Kathryn A. Lee

• University of California, San Francisco

Purpose: Women in the decade before menopause are at risk for depression. This study describes dietary factors associated with depression risk in late premenopausal women that could be modifiable with targeted interventions. Methods: Descriptive cross-sectional study comparing a community-based sample of 342 healthy premenopausal women categorized...

Background Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. Methods This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National...

Study objectives: To describe changes in sleep quality and associated sleep symptoms as women begin menopausal transition compared to pre-menopausal controls. Methods: In a repeated measures design, we analyzed data collected every 2-6 months from a community-based sample of 223 women 40-50 (45.6±2.3) years old over a two-year period. Each 6-mon...

Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to Febr...

Study objectives: To describe the association between preoperative sleep disruption and postoperative delirium. Methods: Prospective cohort study with six time points (3 nights pre-hospitalization and 3 nights post-surgery). The sample included 180 English-speaking patients ≥65 years old scheduled for major non-cardiac surgery and anticipated mi...

Objective: To describe sleep characteristics in the third trimester of pregnancy for women who had a prior pregnancy loss compared to women with no history of loss. Design: Descriptive comparison of baseline data prior to randomization for a clinical trial. Setting: Participants' homes. Participants: Eligible women recruited from childbirth...

Importance: More than 1 in 5 patients do not experience improved physical function after total knee arthroplasty (TKA). Identification of factors associated with physical function may be warranted to improve outcomes in these patients. Objective: To identify preoperative and intraoperative factors associated with physical function at 12 months a...

Sleep and circadian rhythms are altered in association with the hormonal changes in the menstrual cycle and in the presence of menstrual-associated disorders. The magnitude of the effect varies, particularly for self-reported sleep quality, which worsens in some, but not all, women when premenstrual symptoms emerge. Importantly, women with polycyst...

Objective To increase the percentage of women who attend postpartum visits and decrease the number of days to the first postpartum visit by implementing a scheduling change. Design Quality improvement project. Setting/Local Problem A small nurse practitioner maternity care clinic in an academic health center at which only 74% of the women who att...

Background: Validity of the Pittsburgh Sleep Quality Index (PSQI) has not been established for midlife women before menopause, and evidence suggests that two-factor or three-factor models may be more informative than the PSQI global score derived from its seven components. We hypothesized that the PSQI and its factor structure would be valid in pre...

Objectives/background: Sleep disruption is prevalent in older patients. No previous studies have considered the impact of surgery duration or surgery end time of day on postoperative sleep disruption. Accordingly, we examined the duration of surgery and surgery end times for associations with postoperative sleep disruption. Methods: Inclusion cr...

Citation: Zak RS, Lee KA. The glass is half full: gender diversity in sleep medicine award recognition. J Clin Sleep Med. 2021;17(8):1517-1518.

Introduction: One in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology tha...

Purpose The purpose of this pilot study was to evaluate the feasibility, acceptability, and initial efficacy of adding a sleep extension intervention to a well-established diabetes prevention intervention among midlife women with short sleep duration at risk for type 2 diabetes. Methods For this 2-group comparative design, 26 women with prediabete...

Objective To determine whether selected genes and plasma markers involved in energy homeostasis are associated with sleep disruption or duration in adults with HIV/AIDS. Methods A sample of 289 adults with HIV/AIDS wore a wrist actigraph for 72 hours to estimate total sleep time (TST) and wake after sleep onset (WASO). Twenty-three single nucleoti...

Background: Fatigue is a common symptom associated with a wide range of diseases and needs to be more thoroughly studied. To minimise patient burden and to enhance response rates in research studies, patient-reported outcome measures (PROM) need to be as short as possible, without sacrificing reliability and validity. It is also important to have...

We examined the relationships between sleep and inflammatory biomarkers during late pregnancy. Seventy‐four women underwent an overnight sleep assessment by polysomnography. Blood samples were collected before bedtime and again within 1 h upon awakening to measure C‐reactive protein (CRP), interleukin (IL)‐6, and IL‐6 soluble receptor. Sleep parame...

