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The Pittsburgh Sleep Quality Index - A New Instrument For Psychiatric Practice And Research

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Abstract

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

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... The scale consists of 19 items across seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each scale component is equally weighted on a 0-3 scale and summed to produce a global score ranging from 0 to 21, with higher score indicating worse sleep quality (Buysse et al., 1989). The PSQI has high internal consistency estimates with coefficient alphas of 0.83 and documented stability over time (Buysse et al., 1989;Yi et al., 2006). ...
... Each scale component is equally weighted on a 0-3 scale and summed to produce a global score ranging from 0 to 21, with higher score indicating worse sleep quality (Buysse et al., 1989). The PSQI has high internal consistency estimates with coefficient alphas of 0.83 and documented stability over time (Buysse et al., 1989;Yi et al., 2006). A global PSQI score > 5 has diagnostic sensitivity of 89% and specificity of 85% (Kappa = 0.75, p < 0.001), indicating good construct validity for distinguishing good and poor sleepers (Buysse et al., 1989). ...
... The PSQI has high internal consistency estimates with coefficient alphas of 0.83 and documented stability over time (Buysse et al., 1989;Yi et al., 2006). A global PSQI score > 5 has diagnostic sensitivity of 89% and specificity of 85% (Kappa = 0.75, p < 0.001), indicating good construct validity for distinguishing good and poor sleepers (Buysse et al., 1989). In this sample, the seven component scores of the PSQI had an overall internal consistency estimate of 0.78. ...
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Poor sleep confers significant morbidities and is highly prevalent among college students in the United States. This research assessed sleep quality and its association with health-related quality of life (HRQOL). Further, because sleep quality research often lacks a theoretical foundation, we applied a theoretical model using selected constructs from the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). A random, stratified sample of undergraduate students participated in an online survey (N = 494). Structural equation modeling assessed the association between theoretical constructs, sleep quality, and HRQOL. The final model fit was acceptable, with ~ 20% of the variance in sleep quality explained by the theoretical constructs and control variables. HBM constructs were indirectly and negatively related to sleep quality, mediated through behavioral intention, and also positively and directly associated with behavioral intention. Behavioral intention was strongly and negatively associated with sleep quality. Approximately 31% of the variance in HRQOL was explained by poor sleep quality, behavioral intention, and gender. Poor sleep was most strongly associated with reduced HRQOL. HBM constructs and behavioral intention from TPB were significantly associated with poor sleep quality, and poor sleep was significantly related to poor HRQOL.
... Another questionnaire, which is validated and widely used to assess sleep quality in patients with advanced cancer is the Pittsburgh Sleep Quality Index (PSQI) [15,24]. It includes seven components of sleep: sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. ...
... It includes seven components of sleep: sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. The component scores are summed to obtain a global sleep score ranging from 0 to 21, with higher scores indicating worse sleep quality [24]. Using this tool might improve the understanding of sleep difficulties experienced by cancer patients [25]. ...
... The specific PROMs for the assessment of sleep vary in relation to which period they are designed to cover. For instance, the ESAS-r is typically used for the assessment of sleep last night [21], while the PSQI is designed to assess sleep last month [24]. The time interval in the ISI is the last two weeks [27], and the AIS is during the last month, or some other period of time, whose length depends on the purpose of a given study [28]. ...
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Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
... The Pittsburgh Sleep Quality Index (PSQI) global score was used to measure sleep quality [33]. The PSQI is a 19-item self-rated questionnaire that reliably assesses sleep status and disturbances over the past month in healthy and patient populations. ...
... Higher scores on the PSQI indicate worse sleep quality. Poor sleep quality was defined as scores greater than or equal to 5 as has been done previously [33]. The PSQI has internal consistency, reliability, and construct validity (convergent, discriminant, and known group validity) amongst various populations [34]. ...
... This study used validated questionnaires and biomarkers to investigate the relationship between sleep disturbances and OS in a well-characterized cardiovascular disease population. While several studies investigated sleep disorders and cardiovascular mortality, fewer studies have investigated sleep symptoms in CAD patients [33]. Sleep symptoms, as opposed to sleep disorders, are of clinical interest as they indicate sub-clinical disturbances [92] and may provide a specific symptom target for treatment. ...
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Background: (1) Sleep disorders are prevalent in coronary artery disease (CAD) patients and predict cardiac events and prognosis. While increased oxidative stress (OS) has been associated with sleep disorders, less is known about its relationship with sleep quality. Similarly, little is known of how this relationship might change with exercise, which can improve sleep quality. Factors of sleep quality, such as sleep duration and disturbances, are also important as they predict cardiovascular diseases better than a global score alone. This study investigated whether OS was associated with self-rated sleep quality and its factors before and after completing a 24-week exercise intervention. (2) Methods: CAD patients undergoing an exercise program were recruited. OS was measured at baseline by the concentrations of early- (lipid hydroperoxides, LPH) and late-stage (8-isoprostane, 8-ISO) lipid peroxidation products and their ratio. Sleep quality was measured by the self-reported Pittsburgh Sleep Quality Index (PSQI) instrument at baseline and termination. Three sleep factors - perceived sleep quality, sleep efficiency, and daily disturbances - were derived from the PSQI. (3) Results: Among CAD patients (n = 113, 85.0% male, age = 63.7 ± 6.4 years, global PSQI = 5.8 ± 4.0), those with poor sleep (PSQI ≥ 5) had higher baseline 8-ISO levels (F(1,111) = 6.212, p = 0.014, ηp2 = 0.053) compared to those with normal sleep. Concentrations of LPH (F(1,105) = 0.569, p = 0.453, ηp2 = 0.005) and 8-ISO/LPH ratios (F(1,105) = 2.173, p = 0.143, ηp2 = 0.020) did not differ between those with poor sleep and normal sleep. Among factors, perceived sleep quality was associated with 8-ISO and 8-ISO/LPH, and daily disturbances were associated with 8-ISO. (4) Conclusions: A marker of late-stage lipid peroxidation is elevated in CAD patients with poor sleep and associated with daily disturbances, but not with other factors or with sleep quality and its factors after exercise intervention.
... There is no global consensus regarding the definition of sleep quality, but it has been described as "a combination of qualitative and quantitative sleep parameters and their impact on the waking state" (Sancho-Domingo et al., 2021). These parameters usually include sleep duration, sleep latency, and sleep efficiency (Buysse et al., 1989). Good sleep quality has been found to be a significant predictor of physical and psychological well-being as well as quality of life in all age groups (Ohayon et al., 2017). ...
... Specifically, sleep quality is of utmost importance for adolescents both clinical and nonclinical contexts (Manzar et al., 2018). This instrument was developed by Buysse et al. (Buysse et al., 1989) and contains 18 items across seven sleep-related components. A global score is used to differentiate "good" and "bad" sleepers, making the PSQI an adequate screening tool for sleep quality (Mollayeva et al., 2016). ...
... A global score is used to differentiate "good" and "bad" sleepers, making the PSQI an adequate screening tool for sleep quality (Mollayeva et al., 2016). To date, the instrument has been validated widely in Africa (Aloba et al., 2007;Salahuddin et al., 2017), America (Buysse et al., 1989;Cole et al., 2006;Passos et al., 2017), Asia (Tsai et al., 2005;Doi et al., 2000;Chong & Cheung, 2012), Europe (Backhaus et al., 2002;Kotronoulas et al., 2011;Curcio et al., 2013) and Oceania (Magee et al., 2008). ...
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Aims: It is important to assess sleep quality during epidemiological surveillance of psychological and physical health among nonclinical adolescents. The Pittsburgh Sleep Quality Index (PSQI) is a self-report screening tool that measures sleep quality. This study aimed to assess the validity and reliability of the Chinese version of the PSQI among nonclinical adolescents. Methods: In total, 5,399 Chinese students (51.1% female) were included in the study (mean age = 15.13, SD = 1.56). Participants completed a comprehensive questionnaire including the PSQI. Statistical analyses to evaluate the reliability, structural validity, measurement invariance, criterion validity and optimal cutoff point of the PSQI were performed. Results: The internal consistency of the PSQI was moderate. Confirmatory factor analysis supported the three-dimensional model and the configural and metric invariance across gender and age. The correlations between scores on the PSQI and the Minneapolis-Manchester Quality of Life Instrument (as a measure of positive life aspects) as well as between scores on the PSQI and the Hospital Anxiety Depression Scale (as a measure of mental illness and distress) yielded support for criterion validity. The receiver operating characteristic analysis revealed that a score of 6.5 was the optimal cutoff point for the PSQI to diagnose sleep disturbance. Conclusion: The main findings of this study are consistent with many studies from other countries that evaluated the psychometric properties of the PSQI and support the use of this instrument in assessing sleep quality in Chinese nonclinical adolescents. Future studies should continue to verify the ability to monitor sleep quality across the lifespan using the PSQI.
... Moreover, NES is positively associated with poor sleep quality (Akdevelioglu et al., 2020;Cleator et al., 2013;Farhangi, 2019), and poor sleep quality appears to be one of the most central symptoms of NES via network analysis (Beauchamp et al., 2021). Sleep quality includes quantitative aspects of sleep such as sleep latency (i.e., the time a person takes to fall asleep) and sleep duration (Buysse et al., 1989), with poor sleep quality reflecting short sleep duration and long sleep latency. Metaanalytic research supports the association between poor sleep quality and obesity among adolescents (Fatima et al., 2016). ...
... As shown in Snyder et al. (2018), the SQS has demonstrated good convergent validity as indicated by a strong correlation (r = .92) with the Pittsburgh Sleep Quality Index (Buysse et al., 1989). The SQS has been used in numerous studies with adolescents and adults (e.g., Ali et al., 2022;Serlachius et al., 2021), including those from China (e.g., Yuan et al., 2022). ...
Article
Objective: This study examined the bidirectional relationships between sleep quality, loss of control (LOC) eating, and night eating in Chinese adolescents using longitudinal data over an 18-month study period. Method: Four-waves of data measurement (Waves 1-4), at 6-month intervals, were conducted with 2566 adolescents aged 11-17 years at baseline. A set of questionnaires were used to assess night eating, LOC eating, and sleep quality at each wave of data collection. Cross-lagged models were applied to analyze the bidirectional relationships between night eating, LOC eating, and sleep quality. Results: Results indicated that higher night eating scores consistently predicted poorer sleep quality and higher LOC eating scores at Waves 1, 2, and 3. Furthermore, poorer sleep quality predicted higher night eating scores at Wave 1 and Wave 3, and higher LOC eating scores predicted higher night eating scores at Wave 1 and Wave 2. Discussion: These findings highlight that night eating, LOC eating, and sleep quality were interrelated across time in Chinese adolescents. Improving sleep quality and reducing LOC eating might be promising in the prevention of night eating in adolescents. Similarly, reducing night eating might be promising in improving sleep quality and reducing LOC eating in adolescents. Public Significance: This study explored the bidirectional relationship between night eating, LOC eating, and sleep quality in Chinese adolescents using cross-lagged models. Findings indicate bidirectional relationships between these variables and highlight the potential utility in incorporating sleep, LOC eating, and night eating interventions in eating pathology prevention designs for adolescents.
... A higher PSQI score indicates poorer levels of sleep quality, with a cut-off >5 indicating the presence of sleep problems. 51 A sample item of the PSQI is 'During the past month, how would you rate your sleep quality overall?'. The PSQI has been found to have satisfactory psychometric properties in different language versions (e.g. ...
