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Sivertsen B, Krokstad S, Overland S, Mykletun A. The epidemiology of insomnia: associations with physical and mental health. The HUNT-2 study. J Psychosom Res 67: 109-16

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Abstract

The aim of the present study was to examine the association of insomnia symptoms with demographic and physical and mental conditions in a large population-based study. Cross-sectional data on insomnia and comorbid conditions were gathered from 47,700 individuals aged 20-89 in Norway. Comorbid conditions included anxiety and depression and the following physical conditions: asthma, allergy, cancer, hypertension, diabetes, migraine, headache, osteoporosis, fibromyalgia rheumatoid arthritis, arthrosis, Bechterew's disease, musculoskeletal disorders, and obesity (body mass index >30). Insomnia symptoms were found in 13.5% of the population and were more prevalent among women, older adults, and in individuals with less education. Reporting insomnia symptoms significantly increased the associations with a range of conditions, especially mental conditions, pain conditions with uncertain etiology and, to a lesser extent, chronic pain conditions. These findings remained significant also when adjusting for a range of potential confounders, whereas the association between insomnia and somatic conditions was largely reduced to a nonsignificant level in the fully adjusted analyses. This study demonstrates that insomnia symptoms are associated with a range of different conditions. The findings suggest that the independent contribution of insomnia is strongest on conditions characterized by some level of psychological or psychosomatic properties.

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... [9,15] 33.3-71.1% [16][17][18][19] 25.6-70.87% [20][21][22] 5.9-60% [23][24][25] 30.5% [26] 12.5-58% [27][28][29] 10.5-22.6% [18,[21][22][23]25] RLS 7.34-27.8% ...
... [20][21][22] 5.9-60% [23][24][25] 30.5% [26] 12.5-58% [27][28][29] 10.5-22.6% [18,[21][22][23]25] RLS 7.34-27.8% [30][31][32] 20-40.47% ...
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Epidemiological studies have shown that individuals with sleep problems are at a greater risk of developing immune and chronic inflammatory diseases. As sleep disorders and low sleep quality in the general population are frequent ailments, it seems important to recognize them as serious public health problems. The exact relation between immunity and sleep remains elusive; however, it might be suspected that it is shaped by others stress and alterations of the circadian rhythm (commonly caused by for example shift work). As studies show, drugs used in the therapy of chronic inflammatory diseases, such as steroids or monoclonal antibodies, also influence sleep in more complex ways than those resulting from attenuation of the disease symptoms. Interestingly, the relation between sleep and immunity appears to be bidirectional; that is, sleep may influence the course of immune diseases, such as inflammatory bowel disease. Thus, proper diagnosis and treatment of sleep disorders are vital to the patient's immune status and, in effect, health. This review examines the epidemiology of sleep disorders and immune diseases, the associations between them, and their current treatment and novel perspectives in therapy.
... Specifically, we hypothesized that weight-related self-stigma could be a potential mediator in the relationship between excess weight and psychological distress/QoL. Insomnia, a common sleep disorder, may result in severe health consequences similar to the negative consequences resulting from OW/OB, including physical and mental health problems [25][26][27]. People with OW/OB have reported more sleep problems than their normal-weight counterparts [28]. ...
... In other words, physical inactivity could be another reason to explain the mediated role of insomnia in the relationship between excess weight and poor health. The negative effects of insomnia on health, including psychological (e.g., unstable mood) and physical aspects (e.g., lack of energy), have been well documented in the literature [25][26][27]. Additionally, extensive research, including recently published articles [28,29], indicates that BMI serves as a strong determinant in predicting insomnia symptoms. ...
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Purpose To examine whether weight-related self-stigma (aka weight bias internalization) and insomnia are potential predictors of psychological distress and quality of life (QoL) among Iranian adolescents with overweight (OW)/obesity (OB). To examine whether weight-related self-stigma and insomnia are potential mediators in the relationship between excess weight and health outcomes of distress and QoL. Methods All participants (n = 934; 444 males; mean age = 15.7 ± 1.2 years; zBMI = 2.8 ± 1.0) completed questionnaires on weight-related self-stigma and insomnia at baseline. Six months later, they completed questionnaires on psychological distress and QoL to assess health outcomes. Relationships among variables were tested using mediation analyses with bootstrapping method. Results Weight-related self-stigma significantly mediated the effects of zBMI on psychological distress (effect = 0.22; bootstrapping SE = 0.09; 95% CI = 0.08, 0.45), psychosocial QoL (effect = − 0.64; bootstrapping SE = 0.19; 95% CI = − 1.10, − 0.32), and physical QoL (effect = − 1.35; bootstrapping SE = 0.54; 95% CI = − 2.43, − 0.26). Insomnia also significantly mediated the effects of zBMI on psychological distress (effect = 2.18; bootstrapping SE = 0.31; 95% CI = 1.61, 2.81), psychosocial QoL (effect = − 0.89; bootstrapping SE = 0.33; 95% CI = − 1.60, − 0.28), and physical QoL (effect = − 0.83; bootstrapping SE = 0.42; 95% CI = − 1.69, − 0.02). Full mediations were found in psychosocial QoL; partial mediations were found in psychological distress and physical QoL. Conclusions Weight-related self-stigma and insomnia were significant mediators in the effects of excess weight on health outcomes. Therefore, it is important to identify and treat weight-related self-stigma and insomnia for adolescents with OW/OB. Level of evidence Level V, cross-sectional descriptive study.
... The nightmare consequences factors (as determined by the factor analysis) plus nightmare chronicity were entered in step 2, as predictors in each model. Given that sleep problems, as well as anxiety and depression levels are generally higher in both females and younger people (Altemus et al., 2014;Schredl & Pallmer, 1998;Sivertsen et al., 2009;Zhang & Wing, 2006), age and gender were entered in the regression analyses as covariates. ...
... Next, only UK university students were sampled, and the sample comprised largely of young white females, which although is common with online surveys (Smith, 2008) potentially presents a further source of bias. That said, females often report sleep disturbances and nightmare at a higher rate than males, as well as high levels of anxiety, depression, and stress (Altemus et al., 2014;Schredl & Pallmer, 1998;Sivertsen et al., 2009;Zhang & Wing, 2006). Further, the sample mainly comprised of undergraduate students, therefore the current findings are not entirely generalizable to the general population or indeed the whole student population across the UK. ...
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Background: The Disturbing Dreams and Nightmares Severity Index (DDNSI) is commonly used when assessing the experience of nightmares. It comprises two parts examining i) chronicity and ii) nightmare consequences. The primary aim of the present study was to explore the dimensional structure of the optional and currently unvalidated nightmare consequences component using exploratory factor analysis. Internal reliability and construct validity were also examined. A secondary aim explored the relationships between nightmare chronicity and perceived consequences with measures of anxiety, depression, stress, self-efficacy, and insomnia. Methods: A cross-sectional survey was conducted with complete data from N = 757 students from six UK-based universities. Participants completed the chronicity and consequences components of the DDNSI, alongside the Sleep Condition Indicator, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Stress Scale, and General Self-Efficacy Scale. Results: Two nightmare consequences factors emerged; ‘Sleep-Interference’ (four items; α =.848), and ‘Psychosocial Well-being’ (six items; α =.946). Significantly moderate correlations were observed between the two emerging factors and the nightmare chronicity component, as well as with insomnia, anxiety, depression, perceived stress, and self-efficacy. Perceived ‘Sleep-Interference’ (β =−.241) was the strongest predictor of insomnia, and ‘Psychosocial wellbeing’ was the strongest predictor of anxiety (β =.688) depression (β =.804) perceived stress and lower self-efficacy. Conclusions: The perceived nightmare consequences component of the DDSNI is a multidimensional construct comprising two internally consistent and distinct, but related dimensions. The potential importance of distinguishing between types of perceived nightmare consequences and the associations with mental health outcomes in a student population is highlighted.
... Poor sleep is common in chronic pain patients and recent data identifies sleep problems as key factors in the patients with severe pain presentations [6,7]. In a large, recent cross sectional study investigating insomnia in Norwegian adults, the prevalence of insomnia in the complete cohort was 14% [8]. In patients with musculoskeletal pain, the odds ratio (OR) for insomnia, in a fully adjusted model, was 1.7 as compared to the remaining cohort. ...
... 95% CI = 95% confidence interval. ISI = Insomnia Severity Index, with four categories: ISI 1 = no insomnia (0-7), ISI 2 = sub-threshold insomnia (8)(9)(10)(11)(12)(13)(14), ISI 3 = moderate insomnia (15)(16)(17)(18)(19)(20)(21) and ISI 4 = severe insomnia (22)(23)(24)(25)(26)(27)(28). ...
Article
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Insomnia and chronic pain are prevalent health complaints. Previous research has shown that they are closely associated, but their interaction and causality are not completely understood. Further research is needed to uncover the extent to which a treatment strategy focusing on one of the conditions affects the other. This study aimed to map the prevalence of insomnia symptoms among patients in interdisciplinary pain rehabilitation program (IPRP) and investigate associations between the degree of insomnia at baseline and the treatment outcome regarding pain intensity, physical function, social function, mental well-being, anxiety, and depression. Of the 8515 patients with chronic pain, aged 15–81 who were registered in the Swedish Quality Registry for Pain Rehabilitation during 2016–2019 and participated in IPRP, 7261 had follow-up data after treatment. Logistic regression analysis was used to investigate associations. The prevalence of clinical insomnia, according to Insomnia Severity Index (ISI), among chronic pain patients in IPRP was 66%, and insomnia symptoms were associated with both country of birth and educational level. After IPRP, the prevalence of clinical insomnia decreased to 47%. There were statistically significant associations between the degree of insomnia symptoms before IPRP and physical function (p < 0.001), social function (p = 0.004) and mental well-being (p < 0.001). A higher degree of insomnia symptoms at baseline was associated with improvement after IPRP. In conclusion, IPRP seem to have beneficial effects on insomnia symptoms in chronic pain patients. Nevertheless, almost half of the patients still suffer from clinical insomnia after IPRP. The possible effect of systematic screening and treatment of insomnia for improving the effect of IPRP on pain is an important area for future research.
... Epidemiologic studies indicate that insufficient sleep and/or poor sleep quality are associated with multiple adverse effects on health, such as an increased risk for hypertension, type 2 diabetes, and obesity [1][2][3][4] . Insufficient sleep is also associated with anxiety, depression, and an increased risk for other psychiatric disorders [5][6][7] . Physical exercise is recommended by academic sleep associations as a low-cost, easily administered, and non-pharmacologic intervention for improving sleep [8][9][10][11] . ...
Article
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Exercise can improve sleep by reducing sleep latency and increasing slow-wave sleep (SWS). Some studies, however, report adverse effects of exercise on sleep architecture, possibly due to a wide variety of experimental conditions used. We examined the effect of exercise on quality of sleep using standardized exercise parameters and novel analytical methods. In a cross-over intervention study we examined the effect of 60 min of vigorous exercise at 60% V˙O2max on the metabolic state, assessed by core body temperature and indirect calorimetry, and on sleep quality during subsequent sleep, assessed by self-reported quality of sleep and polysomnography. In a novel approach, envelope analysis was performed to assess SWS stability. Exercise increased energy expenditure throughout the following sleep phase. The subjective assessment of sleep quality was not improved by exercise. Polysomnography revealed a shorter rapid eye movement latency and reduced time spent in SWS. Detailed analysis of the sleep electro-encephalogram showed significantly increased delta power in SWS (N3) together with increased SWS stability in early sleep phases, based on delta wave envelope analysis. Although vigorous exercise does not lead to a subjective improvement in sleep quality, sleep function is improved on the basis of its effect on objective EEG parameters.
