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Mood and Sleep Problems in Adolescents and Young Adults: An Econometric Analysis
Abstract
Sleep related problems affect approximately 25-40% of children and adolescents. The acquisition of sleep patterns characterised by later bedtimes, insomnia and excessive daytime sleepiness is related to poorer school performance, daytime drowsiness, physical tiredness and a higher rate of psychiatric illnesses. Many studies have investigated the correlation between sleep and mood in children and adolescents and overall, show a positive association between sleep problems and psychiatric disorders. However, little is known about adolescents' personal perception of their psychological status as it is linked with the occurrence of mood changes and sleep-related problems.
The aim of the study is to explore the impact of variables such as age, gender, education and the perception of their own psychological status (evaluated through suitable questionnaires) on the simultaneous presence of sleep disturbances and affective symptoms in a sample of adolescents. A positive correlation between these two dependent variables signals the need to intervene with proper support programs.
A recursive bivariate probit model has been employed. This method allows us to take into account two dependent dummy variables and to consider the relationship between the two, presuming that one may also influence the other. The analysis has been carried out on a sample of 2,005 adolescents out of a total of 4,000 who declared their willingness to be telephonically interviewed using a questionnaire in two parts designed to obtain information about the participants sleep habits and affective symptoms.
There is a positive correlation between sadness and daytime drowsiness. The estimated joint probability ranging from 5.5% to 9% in girls demonstrates a greater tendency for girls to experience both depression and altered sleep patterns. DISCUSSION AND LIMITATIONS OF THE STUDY: Just as sadness is a key symptom of affective disorders, daytime drowsiness indicates the presence of sleep disorders caused by sleep habits that are likely to evolve into affective symptoms. This assumption is confirmed by the results of this analysis. However, since the interviews were conducted during the years 2003 and 2004, a replication of the analysis would outline whether this evidence is still the same or whether changes in habits and behaviours have intervened to modify substantially this pattern in recent years. As the analysis considers a sample of adolescents living in two southern Italian regions, the study should be replicated in other geographical areas. IMPLICATIONS FOR HEALTH CARE PROVISIONS AND USE: The early detection of affective symptoms in adolescents may presumably lead to a diminished use of antidepressants and an improvement in learning abilities and school results along with strengthening of personal motivations.
Counselling and educational programs directed towards those adolescents demonstrating poor sleep habits should be planned and implemented to avoid further complications and impact on their mental health.
... Some people attempt to enhance their cognitive functions, such as alertness, attention, concentration, and memory, as well as psychological functions, such as mood and sleep [1][2][3], through the use of stimulants [4,5]. This phenomenon is referred to as pharmaceutical neuroprotective enhancement or cognitive enhancement (CE) [1,6]. ...
Cognitive enhancement through stimulants such as modafinil is becoming increasingly popular, with many individuals using prescription stimulants for non-medical purposes to improve alertness, attention, and mood. The misuse of such substances has raised concerns, particularly in forensic toxicology. The UHPLC-QqQ-MS/MS method was developed to quantify modafinil in evidentiary samples and biological materials. Additionally, the authors noted the presence of sodium adducts during the analysis of samples with high concentrations of modafinil. The method was validated for accuracy, precision, and linearity, with a concentration range of 0.1–10.0 µg/mL for the evidences and 1.0–100.0 ng/mL for blood. The method successfully detected modafinil as the sole substance in all evidences, with concentrations ranging from 90.7 to 120.8 mg, corresponding to 45.5% to 80.5% of the labeled dose. The method was applied to real post-mortem human cases, where, among others, the concentration of modafinil in blood was 110 ng/mL, whereas, in another case, the concentration of modafinil in the putrefaction fluid exceeded 1000 ng/mL. The developed UHPLC-QqQ-MS/MS method is effective for the quantification of modafinil in evidentiary samples and biological materials, offering a reliable tool for forensic toxicology applications. This method can be used to evaluate modafinil use in both legal and illicit contexts, including cases of overdose or misuse.
... Since there is no natural ordering of the risk management strategies, an appropriate order will be selected based on economic justification and statistical tests. Much of the existing work beyond the bivariate recursive probit model only addresses two simultaneous models with a natural ordering (e.g., Farace & Mazzotta, 2011;Filippini et al., 2018;Greene, 1998;Kassouf & Hoffmann, 2006;Oyekale & Adeyeye, 2012;Settineri et al., 2014). Mokhtari et al. (2018) utilized a recursive multivariate probit model, but their study only demonstrated a one-way causal impact of the endogenous variables, without exploring different combinations of dependent variables. ...
This study investigates the determinants of farmers’ risk management decisions in Khyber‐Pakhtunkhwa, Pakistan, using a recursive multivariate probit (RMVP) model. Employing data from 382 farmers collected through a multistage sampling process, the study compares the RMVP with the traditional multivariate probit (MVP) model, demonstrating the superior performance of the RMVP in capturing complex decision‐making patterns. Our rigorous statistical analysis demonstrates the significant impact of endogenous covariates on farmers’ risk management choices, revealing complementarity or substitutability among strategies. The study contributes to the literature by providing empirical evidence on the effectiveness of the RMVP model for understanding smallholder farmers’ risk management behavior and offering insights for policymakers to support resilient agricultural systems.
... Mood is another aspect of psychological wellbeing, which also followed a diurnal pattern, showing more depressive moods toward the night. Our results also indicate a clear relationship between mood and sleepiness, as previously suggested (Johnson et al., 1990;Dinges et al., 1997;Settineri et al., 2010Settineri et al., , 2012Wong et al., 2013). The observed dampening of the amplitude of this rhythm under the constant dim light conditions would suggest a possible masking effect of the light/dark cycle on the daily mood rhythm. ...
Isolation from external time cues allows endogenous circadian rhythmicity to be demonstrated. In this study, also filmed as a television documentary, we assessed rhythmic changes in a healthy man time isolated in a bunker for 9 days/nights. During this period the lighting conditions were varied between: (1) self-selected light/dark cycle, (2) constant dim light, and (3) light/dark cycle with early wake up. A range of variables was assessed and related to the sleep-wake cycle, psychomotor and physical performance and clock-time estimation. This case study using modern non-invasive monitoring techniques emphasizes how different physiological circadian rhythms persist in temporal isolation under constant dim light conditions with different waveforms, free-running with a period (τ) between 24 and 25 h. In addition, a significant correlation between time estimation and mid-sleep time, a proxy for circadian phase, was demonstrated.
... At the same time, sleep disturbance has many health, behavioral, occupational, and academic consequences in otherwise healthy individuals as well as those with underlying medical conditions [4]. In comparison with men, women report more sleep disorders and pose a greater risk of insomnia [5][6][7]. ...
Background
Disturbed sleep and menstrual symptoms are prevalent health conditions with limited successful treatments. This study aimed to detect the association between sleep problems and menstrual symptoms among young women in Upper Egypt. In this cross-sectional study, 4122 young women aged 12 to 25 years and residing in Beni-Suef City were recruited using a multi-stage random method. The participants were interviewed for their premenstrual disorders, dysmenorrhea, average daily hours of sleep, and insomnia during the previous 6 months.
Results
Young women who reported sleep < 8 and < 7 h/day had more premenstrual spasm than those who slept ≥ 8 h/day: OR 1.3, 95% CI 1.1–1.5 and OR 1.3, 95% CI 1.1–1.6, respectively. Hours of sleep were not associated with other menstrual symptoms. Compared with those without insomnia, young women with insomnia were more likely to report premenstrual spasm (OR 2.3, 95% CI 18–2.8), nervousness (OR 2.3, 95% CI 1.9–2.8), fatigue (OR 2.9, 95% CI 2.4–3.6), headache (OR 2.6, 95% CI 2.2–3.2), breast pain (OR 1.9, 95% CI 1.5–2.3), weight gain (OR 2.6, 95% CI 2.0–3.3), GIT disturbance (OR 2.8, 95% CI 2.2–3.6), and dysmenorrhea (OR 2.6, 95% CI 1.6–4.3).
Conclusion
Insomnia has been shown to be significantly associated with premenstrual symptoms and dysmenorrhea, but no substantial relationship has been indicated between hours of sleep and most menstrual symptoms.
... Während für das Kindesalter auch Befunde für das gleichzeitige Auftreten psychischer Auffälligkeiten und Schlafprobleme auch in nicht-klinischen Populationsstichproben vorliegen (Wiater, Lehmkuhl, Mischke et al., 2007), gibt es nur wenige Befunde für das Jugendalter. Auch mögliche Geschlechtsunterschiede werden nur selten erfasst (Armstrong, Ruttle, Klein et al., 2013;Settineri, Gitto, Conte et al., 2012). Hier bestehen somit noch Forschungslücken. ...