... Chinese, English, Malay, Korean). [51][52][53][54][55] A Chinese version of the PSQI was used in the current study. The internal consistency of the PSQI in the present study was good (α = 0.77). ...
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Background Problematic internet use, especially in people with substance use disorder, may negatively affect their quality of life (QoL). However, it is unclear whether sleep quality is a key mediator in the association between problematic internet use and QoL among people with substance use disorder. Aims This study aimed to investigate the relationship between problematic internet use and QoL and how sleep quality may mediate the association between these two variables. Method Overall, 319 people (85% male) with substance use disorder (mean age 42.2 years, s.d. 8.9) participated in a cross-sectional study in Taiwan. The Smartphone Application-Based Addiction Scale, Bergan Social Media Addiction Scale, Internet Gaming Disorder-Short Form, Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Questionnaire Brief Version were used. Results The prevalence of sleep problems was 56%. There were significant and direct associations between sleep quality and two types of problematic internet use, and between sleep quality and different dimensions of QoL. All types of problematic internet use were significantly and negatively correlated with QoL. Mediated effects of sleep quality in relationships between the different types of problematic internet use and all dimensions of QoL were significant, except for problematic use of social media. Conclusions Different types of problematic internet use in people with substance use disorder may be directly associated with reduced QoL. Sleep quality as a significant mediator in this association may be an underlying mechanism to explain pathways between problematic internet use and QoL in this population.
... An outcome variable (sleep quality) was assessed by using Pittsburgh Sleep Quality Index (PSQI) a self-report standard questionnaire item introduced in 1989 as an instrument to measure sleep quality (27). It consists of 19 questions evaluating the following 7 domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, sleep medication use, and daytime dysfunction. ...
... The Cronbach alpha of PSQI in the current study was 0.78. Using a global scale PSQ, consider having poor sleep quality, if the score is >5, whereas, good sleep if the score is =5 (27). Proportional allocation of sample size among nurses working at comprehensive specialized hospitals in Northwest, Ethiopia, 2021 (n = 542). ...
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Background: Poor sleep quality is common among nurses. This problem possibly results in negative emotional and psychological consequences in nurses which secondary affect their work performances. However, in Ethiopia, there is a paucity of information about poor sleep quality and associated factors among nurses. This study aimed to assess the prevalence of poor sleep quality and associated factors among nurses working at comprehensive specialized hospitals in Northwest Ethiopia. Methods: An institutional-based cross-sectional study was conducted among 542 nurses who worked at University of Gondar (UOG), Tibebe Ghion, Felege Hiwot Comprehensive Specialized Hospitals, Ethiopia, who were incorporated into the study through a simple random sampling technique from 1 May to 2 June 2021. The Pittsburgh sleep quality index (PSQI) with a cut score of above 5 was used to assess sleep quality using a structured self-administered questionnaire. Other tools used are Depression Anxiety Stress Scales (DASS-21), Shift Work sleep disorders (SWSD), and Oslo-3 social support scales. Epi-Data version 3.1 was used for data entry and SPSS version 25 was used for data analysis. A multivariable logistic regression analysis was performed to identify variables that have a significant association with poor sleep quality among nurse professionals. The degree of association was assessed using an odds ratio (OR) with a 95% confidence interval (CI) at a two-tailed p-value of <0.05. Results: A total of 510 nurses were included in the study with a response rate of 94%. The study showed that the overall prevalence of poor sleep quality among nurses was 75.5% (95% CI (71.8, 79.1). Being female (AOR = 1.72:95% CI = 1.19, 2.28), depressive symptoms (AOR = 2.24:95% CI = 1.24, 3.85), anxiety symptoms (AOR = 2.12: 95% CI = 1.23, 3.62), stress (AOR = 2.85: 95% CI = 1.67, 4.82) and current alcohol drinking (AOR = 1.84 :95% CI = 1.27, 3.13) were significantly associated with poor sleep quality. Frontiers in Psychiatry 01 frontiersin.org Segon et al. 10.3389/fpsyt.2022.931588 Conclusion: The overall prevalence of poor sleep quality among nurses was high. Being female, depressive symptoms, anxiety symptoms, stress, and current alcohol drinking had been significantly associated with poor sleep quality. Therefore, it is essential to institute effective intervention strategies emphasizing contributing factors to poor sleep quality.
... We used the following cut-off scores as indicators of anxiety (HADS-A ≥ 12 points) or depressive (HADS-D ≥ 10 points) levels [15]. The Pittsburgh Sleep Quality Index (PSQI, 0-21 points) was used for evaluating sleep quality during the previous month [16]. We used a cut-off score PSQI ≥ 8.0 points as indicative of being a poor sleeper [16]. ...
... The Pittsburgh Sleep Quality Index (PSQI, 0-21 points) was used for evaluating sleep quality during the previous month [16]. We used a cut-off score PSQI ≥ 8.0 points as indicative of being a poor sleeper [16]. Both the HADS and the PSQI can be properly assessed by telephone [17]. ...
Article
We compared the prevalence of musculoskeletal post-COVID pain between previously hospitalized COVID-19 survivors infected with the historical, Alpha or Delta SARS-CoV-2 variant. Data about musculoskeletal post-COVID pain were systematically collected through a telephone interview involving 201 patients who had survived the historical variant, 211 who had survived the Alpha variant and 202 who had survived the Delta variant six months after hospital discharge. Participants were recruited from non-vaccinated individuals hospitalized due to SARS-CoV-2 infection in one hospital of Madrid (Spain) during three different waves of the pandemic (historical, Alpha or Delta variant). Hospitalization and clinical data were collected from hospital medical records. In addition, anxiety/depressive levels and sleep quality were also assessed. The prevalence of musculoskeletal post-COVID pain was higher (p = 0.003) in patients infected with the historical variant (47.7%) than in those infected with the Alpha (38.3%) or Delta (41%) variants. A significantly (p = 0.002) higher proportion of individuals infected with the historical variant reported generalized pain (20.5%) when compared with those infected with the other variants. The prevalence of new-onset post-COVID musculoskeletal pain reached 80.1%, 75.2% and 79.5% of patients infected with the historical, Alpha or Delta variants, respectively. No specific risk factors for developing post-COVID pain were identified depending on the SARS-CoV-2 variant. In conclusion, this study found that musculoskeletal post-COVID pain is highly prevalent in COVID-19 survivors six months after hospital discharge, with the highest prevalence and most generalized pain symptoms in individuals infected with the historical variant. Approximately 50% developed “de novo” post-COVID musculoskeletal pain symptoms.
... Sleep. The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality and patterns of sleep across multiple domains (e.g., sleep duration and efficiency; Buysse et al., 1989). Scores range from 0 to 21, with higher scores indicating worse sleep quality (a score of 5 or greater indicates a "poor" sleeper). ...
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Effective, scalable mental health programs are greatly needed for older adults. In this study, Mood Lifters—a peer-led, community-based program promoting mental well-being—was adapted to more specifically address the needs of older adults. Two groups completed the 14-week program via Zoom. A total of 24 participants enrolled ( M age = 72 years), with 20 (83%) completing the program. Compared to baseline, program completers showed significant improvements in depression symptoms ( p < .01), perceived stress ( p = .04), sleep quality ( p < .01), physical activity ( p < .01), and brain health behaviors ( p = .01), with improvements maintained at 1-month follow-up. No significant changes were reported in participants’ anxiety, loneliness, or resilience. Participant ratings of program satisfaction were very high ( M = 4.75/5). Results suggest Mood Lifters for Seniors is feasible to disseminate and acceptable to older adults, with preliminary evidence of benefits in several mental health domains. Future randomized trials with larger, more diverse samples are needed to confirm program benefits.
... Also there were 7 assessments conducted in 2 consecutive days for each assessment session in order to avoid or minimize the fatigue effect. On the 1 st day, the 4 assessments included the following: the Barthel index is an instrument that can be utilized on the elderly to measure the activities of daily living [13]; the Pittsburgh Sleep Quality Index is a self-rated questionnaire that can be used in older adults to assesses sleep quality and disturbances over a 1-month time interval [14]; the heart rate recovery is a non-invasive assessment of cardiac autonomic function with the rate drop between 12 and 23 beats within a minute as good [15'16]; and pillows used in supine position. On next day, three more physical functional assessments were randomly conducted, including the 4-stage balance test is a progressive assessment testing balance form side-by-side, semi-tandem, tandem, to single leg stance [17]; the 5-times sit-to-stand test is a reliable functional lower extremity strength assessment that is often used in the elderly [18]; and the 2-minute walk test is to assess a person's endurance or aerobic capability [19]. ...
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Introduction: Interventions for older adults with multiple medical diagnoses may need to have a more general focus that can be applied across a broad range of medical conditions. Ba-Duan-Jin (BDJ), a non-disease specific Tai Chi-QI Gong based mind-body training coordinated with deep breathing, may be a good choice. Case Description: A 79-year-old white female patient, with diagnoses of cardiopulmonary, gastrointestinal, and perceived sleep dysfunctions, was referred for consultation of geriatric rehabilitation for poor endurance and balance in a senior living retirement complex where rehabilitation services were provided. A BDJ-based deep diaphragmatic breathing (DDB) progressive training was provided 45-50 minutes each time and 3 times a week for 6 months. At the baseline, the end of 3rd and 5th month of this study, this patient was assessed with the Barthel index for activity of daily living, 1-minute heart rate recovery, Pittsburg sleep quality index, head elevation during sleeping, 4-stage balance, and 2-minute walk test. At the end of 3rd and 6th month, the patient was able to have improved strength, endurance, balance, cardiorespiratory function, gastral regurgitation, and activities of daily living. The mechanism of the beneficial effects of BDJ-based deep breathing in this case was discussed with body mechanical and anatomical consideration. KEY WORDS: Older adults, Ba-Duan-Jin, Tai Chi, Multimorbidity, Diaphragmatic anatomy.
... Maternal sleep patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated 10-item questionnaire designed to measure sleep quality [24] that has been validated in pregnant women [25]. Items include hours of sleep, medication use, waking during the night, and trouble falling asleep. ...
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During the COVID-19 pandemic, pregnant women have been at high risk for psychological distress. Lifestyle factors may be modifiable elements to help reduce and promote resilience to prenatal stress. We used Machine-Learning (ML) algorithms applied to questionnaire data obtained from an international cohort of 804 pregnant women to determine whether physical activity and diet were resilience factors against prenatal stress, and whether stress levels were in turn predictive of sleep classes. A support vector machine accurately classified perceived stress levels in pregnant women based on physical activity behaviours and dietary behaviours. In turn, we classified hours of sleep based on perceived stress levels. This research adds to a developing consensus concerning physical activity and diet, and the association with prenatal stress and sleep in pregnant women. Predictive modeling using ML approaches may be used as a screening tool and to promote positive health behaviours for pregnant women.
... The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality in the last month (Buysse et al., 1989). There are 19 self-report items in the PSQI, but the last item is not included in the scoring. ...