... Canadian PSP sleep patterns may be impacted by long work hours, varying shift work, high stress, and exposure to potentially psychologically traumatic events [8,9], which may cumulatively increase the risk of mental disorder symptoms [31,65]. Insomnia has been strongly associated with various mental health conditions such as depression, anxiety, and PTSD [23]. In the current study, PSP participants who screened positive for insomnia were approximately 3 to almost 7 times more likely to screen above a clinical threshold for mental disorder symptom measures (i.e., MDD, GAD, PTSD, Social Anxiety Disorder, Panic Disorder, Alcohol Use Disorder). ...
Article
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Poor sleep quality is associated with numerous mental health concerns and poorer overall physical health. Sleep disturbances are commonly reported by public safety personnel (PSP) and may contribute to the risk of developing mental disorders or exacerbate mental disorder symptoms. The current investigation was designed to provide estimates of sleep disturbances among PSP and explore the relationship between sleep quality and mental health status. PSP completed screening measures for sleep quality and diverse mental disorders through an online survey. Respondents (5813) were grouped into six categories: communications officials, correctional workers, firefighters, paramedics, police officers, and Royal Canadian Mounted Police (RCMP). Many PSP in each category reported symptoms consistent with clinical insomnia (49-60%). Rates of sleep disturbances differed among PSP categories (p < 0.001, ω = 0.08). Sleep quality was correlated with screening measures for post-traumatic stress disorder (PTSD), depression, anxiety, social anxiety disorder, panic disorder, and alcohol use disorder for all PSP categories (r = 0.18-0.70, p < 0.001). PSP who screened positive for insomnia were 3.43-6.96 times more likely to screen positive for a mental disorder. All PSP reported varying degrees of sleep quality, with the lowest disturbances found among firefighters and municipal/provincial police. Sleep appears to be a potentially important factor for PSP mental health.
... About 50% of the adult population in the United States (US) experiences sleeping problems, with the highest rates among women and older people, [1][2][3][4] and other socio-demographic subgroups (e.g., college students). 5 Sleep disturbances including insomnia, short or long sleep, and sleep apnea not only create economic burdens on society in terms of medical costs and lost productivity, [6][7][8] but are well-established risk factors for mental and physical health conditions, including depression, 9,10 cognitive impairment, 11,12 chronic pain, 13 obesity, vascular diseases, 14 and overall mortality. 15,16 Sleep disorders are typically treated with cognitive and behavioral therapies and/or prescription pharmaceuticals, namely anti-depressants, benzodiazepines, gammaaminobutyric acid (GABA) medications, and anti-psychotics, each with their own set of side effects, risk profiles, and dangerous drug interactions. ...
Article
This study seeks to understand whether people substitute between recreational cannabis and conventional over-the-counter (OTC) sleep medications. UPC-level grocery store scanner data in a multivariable panel regression design were used to compare the change in the monthly market share of sleep aids with varying dispensary-based recreational cannabis access (existence, sales, and count) in Colorado counties between 12/2013 and 12/2014. We measured annually-differenced market shares for sleep aids as a portion of the overall OTC medication market, thus accounting for store-level demand shifts in OTC medication markets and seasonality, and used the monthly changes in stores' sleep aid market share to control for short-term trends. Relative to the overall OTC medication market, sleep aid market shares were growing prior to recreational cannabis availability. The trend reverses (a 236% decrease) with dispensary entry (-0.33 percentage points, 95% CI -0.43 to -0.24, p < 0.01) from a mean market share growth of 0.14 ± 0.97. The magnitude of the market share decline increases as more dispensaries enter a county and with higher county-level cannabis sales. The negative associations are driven by diphenhydramine- and doxylamine-based sleep aids rather than herbal sleep aids and melatonin. These findings support survey evidence that many individuals use cannabis to treat insomnia, although sleep disturbances are not a specific qualifying condition under any U.S. state-level medical cannabis law. Investigations designed to measure the relative effectiveness and side effect profiles of conventional OTC sleep aids and cannabis-based products are urgently needed to improve treatment of sleep disturbances while minimizing potentially serious negative side effects.
... Previous literature has documented the evidence regarding the negative effects of insomnia on health, especially psychological health, such as unstable mood and high stress (Anothaisintawee et al. 2016;Sivertsen et al. 2009;Sofi et al. 2014). Therefore, treating insomnia for prisoners is important given that it can further help society to decrease the burden in taking care of the negative consequences (i.e., poor health) resulting from insomnia/sleep problems. ...
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Given the high stress and unfriendly environment caused by imprisonment, prisoners are at risk of developing insomnia. It is important to understand potential intervention (in this case, mindfulness) in improving insomnia for this population. The present study investigated whether dispositional mindfulness can be beneficial in helping relieve insomnia among Iranian prisoners. It also investigated whether psychological distress and perceived stress are potential mediators. Male prisoners (N = 208) aged 39.08 years (SD = 7.85) completed questionnaires and reported their demographic information and mindfulness (at baseline); psychological distress and sleep quality (at 1 month after baseline assessment); sleep quality and insomnia (at 3 months after baseline assessment). The mediation models using 10,000 bootstrapping resamples showed that sleep quality and insomnia significantly improved when mindfulness increased. Moreover, psychological distress and stress partially mediated the aforementioned association between dispositional mindfulness and sleep quality/insomnia. Using mindfulness to improve sleep quality/insomnia may be a promising psychological intervention for prisoners.
... However, BMI, gender, chronic health conditions, and attendance were used as covariates or predictors because earlier studies have shown them to be related to poor sleep and/or insomnia. [20][21][22][23] Furthermore, multiple linear regression analyses (backward method) were performed to determine association individually for each of the four insomnia related complaints with anxiety, poor sleep hygiene, and other socio-demographic characteristics. ...
Article
Full-text available
Objective There is a paucity of research evidence available regarding the impact of anxiety and sleep hygiene on insomnia and related sleep complaints among collegiate students in lower-income countries. The purpose of this study was to investigate if insomnia and insomnia related sleep complaints are associated with anxiety, age, and sleep hygiene practices among a sample of university students in Ethiopia. Design, Measures, Setting, and Participants The participants were young adults (n=525; mean age 21.5 ± 3.0 years; mean BMI (kg/m2) of 20.7 ± 2.7kg/m2). Young collegiate adults at Mizan-Tepi University in southwestern Ethiopia were randomly selected to participate in this cross-sectional study. The measures included the Leeds Sleep Evaluation Questionnaire-Mizan (LSEQ-M), the Generalized Anxiety Disorder–7 Scale (GAD-7), and the Sleep Hygiene Index (SHI). Descriptive statistics, binary logistic regression, and multiple linear regressions were used. Results Insomnia was associated with young age group (≤ 25 years) (odds ratio (OR) = 2.20, 95% confidence interval (CI) 1.04–4.66), higher GAD-7 (anxiety) (OR = 1.05, 95% CI 1.0–1.10) and SHI (poor sleep hygiene) (OR = 1.15, 95% CI 1.05–1.26) scores. All four insomnia-related sleep complaints were associated with increasing GAD-7 scores as well as higher SHI scores(p<.001). Conclusions Insomnia was associated with younger age group (≤ 25 years), higher anxiety level, and poor sleep hygiene. Four major sleep complaints in insomnia, i.e., sleep onset problems, poor sleep quality, awakening problems, and daytime disturbances were all associated with higher anxiety levels and poor sleep hygiene.
... Additionally, the correlation analysis further explained the positive correlation between insomnia scores and SCL-90 somatization subscores. A cross-sectional study involving 47,000 participants indicated that insomnia was closely related to somatic symptoms, similar to our results (45). We also demonstrated that the GAD-7 score was positively correlated with anxiety with comorbid somatization. ...
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Background: Anxiety has been a common mental state during the epidemic of Coronavirus Disease 2019 (COVID-19) and is usually closely related to somatization. However, no study on somatization in anxiety and its relationship with insomnia has been conducted. Therefore, this study aimed to identify the prevalence of anxiety, somatization and insomnia and explore the relationships between different psychological states in the general population during the COVID-19 outbreak. Methods: A total of 1,172 respondents were recruited from 125 cities in mainland China by an online questionnaire survey. All subjects were evaluated with the 7-item Generalized Anxiety Disorder (GAD-7) scale, the somatization subscale of the Symptom Checklist 90-Revised (SCL-90-R), and the 7-item Insomnia Severity Index (ISI). Results: The percentages of anxiety, somatization, and insomnia were 33.02%, 7.59%, and 24.66%, respectively. The prevalence of somatization was 19.38% in participants with anxiety. Compared to the anxiety without somatization group, the anxiety with somatization group had a significantly higher percentage of patients with a history of physical disease and insomnia, as well as higher GAD-7 scores and SCL-90 somatization subscores (all p < 0.001). The SCL-90 somatization subscores were positively correlated with age, history of physical disease, GAD-7 scores, and ISI scores (all p < 0.001). Furthermore, multivariate logistic regression showed that GAD-7 score, ISI score, and age were risk factors for somatization in the anxious population. Conclusions: Somatic and psychological symptoms were common in the general population during the COVID-19 outbreak. Somatic symptoms, anxiety, and insomnia are closely related, and improving anxiety and sleep quality may help relieve somatic symptoms.
... Insomnia symptoms are common in the working population (Kuppermann et al., 1995;Linton & Bryngelsson, 2000;Yong, Li, & Calvert, 2017) and may have several negative consequences, such as increased risk of work-related injuries (Uehli et al., 2014) and reduced productivity (Rosekind et al., 2010), leading to increased costs for the employers and the community (Godet-Cayre et al., 2006). Furthermore, insomnia is associated with increased risk of several adverse health outcomes, including cardiovascular disease, type 2 diabetes, hypertension, musculoskeletal pain, and mental disorders (Anothaisintawee, Reutrakul, Van Cauter, & Thakkinstian, 2015;Ayas et al., 2003;Cappuccio, Cooper, D'Elia, Strazzullo, & Miller, 2011;Cappuccio, D'Elia, Strazzullo, & Miller, 2010;Dew et al., 2003;Sivertsen, Krokstad, Øverland, & Mykletun, 2009;Stranges et al., 2010;Uhlig, Sand, Nilsen, Mork, & Hagen, 2018;Vgontzas, Liao, Bixler, Chrousos, & Vela-Bueno, 2009). The negative consequences of insomnia symptoms for both the society and affected individuals underscore the importance of identifying modifiable risk factors. ...
Article
Objective/Background: To examine the prospective association between work-related mental fatigue and risk of insomnia symptoms, and if leisure time physical activity modifies this association. Participants: A total of 8,464 women and 7,480 men who participated in two consecutive surveys of the Norwegian HUNT study. Methods: The study comprises longitudinal data on persons who were vocationally active and without insomnia symptoms at baseline in 1995–1997. We used a modified Poisson regression model to calculate adjusted risk ratios (RRs) with a 95% confidence interval (CI) for insomnia symptoms at follow-up in 2006–2008 associated with work-related mental fatigue and leisure time physical activity at baseline. Results: Women and men who always experienced mental fatigue after a workday had RRs of insomnia symptoms of 2.55 (95% CI 1.91–3.40) and 2.61 (95% CI 1.80–3.78), respectively, compared to workers who never or seldom had this experience. There was no strong modifying effect of leisure time physical activity on this association, but workers who always experienced mental fatigue had a RR of insomnia symptoms of 3.17 (95% CI 2.28–4.40) if they reported low physical activity and a RR of 2.52 (95% 1.89–3.39) if they reported high physical activity. Conclusion: This study shows that work-related mental fatigue, caused by high cognitive workload, is a strong risk factor for insomnia symptoms. There was no clear modifying effect of leisure time physical activity but workers who experienced excessive work-related fatigue accompanied by low physical activity had the highest risk of insomnia symptoms.