Zusammenfassung. Schlafprobleme und eine unzureichende Schlafdauer können die psychische Gesundheit im Kindes- und Jugendalter nachhaltig beeinträchtigen. Daten von 6.670 Jungen und Mädchen im Alter von 11 – 13 und 14 – 17 Jahren, aus dem Kinder- und Jugendgesundheitssurvey (KIGGS), wurden getrennt nach Geschlechtern analysiert, um zu untersuchen, ob Schlafprobleme und eine unzureichende Schlafdauer mit einer höheren Risikowahrscheinlichkeit für psychische Auffälligkeiten einhergehen. Während Schlafprobleme unabhängig von Geschlecht und Alter mit einem höheren Risiko für alle Symptombereiche (OR = 1.52 – 3.49) verbunden sind, findet sich hinsichtlich einer geringen Schlafdauer nur bei Mädchen eine höheres Risikowahrscheinlichkeit für Auffälligkeiten im externalisierenden und internalisierenden Bereich. Damit scheint sich der Zusammenhang zwischen unzureichender Schlafdauer und psychischen Auffälligkeiten bei Jungen und Mädchen zu unterscheiden. Mögliche Ursachen und Implikationen für die pädiatrische und psychiatrische Praxis werden diskutiert.
... Adolescents constitute more than one-fifth of the population of counties in sub-Saharan Africa, and the quality of their health could be a direct predictor of the future productivity of any country [10]. Sleep patterns and problems among adolescents have been reported in different countries and cultures but are understudied in sub-Saharan Africa [11,12]. This underreporting may be due to competing interest in infectious diseases, which are prevalent in the region. ...
Objective:
Understanding sleep patterns and related factors is vital to development in adolescence, but there is a dearth of this information among adolescents in developing countries such as Nigeria. Therefore, this study describes the sleep patterns, problems, and predictors of poor sleep quality among schooling adolescents.
Methods:
In a cross-sectional study design, 450 adolescents were selected and interviewed about their sleep experience and problems over the preceding one-month period using a validated form with components adapted from the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Data were analyzed using descriptive statistics, χ2, and logistic regression model with p set at 0.05.
Results:
The mean age of respondents was 13.4 ± 1.2 years. Only half (50.2%) had a global PSQI score of <6, suggesting little or no difficulty with sleep. Significantly, a higher proportion of respondents spent a short time in bed before sleep, ≤15 min among those who had good sleep quality (81.4%) compared with those who had poor sleep quality (65.2%) (p < 0.001). The odds of having poor sleep quality was significantly higher in the subgroup who had ≤8.5 h sleep than those who had 8.5 h sleep or more (adjusted odds ratio = 4.62; 95% confidence interval = 2.61, 8.17, p < 0.001).
Conclusion:
Remarkably poor sleep quality exists among schooling adolescents in Ibadan, Nigeria, and sleep problems are prevalent, especially among those with short sleep duration.
... This may be linked with evidence showing that sleep-deprived adolescents make less-healthy food choices (Kruger et al. 2014). Poor sleep also affects mental health; reduced hours of sleep are associated with potentially severe mental health problems such as depression, anxiety and suicidal ideation (Settineri et al. 2012;Wong & Brower, 2012;Sarchiapone et al. 2014). Poor sleep quality may co-occur with these disorders or may precede them and be a contributing factor (Wong & Brower, 2012;Sarchiapone et al. 2014). ...
Background
Sleep problems are associated with increased risk of physical and mental illness. Identifying risk factors is an important method of reducing public health impact. We examined the association between maternal postnatal depression (PND) and offspring adolescent sleep problems.
Method
The sample was derived from Avon Longitudinal Study of Parents and Children (ALSPAC) participants. A sample with complete data across all variables was used, with four outcome variables. A sensitivity analysis imputing for missing data was conducted ( n = 9633).
Results
PND was associated with increased risk of sleep problems in offspring at ages 16 and 18 years. The most robust effects were sleep problems at 18 years [adjusted odds ratio (OR) for a 1 s.d. increase in PND, 1.26, 95% confidence interval (CI) 1.15–1.39, p < 0.001] and waking more often (adjusted OR 1.14, 95% CI 1.05–1.25, p = 0.003). This remained after controlling for confounding variables including antenatal depression and early sleep problems in infancy.
Conclusions
PND is associated with adolescent offspring sleep problems. Maternal interventions should consider the child's increased risk. Early sleep screening and interventions could be introduced within this group.
... Additionally, there was an increased prevalence of SDB with age and male gender in our sample, which is consistent with the results in Western samples (Goldstein et al., 2011;Silva et al., 2011) and other Asian samples (Li et al., 2010;Ramli and Samsinah, 2012). Similarly, Settineri et al. (2012) found a relationship between sadness and daytime sleepiness, but it was stronger in girls than in boys. It's also interesting to note that parents reported more problems than children did, possibly due to children's unawareness of having sleeping problems, such as snoring. ...
This study examined the prevalence of sleep disordered breathing (SDB) symptoms and their associations with daytime sleepiness, emotional problems, and school performance in Chinese children. Participants included 3,979 children (10.99 ± 0.99 years old) from four elementary schools in Jintan City, Jiangsu Province, China. Children completed a self-administered questionnaire on sleep behavior and emotional problems, while parents completed the Child Sleep Habit Questionnaire (CSHQ). SDB symptoms included 3 items: loud snoring, stopped breathing, and snorting/ gasping during sleep. Teachers rated the children's school performance. The prevalence rates of parent- and self-reported SDB symptoms were 17.2% and 10.1% for “sometimes” and 8.9% and 5.6% for “usually”. SDB symptoms, more prevalent in boys than in girls, increased the risks for depression, loneliness, and poor school performance. Daytime sleepiness mediated the relationship between SDB symptoms and depression, loneliness, and poor school performance. This study suggests the importance of early screening and intervention of SDB and daytime sleepiness in child behavioral and cognitive development.
... Currently, SD is very frequent among young people [27], who make use of stimulants to prolong wakefulness and to enhance cognitive, emotional and motivational functions [28]. Modafinil [(diphenyl-methyl) sulphinil-2-acetamide] is a medication that has been prescribed to improve excessive daytime sleepiness, alertness, attention, and memory in dementia [29,30]. ...
Animals exposed to an early adverse event may be more susceptible to a second source of stress later in life, and these stressors may have additive deleterious effects. Sleep deprivation is known to be a stressor, affecting multiple body functions such as the cognition. Modafinil enhances working memory and attention in healthy non-sleep deprived subjects and in animal models of sleep deprivation. The first aim of the present study was to investigate the effects of maternal separation (MS) combined with paradoxical sleep deprivation (PSD) in adulthood on recognition memory in rats. Second, we aimed to evaluate whether the administration of modafinil would be able to ameliorate memory deficits induced by MS and PSD. Wistar rat pups were initially distributed into MS and handling (H) groups, with their litters standardized in 4 females and 4 males. In adulthood, the male rats were submitted to PSD or control condition, being redistributed afterwards in modafinil- or vehicle-treatment immediately after the training session of object recognition task. PSD did not potentiate the cognitive deficit due to MS. However, modafinil was able to recover memory impairments associated to PSD and also to MS in the neonatal period. This study demonstrates for the first time that modafinil ameliorates cognitive deficits associated to MS and to PSD in adulthood, independent from MS in the neonatal period.
Autism spectrum disorder (ASD) is a common neurobehavioral disorder with considerable complexity and without clearly defined etiologic underpinnings. A variety of factors are intertwined in this condition including genetic, biochemical, and cellular characteristics. A major aspect of ASD management is behavioral therapy, though pharmacologic agents produce major benefits as well. This work considers current pharmacologic principles in treatment of ASD in children, adolescents, and adults. Pharmacologic intervention is particularly helpful for treatment of the conditions that are frequently co-morbid with ASD—including anxiety, depression, aggressive/violent behaviors, repetitive behaviors, inattention with hyperactivity, and sleep disorders.
Sleep problems are widespread among children and have a high rate of comorbidities including numerous psychiatric disorders. However, it is still unclear whether sleep problems are dimensional or categorical phenomena. Knowing the latent structure of child sleep problems is imperative for several reasons. Our present study seeks to use taxometric procedures to examine the latent structure of sleep problems measured by the Children's Sleep Habits Questionnaire (CSHQ). We applied three taxometric procedures (maximum eigenvalue, mean above minus below a cut and latent-mode factor analysis) to data collected from a nonclinical Chinese sample of children, aged 6 to 12 from primary schools in Shenzhen. Results revealed three main factors attributed to the types of sleep problems; F1 (bad sleep habit), F2 (problems about sleep disorders), F3 (problems about sleep time and daytime napping). From our findings, we were able to show that the latent structure of sleep problems is better categorized as dimensional rather than categorical. Comprehensive findings, implications, and limitations are discussed throughout this article.