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Aim: This study examined the mediating effect of circadian rhythm amplitude (LV) and stability (FR) between work stress and sleep quality among Chinese shift-working nurses (SWNs). Design: A cross-sectional study. Methods: Three-hundred and seventy-nine nurses working in shifts were investigated by convenient sampling from six hospitals in Shanghai, China. The mediating effect was analysed using the structural equation model with bootstrapping procedures. Results: Work stress could directly affect shift nurses' sleep quality and indirectly affect sleep quality through circadian rhythm amplitude and stability. The total indirect effects of work stress on sleep quality accounted for 36.7% of the total effect. The study revealed that poor sleep quality is very common among SWNs, which deserves attention. The mediating effect of the circadian rhythm provides new insights to improve sleep quality, not only by lightening the work stress but also by improving circadian rhythm in SWNs.
... The questionnaire includes 21 questions covering seven components that investigate the symptoms of sleep disturbances. Scores range from 0 to 21, and a score of more than 5 is considered a sleep disorder [19]. ...
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This study aimed to investigate the frequency of CS and its clinical and functional effects on familial Mediterranean fever (FMF). A hundred FMF patients were included in this study. The presence of CS was investigated by the central sensitization inventory (CSI). In addition to the detailed clinical features of patients and genetic mutations, quality of life, disability, sleep disorders, depression, anxiety, and fibromyalgia frequency were examined to evaluate the negative effects of CS on the individual. Patients were divided into groups according to the presence and severity of CS, and their results were compared. Correlation and multivariate regression analysis were performed to investigate the association of CS with selected demographic and clinical parameters. The mean CSI was 37.72 (SD: 19.35), and thirty-eight (38%) patients had CS. Sacroiliitis occurred in 11 patients (11%), amyloidosis in 3 (3%), and erysipelas-like erythema in 11 (11%). The most prevalent genetic mutation was M694/any compound heterogeneous (35.7%), followed by M69V homogeneous (30%). Regarding comparing the patients with and without CS, the number of attacks, disease activity, daily colchicine dose, and all investigated comorbidities were significantly higher in the patients with CS (p < 0.05). In regression analysis, gender, colchicine dose and sleep disturbance were detected as related parameters with CS (OR (95% CI): 6.05 (1.39; 26.32), p: 0.017, OR (95% CI): 6.69 (1.65; 27.18), p: 0.008, OR (95% CI): 1.35 (1.35; 1.59), p: 0.001, respectively). Concomitant pain sensitization appears to be related to FMF patients' clinical and functional characteristics. These results suggest taking into consideration CS in the management of FMF patients.
... Co-occurring mental health disorders were screened using the Patient Health Questionnaire (PHQ-9) (Kroenke et al. 2001) for depression; Generalized Anxiety Disorder (GAD-7) (Spitzer et al. 2006); for anxiety; Barratt Impulsiveness Scale (BIS-11) (Patton et al. 1995) for impulsiveness; Personality Disorder Screener (PDS) (Kessler et al. 1998) for personality disorders; Addiction Severity Index Lite version (ASI-Lite) (Cacciola et al. 2007) for the seven domains addiction severity; Work and Social Adjustment Scale (WSAS) (Mundt et al. 2002) for social and work impairment; and the Pittsburgh Sleep Quality Index (PSQI) (Buysse et al. 1989) for quality of sleep. ...
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Background Opioid craving is suggested to correlate with the rate of reduction in buprenorphine (BUP) plasma levels. No studies explored Buprenorphine elimination rate constant (BUP EL.R) as a predictor of opioid use or retention in BUP treatment. Methods Analysis was performed using data from a randomized controlled trial of 141 adults with opioid use disorder (OUD) randomized to Incentivized Adherence and Abstinence monitoring (I-AAM; experimental (n = 70) and treatment-as-usual; control (n = 71). In the I-AAM, structured access to unsupervised BUP doses was provided up to 28 days contingent of adherence measured by Therapeutic Drug Monitoring and abstinence by Urinary Drug Screens (UDS). In contrast, the treatment-as-usual (control) provided unstructured access to unsupervised doses was provided for up to 14 days considering UDS results. The primary outcome was percentage negative UDS. The secondary outcome, retention in treatment, was continuous enrollment in the study and analysis was via intention-to-treat. Significant bivariate correlations with the outcomes were adjusted for group allocation. Results A significant negative correlation between BUP EL.R and percentage negative opioid screens (Pearson correlation coefficient − 0.57, p < 0.01) was found. After adjusting for trial group, BUP EL.R was shown to be an independent predictor of percentage negative opioid screens (Standardized Beta Coefficient − 0.57, 95% CI − 221.57 to − 97.44, R² 0.322). Conclusion BUP EL.R predicted 32.2% of the variation in percentage negative opioid UDS and may serve as a potential promising tool in precision medicine of BUP treatment. Higher buprenorphine elimination is associated with higher positive opioid urine screens during treatment. Trial registration ISRCTN41645723 retrospectively registered on 15/11/2015.
... The SAS (index, 25-100) is a validated 20-item rating instrument for anxiety disorders, with higher scores indicating greater anxiety [30]. PSQI (score, 0-21) is a validated 19-item self-rated questionnaire for assessing sleep quality and disturbances, with higher scores indicating poorer sleep quality [31]. Possible predictors for smoking cessation were evaluated, and all adverse events or reactions were monitored, appropriately managed, and recorded throughout the study period. ...
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Abstract Background Acupuncture combined with auricular acupressure has been used as a complementary and alternative treatment for smoking cessation in Hong Kong for over 10 years. This study aimed to investigate the success rates of smoking cessation posttreatment, and to evaluate treatment effects on tobacco dependence, smoking behavior, anxiety levels, and sleep disturbances between successful and unsuccessful quit smokers in Hong Kong. Methods This prospective, multicenter clinical study conducted between September 2020 and February 2022 in Hong Kong was part of the Guangdong-Hong Kong-Macau Greater Bay Area project on smoking cessation. Thirty eligible current smokers (mean age 47.10 years; 40% female) were recruited and received a combination of standardized acupuncture and auricular acupressure treatments twice weekly for 8 weeks. The primary outcome was the success rate of smoking cessation at week 24. The secondary outcomes were the success rates of smoking cessation at weeks 8 and 16, exhaled carbon monoxide (CO) levels, and changes in scores on the Fagerström Test for Nicotine Dependence (FTND), Autonomy Over Smoking Scale (AUTOS), Hamilton Anxiety Rating Scale (HAM-A), Self-rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI). Adverse events were also recorded. Results Of 30 eligible participants, 28 completed 6 or more treatment sessions; all completed follow-up assessments. At week 24, the success rate of smoking cessation was 46.67%. The successfully quit rates at weeks 8 and 16 were 36.67% and 43.33%, respectively. The overall change in mean FTND scores from baseline improved significantly from weeks 2 to 24 (P
... It is scored on a fourpoint Likert scale, ranging from "no difficulty" [0] to "severe difficulty" [3]. The total score of PSQI ranges from zero to 21, in which a score lower than five indicates good sleep, while a score higher than five indicates poor sleep quality [54]. The PSQI has been widely used in Iranian nurses' samples and shows great reliability and validity [55]. ...
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Background COVID-19 has created significant and unprecedented psychological distress on nurses working with COVID-19 patients. Nurses dealing with such psychological distress are prone to burnout. This study examined the mediating role of sleep disturbance and rumination in the association between psychological distress and work-related burnout of nurses treating COVID-19 patients. Methods A cross-sectional study was conducted from 26th February to 16th March 2021, on a sample of 250 nurses who were actively working during the COVID-19 pandemic in five referral hospitals in Tehran, Iran. The Oldenburg Burnout Inventory, Kessler Psychological Distress Scale (K10), Pittsburgh Sleep Quality Index, and Ruminative Responses Scale were used to collect data. Data analysis was based on pearson’ correlation analysis and path analysis. Results Psychological distress has a significant effect on job burnout. When sleep disturbances were modeled as a mediator, path coefficients of psychological distress showed a significant effect on job burnout. Also, according to the findings, rumination poses a significant mediating effect on the association between psychological distress and job burnout. Conclusion This study demonstrated the importance of designing psychological interventions intended to reduce sleep disturbances and rumination when experiencing stressful events to avoid job burnout among nurses.
... Among the objective ones, polysomnography is a clinical method able to detect the duration and the characteristics of sleep stages and phases (Kinoshita et al., 2021), whilst actigraphy can objectively record the 24-h motor activity providing the assessment of the sleep-wake cycle in the long term (Ancoli-Israel et al., 2003). The subjective methods include a large variety of questionnaires, of which the most widely used is the Pittsburgh Sleep Quality Index (PSQI) (Mollayeva et al., 2016), a self-reported questionnaire describing various domains of sleep (Buysse et al., 1989). ...
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Balneotherapy and exercise are potential factors influencing sleep through several physiological pathways and relaxing effects. This review aims to assess whether balneotherapy can improve sleep quality in concomitance or not with exercise. The research was conducted on Medline , Scopus , PubMed, Web of Science , and Cochrane Library databases. The current review followed PRISMA reporting guidelines and involves twenty-one articles grouped into four sections based on the characteristics of the balneotherapy protocol: 1.a Balneotherapy–thermal water immersion alone (five studies); 1.b Balneotherapy–thermal water immersion with other spa treatments (six studies); 2.a Balneotherapy and physical exercise–balneotherapy and out-of-the-pool physical exercise (eight studies); 2.b Balneotherapy and physical exercise–balneotherapy and in-pool physical exercise (three studies). Apart from healthy or sub-healthy subjects, patients recruited in the studies were affected by fibromyalgia, ankylosing spondylitis, osteoarthritis, musculoskeletal pain, subacute supraspinatus tendinopathy, and mental disorders. Duration, number of sessions, and study protocols are very different from each other. Only one study objectively evaluated sleep, whereas the others used subjective sleep assessment methods. Eight studies considered sleep as a primary outcome and ten as secondary. Sixteen out of twenty-one studies described improvements in self-perceived sleep quality. Thus, balneotherapy associated with other spa treatments and physical exercise seems to be effective in improving self-perceived sleep quality. However, the miscellany of treatments makes it difficult to discern the isolated effects of balneotherapy and physical exercise. Future studies should consider using an objective sleep assessment method and describing the pathways and physiological mechanisms that could provoke sleep changes during balneotherapy treatments.
... As the classic tool for measuring sleep quality, the Pittsburgh sleep quality index has been developed into many versions around the world [29]. We used the Chinese version of the Pittsburgh sleep quality index (PSQI) [30] to measure sleep quality in the present study, which has been proven to be a tool with good reliability and validity to measure sleep quality for Chinese populations [31][32][33][34][35]. The scale consists of 7 dimensions, namely subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction. ...
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Background: The outbreak of COVID-19 has seriously threatened the health of people around the world. To prevent the spread of the epidemic, Chinese universities have implemented closed management of campuses. The implementation of restrictive measures has gradually caused changes in the quality of sleep and the psychological state of college students. In addition, college students are faced with the dual pressure of employment and study, and the psychological pressure is huge. Therefore, it is necessary to investigate sleep and depressive symptoms among college students. Methods: Using the method of stratified cluster sampling, 6695 college students were selected from three universities in Jiangxi, Anhui, and Xinjiang provinces from April to May 2022. The Chinese version of the Pittsburgh sleep quality index (PSQI) and the self-rating depression scale (SDS) were used for the survey. Hierarchical logistic regression analysis was used to analyze the relationship between the PSQI and the SDS. Results: Overall, during the outbreak of COVID-19, 69.0% of males and 73.5% of females had poor sleep quality among Chinese college students and the detection rate of depressive symptoms was 43.6% for males and 47.8% for females, respectively. Taking students with good sleep quality as references, after controlling for covariates, hierarchical logistic regression shows that Chinese college students with poor sleep quality have a higher OR value (OR = 12.0, 95%CI: 10.2~14.1, p < 0.001), especially in males (OR = 43.8, 95%CI:30.2~63.6, p < 0.001). For both males and females, the OR value of college students with the following characteristics was higher: rural college students (males, OR = 50.32, 95%CI: 32.50–77.93; females, OR = 8.03, 95%CI: 6.45–9.99), overweight college students (males, OR = 62.17, 95%CI: 19.47–198.53; females, OR = 16.67, 95%CI: 6.48–42.88), and college students drinking sugar-sweetened beverages (males, OR = 59.00, 95%CI: 36.96–94.18; females, OR = 8.16, 95%CI: 6.63–10.05) (p < 0.001). Conclusions: Poor sleep quality is associated with depressive symptoms among Chinese college students, especially college males. Our research suggests that it is necessary to consider the improvement of sleep quality and depressive symptoms among college students during the COVID-19 epidemic.