... High smartphone use has a relationship with late bedtime (25). Sleeping disturbances occur across many mental health conditions (26). Sleep period markers have a relationship with the severity of depressive symptoms (27). ...
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Smartphone usage characteristics are useful for identification of the risk factors for smartphone addiction. Risk rating scores can be developed based on smartphone usage characteristics. This study aimed to investigate the smartphone addiction risk rating (SARR) score using smartphone usage characteristics. We evaluated 593 smartphone users using online surveys conducted between January 2 and January 31, 2019. We identified 102 smartphone users who were addicted to smartphones and 491 normal users based on the Korean Smartphone Addiction Proneness Scale for Adults. A multivariate logistic regression analysis was used to identify significant risk factors for smartphone addiction. The SARR score was calculated using a nomogram based on the significant risk factors. Weekend average usage time, habitual smartphone behavior, addictive smartphone behavior, social usage, and process usage were the significant risk factors associated with smartphone addiction. Furthermore, we developed the SARR score based on these factors. The SARR score ranged between 0 and 221 points, with the cut-off being 116.5 points. We developed a smartphone addiction management application using the SARR score. The SARR score provided insights for the development of monitoring, prevention, and prompt intervention services for smartphone addiction.
... However, BMI, gender, chronic health conditions, and attendance were used as covariates or predictors because earlier studies have shown them to be related to poor sleep and/or insomnia. [20][21][22][23] Furthermore, multiple linear regression analyses (backward method) were performed to determine association individually for each of the four insomnia related complaints with anxiety, poor sleep hygiene, and other socio-demographic characteristics. ...
Article
Full-text available
Background High perceived stress and anxiety disorders are usually comorbid with each other, with stress often sequentially preceding the development of anxiety. While prior findings showed a causal role of sleep problems in anxiety, no study has assessed the role of insomnia as a mediator in the relationship between stress and anxiety. Methods A cross-sectional study on university students (n = 475, age = 21.1+2.6 years) was conducted over 3 months. Participants completed self-report measures of Leeds Sleep Evaluation Questionnaire-Mizan (LSEQ-M), Perceived Stress Scale-10 (PSS-10), Generalized anxiety disorder-7 scale (GAD-7), and a sociodemographic tool. The mediation effect model given by Baron and Kelly was used to determine the relationship. Results The prevalence of insomnia and anxiety disorder was 43.6% and 21.9%, respectively. Stress was significantly associated with LSEQ-M (insomnia measure) (b = -.44, SE = .16, p<.01), and high levels of anxiety (b = .25, SE = .03, p < .01). The indirect effect of stress on anxiety through LSEQ-M (insomnia measure) was significant (95% confidence interval [.01, .04]). However, the indirect effect of anxiety on stress through LSEQ-M (insomnia measure) was non-significant (95% confidence interval [-.01, .04]). Conclusions Students having higher perceived stress levels and comorbid insomnia were also likely to have a higher anxiety level.
... Sleep quality and quantity among young adults especially university students has been changed due to the rapid development of technology such as using social media, the internet, etc. [8,9] and there is a positive relationship between insomnia and the use of social media through the internet [10]. It is believed that poor sleep quality has an effect on physical and mental health and also causes mental problems such as anxiety and depression [11,12]. Another study found that the effects of sleep disturbance have secondary behavioral consequences such as impaired social relationships, increased risk-taking behavior, and road accidents, etc. [13]. ...
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Introduction. Insomnia is a global health problem among university students which is associated with various psychiatric problems like depression and anxiety. While different developed and developing countries assessed the prevalence of insomnia in youth, currently there is hardly systematic review of studies found based on the prevalence of insomnia in South Asia. Aims. The aim of this study is to systematically review the evidence relating to the prevalence rate of insomnia in university students in South Asian countries. Methods. Electronic searches of three databases, PubMed, Cochrane library, and Worldwide science were performed from 2010 to 2020 before April. In total, seven studies were included for evaluating insomnia in South Asian region among university students. Results. The prevalence rates of insomnia of the seven studies ranged between 35.4% (95% CI: 32.4-38.5%) and 70% (95% CI: 65.7-74.1%). The pooled prevalence of insomnia among university students was 52.1% (95% CI: 41.1-63.1%). Conclusions. This review emphasized that insomnia in university students might be a common health issue to give full concentration in their studies and academic performance. Thus, more attention should be given to the determinants of insomnia among university students, so that it could be helpful to identify the main causes of insomnia and effective measures could be taken.
... Sex and smartphone operating systems were adjusted to reduce bias in purposive sampling based on these two variables (Etikan, 2016). Age and monthly household income were adjusted due to the differences of age and family economic status in screen media use (Long et al., 2018;Luk et al., 2018) and sleep problems (Lallukka et al., 2012;Sivertsen et al., 2009). We included alcohol drinking as a covariate as drinkers were more likely to have high screen media use (Burleigh et al., 2019;Luk et al., 2018) and sleep problems (Huang et al., 2013). ...
Article
Objectives To explore associations of screen time (total, mobile gaming) with sleep problems in Chinese young adults. Methods This was a 4-week daily morning (completion rate=82.1%, 909/1107) and evening (completion rate=92.4%, 1061/1148) assessment study in 41 university students (22 female, mean age=22.3 [SD 4.2] years). Short sleep duration<7 hours, difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and any of these three insomnia symptoms were self-reported in the morning. Mobile gaming time was self-reported in the evening, whilst total screen time was objectively tracked. Bayesian multilevel mixed-effects modeling disaggregated between- and within-person associations. Results Between person, longer mobile gaming time predicted short sleep duration (adjusted odds ratio [AOR]=1.90, 95% CI 1.39, 2.69), any insomnia symptoms (AOR=1.59, 95% CI 1.20, 2.11), difficulty initiating sleep (AOR=3.05, 95% CI 1.51, 6.24), and difficulty maintaining sleep (AOR=2.19, 95% CI 1.18, 3.74). Short sleep duration (adjusted b=0.99, 95% CI 0.05, 1.95), any insomnia symptoms (adjusted b=1.19, 95% CI 0.24, 1.94), and difficulty initiating sleep (adjusted b=1.72, 95% CI 0.11, 3.19) reversely increased mobile gaming time. Within person, any insomnia symptoms (adjusted b=0.17, 95% CI 0.04, 0.31) and early morning awakening (adjusted b=0.28, 95% CI 0.08, 0.48) increased next-day mobile gaming time. Total screen time was not associated with sleep problems both between and within person. Conclusions Bidirectional between-person associations of mobile gaming time with short sleep duration and insomnia symptoms informed multiple-health-behavior-change interventions. Unidirectional within-person associations of insomnia symptoms with next-day mobile gaming time informed just-in-time adaptive interventions addressing daily variations in insomnia symptoms. [250/250 word limits]
... A possible explanation about the gender difference is the fact that women have higher rates of both acute and chronic insomnia than men from general population studies regardless the setting. 31,32 Stein et al reported that in the general population, women suffer insomnia at higher rates than men and onset is often associated with physical problems of aging. 33 These issues deserve further investigation, ideally with longitudinal or experimental study designs to establish the direction of the effects amongst gender, age, sleep disorders and surgery. ...
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Purpose: To develop a risk prediction nomogram of postoperative sleep disturbance (PSD) in patients undergoing non-cardiac surgery. Patients and methods: Data on 881 consecutive patients who underwent non-cardiac surgery at the Affiliated Hospital of Xuzhou Medical University between June 2020 and April 2021 were prospectively collected. Of these, we randomly divided 881 non-cardiac patients into two groups, training cohort (n = 617) and validation cohort (n = 264) at the ratio of 7:3. Characteristic variables were selected based on the data of training cohort through least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was used to identify the independent risk factors associated with PSD that then were incorporated into the nomogram. The predictive performance of the nomogram was measured by concordance index (C index), receiver operating characteristic (ROC) curve, and calibration with 1000 bootstrap samples to decrease the over-fit bias. Results: PSD was found in 443 of 617 patients (71.8%) and 190 of 264 patients (72.0%) in the training and validation cohorts, respectively. The perioperative risk factors associated with PSD were female sex, anxiety, dissatisfaction of ward environment, absence of combined regional nerve block, postoperative nausea and vomiting (PONV), the longer duration stayed in post anesthesia care unit (PACU), the higher dose of midazolam and sufentanil, the higher postoperative numeric rating score for pain (NRS) score. Incorporating these 9 factors, the nomogram achieved good concordance indexes of 0.82 (95% confidence interval [CI], 0.78-0.85) and 0.80 (95% CI, 0.74-0.85) in predicting PSD in the training and validation cohorts, respectively, and obtained well-fitted calibration curves. The sensitivity and specificity (95% CIs) of the nomogram were calculated, resulting in sensitivity of 74.0% (70.0-78.2%) and 75.3% (68.4-81.7%) and specificity of 79.3% (72.5-85.2%) and 70.3% (58.4-80.7%) for the training and validation cohorts, respectively. Patients who had a nomogram score of less than 262 or 262 or greater were considered to have low or high risks of PSD presence, respectively. Conclusion: The proposed nomogram achieved an optimal prediction of PSD in patients undergoing non-cardiac surgery. The risks for an individual patient to harbor PSD can be determined by this model, which can lead to a reasonable preventive and treatment measures.
... However, it could be argued that the absence of disordered sleep (and relevant treatment-seeking) does not improve stress and health, in the same way that disordered sleep may increase stress levels and worsen health. Further, as sleep disorders tend to become more prevalent in older adults, 33 and as age was controlled in the current study, this may account for the lack of relationships observed. ...
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Background: Sleep health is a relatively new multidimensional concept, however, there is no consensus on its underlying dimensions. A previous study examined potential indicators of sleep health using an aggregated sleep health measure. However, the psychometric properties are yet to be determined. The primary aim was to assess the factor structure, reliability and validity of this measure. A secondary aim was to explore the relationships with perceived stress, and physical and mental health. Methods: A cross-sectional online survey was conducted with 257 adults from the UK aged 18-65 (78.4% female, mean age = 29.39 [SD = 11.37]). Participants completed 13 Sleep health items, the Pittsburgh Sleep Quality Inventory, Insomnia Severity Scale, Epworth Sleepiness Scale, Perceived Stress Scale and SF-12 Health Survey. Results: The measure exhibited good internal consistency (α = 0.785) and construct validity as determined by associations with existing measures. Principle components analysis produced four factors e; sleep quality (α = 0.818), sleep adaptability (α = 0.917), sleep wellness (α = 0.621) and daytime functioning (α = 0.582). Adaptability (β = -241) was strongest predictor of perceived stress, and daytime functioning was strongest predictor of physical (β = 0.322) and mental health (β = 0.312). Conclusions: Sleep health is a multidimensional construct comprising four distinct but related dimensions. The importance of sleep health in terms of perceived stress and mental and physical health is highlighted.
... Sleep problems and fatigue are often linked, such that those who get less sleep experience greater fatigue (Avlund, 2010). Several studies point to quality of sleep decreasing with age (Sivertsen et al., 2009;Mander et al., 2017), which suggests that fatigue may increase with age. However, fatigue and sleep are distinct constructs, and fatigue has not been found to consistently increase with age in the literature. ...
