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The Effects of Stress- and Sleep-Related Variables on the Quality of Life in Insomnia Patients
... In this study, the KESS scores of the NC were significantly higher than those of insomnia group without exercise (Table 3). Although it may be expected that daytime sleepiness will occur to compensate for sleep deprivation in insomnia patients, it has been reported that daytime sleepiness may decrease due to the disrupted sleep homeostasis [39]. In this study, the degree of hyper-arousal indicated by the HAS was observed to be higher in the insomnia group than the NC group, although the difference was not statistically significant. ...
Background and Objective: We aimed to compare the differences in the subjective and objective sleep quality, and quality of life (QOL) according to the duration and timing of exercise in community-dwelling adults, and to compare these between the exercise group (EG) and non-exercise group (non-EG) in insomnia patients. Methods: We recruited 223 volunteers (EG: n = 119, age: 60.8 ± 12.8 years; non-EG: n = 104, age 61.6 ± 13.3 years), who visited to 3 Public Health Centers in a rural area of South Korea. The Pittsburgh Sleep Quality Index (PSQI), Korean version of Epworth Sleepiness Scale (KESS), and Short Form-12 Health Survey Questionnaire (SF-12) were administered for each subject. Actigraphy (Actiwatch-2, Philips Respironics Co.) recording was done for 7 days at home, and we included the data of 183 subjects in our analysis. We compared the scores of questionnaires and objective sleep parameters according to the duration and timing of exercise, and compared these between the EG and non-EG in insomnia patients. Results: Physical component summary (PCS) scores in SF-12 were higher in the EG for more than 60 minutes per day. In the subjects with outdoor exercise, the afternoon EG had lower PSQI scores and higher KESS scores. In insomnia patients, PCS scores in the EG was higher than those of the non-EG. Conclusions: Community-dwelling adults who exercised for more than one hour showed higher physical QOL compared to those for less than one hour. Insomnia patients who exercised also showed higher physical QOL. In outdoor exercise, afternoon exercise would be beneficial for subjective sleep quality than morning exercise.
... The Ford Insomnia Response to Stress Test (FIRST) is a self-report measure developed to measure sleep reactivity, including items that assess the extent that one suffers from sleep difficulty following stressful life events [4]. The FIRST has been used in various studies with many clinical populations, such as shift workers, elders, and young adults, and also in various countries [4,[6][7][8][9][10][11][12]. ...
Background and Objective: This study aimed to examine psychometric properties of the Korean Ford Insomnia Response to Stress Test (K-FIRST). The FIRST measures personal vulnerability of sleep difficulties in response to stressful events. Methods: 377 participants (mean age = 21.80 ± 2.91 years, 76.9% female) completed online surveys about demographic information, sleep reactivity (K-FIRST), insomnia (Insomnia Severity Index, ISI), perceived stress (Perceived Stress Scale, PSS), and depression (Center for Epidemiological Studies-Depression Scale, CES-D). Exploratory factor analysis was conducted to determine the factor structure of the K-FIRST. Results: K-FIRST showed adequate internal consistency (Cronbach's α = 0.85) and significant goodness of fit test result (χ² = 1386.33, p < 0.001). A two-factor structure was selected as a result of the factorial analysis, with rumination and worry as the two factors. K-FIRST was significantly associated with the ISI (r = 0.35, p < 0.01), PSS (r = 0.30, p < 0.01), and CES-D (r = 0.42, p < 0.01). Conclusions: The results of this present study supported the reliability and validity of K-FIRST. It is expected that the K-FIRST can be used in future research in investigating personal vulnerabilities that may predispose individuals to sleep disturbance.
The purposes of this study are to examine the sociodemographic factors that increase the prevalence of insomnia, as well as to identify the relationship between the prevalence of insomnia and health conditions by navigating through the prevalence rates of insomnia in two different geographical regions with different socioeconomic structures.