... A Pittsburgh Sleep Quality Index global score of >5 was defined as poor sleep quality. [7] Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression status. The HADS is a well-validated screening tool initially designed to assess the psychological distress of medically ill patients, [8] and it has been extensively used in clinical settings and research. ...
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Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain. Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease. A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005). In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.
... The total PSQI scores ranged from 0 to 21 points, with higher scores indicating poorer sleep quality. PSQI scores greater than 5 points were defined as poor sleep quality [85]. As shown in Table 3, the pooled results indicated that poor sleep quality increased the risk of MetS (OR = 1.46, 95% CI: 1.03-2.06, ...
... The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality in the sample (36,37). This scale includes 19 items assessing seven dimensions of sleep quality: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. ...
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Objective Adolescents are likely to suffer from negative emotions such as depression and anxiety due to the rapid development of biological, cognitive and social changes. Previous studies have indicated possible risk (rumination) and protective (good social support and high sleep quality) factors for depression and anxiety among this age group. The present study is the first to investigate the association between social support and negative emotions during the Outbreak of Omicron variant, on this basis, to further determine the mediating role of rumination and sleep quality on this link.MethodA total of 1,065 Chinese middle- and high-school students (51.5% female, Mage = 13.80, SD = 1.20) completed a psychosocial battery, including the Social Support Rating Scale (SSRS), the Pittsburgh Sleep Quality Index (PSQI), the Ruminative Responses Scale (RRS), the Depression Anxiety Stress Scale (DASS). Serial multiple mediation analysis was conducted using PROCESS macro based on SPSS.ResultsSocial support, rumination, and sleep quality were significantly negatively correlated with negative emotional states (Ps < 0.05). Further, rumination and sleep quality were found to partially mediate the relationship between social support and negative emotional states.Conclusions For early detection and prevention of depression and anxiety, providing sufficient social support is necessary for adolescents, because rumination and sleep problems are reported during stressful periods, such as the COVID-19 pandemic.
... Sleep condition was assessed using questions taken from the Pittsburgh Sleep Quality Index (PSQI); these include an item on sleep duration ("How many hours of actual sleep did you get at night during on-shift days?") and one on sleep quality ("During the past month, during on-shift days, how would you rate your sleep quality overall?") [49]. Poor sleep condition was classified as participants who reported a sleep duration of less than 7 h and/or rated their sleep quality as fairly to very bad [29]. ...
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Sufficient knowledge on the work productivity impact of the health of fly-in fly-out (FIFO) workers in the mining sector in Australia is lacking. This study examined the impact of health and lifestyle behaviours on the work productivity of FIFO workers in the mining industry in Australia. FIFO workers completed an online questionnaire on health and work productivity loss measures. Linear regressions were used to model annual work productivity losses through absenteeism, presenteeism and total productivity loss. Workers with a high risk for health conditions were, on average, associated with 3.87% more productivity loss (absenteeism: 1.27% and presenteeism: 2.88%) than those with low risk. Workers who had multiple health risks classified as medium (3–4 health conditions) and high (5 or more health conditions) reported 1.75% and 7.46% more total productivity loss, respectively, than those with fewer multiple health risks (0–2 health conditions). Health conditions were estimated to account for an annual additional productivity cost due to absenteeism of AUD 8.82 million, presenteeism of AUD 14.08 million and a total productivity loss of AUD 20.96 million per 1000 workers. FIFO workers with high health risks experience more absenteeism, presenteeism and overall productivity loss. These measures provide strong economic justifications that could support the need for targeted workplace health interventions.
... 19 We used the Korean version of the Pittsburgh Sleep Quality Index (PSQI) to measure overall sleep quality and assess the severity of sleep problems. 28 The design of experimental procedure is presented in Figure 1. The experiment was based on a block design, and consisted of four sleep-related sound (SS) blocks and four neutral sound (NS) blocks. ...
... The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate subjective sleep quality during the previous month in terms of seven sleep domains (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction). 20 The Epworth Sleepiness Scale (ESS) was employed to https://doi.org/10.2147/NSS.S369192 ...
... Standardized questionnaires indicated that participants were right-handed (Oldfield 1971) and did not exhibit excessive anxiety (Beck's Anxiety Inventory;Beck et al. 1988) or depression (Beck's Depression Inventory;Beck et al. 1961). In addition, the quality and quantity of sleep was considered normal in the month prior to the experiment (Pittsburgh Sleep Quality Index; Buysse et al. 1989) as well as during the nights preceding the sessions (St. Mary's Hospital questionnaire; Ellis et al. 1981). ...
Article
Increasing evidence suggests that reactivation of newly acquired memory traces during postlearning wakefulness plays an important role in memory consolidation. Here, we sought to boost the reactivation of a motor memory trace during postlearning wakefulness (quiet rest) immediately following learning using somatosensory targeted memory reactivation (TMR). Using functional magnetic resonance imaging, we examined the neural correlates of the reactivation process as well as the effect of the TMR intervention on brain responses elicited by task practice on 24 healthy young adults. Behavioral data of the post-TMR retest session showed a faster learning rate for the motor sequence that was reactivated as compared to the not-reactivated sequence. Brain imaging data revealed that motor, parietal, frontal, and cerebellar brain regions, which were recruited during initial motor learning, were specifically reactivated during the TMR episode and that hippocampo-frontal connectivity was modulated by the reactivation process. Importantly, the TMR-induced behavioral advantage was paralleled by dynamical changes in hippocampal activity and hippocampo-motor connectivity during task practice. Altogether, the present results suggest that somatosensory TMR during postlearning quiet rest can enhance motor performance via the modulation of hippocampo-cortical responses.
... If the PSQI score is below 5, it indicates that sleep quality is impaired. [6] Statistical analysis SPSS 25.0 (IBM SPSS Statistics 25 software (Armonk, NY: IBM Corp.) was used for statistical evaluation of data. Continuous variables were defined by the mean ± standard deviation, median (IQR: interquartile range, 25 th -75 th percentiles), and minimum-maximum values, and categorical variables were defined by frequencies and percent. ...
Article
Rationale Much of the research linking racism-related stressors to poor health has focused on fairly non-violent forms of racism that directly impact individuals under study. Exposure to particularly extreme and/or violent racist events are increasingly visible via smartphone recordings and social media, with consistent anecdotal reports of the effects of seeing and hearing about these events on sleep among minorities who racially identify with the victims. Objective This study examines whether exposure to direct and vicarious racism-related events (RREs), including more extreme events, are associated with sleep quality. Additionally, we examine effects of less and more violent direct RREs and vicarious RREs witnessed in person and via social media. Methods Among 422 African-American women, we assessed exposure to RREs using a modified version of the Race-Related Events Scale and assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Linear regression analyses were used to model continuous global sleep. Results Direct (β = 0.24 [95% CI: 0.13, 0.35]) RREs were associated with worse continuous global sleep quality scores in analyses adjusted for sociodemographics and risk factors for poor sleep. More violent direct RREs (β = 0.59 [95% CI: 0.30, 0.89]) had stronger associations with poor sleep quality than less violent direct RREs (β = 0.25 [95% CI: 0.11, 0.40]). Vicarious RREs overall (β = 0.04 [95% CI: 0.14, 0.21]) and those witnessed via social media (β = −0.07 [95% CI: 0.29, 0.14]) were not associated with global sleep quality; conversely, vicarious RREs witnessed in person were (β = 0.52 [95% CI: 0.21, 0.83]). Conclusion Extreme, direct experiences of racism, particularly those that are violent in nature, are associated with poor sleep quality. However, extreme vicarious experiences are not-- unless witnessed in person.
Article
Objective The aim of this project was to conduct a randomised control study to examine whether outdoor mindful walking in nature can effectively improve university students’ sleep quality, mood, and mindfulness during the lockdown of Covid-19 pandemic in the U.K. Methods Participants were measured at T0 (pre-study baseline), T1 (pre-intervention), T2 (post-intervention), and T3 (follow-up). A total of 104 participants (female = 94) who were experiencing sleep difficulties were randomly allocated to either an experimental (i.e., nature) or control (i.e., urban) walking environments. Participants in each walking condition independently undertook a daily 35-minute walk for a week (7 days). Subjective sleep quality, total mood disturbance, mindfulness, and degree of nature, and participants’ perspectives and suggestions about the intervention, were collected. Results Findings suggest that both groups exhibited significant improvements on participant's trait mindfulness, sleep quality and mood after the intervention. However, mindful walking in nature did not bring additional mental health benefits to participants than those who walked in urban environment. Participants reflected their perspectives about the intervention, which will assist with further intervention development. Conclusions Findings contribute to the evidence base for the effectiveness of outdoor mindful walking interventions on mental health. Especially these findings add new knowledge of how mindful walking outdoors reduces university students’ mood disturbances and improves their sleep quality and mindfulness level during the pandemic.
Article
Objective We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems. Methods Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects model were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses. Results A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61–6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53–9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regression showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality. Conclusions We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orient further studies on sleep since COVID-19 pandemic.
Article
We investigated whether device-measured sleep parameters are associated with cortical thickness in older adults with probable mild cognitive impairment (MCI). We performed a cross-sectional, exploratory analysis of sleep and structural MRI data. Sleep data were collected with MotionWatch8© actigraphy over 7 days. We computed average and variability for: sleep duration, sleep efficiency, and fragmentation index. T1-weighted MRI scans were used to measure cortical thickness in FreeSurfer. We employed surface-based analysis to determine the association between sleep measures and cortical thickness, adjusting for age, sex, Montreal Cognitive Assessment (MoCA) score, and sleep medication use. Our sample included 113 participants (age = 73.1 [5.7], female = 72 [63.7 %]). Higher fragmentation index variability predicted lower cortical thickness in the left superior frontal gyrus (cluster size = 970.9 mm², cluster-wise p = 0.017, cortical thickness range = 2.1 mm² to 3.0 mm²), adjusting for age, sex, MoCA, and sleep medication. Higher variability in sleep fragmentation, an indicator of irregular sleep pattern, is linked to lower cortical thickness. Future longitudinal studies targeting are needed to determine the directionality of these associations.