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Objective Fatigue is commonly thought to worsen with age, but the literature is mixed: some studies show that older individuals experience more fatigue, others report the reverse. Some inconsistencies in the literature may be related to gender differences in fatigue while others may be due to differences in the instruments used to study fatigue, since the correlation between state (in the moment) and trait (over an extended period of time) measures of fatigue has been shown to be weak. The purpose of the current study was to examine both state and trait fatigue across age and gender using neuroimaging and self-report data. Methods We investigated the effects of age and gender in 43 healthy individuals on self-reported fatigue using the Modified Fatigue Impact Scale (MFIS), a measure of trait fatigue. We also conducted fMRI scans on these individuals and collected self-reported measures of state fatigue using the visual analog scale of fatigue (VAS-F) during a fatiguing task. Results There was no correlation between age and total MFIS score (trait fatigue) ( r = –0.029, p = 0.873), nor was there an effect of gender [ F (1,31) < 1]. However, for state fatigue, increasing age was associated with less fatigue [ F (1,35) = 9.19, p < 0.01, coefficient = –0.4]. In the neuroimaging data, age interacted with VAS-F in the middle frontal gyrus. In younger individuals (20–32), more activation was associated with less fatigue, for individuals aged 33–48 there was no relationship, and for older individuals (55+) more activation was associated with more fatigue. Gender also interacted with VAS-F in several areas including the orbital, middle, and inferior frontal gyri. For women, more activation was associated with less fatigue while for men, more activation was associated with more fatigue. Conclusion Older individuals reported less fatigue during task performance (state measures). The neuroimaging data indicate that the role of middle frontal areas change across age: younger individuals may use these areas to combat fatigue, but this is not the case with older individuals. Moreover, these results may suggest greater resilience in females than males when faced with a fatiguing task.
... Wickwire (2019) reported that untreated insomnia leads to increased all-cause healthcare utilization based on a randomly selected and nationally representative sample from the USA. Data from Norway indicate that insomnia strongly predicts sick leave and disability pension (Overland Sivertsen et al., 2009). Data from France indicated a sum of 2 billion USD in 1995 (Leger et al., 1999). ...
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Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self‐report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive‐behavioural models to (epi‐) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep–wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive‐behavioural models of insomnia led to the conceptualization of cognitive‐behavioural therapy for insomnia, which is now considered as first‐line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive‐behavioural therapy for insomnia merits widespread implementation, and digital cognitive‐behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive‐behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non‐response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.
... Chronic insomnia affects more than 10% of the population [4][5][6] . It is associated with poorer physical and mental health outcomes and an important societal financial burden [7][8][9] , thereby representing a major health issue. Current pharmacotherapeutic treatments are associated with greater risk of tolerance, dependence, drug abuse 10,11 . ...
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Study Objectives: To assess the effects of Cognitive Behavioral Therapy for insomnia (CBTi) on subjective and objective sleep, sleep-state misperception as well as self-reported and objective cognitive performance. Methods: We performed a randomized controlled trial with a treatment group and a wait-list control group to assess changes in insomnia symptoms after CBTi (8 sessions/3 months) in 62 participants with chronic insomnia. To this end, we conducted a multimodal investigation of sleep and cognition including subjective measures of sleep difficulties (Insomnia Severity Index (ISI), sleep diaries) and cognitive functioning (Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire), objective assessments of sleep (polysomnography recording, cognition (attention and working memory tasks), and sleep-state misperception measures, collected at baseline and at 3-months post-randomization. At 6 months post-randomization, we collected similar data from the wait-list group after CBTi. We also assessed ISI one year after CBTi in both groups. Our main analysis investigated changes in sleep and cognition after 3 months (treatment versus wait-list group). In secondary analyses, we pooled data from both groups to observe changes after CBTi. Results: ISI score was reduced and self-reported sleep quality improved after CBTi (treatment group at 3 months and pooled groups after CBTi). Sleep misperception in sleep onset latency and sleep duration decreased after CBTi. In contrast, objective sleep, objective and subjective cognitive functioning did not improve after CBTi. Conclusions: We showed that CBTi has a beneficial effect on variables pertaining to the subjective perception of sleep, which is a central feature of insomnia. However, we observed no significant effect of CBTi on measures of cognitive functioning.
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Insufficient sleep and insomnia promote chronic disease in the general population and may combine with social and economic factors to increase rates of chronic health conditions among AI/AN people. Given that insufficient sleep and insomnia can be addressed via behavioral interventions, it is critical to understand the prevalence and correlates of these disorders among AI/AN individuals in order to elucidate the mechanisms associated with health disparities and provide guidance for subsequent treatment research and practice. We reviewed the available literature on insufficient sleep and insomnia in the AI/AN population. PubMed, PsycINFO, Google Scholar, and ProQuest were searched between June 12 th and October 28 th of 2018. Prevalence of insufficient sleep ranged from 15% to 40%; insomnia prevalence ranged from 25% to 33%. Insufficient sleep was associated with unhealthy diet, low physical activity levels, higher BMI, worse self-reported health, increased risk for diabetes mellitus, cardiovascular disease, frequent mental distress, smoking, binge drinking, depression, and chronic pain. Insomnia was associated with depression, childhood abuse, PTSD, anxiety, alcohol use, low social support, and low trait-resilience levels. Research on evidence-based treatment and implementation practices targeting insufficient sleep and insomnia was lacking, and only one study described the development/validation of a measure of insufficient sleep among AI/AN people. There is a need for rigorous sleep research including testing and implementation of evidence-based treatment for insufficient sleep and insomnia in this population in an effort to help eliminate health disparities. We present recommendations for research and clinical practice based on the current review.
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Insomnia symptoms are highly prevalent and associated with several adverse medical conditions, but only few determinants, including non-modifiable ones, have been highlighted. We investigated associations between body silhouette trajectories over the lifespan and insomnia symptoms in adulthood. From a community-based study, 7 496 men and women aged 50–75 years recalled their body silhouette at age 8, 15, 25, 35 and 45, and rated the frequency of insomnia symptoms on a standardized sleep questionnaire. An Epworth Sleepiness Scale ≥11 defined excessive daytime sleepiness (EDS). Using a group-based trajectory modeling, we identified five body silhouette trajectories: a ‘lean-stable’ (32.7%), a ‘heavy-stable’ (8.1%), a ‘moderate-stable’ (32.5%), a ‘lean-increase’ (11%) and a ‘lean-marked increase’ (15.7%) trajectory. In multivariate logistic regression, compared to the ‘lean-stable’ trajectory, the ‘lean-marked increase’ and ‘heavy-stable’ trajectories were associated with a significant increased odd of having ≥1 insomnia symptoms as compared to none and of having a proxy for insomnia disorder (≥1 insomnia symptom and EDS). The association with the ‘lean-marked increase' trajectory’ was independent from body mass index measured at study recruitment. In conclusion, increasing body silhouette over the lifespan is associated with insomnia symptoms in adulthood, emphasizing the importance of weight gain prevention during the entire lifespan.
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Psidium guajava leaf is reported to contain many bioactive polyphenols which play an important role in the prevention and treatment of various diseases. Our investigation aimed to study the effect of Psidium guajava leaf powder supplementation on obesity and liver status by using experimental rats. To study the effects of guava leaf supplementation in high fat diet induced obesity, rats were randomly divided into four experimental groups (n=7), control (group I), control + guava leaf (group II), HCHF (group III), and HCHF + guava leaf (group IV). At the end of the experimental period (56 days), glucose intolerance, liver enzymes activities, antioxidant enzymes activities, and lipid and cholesterol profiles were evaluated. Our results revealed that guava leaf powder supplementation showed a significant reduction in fat deposition in obese rats. Moreover, liver enzyme functions were increased in high fat diet fed rats compared to the control rats significantly which were further ameliorated by guava leaf powder supplementation in high fat diet fed rats. High fat diet feeding also decreased the antioxidant enzyme functions and increased the lipid peroxidation products compared to the control rats. Guava leaf powder supplementation in high fat diet fed rats reduced the oxidative stress markers and reestablished antioxidant enzyme system in experimental animals. Guava leaf powder supplementation in high fat diet fed rats also showed a relative decrease in inflammatory cells infiltration and collagen deposition in the liver compared to the high fat diet fed rats. The present study suggests that the supplementation of guava leaf powder prevents obesity, improves glucose intolerance, and decreases inflammation and oxidative stress in liver of high carbohydrate high fat diet fed rats
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Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.
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This study investigated the neuroanatomical basis of the association between depression/anxiety and sleep quality among 370 college students. The results showed that there was a significant correlation between sleep quality and depression/anxiety. Moreover, mediation results showed that the gray matter volume of the right insula mediated the relationship between depression/anxiety and sleep quality, which suggested that depression/anxiety may affect sleep quality through the right insula volume. These findings confirmed a strong link between sleep quality and depression/anxiety, while highlighting the volumetric variation in the right insula associated with emotional processing, which may play a critical role in improving sleep quality.
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This study was conducted to investigate the effects of the extracts of green romaine lettuce (GRE) on sleep enhancement. GRE contains 1071.7 and 199.2 µg/g of extracts of lactucin and lactucopicrin, respectively, known as sleep enhancement substances. When 100 mg/kg of GRE was administered orally, sleep latency and duration time were significantly increased compared to controls (p < 0.05). Rapid eye movement (REM) sleep decreased with 100 mg/kg of GRE administration and non-REM (NREM) sleep also increased. There was no significant difference between REM and NREM among the oral GRE administration groups receiving 100, 120, and 160 mg/kg GRE. In the caffeine-induced insomnia model, total sleep time was significantly increased by 100 mg/kg GRE administration compared to the caffeine-treated group (p < 0.05). In addition, GRE inhibited the binding of [³H]-flumazenil in a concentration-dependent manner, and affinity of both lactucin and lactucopicrin to gamma-aminobutyric acid (GABA)A-benzodiazepine (BDZ) receptor was 80.7% and 55.9%, respectively. Finally, in the pentobarbital-induced sleep mouse model, the sleep enhancement effect of GRE was inhibited by flumazenil, an antagonist of BDZ. Thus, these results demonstrate that GRE acts via a GABAergic mechanism to promote sleep in a rodent model. Graphical Abstract Fullsize Image
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Chronic pain is a common public health problem that has a detrimental impact on patient health, quality of life (QoL), and function, and poses a substantial socioeconomic burden. Evidence supports redefinition of chronic pain as a distinct disease entity, not simply a symptom of injury or illness. Chronic pain conditions are characterized by three types of pain pathophysiology – i.e., nociceptive, neuropathic, and centralized pain/central sensitization –influenced by a cluster of coexisting psychosocial factors. Negative risk/vulnerability factors, e.g., mood or sleep disturbances, and positive resilience/protective factors, e.g., social/interpersonal relationships and active coping, interact with pain neurobiology to determine patients’ unique pain experience. Viewing chronic pain through a biopsychosocial lens, instead of a purely biomedical one, clinicians need to adopt a practical integrated management approach. Thorough assessment focuses on the whole patient (not just the pain), including comorbidities, cognitive/emotional/behavioral characteristics, social environment, and QoL/functional impairment. As for other complex chronic illnesses, the treatment plan for chronic pain can be developed based on pain subtype and psychosocial profile, incorporating pharmacotherapy and self-management modalities. Preferred pharmacologic treatment of conditions primarily associated with nociception (e.g., osteoarthritis) includes acetaminophen and non-steroidal anti-inflammatory drugs, whereas preferred pharmacologic treatment of conditions primarily associated with neuropathy or central sensitization (e.g., fibromyalgia) includes tricyclic compounds, serotonin norepinephrine reuptake inhibitors, and α2δ ligands. Education, exercise, cognitive behavioral therapy, and many other non-pharmacological approaches, alone or combined with pharmacotherapy, have been shown to be effective for any type of pain, although they remain underutilized due to lack of awareness of their benefits and reimbursement obstacles.