In adults, the association between obesity and obstructive sleep apnea (OSA) is established, and many are concerned OSA increases surgical risk. Pre-operative screening for OSA is standard, and this is also the case in adolescent bariatric surgery. We noted many of our patients were without significant OSA, despite being obese. We reviewed our experience with screening polysomnography (PSG) to determine any predictive variables or complications.
All bariatric surgery patients from our hospital who had undergone PSG were included, and were stratified into 'OSA' or 'no OSA' by obstructive apnea-hypopnea index (OAHI), as well as by sex.
A total of 49 adolescents enrolled during the study period: 10 males and 39 females. OSA prevalence was 42.9 %; males 80 %, females 33.3 %. Height, weight, body mass index (BMI), and prevalence of hypertension were significantly higher in patients with OSA. By sex, females also had more metabolic syndrome and witnessed apneas, while only weight and BMI remained significant in males. There were no peri-operative complications.
Despite uniform obesity, less than half our adolescents had significant OSA on PSG. As no modeling exists to predict OSA in morbidly obese adolescents, we continue to recommend routine PSG, especially in higher weight and BMI patients, and those with hypertension.
Objective:
To assess the clinical therapeutic effect of acupuncture with meridian acupoints combined with three Anmian acupoints.
Methods:
Sixty subjects were randomly divided into two groups: the acupuncture with meridian acupoints group (Group A), and the acupuncture with meridian acupoints and three Anmian acupoints group (Group B) with 30 cases in each group. After 4-week treatment, the clinical therapeutic effects and scores for the Pittsburgh Sleep Quality Index (PSQI), depression index and anxiety index were assessed in the two groups before and after treatment.
Results:
The total effective rate of therapy was higher in Group B (93.3%) compared with that in the Group A (66.7%, P<0.05). When comparing after treatment with before treatment, there were significant differences in the PSQI score of sleep quality, time to sleep, sleep time, sleep disorders in Group A (P <0.05) and significant differences in the PSQI score of sleep quality, time to sleep, sleep time, sleep disorders and daytime disorders in Group B (P <0.01 or P<0.05). There were significant differences in total PSQI score between Group A and Group B (P<0.05). Both groups improved the depression and anxiety state of the patients, but acupuncture with meridian acupoints combined with three Anmian acupoints was more effective than meridian acupoints alone (P<0.05).
Conclusion:
Acupuncture with meridian acupoints combined with three Anmian acupoints can improve the sleeping quality of patients with insomnia.
The objective of this study is to determine the factors affecting the early retirement preferences of Egyptian government sector employees. In line with the existing literature, we consider the possibility that the early retirement and post-retirement employment decisions are made jointly. We do this by estimating a recursive bivariate probit model in which the endogenous ‘post-retirement work'' variable is among the explanatory variables in the ‘early retirement'' equation. Estimation results based on a 2005 survey reveal that the two decisions are in fact correlated. As expected, people who plan to work after retirement are more likely to choose early retirement.
Telephone interviews have been used extensively as a tool to explore and assess sleep disorders and psychopathological conditions. The aim of this study was to set up and validate a telephone interview aimed at assessing the correlation between mood and sleep variables in adolescents. The study included 16-18 years subjects. A total of approximately 4,000 calls were made; 529 adolescents were finally enrolled. The questionnaire was divided into two parts: the first one focused on affective variables, the second one explored sleep variables. A factorial analysis was carried out to explore the structure of the questionnaire according to two factors: the first, which we labeled "affective factor", and the second, "quality of sleep". A positive correlation was found regarding the feeling of wellbeing on awakening. A negative correlation was found between feeling of wellbeing on awakening and daytime drowsiness. In adolescence, increased daytime sleepiness seemed to correlate with worsening mood.
Sleep disorders are a group of neurological disorders known to cause public health problems associated with interference with daily activities including cognitive problems, poor job performance and reduced productivity. There is strong evidence emerging for the presence of genes influencing sleep disorders, such as narcolepsy (NRCLP), restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). NRCLP is typically characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hallucinations. RLS is manifested by compelling need to move the legs and usually experienced when trying to sleep. OSAS is major sleep problem characterized by recurrent episodes of upper airway collapse and obstruction during sleep. In the recent years, many research groups have attempted to identify the susceptibility and candidate genes for NRCLP, RLS, and OSAS through the sequential analyses of genetic linkage and association. The purpose of this review is to summarize some of remarkable molecular advances in sleep and sleep disorders, thereby providing a greater understanding of the complex sleep processes, and a platform for future therapeutic interventions.
Data from a prospective 11-year longitudinal survey were used to identify early predictors and pathways to symptoms of anxiety and depression at 12-13 years of age, and to examine whether there were unique predictors of anxious versus depressive symptoms. Structural equation modeling was used to explore longitudinal relations between contextual (maternal distress, family adversities, and social support) and temperamental (shyness and emotionality) risk factors in their prediction of informant-consistent symptoms of anxiety and depression. The results show that early risk factors can explain 38% of the variance in boys' covarying symptoms of anxiety and depression in early adolescence, and 25% of variance in girls' covarying symptoms. Two main pathways were identified. One pathway was through temperament, as nearly all risk factors were partly mediated through child emotionality in midchildhood. Another pathway was through early contextual risk factors, with all direct and indirect contextual impact from before 5 years of age. Family adversity uniquely predicted depressive symptoms. These findings underscore the persisting impact of contextual predictors in families with children less than 5 years of age. The importance of early interventions to prevent adolescent internalizing problems is stressed.
In this paper we develop and estimate the first complete and internally consistent model of the effect of Social Security on the labor supply of the aged. We develop a simple life-cycle model that captures the effect of Social Security on the joint choice of the date of retirement and hours of work immediately after retirement. We show that in the presence of Social Security the budget constraint relating these choices is highly complex and nonlinear, and we develop a maximum likelihood procedure for the model that yields consistent parameter estimates. Our procedure avoids the selectivity biases present in prior studies that have ignored the nonlinearity of the constraint or have examined only self-selected subsamples that exclude nonretirees. Our results show that Social Security has a significant, though relatively small, effect on the age of retirement and postretirement hours of work, and that the effect of Social Security grows with advancing age.
The Epworth Sleepiness Scale (ESS) is a simple questionnaire measuring the general level of daytime sleepiness, called here the average sleep propensity. This is a measure of the probability of falling asleep in a variety of situations. The conceptual basis of the ESS involves a four-process model of sleep and wakefulness. The sleep propensity at any particular time is a function of the ratio of the total sleep drive to the total wake drive with which it competes. ESS scores significantly distinguished patients with primary snoring from those with obstructive sleep apnea syndrome (OSAS), and ESS scores increased with the severity of OSAS. Multiple regression analysis showed that ESS scores were more closely related to the frequency of apneas than to the degree of hypoxemia in OSAS. ESS scores give a useful measure of average sleep propensity, comparable to the results of all-day tests such as the multiple sleep latency test.
We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.
The aim of this study was to examine the associations between sleep and neurobehavioral functioning (NBF) in school-age children. These variables were assessed for 135 unreferred, healthy school children (69 boys and 66 girls), from second-, fourth-, and sixth-grade classes. Objective assessment methods were used on the participants in their regular home settings. Sleep was monitored using actigraphy for 5 consecutive nights; and NBF was assessed using a computerized neurobehavioral evaluation system, administered twice, at different times of the day. Significant correlations between sleep-quality measures and NBF measures were found, particularly in the younger age group. Children with fragmented sleep were characterized by lower performance on NBF measures, particularly those associated with more complex tasks such as a continuous performance test and a symbol-digit substitution test. These children also had higher rates of behavior problems as reported by their parents on the Child Behavior Checklist. These results highlight the association between sleep quality, NBF, and behavior regulation in child development; and raise important questions about the origins of these associations and their developmental and clinical significance.
To evaluate the role of age, gender, duration and control of acromegaly on the reversibility of arthropathy.
30 de novo patients with active acromegaly, 30 cured patients and 30 healthy subjects were studied in a tranverse and an open longitudinal study design.
Shoulder, wrist and knee thickening was measured by ultrasonography at study entry in all 90 subjects and after 12 Months of treatment with octreotide-LAR (OCT-LAR) at a dose of 10-40 mg every 28 days in the 30 de novo patients.
Thickness at all joint sites was greater in the active than in the cured patients and controls (P<0.001), and was greater in the cured patients than in the controls (P<0.001). There was no gender difference, but joint thickness was less in the patients with disease duration >10 Years. Age significantly correlated with wrist (r=-0.55; P<0.001), right knee (r=-0.45; P=0.01), and left knee thickness (r=-0.42; P=0.02) in patients with active disease, and with wrist thickness (r=0.88; P<0.0001) in controls. Twelve Months of OCT-LAR treatment led to disease control in 18 patients (60%). There was a decrease in the thickness of the shoulder (15.1+/-3.2%), wrist (20.5+/-3.1%), right knee (22.2+/-3.4%) and left knee (18.2+/-2.8%) in all patients but the reduction in joint thickness at all sites was greater in the patients with controlled disease after OCT-LAR treatment than in the uncontrolled patients (P<0.01). Shoulder and right knee thickening normalized in respectively 11 (61.1%) and 16 (88.9%) well-controlled patients.