Article
Background Psychiatric nurses often face abuse, attacks, escape, suicides, and other situations related to the care of patients with mental disorders, which are more likely to induce psychological distress. Aims This study aimed to examine the relationship between coping styles and psychological distress among Chinese psychiatric nurses in Shandong and the significance of sleep quality as a mediating factor. Methods A total of 812 psychiatric nurses in Shandong, China, were investigated using the Psychological Distress Scale (K10), Simplified Coping Style Questionnaire (SCSQ), Pittsburgh Sleep Quality Index (PSQI) and self-compiled general information questionnaire. Results Psychological distress was detected in 571 psychiatric nurses (70.3%). The psychological distress of psychiatric nurses was significantly different with respect to professional title (χ ² = 10.627, P < 0.05) and shift work (χ ² = 9.120, P < 0.01). Psychological distress positively correlated with negative coping style ( r = 0.266, P < 0.01) and sleep quality (PSQIT) ( r = 0.532, P < 0.01). A significant positive correlation was found between psychological distress and all dimensions of sleep quality ( r = 0.158–0.456, P < 0.05). Professional title, positive coping style, negative coping style, sleep quality (PSQIT), subjective sleep quality, sleep disorder and daytime dysfunction predicted psychological distress in psychiatric nurses ( R ² = 0.363, F = 65.343, P < 0.01). The relationship between negative coping style and psychological distress was partially mediated by sleep quality, with the mediating effect accounting for 37.97% of the total effect. Conclusions Psychiatric nurses have a high rate of psychological distress, which is closely related to coping styles, and sleep quality has a certain regulatory effect.
Article
Using air movements to improve sleeping environments is widely practiced in summer; while research into how to evaluate thermal comfort and sleep quality under such non-uniform environments is lacking, due to the greatly reduced ability of occupants to adjust to the immediate environment during sleep. This study conducted climate chamber sleeping experiments under a combination of conditions of temperature (28/30/32 °C), relative humidity (50%/80%), and air velocity (0.39/0.69/1.17 m/s). The results showed that the appropriate air velocities alleviated the thermal discomfort caused by higher temperature and humidity; however, when the temperature was higher than 32 °C and coupled with high humidity, the cooling efficiency of air velocity was reduced significantly. The subjective evaluations of sleep quality were consistent with the measured sleep indicators - Total Sleep Time (TST), Sleep Onset Latency (SOL), and Slow Wave Sleep (SWS) - indicating that recall-based sleeping evaluations after waking up could reflect the actual sleep quality to some degree. A developed PMVs model was proposed considering three aspects of the body heat exchanges: the parts in contact with the mattress (e.g. back, buttocks), the parts covered by the quilts or clothes (e.g. abdomen, chest), and the parts directly exposed to the air (e.g. head, arms, legs). The upper temperature and humidity limits, appropriate air velocity zones, and different bedding thermal insulation levels were thus obtained. The work can guide the application of local ventilation devices in sleeping environments in summer and contribute to reducing the use of air conditioners and achieving energy savings in residential buildings.
Article
The study examined the relationship between menopausal symptoms and sleep disturbances and the related influencing factors. Methods. We recruited women aged 40-65 years who attended the menopause clinic at Shanghai Jiao Tong University’s Sixth People’s Hospital from February 2011 to November 2019. The Menopause Rating Scale (MRS) was used to collect women’s menopausal symptoms, and the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the subjects’ sleep condition. We used logistic regression models to identify the relationship between menopausal symptoms and sleep quality. Results. A total of 1341 participants were recruited in this study. The most frequent three symptoms assessed by MRS were fatigue (72.9%), sleep disturbance (67%), and hot flashes with night sweats (65%). Participants’ age was significantly associated with the severity of menopausal syndrome ( P < 0.01 ). According to the PSQI sleep evaluation, 66.9 percent of participants had sleep disturbances ( PSQI > 5 ). Logistic regression analysis revealed that women with mild, moderate, or severe menopausal syndrome had a 3-, 7-, and 17-fold increased chance of having sleep disturbances compared to women without menopausal syndrome. Conclusion. Women aged 40–65 years were found to have a significantly higher risk of menopausal syndrome and sleep disturbances.
Rotating shift work places a serious burden on nurses’ physical and psychological health. Gastrointestinal (GI) symptoms are a common complaint among shift workers. This study assessed GI symptoms and identified the associations between dietary habits, psychological status, and sleep quality among rotating shift nurses. Data from 125 female nurses in rotating shifts who worked at two tertiary hospitals in South Korea were collected using a questionnaire that included the Gastrointestinal Symptoms Questionnaire; the Dietary Habit Questionnaire; the Depression, Anxiety, Stress Scale (DASS)-21; and the Pittsburgh Sleep Quality Index (PSQI). All participants experienced various GI symptoms, and 47% of them complained of at least one severe GI symptom. There were significant differences in GI symptom scores according to the status of depression, anxiety, stress, and sleep quality. In multiple linear regression analysis, the factors associated with an increase in the occurrence and severity of GI symptoms were poor sleep quality and morbid anxiety and stress. The model explained power at 43.2%. As most nurses in rotating shifts experience GI symptoms, they should receive counseling and training programs at work to alleviate psychological symptoms, improve sleep quality, and pay more attention to their health status as well as GI symptom management.
Article
Background The aim of this study was to comparing the complications (depression, anxiety, sleep disorders and sexual dysfunction) of buprenorphine, methadone and opium tincture as an alternative drug treatment in patients referred to the National Center for Addiction Studies of Tehran during 2020–2021. This cross-sectional study was concocted on 197 patients referred to the National Center for Addiction Studies of Tehran who were treated with one of the alternative treatments of opioids buprenorphine ( n = 24), methadone ( n = 116), and opium tincture ( n = 57) during 2020–2021. Three questionnaires were used to assess the side effects of drugs including Anxiety and Depression Hospital Scales (HADS), AIS (Athens insomnia scale) and the International Index of Erectile Function (IIEF). Data were analyzed using Stata 14.0. The multinomial logistic regression model was used in order to compare complications in the three groups and adjusted odds ratio (OR) with 95% confidence interval (CI) were estimated. Results The mean age in the buprenorphine, methadone and opium tincture groups were 46.80 ± 9.90, 48.31 ± 13.33 and 55.30 ± 10.34 years, respectively. The numbers of men were 17 (70.80), 90 (77.60), and 50 (78.70); respectively. Multinomial logistic regression model showed OR = 0.73 (95% CI 0.61–0.88) for anxiety in the methadone group in compared to buprenorphine. Likewise, OR = 1.22 (95% CI 1.001–1.48) and OR = 1.34 (95% CI 1.10–1.63) was observed for sleep disorder in the methadone and opium tincture groups in compared to buprenorphine; respectively. Conclusions Sleep disturbance in buprenorphine group is less than opium tincture and methadone. Also, anxiety in the methadone group was lower than the buprenorphine, however, there was no significant difference between the three groups in term of sexual function and depression. In addition to control measures for sleep disorders in receiving methadone and buprenorphine, the cohort studies with a higher sample size are recommended.
Article
Background Autistic adults have poorer 24-hour movement behaviors, including lower levels of physical activity, more time spent being sedentary, and shorter sleep duration than neurotypical adults. Social ecological frameworks posit that 24-hour movement behaviors are determined by multi-level domains; however, not known is which multi-level factors are most important to meeting each of the 24-hour movement behavior guidelines among autistic adults. Objective This study examined the relative importance of a range of multi-level determinants on meeting guidelines for the 24-hour movement behaviors of aerobic physical activity, sedentary behavior, and sleep. Methods We administered at cross-sectional electronic survey to a national self-selecting, convenience sample of autistic adults and caregivers of autistic adults residing in the USA. We used machine learning to examine the relative variable importance (VIMP) of 55 multi-level variables with meeting recommendations for physical activity, sedentary behavior, and sleep duration. VIMPs > 0 indicate predictive variables/domains. Results A greater number of group activities attended in the last 3-months, and greater independence in completing activities of daily living were most important to meeting aerobic physical activity guidelines. Group activity participation and marital status were important to meeting sedentary behavior guidelines while having a fewer number of comorbidities was most important to achieving adequate sleep. Conclusions These data support hypotheses about the role of family and social level interventions targeting movement behaviors in autistic adults.
According to data from the World Health Organization and medical research centers, the frequency and severity of various sleep disorders, including insomnia, are increasing steadily. This dynamic is associated with increased daily stress, anxiety, and depressive disorders. Poor sleep quality affects people’s productivity and activity and their perception of quality of life in general. Therefore, predicting and classifying sleep quality is vital to improving the quality and duration of human life. This study offers a model for assessing sleep quality based on the indications of an actigraph, which was used by 22 participants in the experiment for 24 h. Objective indicators of the actigraph include the amount of time spent in bed, sleep duration, number of awakenings, and duration of awakenings. The resulting classification model was evaluated using several machine learning methods and showed a satisfactory accuracy of approximately 80–86%. The results of this study can be used to treat sleep disorders, develop and design new systems to assess and track sleep quality, and improve existing electronic devices and sensors.
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Background High levels of sleep disturbances reported among individuals with alcohol use disorder (AUD) can stimulate inflammatory gene expression, and in turn, may alter pro-inflammatory cytokines levels. We aimed to investigate associations between pro-inflammatory cytokine markers with subjective measures of sleep quality, psychological variables and alcohol consumption among individuals with AUD. Methods This exploratory study is comprised of individuals with AUD ( n = 50) and healthy volunteers ( n = 14). Spearman correlation was used to investigate correlations between plasma cytokine levels and clinical variables of interest (liver and inflammatory markers, sleep quality, patient reported anxiety/depression scores, and presence of mood and/or anxiety disorders (DSM IV/5); and history of alcohol use variables. Results The AUD group was significantly older, with poorer sleep quality, higher anxiety/depression scores, and higher average drinks per day as compared to controls. Within the AUD group, IL-8 and MCP-1 had positive significant correlations with sleep, anxiety, depression and drinking variables. Specifically, higher levels of MCP-1 were associated with poorer sleep ( p = 0.004), higher scores of anxiety ( p = 0.006) and depression ( p < 0.001), and higher number of drinking days ( p = 0.002), average drinks per day ( p < 0.001), heavy drinking days ( p < 0.001) and total number of drinks ( p < 0.001). The multiple linear regression model for MCP-1 showed that after controlling for sleep status and heavy drinking days, older participants ( p = 0.003) with more drinks per day ( p = 0.016), and higher alkaline phosphatase level ( p = 0.001) had higher MCP-1 level. Conclusion This exploratory analysis revealed associations with cytokines MCP-1 and IL-8 and drinking consumption, sleep quality, and anxiety and depression in the AUD group. Furthermore, inflammatory and liver markers were highly correlated with certain pro-inflammatory cytokines in the AUD group suggesting a possible relationship between chronic alcohol use and inflammation. These associations may contribute to prolonged inflammatory responses and potentially higher risk of co-morbid chronic diseases.
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Sleep is defined as the body's rest cycle. Sleep is triggered by a complex group of hormones that are active in the main, and that respond to cues from the body itself and the environment. A solid night of sleep can help patient maintain a healthy weight. An appropriate sleep helps to boost immune system stay strong. The less they sleep, the harder it can be to fight common infections. While them asleep, their body repairs important cells and tissues. Hence the sleep disturbance experienced by cancer patient’s need to be addressed, resolve and overcome in future. There had been a lot of study conducted related sleep quality on cancer patient yet there had been no large studied conducted on prevalence and nature of significant sleep disorder in hematological malignancy patients in Malaysia. It was not known which types of patients were more likely to had significant problems and whether there was a relationship between sleep disturbances and demographic characteristics, typed of cancer, extent of disease, or typed of treatment. Therefore, researcher had decided to carry out this study at hematology department among Acute Leukemia patient. This cross-sectional study was done to determine demographic, scoring and significance between demographic and treatment characteristics with the sleep quality among Acute Leukemia patient undergoing chemotherapy Pittsburg sleep quality scale (PSQI). A total of 133 patients who had been diagnosed as Acute Leukemia with PSQI score were analyzed. According to Pittsburg Sleep Quality Index score 64.7% (n=87) had a score at risk 5 having significance sleep disorder.