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Objectives: This study looks deeper into the relationship between rheumatoid arthritis (RA) disease activity and distinct dimensions of sleep quality. Methods: The Pittsburgh Sleep Quality Index (PSQI) was administered to a cohort of 147 RA patients. Health-related quality of life (HRQoL) and fatigue were measured with the SF-12 and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) instruments, respectively, whereas RA activity was determined with the Disease Activity Score 28 joints (DAS28). Ethical approval for the study and informed consent from the participants were obtained. Results: Most patients were females (78.2%), and the mean age of the entire sample was 63.7 years. Most participants (77.6%) were poor sleepers (i.e. PSQI ≥ 5) who suffered from fatigue more than good sleepers (FACIT-F: 21.6 vs. 39.3, p < 0.001). Overall sleep quality correlated, in the expected directions, with disease activity (Spearman’s rho = 0.87, p < 0.001), physical health (−0.66, p < 0.001), mental health (−0.71, p < 0.001), and fatigue (0.87, p < 0.001). PSQI and its component scores differed across patient subgroups with increasing RA activity, even after adjusting for confounding variables. Conclusion: RA disease activity distinctly affects sleep quality, and given the already demonstrated importance of good sleep, this ‘deeper look’ might contribute to the effort to improve HRQoL in RA patients.
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The financial crisis has caused an exponential increase of home foreclosures in Spain. Recent studies have shown the effects that foreclosures have on mental and physical health. This study explores these effects on a sample of adults in the city of Granada (Spain), in terms of socio-demographic, socio-economic and process characteristics. A cross-sectional survey was administered to obtain information on self-perceived changes in several indicators of physical and mental health, consumption of medications, health-related behaviors and use of health services. A total of 205 persons, going through a foreclosure process, participated in the study. 85.7% of the sample reported an increase of episodes of anxiety, depression, and stress; 82.6% sleep disturbances; 42.8% worsening of previous chronic conditions, and 40.8% an increase in consumption of medication. Women, married persons and persons already in the legal stage of the foreclosure process reported higher probability of worsening health according to several indicators, in comparison with men, not married, and individuals in the initial stages of the foreclosure process. The results of this study reveal a general deterioration of health associated with the foreclosure process. These results may help to identify factors to prevent poor health among populations going through a foreclosure process.
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Aims. Sleep disturbances are common in addiction and withdrawal. This study examined the course of sleep quality in a population of alcohol dependent patients during qualified detoxification treatment in a psychiatric hospital. Methods. The Pittsburgh Sleep Quality Index (PSQI) was administered to 77 electively admitted alcohol dependent patients hospitalized for qualified detoxification treatment. Sleep quality was measured at admission and at discharge. Results. The prevalence of bad sleep as measured by a PSQI-score > 5 was 70.1% at admission. During detoxification, male and female patients were equally affected by sleep disturbances and improvement of sleep was not significantly different between males and females. The PSQI score at admission predicted the change of the PSQI score during qualified detoxification treatment. After inpatient detoxification, sleep disturbances persisted in 59.7% of the patients. Conclusions. Contrary to our expectations, the average patient’s sleep quality improved in our study after two weeks of detoxification treatment. Sleep disturbances nevertheless persisted in almost two-thirds of the patients. In the view of that finding, patients may require individual evaluation of sleep quality and insomnia-specific treatment in the course of detoxification therapy.
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Aim Experienced by many older adults, insomnia is a significant public health problem that requires the attention of health‐care professionals and researchers. This study aimed to identify insomnia and its risk factors among community‐dwelling older adults. Methods This cross‐sectional study was conducted in Denizli, Turkey. The study sample consisted of 360 elderly individuals aged 60 years and older who were admitted to one of six family health centres for any reason between 29 March 2016 and 17 June 2016. Data were collected by using a descriptive form for the elderly and the Insomnia Severity Index. The χ² test was used to compare independent variables and insomnia status. Logistic regression analysis was used for the variables that were found to be significant at the end of the single‐variable analysis. Results The mean age of the subjects, all of whom lived at home, was 69.52 ± 8.36 years. Insomnia was quite common among them (51%), and its severity was low (8.51 ± 5.56). At the end of logistic regression analysis, a moderate perception of health (OR = 10.859, 95%CI: 3.532–33.385) and the number of medications used (OR = 3.326, 95%CI: 1.014–10.907) were identified as risk factors for insomnia. Conclusion Based on the results of this study, we can state that insomnia is common among older adults. Therefore, older adults who are admitted to health‐care institutions should be evaluated for insomnia. Factors identified as affecting insomnia were health perception and the number of medications used. Given that health perception and polypharmacy are associated with chronic disease management, helping the elderly to effectively manage chronic diseases may alleviate insomnia.
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Objective Insomnia and depression have been inconsistently associated with inflammation. Age may be one important moderator of these associations. This study examined associations between insomnia and depression with inflammatory biomarkers in nurses and how these associations varied by age. Design: Participants were 392 nurses ages 18-65 (M age = 39.54 years ± 11.15, 92% female) recruited from two hospitals. Main outcome measures: Participants completed surveys to assess insomnia and depression symptoms. Serum samples were obtained and analysed for inflammatory biomarkers interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1 beta (IL-1β), and tumour necrosis factor alpha (TNF-α). Results: Neither insomnia nor depression symptoms were associated with inflammatory biomarkers. Older age was associated with higher IL-1β, and age moderated the effects of depression symptoms on CRP and TNF-α: Greater depression symptoms were associated with higher CRP (b = .14, p = .017) and TNF-α (b = .008, p = .165) among older nurses only. Conclusion: Results suggest older nurses with higher depression symptoms may be at increased risk for elevated inflammation. Interventions should consider the role of age-related processes in modifying health and well-being. Given relatively low levels of depression in the current sample, future studies should replicate results in clinical and non-nurse samples.
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Background: Primary insomnia is a worldwide problem and it has a considerable negative impact on one's physical and mental health. Studies have shown that non-synonymous SNPs in 5-hydroxytryptamine(serotonin or 5 -HT)are related to primary insomnia. Previous studies have shown that 5 -HT polymorphism (rs140700) is related to depression, and insomnia is often accompanied by depression and anxiety. The relationship between this site and primary insomnia is unknown. We speculated that this site may be related to primary insomnia, so we investigated the relationship between rs140700 and primary insomnia. Methods: In this study, we included 57 patients with primary insomnia and 54 age- and gender-matched normal controls. The subjects belonged to the Chinese population were subjected to polysomnography for three consecutive nights. Their sleep quality was assessed, and the genotypes of the 5-HT gene polymorphism rs140700 were determined by the Flight Mass Spectrometry. Results: The genotype distributions of the 5-HTgene polymorphism rs140700 were in Hardy-Weinberg equilibrium in both patients and controls (P > 0.05). The allele and genotype distributions of this variant were comparable between the patients and controls in all subjects and between genders (all P > 0.05). The influence of rs140700 on S1% (P = 0.015) change and arousal index(P = 0.028) of primary insomnia was statistically significant. The logistic multi-factor regression analysis results revealed that 5-HT gene polymorphism rs140700 was not a risk factor for primary insomnia in Chinese population (P = 0.589). Conclusion: The 5-HT gene polymorphism rs140700 may not be a susceptibility locus for primary insomnia in the Chinese population. This article is protected by copyright. All rights reserved.
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Despite sleep disturbance and somatic symptoms being common health complaints, the relationship between these disturbances and single somatic symptoms is not well documented. The objectives of this study were to (i) identify somatic symptoms that are particularly associated with sleep disturbance, here referred to as somatic symptoms related to sleep disturbance (SS-SD), (ii) determine increased risk of sleep disturbance for each SS-SD and for a certain number of SS-SD, with and without controlling for anxiety and depression, and (iii) determine sensitivity and specificity for identifying sleep disturbance based on number of SS-SD in a general Swedish sample. Population-based, cross-sectional data based on validated questionnaire instruments were used from participants who constituted a sleep disturbance (n = 864) or a reference (n = 2340) group. Among 15 common somatic symptoms, stomach pain, back pain nausea/gas/indigestion, dizziness, and constipation/loose bowels/diarrhea were identified as SS-SD, with odds ratios of increased risk of sleep disturbance that ranged from 1.93 to 2.44 (1.36–1.79 and 1.54–1.91 when controlled for anxiety and depression, respectively). The risk of sleep disturbance increased by 1.44 times for each SS-SD (1.25 and 1.30 when controlled for anxiety and depression, respectively). A cutoff of two/three or more SS-SD had a sensitivity of 72.5/54.2% and a specificity of 50.0/69.7% for identifying sleep disturbances. When patients present with these somatic symptoms with or without a pathophysiological explanation, primary care clinicians may consider screening for sleep disturbance.
Article
Background: Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic. Participants/methods: A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 741 good sleepers), adjusted for demographic differences. Results: Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19-1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00-5.67) or increased technology use before bed (OR 3.13, CI 1.13-8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32-3.27), increased sleep effort (OR 1.99, CI1.71-2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11-1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18-8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07-1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01-1.05) and depressive (OR 1.29, CI 1.22-1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68-5.81). Conclusion: Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.
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Background Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important. Objective This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation. Methods We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported. Results Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect. Conclusions In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain. Trial Registration ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942
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Recent scientific evidence suggests that chronic pain phenotypes are reflected in metabo-lomic changes. However, problems associated with chronic pain, such as sleep disorders or obesity, may complicate the metabolome pattern. Such a complex phenotype was investigated to identify common metabolomics markers at the interface of persistent pain, sleep, and obesity in 71 men and 122 women undergoing tertiary pain care. They were examined for patterns in d = 97 metabolomic markers that segregated patients with a relatively benign pain phenotype (low and little bothersome pain) from those with more severe clinical symptoms (high pain intensity, more bothersome pain, and co-occurring problems such as sleep disturbance). Two independent lines of data analysis were pursued. First, a data-driven supervised machine learning-based approach was used to identify the most informative metabolic markers for complex phenotype assignment. This pointed primarily at AMP, asparagine, deoxycytidine, glucuronic acid, and propionylcarnitine, and secondarily at cys-teine and nicotinamide adenine dinucleotide (NAD) as informative for assigning patients to clinical pain phenotypes. After this, a hypothesis-driven analysis of metabolic pathways was performed, including sleep and obesity. In both the first and second line of analysis, three metabolic markers (NAD, AMP, and cysteine) were found to be relevant, including metabolic pathway analysis in obesity , associated with changes in amino acid metabolism, and sleep problems, associated with down-regulated methionine metabolism. Taken together, present findings provide evidence that metabo-lomic changes associated with co-occurring problems may play a role in the development of severe pain. Co-occurring problems may influence each other at the metabolomic level. Because the methi-onine and glutathione metabolic pathways are physiologically linked, sleep problems appear to be associated with the first metabolic pathway, whereas obesity may be associated with the second.