Growth hormone and insulin-like growth factor-I (IGF-I) suppression by 12 Months' OCT-LAR treatment is accompanied by a significant decrease in the thickness of both weight-bearing and non-weight-bearing joints (mainly in patients whose disease is controlled) regardless of disease duration. These findings suggest that tIssue hypertrophy in the context of the acromegalic arthropathy can be improved by suppressing IGF-I levels.
There is need for greater clarity around the concept of resilience as it relates to the period of adolescence. Literature on resilience published between 1990 and 2000 and relevant to adolescents aged between 12- and 18-years of age was reviewed with the aim of examining the various uses of the term, and commenting on how specific ways of conceptualizing of resilience may help develop new research agendas in the field. By bringing together ideas on resilience from a variety of research and clinical perspectives, the purpose of the review is to explicate core elements of resilience in more precise ways, in the hope that greater conceptual clarity will lead to a range of tailored interventions that benefit young people.
Are symptoms of daytime sleepiness relevant among patients with insomnia? Patients with insomnia frequently report daytime consequences secondary to their difficulty initiating and maintaining sleep. The purpose of this study was to determine the frequency of daytime sleepiness as defined by a self-reported measure of daytime sleepiness (the Epworth Sleepiness Scale). In addition, the study characterized the patients' psychological status using the Symptom Checklist-90-Revised. The study corroborated a relatively high frequency of excessive daytime sleepiness and psychiatric conditions among patients with insomnia. Furthermore, the results of the study suggest variation in psychological distress levels, according to the different levels of sleepiness/alertness.
Studies of acromegaly have shown a doubling of mortality compared with the general population. With the development of new modalities of treatment, it has become important to identify prognostic factors relating to mortality. Between 1964 and 2000, 208 acromegalic patients were followed for a mean of 13 yr at Auckland Hospital. Treatment was by surgery or radionuclide pituitary implantation, and all except 27 patients received pituitary radiation. Over the duration of the study, 72 patients died at a mean age of 61 +/- 12.8 yr. Those dying were significantly older at diagnosis, had a higher prevalence of hypertension and diabetes, and were more likely to have hypopituitarism. The observed to expected mortality ratio (O/E ratio) fell from 2.6 (95% confidence interval, 1.9-3.6) in those with last follow-up GH greater than 5 microg/liter to 2.5 (1.6-3.8), 1.6 (0.9-3), and 1.1 (0.5-2.1) for those with GH less than 5, less than 2, and less than 1 microg/liter, respectively (P < 0.001). Serum IGF-I, expressed as an SD score, was significantly associated with mortality, with O/E mortality ratios of 3.5 (95% confidence interval, 2.8-4.2) for those with an SD score greater than 2, 1.6 (0.6-2.6) for those with an SD score less than 2 (normal or low levels), and 1.0 (0.1-3) for those with an SD score less than zero. When assessed by multivariate analysis, last serum GH (P < 0.001), age, duration of symptoms before diagnosis (P < 0.03), and hypertension (P < 0.04) were independent predictors of survival. If IGF-I was substituted for GH, then survival was independently related to last IGF-I SD score (P < 0.02), indicating that GH and IGF-I act equivalently as predictors of mortality. These findings indicate that reduction of GH to less than 1 microg/liter or normalization of serum IGF-I reduces mortality to expected levels.
Active acromegaly is associated with significant comorbidity and reduced quality of life. However, the prevalence of comorbidity after long-term remission is not established. Therefore, we assessed the presence of comorbidity in 118 patients in long-term remission after surgery, radiotherapy, and/or somatostatin analog treatment according to strict biochemical criteria of serum GH and IGF-I concentrations and evaluated the impact of comorbidity on quality of life. The mean duration of remission was 12.0 +/- 7.4 yr, and mean actual IGF-I sd scores were 0.6 +/- 1.7. Self-reported joint problems occurred in 77% of patients, hypertension in 37%, a history of myocardial infarction in 9%, and diabetes mellitus in 11%. The presence of joint problems was not related to GH and IGF-I levels, active disease duration, or age. Joint complaints had significant negative impact on quality of life. Patients with a history of myocardial infarction had reduced scores for general health, depression, and fatigue, and diabetes mellitus was associated with reduced scores for anxiety and sleep. In conclusion, acromegalic patients had a high prevalence of joint-related comorbidity and hypertension despite long-term control of GH excess. Especially, joint complaints contributed to a reduced perceived quality of life in these patients.
Objective: To describe a series of patients with restless legs syndrome (RLS) and iron deficiency with and without anemia related to repeated blood donations. Patients and Methods: Study patients were identified by asking consecutive patients with RLS seen at the Mayo Clinic in Rochester, Minn, from February 1 to December 31, 2001, whether they donated blood. All patients who fulfilled the International Restless Legs Syndrome Study Group criteria for RLS, had donated blood a minimum of 3 times a year the preceding 3 years, and had iron deficiency (serum ferritin concentration <20 mug/L) were included in the study. I Results: Eight patients met the study criteria. The mean +/-SD serum ferritin concentration was 8.1+/-3.5 mug/L, and 4 patients had anemia. In 6 of. the 8 patients, RLS began at about the same time (if or after blood donation. Patients had donated blood for 4.2+/-1.3 times a year (range, 3-6 times a year) for 15.2+/-8.3 years (range, 5-25 years)., Hemoglobin concentrations were 12.8+/-1.8 g/dL (range, 10.6-45.5 g/dL). In 2 patients, RLS essentially resolved with correction of iron stores alone, and medications for RLS were successfully discontinued in 2 other patients. Conclusions: Repeated blood donation is associated with induction or perpetuation of RLS due to iron deficiency with or without coexisting anemia. Potential blood donors should be questioned about RLS, and donation should not be allowed until the serum ferritin concentraiion has been measured and iron stores replenished if necessary.
Abstract The purpose of the present study was to determine the prevalence of excessive daytime sleepiness (EDS) and its associations with sleep habits, sleep problems, and school performance in high school students in South Korea. A total of 3871 students (2703 boys and 1168 girls with a mean age of 16.8 years and 16.9 years, respectively) aged 15–18 years in the 11th grade of high school completed a questionnaire that contained items about individual sociodemographic characteristics, sleep habits, and sleep-related problems. The overall prevalence of EDS was 15.9% (14.9% for boys and 18.2% for girls). Mean reported total sleep time was similar in EDS and non-EDS (6.4 ± 1.6 and 6.4 ± 1.3 h/day, respectively). The increased risk of EDS was related to perceived sleep insufficiency (P < 0.001), teeth grinding ≥ 4 days/week (P < 0.001), witnessed apnea ≥1–3 days/week (P < 0.01), nightmares ≥4 days/week (P < 0.05), low school performance (P < 0.01), and two or more insomnia symptoms (P < 0.05). Students with low school performance had a 60% excess in the odds of EDS compared to those whose school performance was high. These findings suggest that EDS is associated with multiple sleep-related factors in adolescents. Whether interventions to modify associated correlates can alter EDS warrants consideration, especially because it may also improve academic performance in high school students.
Only in the last three decades, the restless legs syndrome (RLS) has been examined in randomized controlled trials. The Movement Disorder Society (MDS) commissioned a task force to perform an evidence-based review of the medical literature on treatment modalities used to manage patients with RLS. The task force performed a search of the published literature using electronic databases. The therapeutic efficacy of each drug was classified as being either efficacious, likely efficacious, investigational, nonefficacious, or lacking sufficient evidence to classify. Implications for clinical practice were generated based on the levels of evidence and particular features of each modality, such as adverse events. All studies were classed according to three levels of evidence. All Level-I trials were included in the efficacy tables; if no Level-I trials were available then Level-II trials were included or, in the absence of Level-II trials, Level-III studies or case series were included. Only studies published in print or online before December 31, 2006 were included. All studies published after 1996, which attempted to assess RLS augmentation, were reviewed in a separate section. The following drugs are considered efficacious for the treatment of RLS: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin. Drugs considered likely efficacious are rotigotine, bromocriptine, oxycodone, carbamazepine, valproic acid, and clonidine. Drugs that are considered investigational are dihydroergocriptine, lisuride, methadone, tramadol, clonazepam, zolpidem, amantadine, and topiramate. Magnesium, folic acid, and exercise are also considered to be investigational. Sumanirole is nonefficacious. Intravenous iron dextran is likely efficacious for the treatment of RLS secondary to end-stage renal disease and investigational in RLS subjects with normal renal function. The efficacy of oral iron is considered investigational; however, its efficacy appears to depend on the iron status of subjects. Cabergoline and pergolide (and possibly lisuride) require special monitoring due to fibrotic complications including cardiac valvulopathy. Special monitoring is required for several other medications based on clinical concerns: opioids (including, but not limited to, oxycodone, methadone and tramadol), due to possible addiction and respiratory depression, and some anticonvulsants (particularly, carbamazepine and valproic acid), due to systemic toxicities. © 2008 Movement Disorder Society
A previously specified model aimed at explaining the joint determinants of two binary choice variables (presence of a gender economics course and a women's studies program) is re-estimated with maximum likelihood procedures.