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Introduction: Insomnia is a frequent condition during pregnancy. The aim of this study was to assess if a walking promotion program from the 12th Gestational Week (GW) of pregnancy helps to prevent insomnia and improve the quality of sleep at third trimester. Materials and Methods: A prospective, randomized, and controlled trial was conducted with 270 pregnant women divided into 3 groups in parallel: maximum intervention group, I1 (pedometer and goal of 10,000 steps/day), minimum intervention group, I2 (pedometer without a goal), and control group (no intervention). All groups received recommendations about physical activity in pregnancy. A structured interview was performed at 13th, 20th, and 32nd GW, collecting pedometer mean steps/day, Athens Insomnia Scale (AIS), and Pittsburgh questionnaire (PSQI). Lineal regression models were conducted to determine the association between mean steps/day at 31st GW and AIS or PSQI score. Results: At 19th GW, groups I1 and I2 reached a mean of 6267 steps/day (SD = 3854) and 5835 steps/day (SD = 2741), respectively (p > 0.05). At 31st GW mean steps/day was lower for I2 (p < 0.001). Insomnia and poor sleep quality prevalence increased through pregnancy, but no differences between groups, within trimesters, were found (p > 0.05). Lineal regression showed no association between the average steps/day at third trimester of pregnancy and AIS and PSQI scores. Conclusions: Our walking promotion program based on pedometers did not help to prevent insomnia in the third trimester of pregnancy.
Article
Introduction: Accumulated studies revealed that electromagnetic field can affect human brain and sleep. We explored the effectiveness of electromagnetic field [Schumann resonance (SR)] on nocturia symptoms, quality of life, and sleep in patients with nocturia. Methods: This is a randomized, open-label, and active-controlled study, in which 35 participants were randomized into 2 groups. Group A received oxybutynin and the SR device for 12 weeks, while the active-control group received only the medication. We followed these patients every 4 weeks with a number of questionnaires, including the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) for sleep, the American Urological Association Symptom Score (AUASS) for nocturia symptoms, and the Nocturia-Quality-of-Life-questionnaire (N-QOL) for quality of life. Descriptive statistics, pair t-tests, Chi-squared tests, and repeated measures were applied for data analysis. Results: No significant difference was found in the demographic data between the 2 groups. The AUASS, N-QOL, PSQI, and ESS total scores were significantly improved in the SR-sleep-device group (P < .001, P = .005, P < .001, P = .001) after treatment, but no significant change was found in the active-control group. Several variables of AUASS in the SR-sleep-device group were significantly improved, especially streaming and sleeping (both P = .001), and subjective sleep quality and sleep efficiency also demonstrated significant improvement (both P < .001). Conclusions: Our study revealed that electromagnetic field (SR) as an add-on can improve not only sleep and quality of life but also nocturia symptoms in patients with nocturia. These findings suggest that SR can be effective for sleep disturbance secondary to physical disease, which can be a new application of the electromagnetic field.
Article
Background: Studies suggest seasonal fluctuations of symptoms in Parkinson's disease (PD) patients in Western countries. However, the association between seasonal change and variation in nonmotor symptoms (NMS) in Chinese PD patients is unclear. Here, we studied whether there is a change rule with annual cycle with severity of NMS for patients with PD in Southeast China. Methods: We studied 1005 PD patients between April 2008 and October 2020. Patients were classified into four seasons according to the 24 Chinese solar terms, based on assessment date. We compared comprehensive NMS scales and polysomnography parameters among groups and conducted further analysis of disease severity. Results: Among the 1005 patients studied, the mean age was 64.2 ± 9.7 years and 569 (56.6%) of them were men. Relative to the summer group, patients assessed during winter had higher Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction (SCOPA-AUT) scores (P = 0.045). The sleep efficiency factor scores of Pittsburgh Sleep Quality Index in patients were higher during spring than summer (P = 0.009). Among patients who completed polysomnography during the same period (n = 135), compared with summer follow-ups, we observed a higher percentage of NREMS1 in winter and spring follow-ups (P = 0.042, P = 0.011), a higher NREMS1 time in spring follow-ups (P = 0.0024), a lower NREMS2 time in winter follow-ups (P = 0.007), and a higher percentage of phasic RSWA in autumn and winter follow-ups (P = 0.026 and P = 0.020, respectively). In a subset of patients with PD and REM sleep behavior disorder (RBD; n = 182), those visited during winter had higher scores for RBD questionnaire- Hong Kong and its factor 1 (dream-related sub-score) than those visited during summer (P = 0.034, P = 0.020). We observed similar findings for SCOPA-AUT and sleep efficiency factor scores in early stage patients in subgroup analysis. Conclusions: PD patients assessed for follow-up during summer showed less severe symptoms of autonomic dysfunction and RBD symptoms than those assessed in winter, and less sleep disturbance than those in spring and winter, suggesting that seasonal change and NMS fluctuation are related, especially in patients with early stage PD.
Article
This article highlights the need to screen survivors of traumatic orthopedic injuries for postinjury symptoms associated with stressor-related disorders such as acute stress disorder and posttraumatic stress disorder, including pain, sleep disturbances, anxiety, and depression. The authors discuss the presentation of these postinjury symptoms, the instruments used to screen for each, the various pharmacological and nonpharmacological treatments, and the nursing implications for managing postinjury symptoms in traumatic orthopedic injury survivors.
Article
Objective: Hypertension is one of the most important causes of cardiovascular disease. It has been found that professional drivers are at high risk of hypertension. This study has been performed to determine the prevalence of hypertension and its associated factors among professional drivers in Shahroud. Methods and results: In this study, the prevalence of hypertension was determined according to the definition by the American Heart Association among 1461 professional drivers participating in the first cross-sectional phase of Shahroud drivers' prospective cohort study. The prevalence of elevated blood pressure and hypertension was examined based on the initial age, and gender presented, along with the factors affecting this disease based on multinomial logistic regression. The prevalence of elevated blood pressure, stage 1 and 2 hypertension was 46.9%, 6%, and 1.3%, respectively. In the multivariate multinomial logistic regression model, having diabetes, Body Mass Index ≥25, and driving years was associated with an increased chance of developing elevated blood pressure and hypertension. Conclusions: Attention should be paid to high prevalence of elevated blood pressure and hypertension among professional drivers in Iran as a health priority for drivers. Plans should be made to reduce it as well as to prevent its complications.
Article
Background: Patients with head and neck cancer experience psychoneurological symptoms (PNS) (i.e., depression, fatigue, sleep disturbance, pain, and cognitive dysfunction) during intensity-modulated radiotherapy (IMRT) that decrease their functional status, quality of life, and survival rates. The purpose of this study was to examine and visualize the relationships among PNS within networks over time and evaluate for demographic and clinical characteristics associated with symptom networks. Methods: A total of 172 patients (mean age, 59.8 ± 9.9 years; 73.8%, male; 79.4%, White) completed symptom questionnaires four times, namely, before IMRT (T1), 1 month (T2), 3 months (T3), and 12 months (T4) post IMRT. Network analysis was used to examine the symptom-symptom relationships among PNS. Centrality indices, including strength, closeness, and betweenness, were used to describe the degrees of symptom network interconnections. Network comparison test was used to assess the differences between two symptom networks. Results: Depression was associated with the other four symptoms, and fatigue was associated with the other three symptoms across the four assessments. Based on the centrality indices, depression (rstrength = 1.3-1.4, rcloseness = 0.06-0.08, rbetweeness = 4-10) was the core symptom in all symptom networks, followed by fatigue. Female gender, higher levels of stress, and no alcohol use were associated with stronger symptom networks in network global strength before IMRT. Conclusion: Network analysis provides a novel approach to gain insights into the relationships among self-reported PNS and identify the core symptoms and associated characteristics. Clinicians may use this information to develop symptom management interventions that target core symptoms and interconnections within a network. Lay summary: This study describes the symptom-symptom relationships for five common symptoms in patients with head and neck cancer receiving radiotherapy. Depression and fatigue appeared to be two core symptoms that were connected with sleep disturbance, pain, and cognitive dysfunction within a network. Several characteristics (i.e., female, higher stress, no alcohol use) were associated with stronger symptom networks.
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Background Restless Legs Syndrome (RLS) is a common neurological disorder. Growing evidence shows that dopaminergic dysfunction and iron deficiency are associated with the pathogenesis of RLS. Additionally, the dopaminergic system is linked with the hypothalamic-pituitary-thyroid (HPT) axis. Thus, the current study aimed to compare thyroid function between RLS patients and healthy subjects and investigate the associations with clinical characteristics of RLS. Methods Serum levels of thyroid hormones were investigated in 102 first-episode drug-naïve RLS patients and 80 matched healthy controls (HCs). Baseline data and clinical characteristics were performed by professional personnel. In addition, multivariate regression was used to analyze the relationship between thyroid function and RLS. Results Compared with control group, RLS patients had significantly higher serum thyroid-stimulating hormone (TSH) levels ( p < 0.001), and higher prevalence of subclinical hypothyroidism [Odds ratio (OR) 8.00; 95% confidence interval (CI) = 3.50–18.30; p < 0.001]. The Subclinical hypothyroidism rate (47.1 vs. 10%, p < 0.001) in RLS patients was higher than the HCs group. Regression analysis revealed that serum TSH (OR = 1.77; 95% CI = 1.41–2.23; p < 0.001) was independently associated with RLS. There was a statistically significant positive correlation between TSH and the Pittsburgh sleep quality index (PSQI) scores ( r = 0.728, p < 0.001), and the International Restless Legs Scales (IRLS) points ( r = 0.627, p < 0.001). Spearman correlation analysis showed that FT 3 was positive correlated with HAMA 14 score ( r = 0.239, p = 0.015). In addition, compared with the good-sleeper group, poor-sleeper patients had significantly higher serum TSH levels ( p < 0.001). Conclusion Serum levels of TSH and the prevalence of subclinical hypothyroidism were higher in RLS patients, indicating the imbalance between thyroid hormones (TH) and the dopaminergic system may contribute to the development of primary RLS. Additionally, the TH axis may influence the quality of sleep in RLS patients.
Article
Purpose Parents caring for children with epilepsy have poor sleep quality and experience a certain level of caregiving burden. Individual resilience is a crucial psychological variable that contributes to health during extraordinary challenges. This study aimed to determine the relationships among individual resilience, caregiver burden, and sleep quality. Methods This was a descriptive cross-sectional study with a convenience sample, following the STROBE guidelines. One hundred and ninety-one parents of children with epilepsy were invited to participate in the study. Of these, 173 participants completed measures of sleep quality, caregiver burden, and individual resilience. Path analysis was performed to probe the indirect relationship between individual resilience and sleep quality via caregiver burden. Results Correlation analysis revealed that individual resilience total scores were significantly and marginally negatively correlated with caregiver burden and sleep quality total scores (r = −0.215, P <.01; r = −0.250, P <.01). Moreover, there was a significant moderate positive correlation between the total caregiver burden scores and total sleep quality scores (r = 0.389, P <.001). The path model showed that individual resilience is indirectly associated with sleep quality via caregiver burden. Conclusion The higher the level of individual resilience, the less the caregiver burden and the better the sleep quality for parents of children with epilepsy.