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Sleep is one of the most important functions of the life. The disturbance in sleep or quality of sleep leads to several dysfunctions of the human body. This study aimed to investigate the prevalence of sleep disorders, their possible risk factors and their association with other health problems. The data was collected from the educational community of the Pakistani population. The Insomnia Severity Index (ISI) was used to evaluate the insomnia and the sleep apnea was evaluated through a simple questionnaire method. The blood samples were collected to perform significant blood tests for clinical investigations. Current research revealed that the individuals in the educational community had poor sleep quality. A total of 1998 individuals from the educational community were surveyed, 1584 (79.28%) of whom had a sleep disorders, including insomnia (45.20%) and sleep apnea (34.08%). The measured onset of age for males and females was 30.35 years and 31.07 years respectively. The Clinical investigations showed that the sleep had significant impact on the hematology of the patients. Higher levels of serum uric acid and blood sugar were recorded with a sleep disorder. The individuals of the educational community were using the sleeping pills. The other associated diseases were mild tension, headaches, migraines, depression, diabetes, obesity, and myopia. The use of beverage, bad mood, medical condition, mental stress, disturbed circadian rhythms, workload and extra use of smartphone were major risk factors of sleep disorders. It was concluded that the insomnia was more prevalent than the sleep apnea. Furthermore, life changes events were directly linked with disturbance of sleep. Tension , depression, headaches, and migraine were more associated with sleep disorders than all other health issues.
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Objective: To test the association between pain severity and anxiety, depression, and somatoform symptoms in burning sleep syndrome (BMS). Material and methods: The study included 36 patients (33 women, 3 men), mean age 58.0±14.8 years. Psychopathological, clinical-dermatological, parametric, statistical methods were used. Psychometric examination included the Visual Analogue Scale (VAS) for assessment of pain (severity of glossalgia), PHQ-4 for self-assessment of severity of anxiety (GAD-2) and depression (PHQ-2), the Hospital Anxiety and Depression Scale (HADS), the Screening for Somatoform Symptoms-2 (SOMS-2), the Pittsburgh Sleep Quality Index (PSQI), the EQ-5D-5L quality of life assessment scale. Results and conclusion: Insomnia in chronic pain is very common. On the one hand, studies show that sleep deprivation can enhance pain perception. On the other hand, chronic pain can trigger a variety of sleep disorders. One of the localizations of chronic pain syndrome is the oral mucosa. Somatoform pain disorder related to oral mucosa called «glossalgia» or «burning mouth syndrome» (BMS). The prevalence of insomnia in the study sample was 61.1%. The statistically significant positive correlation was found between the severity of insomnia (PSQI) and the severity of anxiety on both GAD-2 and HADS, while insomnia showed no correlation with depression and pain severity. At the same time, the severity of anxiety showed statistically significant positive correlation with the severity of pain assessed by VAS.
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This narrative review explores the full scope of harmful psychological effects of the COVID-19 (Coronavirus Disease of 2019) pandemic on FLHCWs (Frontline healthcare workers). Additionally, we highlight the risk factors for worse outcomes. A literature review identified 24 relevant papers included in this synthesis. The majority of studies reported a high number of mental health conditions in HCWs (Healthcare workers) overall. Working in the frontline setting was repeatedly identified as an independent risk factor for poorer mental health. Additional risk factors, such as gender, occupational pressure, and low level of support from hospital administration, family, and the community, were also commonly identified. In the past, defined interventions have been shown to mitigate the psychological impact of high-stress situations on frontline workers. This review is aimed at identifying individuals at higher risk to help effectively target preventative measures in future stress situations in our healthcare system.
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Objective: Smartphones have become common, and problematic smartphone use (PSU) is increasing. Predictors of PSU should be identified to prevent it. Little is known about the role of content types of smartphone use as predictors of PSU. Therefore, we aimed to evaluate the predictors of two proposed concepts of PSU, namely habitual smartphone behavior (SB) and addictive SB, within the context of the application (app) categories. Methods: We studied 1,039 smartphone users using online surveys conducted between January 2 and 31, 2019. We employed multiple regression analysis to identify the predictors of habitual and addictive SB. We controlled for sex and age (mean=39.20). Results: Common predictors of habitual and addictive SB were the use of social networking services, games, entertainment apps, and average weekend smartphone usage time. The predictors of habitual SB were the use of web and lifestyle apps, weekly usage frequency, and sex (female) and the predictors of addictive SB were the use of shopping apps and sleep duration. Conclusion: This study revealed the need to consider habitual and addictive SB in evaluating PSU. The predictors in terms of the content types of smartphone usage can be used to develop monitoring and prevention services for PSU.
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Insomnia is a major comorbid symptom of chronic pain and is likely to affect caregiver burden. This cross-sectional study investigated the association between insomnia in chronic pain patients and family caregiver burden. Participants were 60 patients with chronic pain of ≥3 months duration. Demographic and clinical information were collected using the Athens Insomnia Scale (AIS), the Pain Disability Assessment Scale (PDAS), the Hospital Anxiety and Depression Scale (HADS), and a pain intensity numerical rating scale (NRS). Family members who accompanied chronic pain patients to hospital completed the Zarit Burden Interview (ZBI). Univariate regression analysis and multiple regression analysis were conducted to clarify the associations between ZBI scores and total/subscale AIS scores. Covariates were age; sex; pain duration; and scores on the PDAS, HADS anxiety subscale, HADS depression subscale, and NRS. Insomnia was independently associated with ZBI scores [β: 0.27, 95% confidence interval (CI): 0.07–0.52, p = 0.001]. Scores on the AIS subscale of physical and mental functioning during the day were significantly associated with ZBI scores (β: 0.32, 95% CI: 0.05–0.59, p = 0.007). In conclusion, the findings suggest that in chronic pain patients, comorbid insomnia and physical and mental daytime functioning is associated with family caregiver burden independently of pain duration, pain-related disability, and pain intensity.
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Purpose: The purpose of the current study is to translate, test and evaluate the psychometric properties of the Glasgow Sleep Effort Scale (GSES) in Persian language. Methods: Participants consisted of two samples: a clinical sample of 120 patients (58%) with insomnia disorder meeting DSM-5 criteria for insomnia and a non-clinical sample of 110 participants (42%) with normal sleep. Both samples completed the following measures: GSES, Pittsburg Sleep Quality Index, Insomnia Severity Index, Dysfunctional Beliefs and Attitudes about Sleep Scale-10, Pre Sleep Arousal Scale-cognitive subscale, Depression-Anxiety-Stress Scale-21 and sleep diary. Results: Significant correlations were found between GSES and related measures in both groups. Principal component analysis indicated a single component accounted for 64.77% of total variance in the clinical group. Results of the fit estimates for the one-factor model were consistent with the previously specified fit criteria and adequately fitted the data in the non-clinical group. Statistical analyses showed that the GSES has acceptable internal consistency in terms of Cronbach’s Alpha in the clinical (0.75) and non-clinical (0.77) samples. Test–retest reliability for a 4-week interval was significant (r = 0.70). The cut-off point, sensitivity, and specificity of the scale were 6, 85% and 94.5%, respectively. Conclusion: The Persian translated and validated version of the GSES obtained adequate values in psychometric properties in both clinical and non-clinical samples and it can be used for research and clinical purposes in Iran.
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Multiple studies on the pathomechanisms of depressive disorder and antidepressants have been reported. However, literature involving scientometric analysis of depressive disorder is sparse. Here, we use scientometric analysis and a historical review to highlight recent research on depression. We use the former to examine research on depressive disorders from 1998 to 2018. The latter is used to identify the most frequent keywords in keyword analysis, as well as explore hotspots and depression trends. Scientometric analysis uncovered field distribution, knowledge structure, research topic evolution, and topics emergence as main explorations in depressive disorder. Induction factor, comorbidity, pathogenesis, therapy and animal models of depression help illustrate occurrence, development and treatment of depressive disorder. Scientometric analysis found 231,270 research papers on depression, a 4-fold increase over the last 20 years. These findings offer a vigorous roadmap for further studies in this field.
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In recent years, there has been a growing interest in understanding the relationship between sleep and suicide. Although sleep disturbances are commonly cited as critical risk factors for suicidal thoughts and behaviours, it is unclear to what degree sleep disturbances confer risk for suicide. The aim of this meta-analysis was to clarify the extent to which sleep disturbances serve as risk factors (i.e., longitudinal correlates) for suicidal thoughts and behaviours. Our analyses included 156 total effects drawn from 42 studies published between 1982 and 2019. We used a random effects model to analyse the overall effects of sleep disturbances on suicidal ideation, attempts, and death. We additionally explored potential moderators of these associations. Our results indicated that sleep disturbances are statistically significant, yet weak, risk factors for suicidal thoughts and behaviours. The strongest associations were found for insomnia, which significantly predicted suicide ideation (OR 2.10 [95% CI 1.83–2.41]), and nightmares, which significantly predicted suicide attempt (OR 1.81 [95% CI 1.12–2.92]). Given the low base rate of suicidal behaviours, our findings raise questions about the practicality of relying on sleep disturbances as warning signs for imminent suicide risk. Future research is necessary to uncover the causal mechanisms underlying the relationship between sleep disturbances and suicide.
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Objective Anxiety and depression are great public health concerns among college students. The purpose of this study was to explore whether sleep quality and quality of life (QoL) play mediating roles in anxiety and depression among Chinese college students. Method A total of 2757 college students (mean age = 19.07; SD = 1.14) completed the questionnaires, including a brief demographic survey. The 2-item General Anxiety Disorder (GAD-2) and the 2-item Patient Health Questionnaire (PHQ-2) were used to assess the symptoms of anxiety and depression, respectively. And the Pittsburgh Sleep Quality Index (PSQI) and the Short-Form 36 Health Survey (SF-36) were used to evaluate college students’ sleep quality and QoL, respectively. Mediation analyses were conducted by using PROCESS macro in the SPSS software. Result Anxiety had both direct and indirect effects on depression. Sleep quality and QoL were not only independent mediators in the relationship between anxiety and depression but also chain mediators. Conclusion The results of the current study highlight the crucial role of early intervention for depression with a focus on college students with anxiety, more especially, on those with poorer sleep quality and lower QoL.
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Epidemiological studies assessing adult sleep duration have yielded inconsistent findings and there are still large variations in estimation of insomnia prevalence according to the most recent diagnostic criteria. Our objective was to describe sleep patterns in a large population of middle‐aged and older adults, by employing accurate measures of both sleep duration and insomnia. Data stem from the Tromsø Study (2015–2016), an ongoing population‐based study in northern Norway comprising citizens aged 40 years and older (n = 21,083, attendance = 64.7%). Sleep parameters were reported separately for weekdays and weekends and included bedtime, rise time, sleep latency and total sleep time. Insomnia was defined according to recent diagnostic criteria (International Classification of Sleep Disorders; ICSD‐3). The results show that 20% (95% confidence interval,19.4–20.6) fulfilled the inclusion criteria for insomnia. The prevalence was especially high among women (25%), for whom the prevalence also increased with age. For men, the prevalence was around 15% across all age groups. In all, 42% of the women reported sleeping <7 hr (mean sleep duration of 7:07 hr), whereas the corresponding proportion among males was 52% (mean sleep duration of 6:55 hr). We conclude that the proportion of middle‐aged and older adults not getting the recommended amount of sleep is worryingly high, as is also the observed prevalence of insomnia. This warrants attention as a public health problem in this population.