Sleep onset insomnia, defined as difficulty initiating asleep, is a common disorder with associated impairment or significant distress and is associated with daytime consequences. Although these sleep onset insomnia has generally been attributed to psychological or psychiatric causes, it can also be secondary to a medical, circardian, or sleep disorder. Usually, many patients have various causes or conditions such as psychophysiological insomnia (PPI), periodic limb movements in sleep (PLMS), restless legs syndrome (RLS), obstructive sleep apnea-hypopnea syndrome (OSAS), congestive heart failure (CHF), delayed sleep phase syndrome (DSPS), etc. These patients are characterized by frequent arousals or failing to get to sleep in the early sleep stage and don’t feel refreshed in the morning. They result in complaints of insomnia or sleep state misperception and have significant decreased daily activities and impaired cognitive functions. For more accurate evaluation, polysomnography (PSG), multiple sleep latency test (MSLT), neuropsychological test (NP test), and suggested Immobilization Test (SIT) can be necessary to these patients. After these studies, the most appropriate treatments are adjusted including sleep hygiene education, cognitive behavior therapy, pharmacologic therapy, continuous positive airway pressure titration, and surgery, etc. These article introduces the clinical approach to the diagnosis and management of the sleep onset insomnia that can be caused by the various possibilities, such as PPI, SSM, PLMS, RLS, DSPS, OSAS, and CHF.
Cognitive behavioral therapy for insomnia (CBT-I) is a group of strategies which includes sleep restriction, stimulus control therapy, relaxation training, cognitive therapy, and various combinations of those methods. Growing evidence from controlled clinical trials indicates that the majority of patients (70 to 80%) with persistent insomnia respond to CBT, and approximately half of them achieve clinical remission. CBT-I produces significant improvements of sleep-onset latency, wake after sleep onset, sleep efficiency, and sleep quality. These benefits are paralleled by reductions of daytime fatigue, improvement in psychological symptoms, and decreased usage of hypnotics. Changes in sleep patterns are well maintained after completing therapy. Treatment outcomes have been documented primarily with prospective sleep diaries; studies using polysomnography and actigraphy have also supported these results. Considering the results of current peer-reviewed research, CBT-I should be the first-line therapy for persistent insomnia. Despite strong evidence supporting its efficacy and effectiveness, CBT-I remains under utilized by health care practitioners. Increased application of evidence-based CBT-I therapies and their extension into primary medical practices should be highly effective and should be recommended in the future for better clinical management of insomnia-related disorders.
Insomnia is the most common sleep problem affecting nearly one-third of the population as either a primary or comorbid condition. Insomnia has been defined as both a symptom and a disorder, and is characterized as sleep that is chronically unrestorative or poor in quality often due to difficulty in initiating sleep, in maintaining sleep, or with waking up too early. Insomnia results in some form of daytime impairment in the patient's normal activites. Although the exact pathophysiology of insomnia is poorly understood, it is often believed to arise from a state of hyperarousal in multiple neurophysiological and/or psychological systems. Population-based studies suggest that while about one-third of the general population complains of sleep disturbance, only 10-15 percent has associated symptoms of daytime functional impairment, and even fewer, only 6-10 percent have impairments sufficient for the diagnostic criteria of insomnia. The cornerstone of the insomnia evaluation and diagnosis is a comprehensive history obtained by the clinical interview with patient and/or family. Additional assessment tools, such as sleep diary or log, various questionnaires, actigraphy, and multichannel polysomnography (PSG) have been used as an aid to diagnosis, although many are limited in their validation. Insomnia causes a significant burden of medical, psychiatric, societal consequences on the individual and societal level. Clinicians in either primary settings or specialized clinics should have knowledge to manage insomnia with confidence.
Sleep comprises one third of human life and is very important for maintaining healthy mental and physical states. Sleep disorders disturbing normal sleep are very common and may induce serious consequences. Sleep disorder medicine is based on the concept of two different states (waking and sleep) of the human brain. The problems of the waking conscious state affect sleep and problems during sleep also affect daytime mental and physical activities. The common symp-toms of patients with sleep disorders are excessive daytime sleepiness, a decrease in alertness, and fatigue. To detect sleep disorders, we should understand the physiology of normal sleep. Normal sleep consists of non-rapid eye movement (75% to 80%) and rapid eye movement (20% to 25%) sleep. The International Classification of Sleep Disorders second edition lists 77 different sleep disorders divided into 8 categories. Clinical approaches to sleep disorder patients should include detailed history taking including sleep history, a sleep questionnaire, sleep diary, physical examination including the nasal/oral cavities and airway, and neurological/psychological examination. The common sleep disorders are obstructive sleep apnea, insomnia, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder, and circadian rhythm sleep disorder. We should learn the characteristic clinical features of each sleep disorder and how to detect and treat them. We need a more active effort to educate physicians about sleep disorder medicine and should try large sample, long-term, and prospective studiesto reveal the pathophysiology and enhance the treatment of sleep disorders. Sleep disorders are common, serious, and treatable. However, most patients with sleep disorders are underdiagnosed and not treated appropriately due to lack of knowledge of sleep disorder medicine. The Ministry of Health and Welfare of South Korea should focus more attention on and provide more support for timely diagnosis and treatment of sleep disorders.