Article
Objective/background The present study examined the associations among physical activity during different times of the day(i.e., morning, midday,evening) and days of the week(i.e., weekdays, weekend days) with restless legs syndrome(RLS) severity and sleep quality in adults with multiple sclerosis(MS). Patients/methods Participants(N = 39) completed the International Restless Legs Syndrome Study Group Scale and the Pittsburgh Sleep Quality Index as measures of RLS severity and global sleep quality, respectively, and wore an ActiGraph GT3X + on the non-dominant hip for seven days for measuring physical activity(i.e., light physical activity[LPA], moderate-to-vigorous physical activity[MVPA], and steps). Results There was a significant effect of time of day wherein participants had more midday activity compared with morning or evening for LPA, MVPA, and steps; there was no effect of day of the week. Spearman's rho correlations across the week indicated higher evening LPA, evening steps, and overall daily steps (ρ = −0.42,ρ = −0.51,ρ = −0.40,respectively) were associated with lower RLS severity. Similar associations were demonstrated for weekdays(ρ = −0.39,ρ = −0.50,ρ = −0.41,respectively) and weekend days(ρ = −0.44,ρ = −0.51,ρ = −0.39,respectively). Higher evening MVPA on weekend days(ρ = −0.42) was associated with lower RLS severity. Higher morning and overall daily LPA(ρ = 0.34,ρ = 0.33,respecitvely) were associated with worse sleep quality. Similar associations were demonstrated on weekdays(ρ = 0.33,ρ = 0.37,respectively) and more evening MVPA(ρ = 0.32) was associated with worse sleep quality. On weekend days, more morning MVPA(ρ = 0.42) was associated with worse sleep quality. Conclusions Our results suggest that undertaking physical activity, particularly LPA and steps, in evenings may be important for managing symptoms of RLS without worsening sleep quality.
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A systematic sleep questionnaire has been devised for assessing the previous night's sleep of a subject. It has been designed for repeated use. It is completed by the subject and is framed with the needs of the hospital patient in mind. In the present study it was given to 93 subjects in four different groups: 16 surgical inpatients, 21 medical inpatients, 32 psychiatric inpatients (in a general hospital unit), and 24 normal volunteers. Test retest reliability correlations have been derived using a nonparametric correlation coefficient (Kendall's tau). Each of the items achieved statistically significant reliability (p < 0.0001) in all four groups, with the value for tau on the total sample varying from 0.70 to 0.96. The St. Mary's (or SMH) Sleep Questionnaire is put forward as an instrument that is a systematic inquiry into the subject's experience of sleep and that is composed of items of demonstrable reliability.
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The authors compared the sleep laboratory recordings of 122 drug-free subjects who complained of chronic insomnia with the subjects' estimates of their habitual sleep characteristics and their estimated sleep time on the morning after sleeping in the laboratory. Most subjects consistently underestimated the amount of time they slept and overestimated the amount of time it took them to get to sleep in comparison with laboratory data. All subjects consistently underestimated the number of arousals they experienced. The authors discuss the implications of these findings for the treatment and definition of insomnia and for further research.
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Previous studies have suggested that depression might be more strongly related to sleep disturbances in older than in younger individuals. However, few of these studies have simultaneously considered variables other than depression that have been demonstrated to influence the sleep of elderly persons, and none has examined the relationship between depression and sleep longitudinally. The present study examined the association between frequency of depressed mood, using the Depression Adjective Checklist (DACL), and self-reports of four sleep problems over a 3-year period in a sample of community-residing elderly persons. Results showed that frequency of depressed affect was related positively to sleep disturbance, even when subjects' age, gender, and health status were considered simultaneously. Early morning awakening was the sleep symptom that most consistently related to depressed mood over the course of the study. Poor health and female gender showed positive but less consistent relationships to the sleep complaints than depressed affect. Research on biological mechanisms underlying the disturbed sleep of elderly depressed individuals is discussed.
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The Leeds Sleep Evaluation Questionnaire comprises ten self-rating 100-mm-line analogue questions concerned with aspects of sleep and early morning behaviour. The questionnaire has been used to monitor subjectively perceived changes in sleep during psychopharmacological investigations involving a variety of psychoactive agents, including sedative-hypnotics, antidepressants, anxiolytics, CNS stimulants, and antihistamines. Dose-related improvements in the self-reported ratings of getting to sleep and perceived quality of sleep were generally associated with reductions in the self-reported levels of alertness and behavioural integrity the morning following the nocturnal administration of sedative hypnotic and anti-anxiety agents. Psychostimulants, on the other hand, impaired subjective ratings of sleep and produced increases in early morning assessments of alertness. Certain antidepressant and antihistaminic agents produced effects similar to the sedative-hypnotics, while others did not affect self-reported aspects of sleep and early morning behaviour.
Article
Full-text available
A systematic sleep questionnaire has been devised for assessing the previous night's sleep of a subject. It has been designed for repeated use. It is completed by the subject and is framed with the needs of the hospital patient in mind. In the present study it was given to 93 subjects in four different groups: 16 surgical inpatients, 21 medical inpatients, 32 psychiatric inpatients (in a general hospital unit), and 24 normal volunteers. Test retest reliability correlations have been derived using a nonparametric correlation coefficient (Kendall's tau). Each of the items achieved statistically significant reliability (p less than 0.0001) in all four groups, with the value for tau on the total sample varying from 0.70 to 0.96. The St. Mary's (or SMH) Sleep Questionnaire is put forward as an instrument that is a systematic inquiry into the subject's experience of sleep and that is composed of items of demonstrable reliability.
Article
• Sleep polygraph and questionnaire data of 18 chronic primary insomniacs were compared with those of 18 age- and sex-matched controls. The insomniacs had significantly longer sleep latencies, less total sleep, less sleep efficiency, more terminal wake time, and less delta sleep. There were significant discrepancies between the insomniacs' and controls' subjective assessments of their sleep and the sleep-polygraph data, but in opposite directions. The insomniacs' recorded sleep also showed more night-to-night variability than that of the controls. However, the controls, in contrast to the insomniacs, reported sleeping worse in the laboratory than at home. Significant differences between insomnia subtypes validly reflected the insomniacs' subjective complaints and were generally in accord with expectations based on them.
Article
Twenty-one carefully screened normal Ss used to the sleep laboratory filled out sleep and dream logs both at home and after one or more nights in the laboratory. Subjective descriptions of sleep ordinarily associated with reports of "poor" sleep were related to transient episodes of wakefulness. In general, subjective sleep parameters appeared related to episodes of wakefulness rather than to other sleep stages. Abrupt as opposed to gradual awakenings from sleep favored REM period dream recall. Terminal as opposed to earlier REM periods tended to be associated with detailed rather than vague or no-content dream recall. Presleep tension favored longer sleep latencies, while unusual fatigue promoted transient intercurrent wakefulness. By a number of criteria, Ss appeared to sleep better at home than in the lab.
Article
Seventeen patients with chronic primary insomnia each received 30 daytime electrosleep treatments in two courses at two different pulse frequencies over a seven-week period. The analyses of pretreatment and posttreatment all-night sleep polygraph recordings, sleep questionnaire and mood scale responses, and 24-hour urinary steroid levels did not demonstrate any significant effect in these patients. Future research studies of electrosleep should emphasize effective double-blind techniques, objective measure of evaluation and response, and the careful delineation of patient populations which this new treatment technique may really help.
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A post sleep inventory has been developed to permit an adequate description of subjective responses to a preceding sleep period. A factor analysis on a 2 wk. administration to 70 subjects is reported. Construct validity is assessed by demonstrating the scale's sensitivity in differentiating between subjectively designated 'good' and 'bad' nights of sleep and among three populations of individuals ('home sleepers,' college students, and an aged group). Construct validity is shown to be high.
Article
“When we consider the immense human significance of sleep, the absolute necessity for us to spend a considerable part of our lives in abject mental annihilation, it is remarkable how little we know about it. …” In these words, Sir John Eccles introduced the recently published Ciba Foundation Symposium on “The Nature of Sleep” (3), in which are described many of the advances which have been made in recent years in our attempts to understand the phenomena which are involved in the state of sleep. In one of the papers included in this Symposium, Bremer (2) reviews the work which has been reported since 1954 on the neurophysiological mechanisms involved in sleep. The relationship of dreaming to the depth of sleep has been investigated by such workers as Kleitman (5), Dement (4) and Wolpert (11). These studies have been made possible by the application of modern techniques of measuring mental activity. The use of electroencephalographic methods has allowed an approximate classification of the different levels of sleep which enables different workers to adopt a standard frame of reference. Measurements of rapid eye movements and of changes in muscle potential during sleep have provided more objective methods of assessing dream activity. Other recent studies have attempted to make an objective assessment of the physical and mental effects of sleep deprivation (Morris et al. , 7, Bliss et al. , 1, Murray et al. , 8, Wilkinson, 9, Williams et al. , 10).
Article
The relationship between perceived sleep quality and career effectiveness was studied in Navy corpsmen. Two samples of Naval School of Health Sciences students were asked, 'Overall, what kind of sleeper are you?' Based on responses, 506 'good' sleepers and 109 'poor' sleepers were selected for longitudinal study and followed for 6 years. Fore replication, Sample 2, consisting of 1,024 good and 188 poor sleepers, was identified in 1978-1979 and followed for 2 years. At enlistment, there were no differences between good and poor sleepers on measures used as predictors of career effectiveness, i.e., age, education, AFQT, and SCREEN score.
Article
A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should be so divided before using the formula. The index [`(r)]ij\bar r_{ij} , derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches. Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial group-factor clusters within a subtest. Scalability is not a requisite.
Article
Ten insomniacs and matched control subjects, in whom major physiologic disorders such as sleep apnea and nocturnal myoclonus were ruled out, underwent studies of sleep, temperature, motor activity, cognitive performance, and perception of depth of sleep. Subjective descriptions of sleep differed significantly between insomniacs and normals on a variety of variables. In contrast, polysomnographic evaluation showed increased intermittent waking time and decreased sleep efficiency, and only a tendency toward decreased total sleep and increased sleep latency. Minnesota Multiphasic Personality Inventory (MMPI) evaluation revealed that insomniacs had higher scores on the F,D, and SI scales, and lower values on the K scale. On cognitive testing, insomniacs did well on tests of episodic (recent) memory, but displayed major deficits in accessing semantic memory (retrieval of material already known). Compared to normals, insomniacs described rapid eye movement (REM) sleep as relatively “light” sleep.
Article
SYNOPSIS A self-completion sleep evaluation questionnaire (SEQ), consisting of 10 cm line analogue rating scale questions, was constructed to investigate subjects' responses to aspects of sleep and early morning behaviour. The questions were grouped into 4 chronological areas: the ease of getting to sleep (GTS), the perceived quality of sleep (QOS), the ease of awakening from sleep (AFS), and the integrity of early morning behaviour following wakefulness (BFW). Five hundred and one SEQs were completed during several investigations into the comparative effectiveness of hypnotic drugs. The classical factor analysis produced 4 factors which corresponded to the 4 aspects of sleep and early morning behaviour listed above. The GTS and QOS factors were positively correlated (+ 0·57), as were the AFS and BFW factors (+ 0·48). The 2 sleeping state factors (GTS and QOS) were orthogonal to the 2 waking state factors (AFS and BFW).