Introduction Maternal sleep disturbance is common during pregnancy and is associated with adverse maternal and child outcomes, such as postpartum depression and preterm birth. The extent to which sleep disorder symptoms are normative among women of reproductive age, however, is largely unknown. The present study’s primary aim was to explore cumulat...

Although some sleep disturbance is normal during pregnancy, a subset of women experience sleep disturbances that are associated with clinically significant distress or impairment that warrants further evaluation and treatment. This chapter provides a broad overview of the epidemiology, etiological factors, and consequences of poor sleep quality, sh...

Objectives: To investigate the association between measures of sleep quality, sleep duration and sleep disorder symptoms in late pregnancy and likelihood of emergency caesarean section. Design: Population-based prospective cohort study SETTING: New Zealand PARTICIPANTS: 310 Māori (Indigenous New Zealanders) and 629 non-Māori women MEASUREMENTS:...

Background: It is unclear if the relationship between depression and physical health problems in women is related to age, reproductive stage, obesity or socio-demographic risk factors. Methods: Longitudinal data were obtained every 6 months for 36 months in 264 midlife African American, Caucasian and Latina women who began the study as healthy r...

Background: Nocturnal bladder symptoms and sleep disruption commonly co-exist in middle-aged and older women. While sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, non-bladder factors may also influence sleep in this population. Many women with overactive bladder are eager to identify n...

Objective: To describe correlates of fatigue and lack of energy symptoms in adults living with HIV. Methods: Adults living with HIV were recruited if they were ≥45 years old, unemployed, and reported either fatigue or lack of energy in the past week. HIV-associated correlates included CD4 cell count, viral load, and hemoglobin. Daytime correlate...

Objectives: The objective of this study was to examine the association between high risk of obstructive sleep apnea (OSA) and subclinical atherosclerosis among South Asians in the United States. Design: A secondary analysis of cross-sectional data. Setting/participants: A community-based cohort of 906 men and women participating in the Mediato...

Fatigue is a prevalent symptom for adults living with HIV infection. The purpose of this randomized clinical trial was to pilot test a behavioral‐educational intervention to reduce fatigue. The intervention included education about daytime behaviors as well as nighttime sleep behaviors. Participants were HIV‐positive, between 45 and 75 years old, u...

Aim To critically review and synthesize the findings of studies that evaluated the effectiveness of nursing interventions for improving breathlessness in adults with chronic obstructive pulmonary disease. Background Systematic reviews of nursing interventions for breathlessness in people with chronic obstructive pulmonary disease have not been spe...

To the Editor: We read with great interest the secondary analysis by Perkin et al¹ of sleep duration among infants randomized to receive early introduction to solid foods compared with infants randomized to standard introduction.¹ Infants in the early introduction group slept a mean of 7 minutes longer per night across the 3-year study period compa...

The aim of this secondary analysis was to determine whether seasonal light exposure, categorized by type of day length, is associated with or predictive of depressive symptoms in late pregnancy and the first 3 months postpartum. Women (n = 279) expecting their first child were recruited from prenatal clinics and childbirth education classes. Depres...

Subjective and objective sleep changes occur during the menstrual cycle. Poorer sleep quality in the premenstrual phase and menstruation is common in women with premenstrual symptoms or painful menstrual cramps. There is increased sleep spindle activity from follicular to luteal phase, potentially progesterone related. Luteal phase changes also inc...

Study objectives: To compare causes of sleep disturbance and to compare self-reported sleep duration among groups of late premenopausal women and early perimenopausal women. Methods: In a longitudinal study of a community-based sample of healthy women 40 to 50 years of age, menstrual cycle and symptom data were collected every 2 months; anthropo...

Purpose: Given the inter-relatedness among symptoms, research efforts are focused on an evaluation of symptom clusters. The purposes of this study were to evaluate for differences in the number and types of menopausal-related symptom clusters assessed prior to and at 12-months after surgery using ratings of occurrence and severity and to evaluate...