This study aimed to investigate how sleep quality affects quality of life in the elderly of rural communities.
The objective of this study was to examine the associations between the temporal and severity characteristics of sleep disturbance and subsequent depression in community-dwelling older adults.
A prospective cohort study with assessment of sleep disturbance and depression at baseline and across 2 years of follow-up.
Three urban communities in the United States.
Community-dwelling older adults in whom prior depression (n = 145), current depression (n = 68), or never mentally ill (n = 206) were diagnosed at the baseline assessment.
Major depression at year 2, defined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Among patients with either a depression history or current depression at baseline, persistent sleep disturbance throughout year 1 was associated with persistent or recurrent depression at year 2, after adjustment for group status, antidepressant and hypnotic sedative use, severity of depressive symptoms, chronic medical burden, and sociodemographic variables (adjusted odds ratio = 5.20, 95% confidence interval [CI] = 1.16 to 23.29). Among those who were not depressed at year 1, persistent sleep disturbance throughout year 1 predicted depression recurrence during year 2 (adjusted hazards ratio = 16.05, CI = 1.21 to 213.06), independent of the severity of sleep disturbance. None of the older adults who were never mentally ill developed a depression.
Persistent sleep disturbance during a year-long period is associated with depression the following year. Among older adults with prior depression, identification of those with persistent sleep disturbance may optimize the efficacy of sleep related interventions to improve depression remission and/or prevent late-life depression.
Lee E; Cho HJ; Olmstead R; Levin MJ; Oxman MN; Irwin MR. Persistent sleep disturbance: a risk factor for persistent or recurrent depression in community-dwelling older adults. SLEEP 2013;36(11):1685-1691.
Life satisfaction is a crucial component of well being, thus research of its determinants are of great importance and are conducted worldwide. Recently, morningness has been shown to be related to greater life satisfaction in Polish and German samples; and in the present study, this relationship was tested in a Spanish adult sample. The results provide further evidence for the relationship of morningness with higher life satisfaction, which it seems independent of culture and geographic location.
Objectives: A number of investigations have suggested that thresholds for pressure pain may be lowered in myofascial dysfunction syndromes, infibromyalgia, and in certain gastrointestinal disorders. We investigated the relationships between anxiety, depression and pressure pain thresholds in normal controls compared with two groups of patients with abdominal complaints, namely Crohn's disease and the syndrome of abdominal bloathing. Methods: Subjects meeting clinical criteria for one of the entry conditions completed the Hospital Anxiety and Depression Scale and were examined at 3 musculoskeletal sites with a pressure algometer to determine pain thresholds. Results: Crohn's disease patients exhibited a significantly lower-than-normal threshold not seen with the bloating subjects. That remained true even after controlling for sex, weight, intensity of pain, anxiety, and depression, variables which showed little impact on thresholds. Females exhibited lower thresholds than males while body weight was directly related to threshold. Conclusions: These findings failed to support the hypothesis that patients with the seemingly more functional bloating syndrome would exhibit a lower threshold for pressure pain than Crohn's disease.
Previous studies have provided evidence that eveningness could be related to disadvantageous individual characteristics. The hypothesis that more evening-oriented individuals exhibit lower satisfaction with life has been tested by Randler using a sample of 164 German university students, and this showed that eveningness is associated with lower satisfaction with life (r = .177). The aim of the present study was to answer the question of whether or not this relationship is culturally independent, and would exist if a sample from another geographical location and culture had been studied. A sample of 349 residents (149 men) aged between 13 and 59 yrs from two Polish cities completed the Morningness-Eveningness Questionnaire and the Satisfaction with Life Scale. Analysis revealed that morningness was related to greater life satisfaction (r = .105), regardless of age and sex. The magnitude of this relationship did not differ significantly between the Polish and the German sample, which suggests that the magnitude and direction of association between morningness/eveningness and satisfaction with life could be independent of culture or geographical location.
Purpose: Examine the relationship between stress level and quality of life at a worksite wellness center.
A survey completed when joining the wellness center. Setting . Employee wellness center.
Survey that inquired about stress, health behaviors, and quality of life of more than 13,000 employees joining a wellness center.
A series of questions about current health status and health behaviors.
Two-sample t-tests assuming unequal variances.