Article
Sleep polygraph and questionnaire data of 18 chronic primary insomniacs were compared with those of 18 age- and sex-matched controls. The insomniacs had significantly longer sleep latencies, less total sleep, less sleep efficiency, more terminal wake time, and less delta sleep. There were significant discrepancies between the insomniacs' and controls' subjective assessments of their sleep and the sleep-polygraph data, but in opposite directions. The insomniacs' recorded sleep also showed more night-to-night variability than that of the controls. However, the controls, in contrast to the insomniacs, reported sleeping worse in the laboratory than at home. Significant differences between insomnia subtypes validly reflected the insomniacs' subjective complaints and were generally in accord with expectations based on them.
Article
The authors determined the prevalence of sleep disorders in a general population through a survey of 1,006 representative households in the Los Angeles metropolitan area. They found an overall prevalence of current or previous sleep disorders in adults of 52.1%. Specifically, they found a 42.5% prevalence of insomnia, 11.2% of nightmares, 7.1% of excessive sleep, 5.3% of sleeptalking, and 2.5% of sleepwalking. These conditions were often chronic and usually started early in life. Insomnia was more frequent in older people, particularly older women, and in people of lower educational socioeconomic status. Insomnia, nightmares, and hypersomnia were correlated with more frequent general physical and mental health problems.
Article
A crucial problem in psychiatry, affecting clinical work as well as research, is the generally low reliability of current psychiatric diagnostic procedures. This article describes the development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC). The RDC are being widely used to study a variety of research issues, particularly those related to genetics, psychobiology of selected mental disorders, and treatment outcome. The data presented here indicate high reliability for diagnostic judgments made using these criteria.
Article
The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episodes of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.
Article
Prospective epidemiologic data of the American Cancer Society disclosed that reported usual sleep durations among groups who complained of insomnia and sleeping pill use "often" overlapped with those of groups who had no complaints. Reports of insomnia were not consistently associated with increased mortality when several factors were controlled; however, men who reported usually sleeping less than four hours were 2.80 times as likely to have died within six years as men who reported 7.0 to 7.9 hours of sleep. The ratio for women was 1.48. Men and women who reported sleeping ten hours or more had about 1.8 times the mortality of those who reported 7.0 to 7.9 hours of sleep. Those who reported using sleeping pills "often" had 1.5 times the mortality of those who "never" used sleeping pills. These results do not prove that mortality could be reduced by altering sleep durations or by reducing hypnotic prescribing. Rather, studies are needed to determine the causes of these mortality risk factors.
Article
Data for this paper originated from the Florida Health Study Program, a comprehensive survey eliciting general health information from a random sample of 1645 individuals in Alachua County, Florida. Patterns of socio-demographic differences were studied for each of six questionnaire items relating to sleep. More than one-third of respondents reported having trouble with sleep. This was greatest for older non-single females at a low SES level but unrelated to race. Use of sleeping medications was highest among older white females, but unrelated to race, SES, and marital status. Life-style implications were reflected in types of sleeping difficulty.
Article
Data for this report come from a nationally representative probability sample survey of noninstitutionalized adults, aged 18 to 79 years. The survey, conducted in 1979, found that insomnia afflicts 35% of all adults during the course of a year; about half of these persons experience the problem as serious. Those with serious insomnia tend to be women and older, and they are more likely than others to display high levels of psychic distress and somatic anxiety, symptoms resembling major depression, and multiple health problems. During the year prior to the survey, 2.6% of adults had used a medically prescribed hypnotic. Typically, use occurred on brief occasions, one or two days at a time, or for short durations of regular use lasting less than two weeks. The survey also found a small group of hypnotic users (11% of all users; 0.3% of all adults) who reported using the medication regularly for a year or longer. If we include anxiolytics and antidepressants, 4.3% of adults had used a medically prescribed psychotherapeutic drug that was prescribed for sleep; 3.1% had used an over-the-counter sleeping pill. The majority of serious insomniacs (85%) were untreated by either prescribed or over-the-counter medications.
Article
The authors examined the accuracy of the differential diagnosis of chronic insomnia with and without sleep laboratory studies in a consecutive series of 123 patients. All patients were evaluated by means of a sleep/wake log, a sleep habits questionnaire, structured psychiatric and clinical interviews, and a minimum of two consecutive nights of polysomnography. Notwithstanding a high rate of Research Diagnostic Criteria (RDC)-diagnosed psychopathology (63%) in this sample, the major finding was that in 49% of the patients laboratory results added to, refuted, and/or failed to support the clinical impression. This resulted in substantial modification of the initial diagnostic formulation and therefore in increased specificity of diagnosis.
Article
Although insomnia is a major public health problem in the elderly, little information concerning the relation between subjective reports of sleep and laboratory measures in the elderly has been published. Also, while laboratory studies of the healthy elderly typically show that women steep better than men, epidemiologic studies suggest that women complain more often than men about disturbed sleep. We report here a study of 20 healthy elderly subjects without sleep complaints (10M. 10F), in which relations between subjective and objective measures of sleep were explored. Both men and women showed significant correlations between objective measures of Sleep Latency (SL) and subjective estimates of fall asleep time; similarly, in both groups, subjective estimates of sleep duration were significantly and positively correlated with Time Spent Asleep (TSA). However, in the women, but not in the men, “restlessness” of sleep was significantly correlated with WASO (wake time after sleep onset), while “soundness” of sleep was positively related to amount of slow wave sleep. In general, women showed a higher proportion of significant and more stable correlations between subjective and objective measures than did men. These findings suggest that elderly women may report sleep loss more accurately than elderly men.
Article
Ten insomniacs with age- and sex-matched controls had studies of baseline sleep, relation of polygraphically defined sleep to retrospective reports, and arousal thresholds to electronic tones or to a recording of a voice calling out the subject's name. The two groups differed in 10 out of 13 questions about habitual sleep and daytime feelings. In contrast, polygraphic measures of baseline sleep indicated only that insomniacs tended to have slightly less total sleep and had a small but significant increase in early morning awakening time. Unlike the descriptions of habitual sleep, the subjects' retrospective reports of the previous night's sleep differed significantly only for the variable of total sleep time, and there were virtually no differences in the description of their status at a given moment. Auditory arousal thresholds were similar in the two groups, and both went back to sleep and stayed asleep with equal facility. These findings suggest that subjectively poor sleep is not necessarily "light" sleep. For both groups, arousal thresholds differed across the sleep stages, and thresholds to hearing the subject's name were lower than those in response to electronic tones. Although insomniacs had as much polygraphically defined sleep as controls between the forced awakenings of the arousal threshold studies, they perceived their sleep to be only approximately half as long. Insomniacs described themselves as having been awake more frequently than controls in 8 out of 10 forced awakening situations. In one case, insomniacs also overestimated the time between awakenings. In both groups, there was little relationship between reported habitual aspects of sleep and baseline polygraphically defined sleep variables. On questionnaires the following mornings, however, in both groups there was a positive correlation of subjective quality of sleep on the baseline nights with percentage of rapid eye movement sleep, and a negative correlation to various aspects of slow-wave sleep.
Article
Although there has been a considerable amount of research into sleep using either subjective estimates or objective (EEG) estimates, there has been no attempt to validate the accuracy of subjective estimates of sleep. The present study investigates the relation between subjective estimates of total sleep time, delay to sleep onset and the number of awakenings in eight normal subjects over 116 subject-nights. They were studied before taking drugs, during drug administration and in withdrawal. It was found that they underestimated total sleep time but overestimated the delay to sleep onset and the number of awakenings. There was a significant withdrawal effect. The implications of this withdrawal effect are discussed in relation to the design of hypnotic drug trials. The reliability of norms for sleep are also discussed.
Article
PHYSIOLOGICAL, PERSONALITY, AND EEG SLEEP PATTERNS OF 16 POOR-SLEEP GROUP (PSG) SS WERE COMPARED WITH 16 GOOD-SLEEP GROUP (GSG) SS. COMPARED WITH GOOD SLEEPERS, POOR SLEEPERS HAD LESS SLEEP TIME, A HIGHER PROPORTION OF STAGE 2 SLEEP, MARKEDLY LESS REM SLEEP DESPITE A SIMILAR NUMBER OF REM PERIODS, MORE AWAKENINGS, AND REQUIRED MORE TIME TO FALL ASLEEP. SIGNIFICANT PHYSIOLOGICAL DIFFERENCES BETWEEN THE GROUPS WERE OBSERVED DURING ALL STAGES OF SLEEP AND DURING A PRESLEEP PERIOD. PERSONALITY TEST RESULTS CLEARLY INDICATED A MUCH HIGHER PROBABILITY OF SYMPTOMATIC COMPLAINTS AMONG POOR SLEEPERS AS WELL AS A STRONG POTITIVE RELATIONSHIP BETWEEN DREAMING AND INDEXES OF PSYCHOPATHOLOGY. THIS STUDY DID NOT RESOLVE CAUSE AND EFFECT RELATIONSHIPS AMONG PHYSIOLOGICAL VARIABLES, PERSONALITY MEASURES, AMOUNT OF DREAMING, AND GOOD AND POOR SLEEP; HOWEVER, SIGNIFICANT EEG, PHYSIOLOGICAL, AND PSYCHOLOGICAL DIFFERENCES WERE DEMONSTRATED. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A 55-item Sleep Questionnaire is presented for possible use as a standardized instrument in psychological studies of sleep. A factor analysis of responses from 145 adults to the questionnaire indicated 7 factors accounted for 71.7% of the total variance. These factors are congruent with sleep dimensions discussed in the literature and with other factor analytic investigations. A set of 11 clinical judgment scales are also presented. The reliabilities of both factor and clinical scales are adequate as judged by test-retest, internal consistency, and comparisons of self vs spouse ratings. The construct validity is supported by three studies showing significant differences between (a) medical patients with and without sleep disturbances, (b) psychiatric patients with and without symptoms of depression, and (c) short and long sleepers.
Article
The sleep of 18 depressed female patients was observed for 12 nights, on 6 of which 50 mg. of thioridazine was given before retiring, while on the other 6 a placebo was administered. Neither nurses nor patients knew when the drug was used. Bed movements were counted instrumentally as "beats" and patients and nurses rated the quality of sleep on a 4-point scale. Over the whole trial, patients' own ratings of their sleep discriminated significantly (p o.10). The effect of a clinical dose of thioridazine on motility was insignificant by comparison with the variability among individual patients, the variability among beds and instruments and interactions between these and the drug. Nurses' ratings of sleep showed a definite positive correlation (η=+0.51) with those of the patients. They did show a closer relation to motility (η=+0.36) than did the patients' ratings (η=+0.31). Patients' accounts of their sleep, while sometimes at variance with the nurses' reports, appear to have a definite basis not indicated by instruments or observers.
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Diagnosis, treatment, and follow-up of about 8,000 sleep/wake disorder patients
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Diagnostic Classification of Sleep and Arousal Disorders
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Good and poor sleepers: An epidemiological survey of the San Marion population
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A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects
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Insomnia in the San Francisco Bay Area: A telephone survey
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Psychological variables in the diagnosis of insomnia
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Sleep disturbance: A community survey
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