The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample.
Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change.
The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
SINCE THE PUBLICATION OF OUR RECENT REVIEW IN SLEEP,1 WE HAVE BECOME AWARE OF A FEW LARGER STUDIES THAT WE EITHER DID NOT COVER IN OUR review2,3 or have come to publication recently.4–6
We are sorry that we missed the older study by Ferri et al. published in 2007, where he and coauthors show in 16 patients with restless legs syndrome (RLS) that the pulse rate elevations seen with isolated leg movements are even higher than those seen with periodic limb movements in sleep (PLMS).2 This is in contrast to the study by Guggisberg et al. quoted in our review, where 24 patients with PLMS but not RLS have pulse rate elevations with PLMS that are higher than those with isolated leg movements.6 In both studies pulse rate elevations accompanying PLMS are significant, however, and could conceivably convey additional cardiovascular risk as blood pressure elevations would be expected to follow.1
We are also sorry that we missed the study previously published by Elwood et al., where 1986 men aged 55-69 years completed a questionnaire regarding RLS and other sleep disorders. During the following 10 years, 107 men experienced an ischemic stroke and 213 had an ischemic heart event. Compared with men who reported no symptoms of sleep disturbance of any kind, the relative odds of an ischemic stroke was 1.67 (1.07-2.60) P = 0.024 in patients who responded positively to a question on RLS.3
A new study by Lee et al. evaluates 137 patients immediately after ischemic stroke and documents the new onset of RLS symptoms directly after the stroke in 12.4%. The vast majority of these are in subcortical regions, suggesting that these regions are pertinent to the pathogenesis of RLS symptoms.4
A new study by Minai and colleagues documents RLS symptoms in 43.6% of 55 patients with pulmonary hypertension.5 The authors conclude that patients with pulmonary hypertension should be screened for RLS because good treatment options are available.
These larger studies add to the growing body of knowledge regarding the relationship of RLS/PLMS to hypertension, heart disease, and stroke. We plan new studies to look for the presence of silent stroke in patients with RLS versus controls. A study of isoprostanes which are markers of inflammation would be interesting as well.
Restless legs syndrome (RLS) is a common neurological condition. We investigated the prevalence of RLS in patients suffering from unpleasant sensations in the legs.
We included 16,543 patients consulting one of 312 primary care practices in Germany on November 8, 2007. All patients filled out a self-assessment questionnaire. Patients who reported suffering from unpleasant sensations in the legs were then assessed by the physician. Main outcome measures were the overall prevalence of unpleasant sensations in the legs and the prevalence of RLS; the most common differential diagnoses in the subpopulation suffered from unpleasant leg sensations.
Out of all participating patients 7704 (46.6%) suffered from unpleasant sensations in the legs and 1758 (10.6%) were diagnosed with RLS according to the four essential clinical criteria. Among patients with unpleasant leg sensations, the prevalence of RLS was considerably higher (22.7%) than in the total population. The most common differential diagnoses were osteoarthritis (21.5%), disc lesion (19.2%), varicose veins (18.8%) and muscle cramps (14.6%). Of the patients with RLS 53.4% had already consulted their physician about their leg problems in the past. Still, only 20.1% of the RLS patients had received the correct diagnosis. Comorbidity rates were significantly increased in RLS patients compared to patients suffering from leg symptoms of other origin.
This study showed a high prevalence of RLS in primary care patients with unpleasant sensations in the legs. Thus, in patients presenting with these symptoms the diagnosis of RLS should routinely be considered.
The relationship between reports of insomnia and daytime functioning was investigated using hierarchical regression. The presence or absence of a report of insomnia was the predictor of primary interest. A number of covariates were included in the model: demographic variables, health variables, and quantitative sleep parameters.
Data were collected from a community sample in the Memphis, Tennessee area. Data from 734 volunteers, ranging in age from 20 to 96years were analyzed. The sample included 235 individuals who reported having chronic insomnia and 499 individuals who reported no sleep problems. Participants completed a 2-week sleep diary, a battery of daytime functioning questionnaires, and a medical disorders checklist. Demographic information was also collected. The daytime functioning assessment included the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Epworth Sleepiness Scale, the Insomnia Impact Scale, and the Fatigue Severity Scale. The hierarchical regression model included four sets. The first three sets consisted of 18 variables capturing demographic, health, and sleep diary parameters. The fourth set included a single dichotomous variable representing the presence or absence of a report of insomnia.
Reports of insomnia were a significant predictor of all five daytime functioning measures, which is consistent with previous research. We also showed that reports of insomnia were able to uniquely explain a significant amount of variability in self-reported daytime functioning after controlling for demographics, health, and sleep diary variables. The pattern of individual variables that reached significance in the first three sets varied depending on which daytime functioning measure was predicted, however, age, the presence of pain, the presence of mental health problems, SOL, and WASO were the most commonly significant predictors of poor daytime functioning from these sets across measures.
Individuals' perceptions of their sleep are related to differences in their reported daytime functioning, which are not accounted for by demographic factors, health surveys, or quantitative sleep assessments. Reports of insomnia may be related to a set of common cognitive factors among individuals who report having insomnia which cause them to be distressed with their sleep and increase their dissatisfaction with daytime functioning. Relevance of the findings to insomnia research and clinical management are discussed.
Evidence is reviewed documenting an intimate relationship among restless legs syndrome (RLS) / periodic limb movements in sleep (PLMS) and hypertension and cardiovascular and cerebrovascular disease. Sympathetic overactivity is associated with RLS/PLMS, as manifested by increased pulse rate and blood pressure coincident with PLMS. Causality is far from definitive. Mechanisms are explored as to how RLS/PLMS may lead to high blood pressure, heart disease, and stroke: (a) the sympathetic hyperactivity associated with RLS/PLMS may lead to daytime hypertension that in turn leads to heart disease and stroke; (b) in the absence of daytime hypertension, this sympathetic hyperactivity may predispose to heart disease and stroke either directly or indirectly via atherosclerotic plaque formation and rupture; and (c) comorbidities associated with RLS/PLMS, such as renal failure, diabetes, iron deficiency, and insomnia, may predispose to heart disease and stroke. One theoretical cause for sympathetic hyperactivity is insufficient All diencephalospinal dopaminergic neuron inhibition of sympathetic preganglionic neurons residing in the intermediolateral cell columns of the spinal cord. We cannot exclude the possibility that peripheral vascular, cardiovascular, and cerebrovascular disease may also contribute to RLS/PLMS, and mechanisms for these possibilities are also discussed.
This article provides an overview of the daytime symptoms associated with the most common sleep disorders, namely insomnia, restless legs syndrome, obstructive sleep apnea syndrome and shift wake-sleep disorder. Psychological and social dysfunction resulting from these sleep disturbances are explained and discussed in detail. Health-related quality of life is a concept that reflects the changes in diverse aspects of subjective wellbeing of the patients due to an illness. Therefore, studies reporting quality-of-life issues associated with the aforementioned sleep disorders will also be presented. Finally, we review the limited data regarding the effects of treatment on quality-of-life outcomes.
This prospective longitudinal study of a representative community sample of children and adolescents (N = 269) examined the long-term course and predictive power of psychiatric symptoms in childhood/adolescence for diagnostic outcome (ICD-10) 18 years later at adult age.
At both cross-sectional assessments, baseline (1980-1984) and the 18-year follow-up (2001-2004), psychiatric symptoms were assessed using the 'Standardized Psychiatric Interview' (Goldberg et al. in Br J Prev Soc Med 24:18-23, 1970). At follow-up, study participants were reassessed with the standardized M-CIDI (Wittchen and Pfister in Manual und Durchführungsbeschreibung des DIA-X-M-CIDI, Swets and Zeitlinger, Frankfurt, 1997) interview.
The participation rate at 18-year follow-up was 82% of those alive. The frequency of clinically relevant depressive symptoms and symptoms of anxiety or phobia was considerably higher when the participants were younger (baseline assessment at childhood, adolescent age) as compared to their scores in adult age. Increased levels of somatic symptoms, fatigue, irritability, sleep disturbances, depression, anxiety and worry as well as phobic symptoms in childhood/adolescence were related to a higher risk of suffering from a psychiatric disorder in adulthood. Depressive symptoms predicted both mood disorders and substance use disorders in adulthood. Phobias predicted later anxiety disorders.