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Background Recent evidence suggests that insomnia negatively influences the occurrence of generalized pain. This study examined whether insomnia is a risk factor for the transition from local pain to generalized pain (i.e., spreading of pain). Methods This longitudinal study, with a follow‐up of 24 months, included 959 participants (mean age: 55.8 years; SD: 13.9) with local or regional pain at baseline. Participants were grouped by insomnia symptoms as measured by the Insomnia Severity Index. Spreading of pain was measured by body manikins based on the spatial distribution of pain on the body. We defined two outcome categories; one with relatively localized pain (i.e., local pain and moderate regional pain ), and one with relatively generalized pain (i.e., substantial regional pain and widespread pain). Baseline age, sex, education, depressive symptoms, anxiety symptoms, catastrophizing, pain intensity, and spread of pain were also included in the Generalized Linear Model analysis. Results The unadjusted model showed that the risk of spreading of pain increased with an increase in insomnia symptoms (no insomnia: 55.4%; subthreshold insomnia: 25.4% moderate insomnia: 16.5% and severe insomnia: 2.7%). The risk increased in a dose‐dependent manner; moderate insomnia risk ratio (RR) 2.34 (95% confidence interval [CI]: 1.34 – 4.09) and severe insomnia RR 4.13 (95% CI: 1.56 – 10.92). The results were maintained in the fully adjusted model although moderate regional pain was the strongest predictor RR 6.95 (95% CI: 3.11‐15.54). Conclusion Our findings show a strong prospective relationship between insomnia symptoms and the transition from relatively localized to generalized pain.
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Objective:: In elderly patients, women have better qualities of sleep than men in objective parameters; however, women subjectively complain more about sleep disturbances than men. We performed visual scoring and spectral analysis of sleep electroencephalograms to explain these gender differences in the degree of arousal, the most representative marker in insomnia. Methods:: A total of 354 participants (≥60 years old) were recruited from a Korean community underwent nocturnal polysomnography (NPSG). A Fast Fourier transform was used for the spectral analysis of the NPSG data. Relative power was calculated as absolute power of each band divided by total absolute power. Difference in total sleep time (D_TST) is obtained by subtracting the total sleep time reported in Pittsburgh Sleep Quality Index (PSQI) from the TST measured by the NPSG. Results:: A total of 75 participants (women, 51) were finally analyzed. Women had higher PSQI, longer sleep latencies, sleep inefficiencies, and daytime dysfunctions compared to men. The percentage of stage 1 sleep was higher in men versus in women, whereas percentage of stage 3 sleep was higher in women than in men ( P = .001; P = .001). Women had higher relative alpha and beta powers than men during nonrapid eye movement (NREM) sleep ( P = .017; P = .015). During NREM sleep, beta power was negatively correlated with D_TST ( R = -0.250, P = .033), and relative alpha power in stage 3 sleep was positively correlated with sleep latency in PSQI ( R = 0.267, P = .022). Conclusion:: Spectral analysis showed that women had more disturbed sleep than men. The result from the spectral analysis may explain hyperarousal in elderly women.
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Study objective: To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample. Design: Cohort study based on data from 2 general health surveys of the adult population. Setting: Two general health surveys in the adult population in Nord-Trøndelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7 Participants: Participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130). Measurements and results: Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys. Conclusions: Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.
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The second Nord-Trøndelag Health Study in 1995-97 (HUNT 2) was partly a follow-up study of HUNT 1, conducted in 1984-86. HUNT 2 comprised, however, a larger scientific program. The large amount of information collected from each participant, and the large number of participants in a wide age range covering an entire county population, make HUNT one of the largest health studies ever performed. This paper describes the survey covering persons aged 20 years and older. In total, 66.7% of men (n=30,860) and 75.5% of women (n=35,280) participated, the highest participation was in age group 60-69 and the lowest among the young and the elderly. Data collected from several questionnaires and with blood and urine samples and various clinical measurements, some of them in sub-samples of the study population, comprise a huge database for research. All data for each person are linked, and data are also linked to various health registries; all data handling being supervised by The Data Inspectorate and The Regional Ethical Committee. Procedures for data access are established, and more than 100 researchers are currently working on HUNT data. A large number of scientific papers in various disciplines are published, among them 15 doctoral theses (June 2003). The research potential of the HUNT biobank is still not fully exploi- ted, but initiatives are taken. In line with other population based studies both in Norway and abroad, there was a decline in participation rate from HUNT 1 to HUNT 2 (16.9%). This has raised concern about the validity of future population based health studies. However, the good local and national network and the support from the population, make up a good platform also for future health studies in Nord-Trøndelag.
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The aim was to validate information about diabetes mellitus collected by questionnaire in a large epidemiological survey. Questions on diabetes diagnosis, medical treatment for diabetes, diabetes duration, and hypertension treatment were selected from the Nord-Trøndelag health survey questionnaires. One of the municipalities was selected for the validation study. The health survey 1984-86 addressed all inhabitants > or = 20 years of age in Nord-Trøndelag county, Norway; 76,885 (90.3%) of the eligible population participated in answering the question on diabetes. All inhabitants in the municipality answering "yes" to the question on diabetes (n = 169) and the persons with the same sex born closest before and after each diabetic patient and answering "no" to the diabetes question (n = 338) were included. A very thorough search was made in the medical files of the general practitioners in the municipality for corresponding information. Compared to the files, diabetes was verified in 163 out of the 169. The commonest cause of discrepancy was renal glycosuria. One out of the 338 registered non-diabetic persons was found to have diabetes. Diabetic patients tended to overestimate diabetes duration significantly. Insulin treatment was verified in 19/20 (95%) and treatment with oral hypoglycaemic agents in all 44 with an affirmative questionnaire answer. A negative answer on insulin and oral hypoglycaemic agents was verified in 100% and 99% respectively. The concordance was considerably higher than in a comparable Norwegian study performed 10 years earlier. Patient administered questionnaires may be a very reliable source of information for epidemiological purposes in a well defined chronic disease such as diabetes mellitus.
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A representative adult sample (18 years and above) of the Norwegian population, comprising 2001 subjects, participated in telephone interviews, focusing on the one-month point prevalence of insomnia and use of prescribed hypnotics. Employment of DSM-IV inclusion criteria of insomnia yielded a prevalence rate of 11.7%. Logistic regression analysis performed on the different insomnia symptoms revealed that somatic and psychiatric health were the strongest predictors of insomnia, whereas gender, age, and socioeconomic status showed a more inconsistent relationship. Use of prescribed hypnotic drugs was reported by 6.9% and was related to being female, elderly, and having somatic and emotional problems. Sleep onset problems and daytime impairment were more common during winter compared to summer. Use of hypnotics was more common in the southern (rather than the northern) regions of Norway. For sleep onset problems a Season x Region interaction was found, indicating that the prevalence of sleep onset problems increased in southern Norway from summer to winter, while the opposite pattern was found in the northern regions. The importance of clinically adequate criteria and seasonal variation in the evaluation of insomnia is briefly discussed.
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To investigate the role of disturbed sleep in the daily functioning of persons with chronic pain. subjects and Participants comprised 287 patients seeking treatment for chronic pain at a university pain clinic. All patients completed the measures employed in the present study as part of a comprehensive initial evaluation. Descriptive analyses showed that 88.9% of patients reported as least one problem with disturbed sleep. Correlation analyses showed that greater sleep disturbance was associated with greater pain, disability, depression and physical symptoms, and less daily uptime. Hierarchical regression analyses showed that sleep disturbance predicted disability, daily uptime and physical symptoms independent of pain or depression. Sleep disruption is usually considered to be a consequence of the pain experience. However, the results of the present study reinforce the view that sleep disturbance may have a bidirectional relation with other features of chronic pain. Future studies should confirm that repairing disrupted sleep leads to an improvement in patients' daily activity and a reduction in their suffering.
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The purpose of this study is to assess the prevalence of insomnia symptoms and diagnoses in the general population of Finland. A total of 982 participants, aged 18 years or older and representative of the general population of Finland, were interviewed by telephone using the Sleep-EVAL system. The participation rate was 78%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and International Classification of Sleep Disorders (ICSD), associated and sleep/mental disorders and daytime consequences. The overall prevalence of insomnia symptoms occurring at least three nights per week was 37.6%. Difficulty initiating sleep were mentioned by 11.9% of the sample, difficulty maintaining sleep by 31.6%, early morning awakenings by 11.0% and non-restorative sleep by 7.9% of the sample. Global dissatisfaction with sleep was found in 11.9% of the sample. Daytime consequences (fatigue, mood changes, cognitive difficulties or daytime sleepiness) were reported by 39.9% of participants with insomnia symptoms and 87.6% of those with sleep dissatisfaction. A deterioration of sleep in summer or winter was associated with more complaints of sleep dissatisfaction. Prevalence of any DSM-IV insomnia diagnosis was 11.7%. More specifically, DSM-IV diagnosis of primary insomnia had a prevalence of 1.6% and DSM-IV diagnosis of insomnia related to another mental disorder was at 2.1%. Insomnia was a symptom of another sleep disorder in about 16% of cases and of a mental disorder in about 17% of cases. As reported in other Nordic studies, sleep quality was worse in summer. Insomnia symptomatology was common and was reported by more than a third of Finnish participants. Compared with other European countries studied with the same methodology (France, the UK, Germany, and Italy), the prevalence of DSM-IV insomnia diagnosis was 1.5 to two times higher in Finland.
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The aim of the study was to evaluate Norwegian cancer patients' awareness of their prior cancer diagnosis in a general population-based study. A cross-sectional population-based study of cancer patients' responses to the index question: 'Do you have or have you had cancer?' was carried out. We assessed correctness of the response in relation to cancer site, date of diagnosis, marital status, age and education. Smoking was chosen as a marker of health awareness. A total of 65,330 persons participated in the Nord-Trøndelag Health Survey (HUNT-II), performed in 1995-1997. The database of HUNT-II was merged with the Cancer Registry of Norway (CRN), thus identifying each of the 2983 (4 percent) participants with an invasive cancer diagnosis. Excluding basal cell epithelioma, a total of 20 percent of the patients denied their prior cancer diagnosis. This group consisted mainly of men (54 percent) and those who were diagnosed as very young or as elderly. More smokers than non-smokers were unaware of their prior malignancy (24 percent versus 20 percent). A 20 percent rate of patients who denied their former malignancy is surprisingly and unacceptably high. Disclosure of a cancer diagnosis should help the patient to develop increased health awareness. It should enable a person to report his or her former cancer diagnosis when necessary.
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Insomnia is a highly prevalent, often debilitating, and economically burdensome form of sleep disturbance caused by various situational, medical, emotional, environmental and behavioral factors. Although several consensually-derived nosologies have described numerous insomnia phenotypes, research concerning these phenotypes has been greatly hampered by a lack of widely accepted operational research diagnostic criteria (RDC) for their definition. The lack of RDC has, in turn, led to inconsistent research findings for most phenotypes largely due to the variable definitions used for their ascertainment. Given this problem, the American Academy of Sleep Medicine (AASM) commissioned a Work Group (WG) to review the literature and identify those insomnia phenotypes that appear most valid and tenable. In addition, this WG was asked to derive standardized RDC for these phenotypes and recommend assessment procedures for their ascertainment. This report outlines the WG's findings, the insomnia RDC derived, and research assessment procedures the WG recommends for identifying study participants who meet these RDC.
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This study used empirically validated insomnia diagnostic criteria to compare depression and anxiety in people with insomnia and people not having insomnia. We also explored which specific sleep variables were significantly related to depression and anxiety. Finally, we compared depression and anxiety in (1) different insomnia types, (2) Caucasians and African Americans, and (3) genders. All analyses controlled for health variables, demographics, organic sleep disorders, and symptoms of organic sleep disorders. Cross-sectional and retrospective. Community-based sample (N=772) of at least 50 men and 50 women in each 10-year age bracket from 20 to more than 89 years old. Self-report measures of health, sleep, depression, and anxiety. People with insomnia had greater depression and anxiety levels than people not having insomnia and were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety, respectively. Increased insomnia frequency was related to increased depression and anxiety, and increased number of awakenings was also related to increased depression. These were the only 2 sleep variables significantly related to depression and anxiety. People with combined insomnia (ie, both onset and maintenance insomnia) had greater depression than did people with onset, maintenance, or mixed insomnia. There were no differences between other insomnia types. African Americans were 3.43 and 4.8 times more likely to have clinically significant depression and anxiety than Caucasians, respectively. Women had higher levels of depression than men. These results reaffirm the close relationship of insomnia, depression, and anxiety, after rigorously controlling for other potential explanations for the relationship.