A total of 2147 of these employees reported having high stress levels. Employees with high stress levels had statistically significant lower quality of life, more fatigue, and poorer health compared with employees with low stress levels. In terms of their ability and motivation to participate in wellness programs, the high-stress employees were also less active and had less healthy nutritional habits, less support, and less confidence in their ability to be active. They also reported having more health problems, including high blood pressure, high blood sugar, high cholesterol, and overweight.
It appears that employees with high stress levels--those who might most benefit from participation in wellness programs--may experience the greatest difficulty participating actively in wellness programs because of their lack of support, low confidence, and numerous health problems. Perhaps offering tailored stress reduction programs for these employees would be beneficial.
Most recommendations are that adults should obtain 7-8 hours of sleep per night, although there are individual differences in self-reported sleep need. Chronotype (preference for early or late sleep timing), in combination with social demands, may affect the ability to obtain adequate sleep. This questionnaire study assessed perceived sleep need and self-reported sleep timing and duration during the week and on the weekend with respect to chronotype in visitors to the Museum of Science in Boston. Increasing age was associated with greater morningness. After adjusting for age, we found no significant association between chronotype and self-reported sleep need, or between chronotype and weekday sleep duration. However, we did find that greater eveningness was associated with a larger gap between self-reported sleep need and weekday sleep duration. On weekends, greater eveningness was associated with a longer sleep duration and greater extension of sleep, with the sleep extension achieved by later wake times. Together, these findings suggest that evening types accumulate a sleep debt during the week, despite reporting a similar sleep need and duration as morning types, and evening types then attempt to make up for that lost weekday sleep on the weekends. Studies of sleep need and sleep duration should take chronotype into account, and studies of chronotype may be confounded by the association between age and morningness, and must account for this potential confound in selection criteria and/or analysis.
Because insomnia with objective short sleep duration is associated with increased morbidity, we examined the effects of this insomnia subtype on all-cause mortality.
Longitudinal.
Sleep laboratory.
1,741 men and women randomly selected from Central Pennsylvania.
Participants were studied in the sleep laboratory and were followed-up for 14 years (men) and 10 years (women). "Insomnia" was defined by a complaint of insomnia with duration > or = 1 year. "Normal sleeping" was defined as absence of insomnia. Polysomnographic sleep duration was classified into two categories: the "normal sleep duration group" subjects who slept > or = 6 h and the "short sleep duration group" subjects who slept < 6 h. We adjusted for age, race, education, body mass index, smoking, alcohol, depression, sleep disordered breathing, and sampling weight.
The mortality rate was 21% for men and 5% for women. In men, mortality risk was significantly increased in insomniacs who slept less than 6 hours compared to the "normal sleep duration, no insomnia" group, (OR = 4.00, CI 1.14-13.99) after adjusting for diabetes, hypertension, and other confounders. Furthermore, there was a marginally significant trend (P = 0.15) towards higher mortality risk from insomnia and short sleep in patients with diabetes or hypertension (OR = 7.17, 95% CI 1.41-36.62) than in those without these comorbid conditions (OR = 1.45, 95% CI 0.13-16.14). In women, mortality was not associated with insomnia and short sleep duration.
Insomnia with objective short sleep duration in men is associated with increased mortality, a risk that has been underestimated.
The Epworth sleepiness scale (ESS) is widely used to measure the subject's average sleep propensity across those different situations in daily life, particularly in patients with sleep-disordered breathing. The purposes of this study were to test the hypothesis that the Korean version of the ESS (KESS) is valid and evaluate its usefulness.
We developed the KESS, which involved translating into Korean and then translating back into English to check its accuracy. A total of 273 participants (181 obstructive sleep apnea (OSA)-37 mild, 61 moderate, 83 severe, 32 simple snoring and 60 normal) were included in this study. All subjects completed the overnight polysomnograph and 53 of the total subjects were randomly selected for a retest with the questionnaire approximately 2∼4 weeks later. The associations between KESS and the degree of OSA were examined through ANCOVA, adjusted for age, sex and BMI.
The total score and each item's score of KESS in patients with OSA were significantly higher than subjects with normal controls (p < 0.01). As the severity of OSA increased, the KESS showed significantly increasing patterns (p for trend <0.01). The KESS in patient groups showed good internal consistency (Cronbach's α = 0.90) and test-retest reliability (r = 0.78 to 0.93).
The KESS is a reliable and valid tool for screening patients with daytime sleepiness in Korea.
Despite its high prevalence, little information is available about the natural history of insomnia. The extent to which episodes of insomnia will persist or remit over time is difficult to predict. We examined the natural history of insomnia and describe the most common trajectories over 3 years.