Signs and symptoms are important aspects of health and illness that disrupt physical, mental, and social functioning. Whether the goal is to eliminate the symptom or to minimize the distress of the symptom experience, the Symptom Management Theory (SMT) provides a useful framework for organizing the relevant concepts for research and practice. This...

Sleep disturbances often begin with the onset of pregnancy and become quite common in the third trimester. Pregnancy-related physiologic and anatomic changes can influence sleep quality and duration. • In the first trimester, hormonal fluctuations and associated physiologic changes may disturb sleep. By the end of the second trimester, discomfort a...

Aims: To examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States. Methods: A secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questio...

Context: Approximately 60% to 100% of women with breast cancer experience at least one menopausal-related symptom. Little is known about associations between menopausal status and symptoms in women 12 months after breast cancer surgery. Objective: Purpose of this study was to evaluate for differences in occurrence, severity, and distress of symp...

INTRODUCTION While patients with brain tumors (BT) report sleep disturbances during radiation therapy (RT), no study has compared patients and their family caregivers (FCs). This study examined changes in total sleep time (TST) in patients and FCs during and after RT. METHODS From a longitudinal study on fatigue, pain, and sleep disturbance during...

Study objectives: To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients. Methods: Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual...

Objective: To compare symptoms of depression, maternal adjustment, and perceived stress in late adolescent and young adult mothers and to examine the patterns of these symptoms during the first 3 months after birth. Design: Secondary analysis of extant longitudinal data. Setting: San Francisco Bay Area, with participants in their home environm...

Background: Breast cancer treatments can change women's hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer before surgery. Objective: The purpose of this study was to evaluate for differences in occurrence, severity, and distress of...

Purpose: In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with ini...

( Obstet Gynecol. 2016;128(5):964–971) Poor sleep in the late stages of pregnancy as well as in the early postpartum period is known to be associated with various problems. There are few sleep improvement interventions that are available although a well-known one is the Sleep Enhancement Training System. This training is a cognitive-behavioral inte...

Objective: To compare leukocyte telomere length (LTL) by race and describe demographic, health, and psychosocial factors associated with LTL in postmenopausal women. Design: Descriptive study with comparative analyses and correlations. Setting: Data were collected at the University of California-San Francisco, San Francisco Clinical and Transl...

Objective: To evaluate the frequency, severity, distress, and correlates of common and rare symptoms reported by nulliparous women during the last month of pregnancy. Design: Secondary cross-sectional analysis of data obtained in a larger randomized clinical trial. Setting: San Francisco Bay area. Participants: Nulliparous, ethnically divers...

Introduction While postpartum depression has been linked to poorer maternal sleep quality, the pathways underlining this relationship are not well known. This study aimed to investigate the links between maternal postpartum depression, cognitions regarding infant sleep, nighttime behaviours and reported sleep quality. We propose a model linking pos...

Introduction Relationships between subjective, but not objective sleep outcomes, and postpartum depression have been observed in small, cross-sectional samples. The purpose of this study was to examine these relationships using a large sample followed prospectively from birth through 6 and 12 weeks postpartum. Methods Data from a RCT of a behaviou...

Background: Despite advances in cancer diagnosis and treatment have significantly improved survival rates, patients post-treatment-related health needs are often not adequately addressed by current health services. The aim of the Women's Wellness after Cancer Program (WWACP), which is a digitised multimodal lifestyle intervention, is to enhance he...

Background: Poor sleep during pregnancy has been associated with poorer birth outcomes. High body mass index (BMI) is often associated with poor sleep, but little is known about the relationship between gestational weight gain and sleep in late pregnancy. The purpose of this study was to evaluate the relationships of both gestational weight gain a...

Background: Approximately 28% of patients with gastrointestinal (GI) cancers will receive targeted therapy (TT) because of the associated increases in survival. Only four studies have examined the symptom experience of these patients. To date, no studies have evaluated for differences in symptom occurrence, severity, and distress between patients...

Objective/background Daytime napping longer than one hour has been associated with an increased risk for all-cause mortality. Associations between cytokine polymorphisms and daytime napping in chronic illnesses such as HIV, however, have not been well described. The purpose of this study was to examine cytokine polymorphisms associated with long da...