These data spanning almost two decades add significant information to the existing literature on the course of mental disorders in the community during the transition from adolescence to adulthood.
To use the 2003 International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria and to evaluate restless legs syndrome (RLS) prevalence in a rheumatoid arthritis (RA) and osteoarthritis (OA) population. Further, we wished to evaluate physician awareness of this disorder by as reflected in prevalence of preexisting diagnoses of RLS in these populations.
This was a questionnaire study of Saskatchewan RA and OA patients enrolled in a longitudinal database study. A data collection instrument, including the 2003 IRLSSG criteria for RLS was distributed to the patients enrolled.
Of the 193 respondents, 158 (81.9%) were women. The population consisted of 148 RA and 45 OA patients. RA patients were younger (mean age, 65.8 years) in comparison with those in the OA group (mean age, 72.8 years; P < 0.001). All criteria for RLS were met by 27.7% of RA patients and by 24.4% of OA patients. A previous diagnosis of RLS was reported by 2.6% of patients.
A quarter of all our patients met the 2003 IRLSSG criteria, in both RA and OA groups; however, only 2.6% of study patients reported a previous diagnosis of RLS. As RLS can significantly affect quality of life, increased awareness with improvement in surveillance, recognition, and treatment would be beneficial to patient care. We advocate screening for symptoms of sleep disorders to be incorporated into the routine rheumatologic history for all patients with RA and OA.
In a longitudinal epidemiological study of young adults, we estimated the association between sleep disturbance and psychiatric disorders, cross-sectionally and prospectively. A random sample of 1200 was drawn from all 21-30-year-old members of a large health maintenance organization (HMO) in Michigan; 1007 were interviewed in 1989 and 979 were reinterviewed in 1992. Lifetime prevalence of insomnia alone was 16.6%, of hypersomnia alone, 8.2%, and of insomnia plus hypersomnia, 8%. The gender-adjusted relative risk for new onset of major depression during the follow-up period in persons with history of insomnia at baseline was 4.0 (95% confidence interval [CI] 2.2-7.0) and in persons with baseline history of hypersomnia, 2.9 (95% CI 1.5-5.6). When history of other prior depressive symptoms (e.g., psychomotor retardation or agitation, suicidal ideation) was controlled for, prior insomnia remained a significant predictor of subsequent major depression. Complaints of 2 weeks or more of insomnia nearly every night might be a useful marker of subsequent onset of major depression.
To provide a 10-year review of pediatric sleep disorders medicine.
DSM-IV is used to organize the presentation from a developmental perspective.
Pediatric sleep disorders can be subdivided into four broad categories: Primary Sleep Disorders that include two subcategories, Dyssomnias and Parasomnias; Sleep Disorder Related to Another Mental Disorder; Sleep Disorder Due to a General Medical Condition; and Substance-Induced Sleep Disorder. Behavioral and supportive methods of treatment remain the most useful methods for treating primary sleep disorders in childhood.
A high proportion of patients with restless legs syndrome (RLS) also complain of arm paresthesia but the presence of periodic arm movements (PAM) has never been documented in a sleep laboratory in these patients. We investigated the prevalence of PAM during nocturnal sleep and awakenings in 22 RLS patients. Fifteen patients had a PAM index >5 movements per hour during wakefulness and among them only 3 had a PAM index >5 during sleep. Twenty patients had a periodic leg movement (PLM) index >5 during wakefulness and 17 had a PLM index >5 during sleep. In 42.8% of cases, PAM showed temporal relationship with PLM during wakefulness. These results show that PAM is frequent in RLS and suggest that the basic neurological dysfunction responsible for RLS is probably not located exclusively at the level of the lumbar spinal cord but involves neuronal systems located at upper levels.
Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence.
A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19-24 years of age).
Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder.
Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.
This paper reviews sleep disturbances in patients with major depressive disorders and the effects of different classes of antidepressants on sleep. It is clear from the studies reviewed that not all antidepressants improve sleep, and, indeed, some worsen sleep disturbances in patients with depression. Whether sleep is improved or further disrupted is of high clinical significance, because persistent sleep problems elevate the risk of relapse, recurrence, or suicide, as well as the need for augmenting medications.
The purpose of this study is to evaluate the predictors of subjective daytime sleepiness (SDS) and its chronicity in adolescents. Two groups of adolescents (107 with SDS and 107 without SDS) from our first questionnaire study were invited to an interview after 3 y. A follow-up questionnaire had been sent to them one year earlier. The interview included questions about sleep, daytime sleepiness, living habits, physical and mental health, and progress at school. The adolescents were also examined clinically. Interviews were conducted with 66 out of 107 subjects with SDS and 64 out of 107 without SDS (age range 12 to 19 y). In this interview 42 out of the 130 adolescents had SDS. A total of 20 adolescents reported SDS in both questionnaire studies and in the interview (chronic SDS). In a multivariate analysis (logistic regression) sleep disorders, frequent medication and depressive emotions were significantly associated with SDS. Chronic SDS was connected in a bivariate analysis (Pearson's chi-square) with excessive night waking, difficulty in falling asleep, dreaming, frequent medication, frequent alcohol drinking, and irregular breakfast eating, and in our previous studies also with delayed sleep rhythm.
Conclusion: Sleep disorders and health problems were more common causes of SDS than undesirable living habits. However, alcohol drinking and delayed sleep rhythm were associated with chronic SDS in addition to sleep disorders and medication.
We performed a cross-sectional study with 342 medical students (age range, 18-35 years) to identify, among a group of sleep disturbances, those which are related to minor psychiatric disorders in this population. The instruments employed for data collection were the self-reporting questionnaire (SRQ-20), the morningness/eveningness questionnaire, the Epworth sleepiness scale, and a general questionnaire regarding demographic characteristics, use of drugs, history of psychopathology, usual fall-asleep time, usual wake-up time, amount of sleep, arousal during the night, and insomnia. We used a logistic regression model to determine independent factors associated with minor psychiatry disorders. Daytime sleepiness [odds ratio (OR), 2.12; 95% CI, 1.21-3.71], arousal [OR, 4.54; 95% CI, 1.97-10.47], insomnia [OR 2.45; 95% CI, 1.32-4.56], and sleeping less than 7 hours per night [OR, 2.02; 95% CI, 1.11-3.67] were associated with minor psychiatric disorders. This group of variables determined a cumulative risk ratio of 5.47 [95% CI, 2.87-10.41] for the main outcome.
To examine the impact of insomnia among adolescents on somatic, interpersonal, and psychological functioning using data from a two-wave, prospective study.
Subjects were adolescents 11-17 years of age sampled from managed care enrollment rosters in the United States. The baseline sample was 4175 and the follow-up sample a year later was 3136. Data were collected using computer-assisted personal interviews and self-administered questionnaires. Insomnia was measured using DSM-IV symptom criteria, scored as a summated scale and as separate symptoms. Indicators of somatic functioning were perceived health, limitations due to health problems, and impact of illness on family activities. Indicators of interpersonal functioning were social support, relations with parents, relations with peers and relations at school. Indicators of psychological functioning were self-esteem, perceived mental health, life satisfaction, and depression.
Symptoms of insomnia were common, with 17% reporting nonrestorative sleep, 6% difficulty initiating sleep, 7% daytime fatigue, and 5% daytime sleepiness almost every day. Without adjustment for insomnia at follow-up, the odds of dysfunction at follow-up for those with insomnia averaged 2.5 across 11 indicators of functioning. For 9 of 11 indicators, there was a clear dose-response relation such that moderate levels of insomnia increased risk and this risk increased with greater insomnia. Adjusting for insomnia at follow-up eliminated the association with somatic functioning and attenuated associations with interpersonal and psychological functioning.
These prospective data provide additional evidence that insomnia can have adverse consequences for the functioning of adolescents. Given the growing evidence for a relation between disturbed sleep and impaired adolescent functioning, more attention needs to be directed to identifying causal pathways and possible strategies for intervention.
The aim of this epidemiological study was to utilise a cross-sectional as well as a longitudinal approach to examine sleep habits and how they develop in young people in Iceland. The 668 subjects (1-20 years) who responded to a postal survey in 1985 were followed up 5 and 10 years later. The majority of the variance in bedtime and sleep duration was explained by age, but also to a considerable degree by other factors such as residence, season, and year of survey or interaction of these factors. Natural phenomena, such as the diminution of total sleep duration in the first years of life and the tendency for longer sleep on weekends compared to weekdays were confirmed. The lengthening of sleep on weekends was first significant at the age of 9 and was greater among adolescents than young adults. The incidence of daytime sleepiness increased in adolescence, as did napping, at which time their nocturnal sleep time significantly decreased. Over a period of 10 years, a significant shift to earlier wake-up times occurred in children up to 15 years of age, which resulted in a shortened total sleep time. The idea that individual sleep duration is an inherent parameter is supported by the high positive correlation of total sleep time across a 10-year period (r=.73). The present data confirm that Icelandic adolescents (aged 11, 13, and 15) have delayed bedtimes and shorter nocturnal sleep compared to European peers.