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General practitioners' (GPs) diagnostic skills lead to underidentification of generalized anxiety disorders (GAD) and major depressive episodes (MDE). Supplement of brief questionnaires could improve the diagnostic accuracy of GPs for these common mental disorders. The aims of this study were to examine the usefulness of The Hospital Anxiety and Depression Rating Scale (HADS) for GPs by: 1) Examining its psychometrics in the GPs' setting; 2) Testing its case-finding properties compared to patient-rated GAD and MDE (DSM-IV); and 3) Comparing its case finding abilities to that of the GPs using Clinical Global Impression-Severity (CGI-S) rating. In a cross-sectional survey study 1,781 patients in three consecutive days in September 2001 attended 141 GPs geographically spread in Norway. Sensitivity, specificity, optimal cut off score, and Area under the curve (AUC) for the HADS and the CGI-S were calculated with Generalized Anxiety Questionnaire (GAS-Q) as reference standard for GAD, and Depression Screening Questionnaire (DSQ) for MDE. The HADS-A had optimal cut off > or =8 (sensitivity 0.89, specificity 0.75), AUC 0.88 and 76% of patients were correctly classified in relation to GAD. The HADS-D had by optimal cut off > or =8 (sensitivity 0.80 and specificity 0.88) AUC 0.93 and 87% of the patients were correctly classified in relation to MDE. Proportions of the total correctly classified at the CGI-S optimal cut-off > or =3 were 83% of patients for GAD and 81% for MDE. The results indicate that addition of the patients' HADS scores to GPs' information could improve their diagnostic accuracy of GAD and MDE.
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Mental illness is consistently underrecognized in general health care, which may lead to underestimation of its effects on awards for social security payments. The authors investigated empirically the contribution of psychiatric morbidity to the award of disability pensions, in particular those awarded for physical diagnoses. Using a historical cohort design, the authors utilized a unique link between a large epidemiological cohort study and a comprehensive national database. Baseline information on mental and physical health was gathered from a 1995-1997 population-based health study of those of working age (20-66 years) in Nord-Trøndelag County, Norway, who were not recipients of disability pension (N=45,782). The outcome assessed was the awarding of disability pensions ascribed to specific ICD-10 diagnoses within 6 to 30 months as registered in the National Insurance Administration. Anxiety and depression were robust predictors of disability pension awards in general, even when disability pensions awarded for any mental disorder were excluded. These effects were only partly explained by baseline somatic symptoms and diagnoses and were stronger in individuals aged 20-44 than in those aged 45-66. Somatic symptoms accounted for far more disability pension awards than did somatic diagnoses. The cost of common mental disorders in terms of disability pensions and lost productivity may have been considerably underestimated by official statistics, particularly for younger claimants. The results suggest this might be due both to overuse of physical diagnoses and underrecognition of common mental disorders in primary care.
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Determine the comorbidity of insomnia with medical problems. Cross-sectional and retrospective. Community-based population of 772 men and women, aged 20 to 98 years old. Self-report measures of sleep, health, depression, and anxiety. People with chronic insomnia reported more of the following than did people without insomnia: heart disease (21.9% vs 9.5%), high blood pressure (43.1% vs 18.7%), neurologic disease (7.3% vs 1.2%), breathing problems (24.8% vs 5.7%), urinary problems (19.7% vs 9.5%), chronic pain (50.4% vs 18.2%), and gastrointestinal problems (33.6% vs 9.2%). Conversely, people with the following medical problems reported more chronic insomnia than did those without those medical problems: heart disease (44.1% vs 22.8%), cancer (41.4% vs 24.6%), high blood pressure (44.0% vs 19.3%), neurologic disease (66.7% vs 24.3%), breathing problems (59.6% vs 21.4%), urinary problems (41.5% vs 23.3%), chronic pain (48.6% vs 17.2%), and gastrointestinal problems (55.4% vs 20.0%). When all medical problems were considered together, only patients with high blood pressure, breathing problems, urinary problems, chronic pain, and gastrointestinal problems continued to have statistically higher levels of insomnia than those without these medical disorders. This study demonstrates significant overlap between insomnia and multiple medical problems. Some research has shown it is possible to treat insomnia that is comorbid with select psychiatric (depression) and medical (eg, pain and cancer) disorders, which in turn increases the quality of life and functioning of these patients. The efficacy of treating insomnia in many of the above comorbid disorders has not been tested, indicating a need for future treatment research.
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To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample. Cohort study based on data from 2 general health surveys of the adult population. Two general health surveys in the adult population in Nord-Trøndelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7 Participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130). Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys. Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.
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• Several methods are used to minimize and measure error in the NIMH Epidemiologic Catchment Area program. Sampling methods involve the inclusion of group quarters such as prisons, nursing homes, and mental hospitals in the sample frame and the use of probability sampling throughout. Interviewing, methods include use of identical diagnostic interview protocols, centralized training of interview supervisors, standard instructions to interviewers, and reinterview of a subsample by clinicians. In the area of completion, the methods include a 75% to 80% respondent completion rate, a 95% or greater completion rate for individual questions, use of informant interviews where necessary, and statistical adjustments to correct for low completion rates in some subgroups. Analytic methods include use of a computerized diagnostic algorithm, common estimation formulas on identically formatted data files, and estimation of exact variances that take account of the multistage sample design.
Article
As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders. (JAMA. 1989;262:1479-1484)
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
Complaints of insomnia are very common, especially in older adults. Although pharmacotherapy is the most common form of treatment, recent evidence shows cognitive-behavioural therapy to be superior in the short- and long-term management of insomnia. Low-threshold intervention programmes may reduce both the individual and societal burden of insomnia, coexisting with or without other mental or physical disorders.
Article
As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.
Article
Several methods are used to minimize and measure error in the NIMH Epidemiologic Catchment Area program. Sampling methods involve the inclusion of group quarters such as prisons, nursing homes, and mental hospitals in the sample frame and the use of probability sampling throughout. Interviewing, methods include use of identical diagnostic interview protocols, centralized training of interview supervisors, standard instructions to interviewers, and reinterview of a subsample by clinicians. In the area of completion, the methods include a 75% to 80% respondent completion rate, a 95% or greater completion rate for individual questions, use of informant interviews where necessary, and statistical adjustments to correct for low completion rates in some subgroups. Analytic methods include use of a computerized diagnostic algorithm, common estimation formulas on identically formatted data files, and estimation of exact variances that take account of the multistage sample design.
Article
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
Headaches and sleep problems are common complaints in the daily practice of the general practitioner. Since the relationship between headaches and sleep complaints is complex, clear models of interaction are needed for adequate diagnosis and treatment. All subjects, successively seen in a headache clinic during a defined period, were subdivided based on the time of onset of cephalalgia. Subjects who reported onset of headache on a long-term basis, during the nocturnal or early morning (before final awakening) period, were systematically studied by a headache clinic and a sleep disorders center. This subgroup represented 17% of the total headache group. Although the results of the headache clinic study did not differentiate this subgroup from the other patients, the sleep disorders center's interviews and questionnaires demonstrated a significant impact of the sleep disorders on headache and daytime function. Nocturnal monitoring during sleep identified specific sleep disorders in 55% of the subjects with onset of headache during the nocturnal sleep period. Follow-up after treatment of the sleep disorder showed that all subjects with an identifiable sleep disorder reported either an improvement or absence of their headache. The subjects identified with periodic limb movement syndrome were mostly those who reported only an improvement in their sleep and still needed treatment for their headaches. The question of the interaction and association of sleep-related headache and periodic limb movement syndrome is unresolved. Headaches occurring during the night or early morning are often related to a sleep disturbance.
Article
Epidemiological studies of insomnia in the general population have reported high prevalence rates. However, few have applied diagnostic criteria from existing classification systems. Consequently. It is not possible to determine whether subjects suffered from a sleep disorder or whether the insomnia constituted a symptom of a mental disorder. Insomnia and its relationship with other mental disorders was investigated in the general population using DSM-IV criteria. A representative sample of 5622 subjects from the French population were interviewed about their sleep habits over the telephone by lay interviewers. The course and content of interviews were customized by means of the Sleep-Eval knowledge-based system. A total of 18.6% of the sample reported insomnia complaints. The presence of insomnia complaints, lasting for at least one month with daytime repercussions was found for 12.7% of the sample. Subsequently, subjects were classified according to the Sleep Disorder decision-making process proposed by the DSM-IV classification, but without the recourse of polysomnographic recordings. Specific sleep disorder diagnoses were given for 5.6% of the sample, mostly as insomnia related to another mental disorder, primary insomnia was given for 1.3% of the sample. Primary mental disorder diagnoses were supplied for 8.4% of the sample, mostly as generalized anxiety disorder. The results of this investigation emphasize the need to use classifications to determine whether subjects with insomnia complaints suffer from a sleep disorder or whether insomnia constitutes a symptom of some other mental disorder. These distinctions are of utmost importance as they have a bearing on the choice of treatment. Conversely, diagnoses were obtained by lay interviews, which may have caused a lack of recognition and/or discrimination for light or borderline symptomatology.
Article
This study compared myofascial pain of the masticatory muscles to fibromyalgia. Study data show that, in both myofascial pain and fibromyalgia patients, facial pain intensity and its daily pattern and effect on quality of life are very similar. This indicates that fibromyalgia should be included in the differential diagnosis for myofascial pain of the masticatory muscles. However, with the higher prevalence of neurologic and gastrointestinal symptoms, and the stronger words used to describe the affective dimension of pain, it is apparent that fibromyalgia may be a more debilitating condition than myofascial pain of the masticatory muscles. Since the intensity of facial pain was strongly and significantly correlated to the body-pain index in fibromyalgia but not in myofascial pain patients, it can be concluded that facial pain may be part of the clinical manifestations of fibromyalgia, but it is unlikely to be related to body pain in myofascial pain patients. On the other hand, while body pain is episodic in most myofascial pain patients, it is constant and more severe in the majority of fibromyalgia patients. This difference in the pain patterns suggests that body pain in fibromyalgia and myofascial pain could have different etiologies. The lack of correlation between the intensity of pain and the length of time since onset also supports the concept that myofascial pain of the masticatory muscles and fibromyalgia are unlikely to be progressive disorders.
Article
Sleep disorders are very prevalent in the general population and are associated with significant medical, psychological, and social disturbances. Insomnia is the most common. When chronic, it usually reflects psychological/behavioral disturbances. Most insomniacs can be evaluated in an office setting, and a multidimensional approach is recommended, including sleep hygiene measures, psychotherapy, and medication. The parasomnias, including sleepwalking, night terrors, and nightmares, have benign implications in childhood but often reflect psychopathology or significant stress in adolescents and adults and organicity in the elderly. Excessive daytime sleepiness is typically the most frequent complaint and often reflects organic dysfunction. Narcolepsy and idiopathic hypersomnia are chronic brain disorders with an onset at a young age, whereas sleep apnea is more common in middle age and is associated with obesity and cardiovascular problems. Therapeutic naps, medications, and supportive therapy are recommended for narcolepsy and hypersomnia; continuous positive airway pressure, weight loss, surgery, and oral devices are the common treatments for sleep apnea.