Objective: Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with...

Context: While energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment. Objectives: To identify variations in the trajectories of morning and evening energy levels and to determine which characteristics predicted initial levels...

Context: Patients with breast cancer receiving chemotherapy (CTX) experience multiple concurrent symptoms, but little is known about how symptoms change during and after treatment. Knowledge of the identity and trajectory of symptom clusters (SCs) would enhance measurement and management. Objectives: We aimed to identify SCs and their change ove...

Sleep disturbance can contribute to negative health outcomes. However, sleep complaints have been under-recognized and undertreated in caregivers of ill family members. This systematic review describes the impact of family caregiving on sleep and summarizes factors associated with sleep disturbance in caregivers. A literature search using PubMed, M...

Objective: To evaluate the feasibility and efficacy of a home-based cognitive-behavioral training program for sleep during late pregnancy. Methods: A nonrandomized quasiexperimental sample of nulliparous women who received the intervention during pregnancy (n=25) was compared with two control groups (n=76 and n=48) from other intervention studie...

Objectives: The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of women's reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-se...

African-American women suffer from disproportionate adverse health outcomes compared to women of other ethnicities living in the United States. It is suggested in the literature that chron- ic stress can be an antecedent to health disparity. The purpose of this study was to evaluate changes in perceived stress from late pre-menopause to post-menopa...

Objectives: This exploratory study examined the association between exposure to stressful life events, polymorphisms (rs165774 and rs4680) in the catechol-O-methyltransferase (COMT) gene, and risk of depression in women. Materials and methods: A cross-sectional design gathered information from 150 Australia women, aged 60-70 years, on sociodemog...

The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D’s validity and reliability in relation to key demograp...

Context: To accurately investigate diurnal variations in fatigue, a measure needs to be psychometrically sound and demonstrate stable item function in relationship to time of day. Rasch analysis is a modern psychometric approach that can be used to evaluate these characteristics. Objectives: To evaluate, using Rasch analysis, the psychometric pr...

Background: Psychosocial and behavioural interventions that address suicidal thoughts and behaviour during treatment (direct interventions) might be more effective in preventing suicide and suicide attempts than indirect interventions that address symptoms associated with suicidal behaviour only (eg, hopelessness, depression, anxiety, quality of l...

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transge...

Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Māori and non-Māori women. Methods: In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal...

Purpose: Bladder symptoms are common in women and result in use of healthcare resources and poor quality of life. Bladder symptoms have been linked to age and menopause, but debate exists in the literature. This article examines factors associated with bladder symptoms and compares women in late reproductive stage with those in menopausal transiti...

Objectives This pilot study aimed to describe the sleep of partners and other family caregivers prior to and in the first year after a hospice patient's death. The study also evaluated the feasibility of the study protocol and determined the effect sizes in preparation for a full-scale study. Design The pilot study used a longitudinal, descriptive...

The Stress of Immigration Survey (SOIS) is a screening tool used to assess immigration-related stress. The mixed methods approach included concept development, pretesting, field testing, and psychometric evaluation in a sample of 131 low-income women of Mexican descent. The 21-item SOIS screens for stress related to language, immigrant status, work...

Up to 50% of people living with HIV have some neurocognitive impairment. We examined associations of sleep and fatigue with self-reported cognitive problems in 268 adults living with HIV. Multivariate regression was used to examine associations between cognitive problems, self-reported sleep quality, actigraphy-measured total sleep time and wake af...

Genes involved in circadian regulation, such as circadian locomotor output cycles kaput [CLOCK], cryptochrome [CRY1] and period [PER], have been associated with sleep outcomes in prior animal and human research. However, it is unclear whether polymorphisms in these genes are associated with the sleep disturbances commonly experienced by adults livi...

The purpose of this article is to examine the factors associated with women's mental health. A random sample of Australian 340 women aged 40-55, completed surveys on menopausal, lifestyle factors, and mental health at three time points. We used hierarchical models to show that decrements in mental health were associated with a corresponding increas...