To develop a disease-specific questionnaire suitable to measure health-related quality of life (HRQOL) in acromegaly (ACROQOL).
For the development of the ACROQOL questionnaire different sources of information were used: First, a literature search was performed to identify relevant papers describing the impact of acromegaly in HRQOL. Second, 10 endocrinologists identified the main domains of impact on HRQOL in patients with acromegaly. Third, 10 in-depth, semistructured interviews were conducted in acromegalic patients to identify domains and items related to the self-perceived impact of acromegaly in patients' life. Qualitative analyses of the information were performed identifying domains and items to be included in the questionnaire. Those items considered ambiguous, complicated to read, double-barrelled, with jargon terms, too long, or negatively worded were excluded. Each remaining item was subsequently rated by the same panel of endocrinologists and experts in HRQOL evaluation, and assessed according to clarity of wording, frequency of occurrence and importance among patients with acromegaly. Analysis of internal consistency of the questionnaire was evaluated with a Cronbach's Alpha. A preliminary questionnaire was administered to 72 patients with acromegaly. Rasch analysis (dichotomous logistic response model) of the answers given by these patients allowed parameter estimates and model data fit indices to be computed and misfitting items deleted. Frequency of occurrence and degree of agreement with the statements were selected as response choices in a 5-point Likert type scale.
The following domains related to HRQOL in acromegaly were identified: physical and psychological functions, social, daily activities, symptoms, cognition, general health perception, sleep, sexual function, pain, energy and body image. An initial set of 204 expressions were identified from the initial transcripts of the patient interviews. After elimination of ambiguous or unclear expressions, 142 items remained drafted in question form. From the quantitative analysis of the item rank position within each of the three areas of clarity, frequency and importance, the 38-item questionnaire was produced, with satisfactory internal consistency (Cronbach's Alpha 0.94). Rasch analysis produced a further reduction to the final 22-item questionnaire (Cronbach's Alpha 0.91) containing two scales that evaluate physical (eight questions) and psychological aspects related to appearance and personal relations (seven items each). The evaluation of the item parameters confirmed the construct validity of the new instrument. The substantial reliability of the questionnaire suggested the sample was well targeted by the questionnaire. The initial Spanish version was translated into English and presented to five English-speaking Australian patients with acromegaly to assess and correct for comprehension, clarity, cultural relevance and suitable wording.
We present the ACROQOL questionnaire, developed and preliminarily validated to specifically assess HRQOL in patients with acromegaly.
We analyzed the effects of age and sex on habitual sleep/wake rhythm and Morningness-Eveningness scores of 2,252 subjects (6-89 years) randomly selected in Shimonoseki, Japan. Subjects were divided into 21 age groups with a matching number of men and women in each age group. The most common sleep parameter patterns by age showed a v- or inverted v-pattern with a turning point in young adulthood or at the period of puberty. During the period between 6 yr. of age to puberty or young adulthood, the bedtimes on weekdays and weekends and the waking times on weekends were delayed, Morningness-Eveningness scores shifted to the evening type, and sleep length on weekdays decreased. After that period, across groups of increasing age, bedtime and waking time on weekdays and weekends became earlier, sleep length on weekdays and sleep latency increased, Morningness-Eveningness scores shifted to morning type, and the number of awakenings increased. The number of daytime naps increased in the 16-19 yr. group, decreased slightly after that age group, but increased again in older groups. The weekday bedtimes of women above 40 yr. of age was significantly later and their sleep lengths significantly shorter than those of men of the same age. Average sleep latency was longer for women than men. The number of awakenings was larger in women above 50 yr. of age than men of the same age group. The turning point of age, gained from the two linear regressions on data for subjects that have a minimum sum of squared error, was between 16 and 25 yr. of age. Average phase of sleep/wake rhythm shifted backward and sleep length decreased in groups from age 6 to puberty or young adulthood. After early adolescence, the average phase of the sleep/wake rhythm shifted forward, sleep latency became longer, and daytime napping increased. Number of awakenings increased rapidly for women's groups over 40 yr. of age and for men's groups after 50 yr. of age. Sex differences in our research are in apparent conflict with previous data and are discussed from the perspective of women's social and domestic roles in Japan.
Purpose: Depressive disorders (DD) in adolescence are often misdiagnosed and under-recognised. A major clinical problem regards the high rate of co-morbidity with other disorders, namely substance abuse. The aim of this study was to assess the discriminative power of the Beck Depression Inventory II (BDI-II) to characterise specific social-demographic variables related to DD in adolescence.
A Portuguese version of the BDI-II and a social-demographic questionnaire were administered to 775 Portuguese adolescents (312 males, 463 females; mean age: 16.9 years); 83 adolescents performed a clinical interview following DSM-IV criteria.
Mean BDI-II Portuguese version (BDI-II-P) total score was 10.31 (standard deviation: 8.4), with females reporting more depressive symptoms than males (P < 0.001). Low academic achievement, sleep disturbances, and alcohol consumption were consistently associated with depressive symptoms for both genders. Higher tobacco consumption was significantly associated with depressive symptoms in females. Familial factors did not appear to be associated with depressive symptoms in males. However, a higher frequency of siblings, having separated parents as well as a more extreme perception of the mother's educational style were consistently associated with depressive symptoms in females.
The BDI-II-P showed discriminative power to characterise social-demographic variables related to DD especially in adolescent females.
To describe a series of patients with restless legs syndrome (RLS) and iron deficiency with and without anemia related to repeated blood donations.
Study patients were identified by asking consecutive patients with RLS seen at the Mayo Clinic in Rochester, Minn, from February 1 to December 31, 2001, whether they donated blood. All patients who fulfilled the International Restless Legs Syndrome Study Group criteria for RLS, had donated blood a minimum of 3 times a year the preceding 3 years, and had iron deficiency (serum ferritin concentration <20 microg/L) were included in the study.
Eight patients met the study criteria. The mean +/- SD serum ferritin concentration was 8.1 +/- 3.5 microg/L, and 4 patients had anemia. In 6 of the 8 patients, RLS began at about the same time of or after blood donation. Patients had donated blood for 4.2 +/- 13 times a year (range, 3-6 times a year) for 15.2 +/- 83 years (range, 5-25 years). Hemoglobin concentrations were 12.8 +/- 1.8 g/dL (range, 10.6-15.5 g/dL). In 2 patients, RLS essentially resolved with correction of iron stores alone, and medications for RLS were successfully discontinued in 2 other patients.
Repeated blood donation is associated with induction or perpetuation of RLS due to iron deficiency with or without coexisting anemia. Potential blood donors should be questioned about RLS, and donation should not be allowed until the serum ferritin concentration has been measured and iron stores replenished if necessary.
Chronic effects of excessive GII secretion are not only disabling but also disfiguring. Most acromegalic patients present with 4–10 years history of changes in features, bony overgrowth, soft tissue swelling, skin changes, diabetes mellitus, hypertension and other cardiovascular symptoms.
In addition to sign and symptoms of GII excess the patients demonstrate a loss initiative and spontaneity, mood swings, an impairments in self esteem, body image distortion, disruption in interpersonal relations and social withdrawal anxiety.
Little research is available on the psychological features of acromegaly, despite their importance in this chronic and debilitating condition. Extremely little, however has appeared in the medical and psychological literature about mental and emotional disfunction in patients with acromegaly.
A questionnaire survey was carried out to examine the sleep habits and excessive daytime sleepiness (EDS) of 3871 high school students with a mean age of 16.8 years in Korea. The results showed that mean total sleep time was 6.3 h/day for male students and 6.5 h/day for female students, which may be insufficient for adolescence during puberty. The overall prevalence of EDS (defined as an Epworth sleepiness scale score of >10) was 15.9% (14.9% for boys and 18.2% for girls). The prevalence of EDS increased significantly (P < 0.001) with a decline in school performance.
The two-process model of sleep regulation has been applied successfully to describe, predict, and understand sleep-wake regulation in a variety of experimental protocols such as sleep deprivation and forced desynchrony. A non-linear interaction between the homeostatic and circadian processes was reported when the model was applied to describe alertness and performance data obtained during forced desynchrony. This non-linear interaction could also be due to intrinsic non-linearity in the metrics used to measure alertness and performance, however. Distinguishing these possibilities would be of theoretical interest, but could also have important implications for the design and interpretation of experiments placing sleep at different circadian phases or varying the duration of sleep and/or wakefulness. Although to date no resolution to this controversy has been found, here we show that the issue can be addressed with existing data sets. The interaction between the homeostatic and circadian processes of sleep-wake regulation was investigated using neurobehavioural performance data from a laboratory experiment involving total sleep deprivation. The results provided evidence of an actual non-linear interaction between the homeostatic and circadian processes of sleep-wake regulation for the prediction of waking neurobehavioural performance.
