks after vaccination (30,100% dependent on vaccine variant), whereas flexibility training did not. CONCLUSION: Participants randomized to cardiovascular exercise experienced improvements in influenza seroprotection throughout the entire influenza season, whereas those in the balance and flexibility intervention did not. Although there were no differences in reported respiratory tract infections, the exercise group exhibited reduced overall illness severity and sleep disturbance. These data support the hypothesis that regular endurance exercise improves influenza vaccine responses. [source]

Sleep disturbance experiences among perimenopausal women in Taiwan

Hsiu-Chin Hsu
Aim., To generate a descriptive theory framework regarding the experiences of sleep disturbances among perimenopausal women in Taiwan. Background., Although studies show that some perimenopausal women are troubled by sleep problems, little information was found about the subjective experiences of sleep disturbances among these women. Research is required to explore women's feelings or perceptions in dealing with their sleep problems. These understandings will be important to help alleviate perimenopausal women's sleep problems. Design., A grounded theory research design was applied. Method., Twenty-one Taiwanese sleep disturbed women, aged 46,57 years, participated in in-depth interviews. Results., ,Getting back a good night's sleep' was the core theme for describing and guiding the process of the women's sleep disturbance experiences. During the process, ,disturbed sleep' was identified as the antecedent condition that included subcategories: easy awakening, difficulty falling asleep, inner worries, physical discomfort and genetic and bodily constitution. Analyses showed five categories (some with subcategories) of the sleep disturbed women: (i) worsening health status , physical exhaustion, impaired social interactions, emotional swings and decreased work performance; (ii) living with lonely nights , self-help and endurance; (iii) a search for resources to relieve sleep difficulties , doctor shopping, trying alternative therapies, exercising and seeking support; (iv) vicious cycle and (v) acceptance of insomnia. Conclusions., Women expected to relieve their sleep disturbance by finding comprehensive counselling or by their body constitution responding to treatment. Healthcare providers need to value women's individual concerns and subjective voices. Providers must seek out sleep counselling instead of simply prescribing drugs for their sleep difficulties. Relevance to clinical practice., It is crucial to integrate perimenopausal sleep care by implementing a multidimensional approach such as sleep assessment laboratories, sleep counselling, complementary alternative medicine, sleep strategies and support groups. [source]

Sleep in adolescence: a review of issues for nursing practice

Tamara Vallido
Aims and objectives., The aim of this review was to explore the literature to determine what is known about adolescent sleep, the causes and consequences of disturbed sleep in adolescence and the implications this has for nursing practice. Background., Sleep disorders are relatively common in young people. Disturbed sleep can be both a cause and a result of ill health and if recognised can indicate psychosocial, psychological or physical difficulties. Design., Literature review. Methods., Searching of key electronic databases. Results., Disturbed sleep in adolescents has several potential consequences, including daytime sleepiness, reduced academic performance and substance use/abuse. However, despite its significance and frequency, sleep disturbance is an area of adolescent health that is almost entirely unaddressed within the nursing literature. Conclusion., Nursing has a role to play in assisting adolescents and their families to recognise the importance of sleep to the general health and well-being of young people. Relevance to clinical practice., There is a need for nursing to develop tools to assess sleep in adolescent clients and non-pharmaceutical interventions to assist adolescents achieve optimum sleep and rest. Nurses may also contribute to educating adolescents and their families regarding the importance of good sleep hygiene. [source]

Cognitive-behavioral treatment for chronic nightmares in trauma-exposed persons: assessing physiological reactions to nightmare-related fear

Jamie L. Rhudy
Abstract Cognitive-behavioral treatments (CBTs) that target nightmares are efficacious for ameliorating self-reported sleep problems and psychological distress. However, it is important to determine whether these treatments influence objective markers of nightmare-related fear, because fear and concomitant physiological responses could promote nightmare chronicity and sleep disturbance. This randomized, controlled study (N=40) assessed physiological (skin conductance, heart rate, facial electromyogram) and subjective (displeasure, fear, anger, sadness, arousal) reactions to personally relevant nightmare imagery intended to evoke nightmare-related fear. Physiological assessments were conducted at pretreatment as well as 1-week, 3-months, and 6-months posttreatment. Results of mixed effects analysis of variance models suggested treatment reduced physiological and subjective reactions to nightmare imagery, gains that were generally maintained at the 6-month follow-up. Potential implications are discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66: 1,18, 2010. [source]