This chapter reviews the development of knowledge related to women’s sleep and highlights key milestones associated with reproductive phases during the lifespan. These phases include menstruation, pregnancy, and menopausal transition. Historical perspectives on women’s sleep during these three phases are presented. Selected sleep disorders associat...

The purposes of this study, in a sample of women with breast cancer receiving chemotherapy (CTX), were to identify subgroups of women with distinct experiences with the symptom cluster of pain, fatigue, sleep disturbance, and depressive symptoms and evaluate differences in demographic and clinical characteristics, differences in psychological sympt...

Advancements in sleep medicine have been escalating ever since research began appearing in the 1950s. As with most early clinical trials, women were excluded from participation. Even if researchers included women or addressed sex differences by age, reproductive stage was seldom considered. Recently, there has been an exponential increase in resear...

Poster PresentationObjective To ascertain whether the quality and quantity of sleep in late pregnancy were associated with length of labor or mode of delivery (vaginal/cesarean) for women living at moderate altitude.DesignA prospective, descriptive study based on the symptom management theory, the theory of integral nursing, and Lee's conceptual mo...

To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). University medical center. The sample consisted of 50 English-speaking patients ≥40 years of age scheduled for major non-cardiac surgery, wi...

Objective To describe the use of social media during the antepartum and postpartum periods among first-time African American mothers and their support persons.DesignA qualitative critical ethnographic research design within the contexts of family life course development theory and Black feminist theory.SettingParticipants were recruited from commun...

CA125, a tumor-associated antigen, is primarily used to monitor epithelial ovarian cancer. There is evidence that different species of CA125 exist; however, it is not known if any of these species are present in healthy women during the menstrual cycle and if they are associated with serum concentrations of CA125. The purpose of this study was to d...

Sleep disturbance has been associated with inflammation and cytokine activity, and we previously described genetic associations between cytokine polymorphisms and sleep maintenance and duration among adults with HIV/AIDS. Although sleep onset insomnia (SOI) is also a commonly reported sleep problem, associations between cytokine biomarkers and SOI...

Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is common during pregnancy, affecting approximately one in five pregnant women in Western countries. Many report moderate or severe symptoms and negative impact on sleep. There is very little information in the medical literature for practitioners on the management of this condition during pre...

Objectives Compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and examine the influence of socio-demographic factors. Methods Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale...

The purpose of this paper is to highlight innovative analytic approaches in symptom science. Complex systems modeling is discussed using fatigue as an example. Fatigue is a common symptom among individuals of any age. It can be acute or chronic, and it can vary across the day and on weekends compared to weekdays. Fatigue can overlap with other symp...

Symptom assessment and management continue to be a priority issue for nursing science and practice. However, as the complexity of symptom etiology and expression becomes clear, new approaches and technologies are needed to better address biology and context, common data sources need to be built and shared, and addressing the impact of empirical fin...

For mothers with breastfeeding difficulties, pumping can be recommended to help establish milk production. However, pumping may present some barriers to successful breastfeeding. Mothers with milk supply concern may be at higher risk of barriers to successful breastfeeding. No previous studies have described experiences of pumping among mothers wit...

The goal of the Patient-Reported Outcomes Measurement Information System (PROMIS) is to create efficient, reliable, and valid assessments of adult and child health. The nursing science literature in which PROMIS measures are used is rapidly expanding. Investigators have been encouraged to consider the integration of PROMIS measures into both descri...

Fatigue has been associated with inflammation and cytokine activity among adults, but this relationship has not been evaluated among adults living with HIV. Diurnal patterns of fatigue have been previously identified in adults with HIV/AIDS. Thus, the purpose of this study was to describe these fatigue patterns in relation to cytokine plasma concen...

BACKGROUNDA large amount of interindividual variability exists in the occurrence of symptoms in patients receiving chemotherapy (CTX). The purposes of the current study, which was performed in a sample of 582 oncology outpatients who were receiving CTX, were to identify subgroups of patients based on their distinct experiences with 25 commonly occu...