There is a need for an easily administered instrument which can be applied to all patients with restless legs syndrome (RLS) to measure disease severity for clinical assessment, research, or therapeutic trials. The pathophysiology of RLS is not clear and no objective measure so far devised can apply to all patients or accurately reflect severity. Moreover, RLS is primarily a subjective disorder. Therefore, a subjective scale is at present the optimal instrument to meet this need.
Twenty centers from six countries participated in an initial reliability and validation study of a rating scale for the severity of RLS designed by the International RLS study group (IRLSSG). A ten-question scale was developed on the basis of repeated expert evaluation of potential items. This scale, the IRLSSG rating scale (IRLS), was administered to 196 RLS patients, most on some medication, and 209 control subjects.
The IRLS was found to have high levels of internal consistency, inter-examiner reliability, test-retest reliability over a 2-4 week period, and convergent validity. It also demonstrated criterion validity when tested against the current criterion of a clinical global impression and readily discriminated patient from control groups. The scale was dominated by a single severity factor that explained at least 59% of the pooled item variance.
This scale meets performance criteria for a brief, patient completed instrument that can be used to assess RLS severity for purposes of clinical assessment, research, or therapeutic trials. It supports a finding that RLS is a relatively uniform disorder in which the severity of the basic symptoms is strongly related to their impact on the patient's life. In future studies, the IRLS should be tested against objective measures of RLS severity and its sensitivity should be studied as RLS severity is systematically manipulated by therapeutic interventions.
Restless legs syndrome is a common yet frequently undiagnosed sensorimotor disorder. In 1995, the International Restless Legs Syndrome Study Group developed standardized criteria for the diagnosis of restless legs syndrome. Since that time, additional scientific scrutiny and clinical experience have led to a better understanding of the condition. Modification of the criteria is now necessary to better reflect that increased body of knowledge, as well as to clarify slight confusion with the wording of the original criteria.
The restless legs syndrome diagnostic criteria and epidemiology workshop at the National Institutes of Health.
Members of the International Restless Legs Syndrome Study Group and authorities on epidemiology and the design of questionnaires and scales.
To modify the current criteria for the diagnosis of restless legs syndrome, to develop new criteria for the diagnosis of restless legs syndrome in the cognitively impaired elderly and in children, to create standardized criteria for the identification of augmentation, and to establish consistent questions for use in epidemiology studies.
The essential diagnostic criteria for restless legs syndrome were developed and approved by workshop participants and the executive committee of the International Restless Legs Syndrome Study Group. Criteria were also developed and approved for the additional aforementioned groups.
To determine the prevalence, risk factors, and clinical presentation of restless legs syndrome (RLS) in a Turkish population.
A face-to-face, population-based epidemiologic survey was conducted. Multistep, stratified, cluster, and systematic samplings were used. A total of 3,234 adults were interviewed.
Of the 3,234 participants, 103 (3.19%) experienced RLS. This prevalence rate is lower than those of other epidemiologic studies conducted among European and North American populations. RLS was found to be more common among women, cigarette smokers, and individuals residing in high altitudes. The self-reported mental and general health status of patients was worse than in the control subjects. The prevalence of RLS did not differ by age or body mass index.
The discrepancy in RLS prevalence studies (including the authors') suggests that prevalence varies among different races, thus supporting a genetic predisposition.
Adolescent development is accompanied by profound changes in the timing and amounts of sleep and wakefulness. Many aspects of these changes result from altered psychosocial and life-style circumstances that accompany adolescence. The maturation of biological processes regulating sleep/wake systems, however, may be strongly related to the sleep timing and amount during adolescence-either as "compelling" or "permissive" factors. The two-process model of sleep regulation posits a fundamental sleep-wake homeostatic process (process S) working in concert with the circadian biological timing system (process C) as the primary intrinsic regulatory factors. How do these systems change during adolescence? We present data from adolescent participants examining EEG markers of sleep homeostasis to evaluate whether process S shows maturational changes permissive of altered sleep patterns across puberty. Our data indicate that certain aspects of the homeostatic system are unchanged from late childhood to young adulthood, while other features change in a manner that is permissive of later bedtimes in older adolescents. We also show alterations of the circadian timing system indicating a possible circadian substrate for later adolescent sleep timing. The circadian parameters we have assessed include phase, period, melatonin secretory pattern, light sensitivity, and phase relationships, all of which show evidence of changes during pubertal development with potential to alter sleep patterns substantially. However the changes are mediated-whether through process S, process C, or by a combination-many adolescents have too little sleep at the wrong circadian phase. This pattern is associated with increased risks for excessive sleepiness, difficulty with mood regulation, impaired academic performance, learning difficulties, school tardiness and absenteeism, and accidents and injuries.
The clinical characteristics of childhood-onset restless legs syndrome are described. Thirty-two of 538 subjects (5.9%) examined in our sleep disorders center received diagnoses of restless legs syndrome. They were classified based on published criteria into probable (n = 9/32 or 28%) and definite (n = 23/32 or 78%) categories. Apart from an earlier age of diagnosis of the probable group, no differences were found between the two categories. Sleep onset or sleep maintenance insomnia was the most common symptoms, being present in 28 of 32 subjects (87.5%). Inattentiveness was seen in 8 of 32 subjects (25%). Serum ferritin levels were measured in 24 of 32 subjects and were below 50 microg/L in 20 of 24 subjects (83%). A family history of restless legs syndrome was present in 23 of 32 (72%) subjects, with mothers almost three times more likely to be affected than fathers (p = 0.02). We conclude that iron deficiency and a strong family history are characteristic of childhood-onset restless legs syndrome.
There is considerable research evidence suggesting that sleep is biologically linked to mood disorders in adults. However, polysomographic and neuroendocrine studies in children and adolescents have not found consistent changes in sleep architecture paralleling adult major depression. This review provides a detailed description of sleep research that has been conducted in early-onset affective disorders, uncovers the potential limitations of the available data, and formulates future research directions in this important subject.
Acromegaly Quality of Life Questionnaire (AcroQoL) is a new disease-generated quality of life (QOL) questionnaire comprising 22 questions covering physical and psychological aspects of acromegaly and subdivided into "appearance" and "personal relations" categories. We have performed a cross-sectional study of QOL in 80 patients [43 male (mean age, 54.2 yr; range, 20-84); median GH, 0.93ng/ml (range, <0.3 to 23.7); IGF-I, 333.1 ng/ml (range, 47.7-899)] with acromegaly. In addition to AcroQoL, patients completed three generic QOL questionnaires: Psychological General Well-Being Schedule (PGWBS), EuroQol, and a signs and symptoms score (SSS). All three generic questionnaires confirmed impairment in QOL [mean scores: PGWBS, 69.6; EuroQol, visual analog scale, 66.4 (range, 20-100) and utility index, 0.7 (range, -0.07 to 0.92); and SSS, 12 (range, 0-27)]. There was no correlation between biochemical control and any measure of QOL. AcroQoL (57.3%; range, 18.2-93.2) correlated with PGWBS (r = 0.73; P < 0.0001); and in patients with active disease, AcroQoL-physical dimension correlated with SSS (r = -0.67; P < 0.0003). In all questionnaires, prior radiotherapy was associated with impaired QOL. In conclusion, these data underline the marked impact that acromegaly has on patients' QOL and provide the first evidence validating AcroQoL against well-authenticated measures of QOL. This indicates the potential of AcroQoL as a patient-friendly measure of disease activity.
To estimate prevalence and severity (using the International Restless Legs Syndrome Study Group Rating Scale (IRLS)) and to identify risk factors of restless legs syndrome (RLS).
Population-based cross-sectional study; 2005 randomly selected adults 18 years and above participated in a telephone interview in Norway and Denmark, employing the next-birthday technique.
Of the cross-section, 11.5% fulfilled the diagnostic criteria for RLS. Half of these reported the symptoms as moderate to very severe. Mean duration of the complaint was 10 years. Prevalence was higher in females than in males (13.4 vs 9.4%) and lowest in the youngest age group (18-29 years, 6.3%). From 30 years and above, no clear age-related difference was seen. Main predictors of RLS were insomnia (odds ratios: 1.71-3.16) and symptoms of periodic limb movements in sleep (3.20-7.85). The response rate was 47%, making the results less reliable.
This study indicates that there is a high occurrence of RLS among adults. Main predictors are insomnia and periodic limb movements in sleep.