Three hundred eighty-eight adults (mean [SD] age, 44.8 [13.9] years; 61% women) were selected from a larger population-based sample on the basis of the presence of insomnia at baseline. They completed standardized sleep/insomnia questionnaires at 3 annual follow-up assessments. For each follow-up assessment, participants were classified into 1 of 3 groups (individuals with an insomnia syndrome, individuals with insomnia symptoms, and individuals with good sleep) on the basis of algorithms using standard diagnostic criteria for insomnia. Rates of persistent insomnia, remission, and relapse were computed for each group.
Of the study sample, 74% reported insomnia for at least 1 year (2 consecutive assessments) and 46% reported insomnia persisting over the entire 3-year study. The course of insomnia was more likely to be persistent in those with more severe insomnia at baseline (ie, insomnia syndrome) and in women and older adults. Remission rate was 54%; however, 27% of those with remission of insomnia eventually experienced relapse. Individuals with subsyndromal insomnia at baseline were 3 times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well.
These findings indicate that insomnia is often a persistent condition, in particular when it reaches the diagnostic threshold for an insomnia disorder.
To explore the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. Sleep problems are being increasingly recognized as a source of morbidity and role impairment. Little is known, however, about the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems.
We utilized data from the German Health Survey (n = 4181; response rate: 87.6%; ages 18-65 years) to examine the relationships between sleep problems (assessed by the Pittsburgh Sleep Quality Inventory (PSQI)), mental and physical health comorbidity, and disability and health-related quality of life (assessed by the Medical Outcomes Scale Short Form-36 (SF-36)).
A total of 1595 (35.2%) respondents reported current sleep problems (PSQI score of >5). After adjusting for sociodemographic factors, we found the presence of sleep problems was associated with having one or more physical health problems (adjusted odds ratio (AOR) = 1.21, 95% Confidence Interval (CI) = 1.01-1.45) and one or more mental disorders (AOR = 3.58, 95% CI = 2.95-4.35). Among persons with one or more physical health problems, the co-occurrence of a sleep problem was associated with poorer physical component scores on the SF-36 (45.7 versus 48.6, p <.001) and increased odds of >or=1 disability days in the past 30 days due to physical problems (AOR = 1.55, 95% CI = 1.20-1.98), even after adjusting for sociodemographic factors and comorbidity with other mental and physical health conditions.
More than one third of adults in the community report sleep problems. These often co-occur with other physical and mental health problems, and when they do they are generally associated with an increased burden of role disability and functional impairment.
The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
Groups of 10 objectively defined insomniacs and age-, sex- and weight-matched normal sleepers were evaluated on sleep, performance, mood, personality and metabolic measures over a 36-hour sleep laboratory stay. Insomniacs were defined to have increased wake time during the night but also had decreased stage 2 and rapid eye movement sleep. As expected insomniacs reported increased confusion, tension and depression and decreased vigor on the profile of mood states mood scale throughout the evaluation period as compared to the normals. Insomniacs also had decreased memory ability on the short-term memory test and the MAST. These performance and mood differences were not secondary to sleepiness because the insomniacs also had significantly increased multiple sleep latency test (MSLT) values throughout the evaluation period. In conjunction with the consistent mood, performance and MSLT differences during the day and the sleep differences at night, whole body VO2, measured at intervals across the day and throughout one night of sleep, was consistently elevated at all measurement points in the insomniacs as compared to the normals. The nocturnal increase in metabolic rate remained even after metabolic values from periods during the night containing wake time or arousals were eliminated from the data set. It was concluded that patients who report chronic insomnia may suffer from a more general disorder of hyperarousal (as measured here by a 24-hour increase in metabolic rate) that may be responsible for both the daytime symptoms and the nocturnal poor sleep. Future studies need to explore 24-hour insomnia treatment strategies that decrease hyperarousal.
Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n=2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.918 in predictions of the SF-36 Physical Component Summary and SF-36 Mental Component Summary scores, respectively. Scoring algorithms from the general population used to score 12-item versions of the two components (Physical Components Summary and Mental Component Summary) achieved R squares of 0.905 with the SF-36 Physical Component Summary and 0.938 with SF-36 Mental Component Summary when cross-validated in the Medical Outcomes Study. Test-retest (2-week)correlations of 0.89 and 0.76 were observed for the 12-item Physical Component Summary and the 12-item Mental Component Summary, respectively, in the general US population (n=232). Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the 12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported 1-year changes in health, and recovery for depression. In 14 validity tests involving physical criteria, relative validity estimates for the 12-item Physical Component Summary ranged from 0.43 to 0.93 (median=0.67) in comparison with the best 36-item short-form scale. Relative validity estimates for the 12-item Mental Component Summary in 6 tests involving mental criteria ranged from 0.60 to 107 (median=0.97) in relation to the best 36-item short-form scale. Average scores for the 2 summary measures, and those for most scales in the 8-scale profile based on the 12-item short-form, closely mirrored those for the 36-item short-form, although standard errors were nearly always larger for the 12-item short-form.
The complex nature of insomnia and its relationship with organic and mental disorders render diagnosis problematic for epidemiologists and physicians.
A representative UK sample (non-institutionalised, > 14 years old) was interviewed by telephone (n = 4972; 79.6% participation rate) with the Sleep-EVAL system. Subjects fell into three groups according to presence of insomnia symptom(s) and/or sleep dissatisfaction.
Insomnia symptoms occurred in 36.2% of subjects. Most of these (75.9%), however, reported no sleep dissatisfaction. In comparison, those also with sleep dissatisfaction had higher prevalence of sleep and mental disorders and longer duration of insomnia symptoms, and were more likely to take sleep-promoting medication, dread bedtime, and complain of light sleep, poor night-time sleep and daytime sleepiness.
Insomnia sufferers differ as to whether they are satisfied or dissatisfied with sleep. Although insomnia symptoms are common in the general population, sleep disturbances among sleep-dissatisfied individuals are more severe. Sleep dissatisfaction seems a better indicator of sleep pathology than insomnia symptoms.
It was hypothesized that psychophysiological insomniacs, who have been shown to have elevated heart rate, body temperature, and whole body metabolic rate, would also have increased low frequency and decreased high frequency power in the spectral analysis of their heart period data.
Groups of 12 objectively defined insomniacs and age-, sex-, and weight-matched controls with normal sleep were evaluated on sleep and EKG measures over a 36-hour sleep laboratory stay.
Heart period was decreased (ie, heart rate was increased) and its SD was decreased in all stages of sleep in the insomniacs compared with the controls. Spectral analysis revealed significantly increased low frequency power and decreased high frequency power in insomniacs compared with controls across all stages of sleep.
Because increased low frequency spectral power is an indicator of increased sympathetic nervous system activity, these data imply that chronic insomniacs could be at increased risk for the development of disorders, such as coronary artery disease, that are related to increased sympathetic nervous system activity.
Patients with depression, particularly those seen by primary care physicians, may report somatic symptoms, such as headache, constipation, weakness, or back pain. Some previous studies have suggested that patients in non-Western countries are more likely to report somatic symptoms than are patients in Western countries. We used data from the World Health Organization's study of psychological problems in general health care to examine the relation between somatic symptoms and depression. The study, conducted in 1991 and 1992, screened 25,916 patients at 15 primary care centers in 14 countries on 5 continents. Of the patients in the original sample, 5447 underwent a structured assessment of depressive and somatoform disorders.
A total of 1146 patients (weighted prevalence, 10.1 percent) met the criteria for major depression. The range of patients with depression who reported only somatic symptoms was 45 to 95 percent (overall prevalence, 69 percent; P=0.002 for the comparison among centers). A somatic presentation was more common at centers where patients lacked an ongoing relationship with a primary care physician than at centers where most patients had a personal physician (odds ratio, 1.8; 95 percent confidence interval, 1.2 to 2.7). Half the depressed patients reported multiple unexplained somatic symptoms, and 11 percent denied psychological symptoms of depression on direct questioning. Neither of these proportions varied significantly among the centers. Although the overall prevalence of depressive symptoms varied markedly among the centers, the frequencies of psychological and physical symptoms were similar.
Somatic symptoms of depression are common in many countries, but their frequency varies depending on how somatization is defined. There is substantial variation in how frequently patients with depression present with strictly somatic symptoms. In part, this variation may reflect characteristics of physicians and health care systems, as well as cultural differences among patients.
Introduction: The objective of the present study was to investigate the independent effects of major depressive disorder (MDD) and insomnia on somatization, respectively. Methods: A total of 181 participants (73 males and 108 females ; mean age ) without serious medical problem were recruited from a community and a psychiatric clinic in Republic of Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire : 1) normal controls (n=127), 2) primary insomnia (n=11), 3) MDD without insomnia (n=14), and 4) MDD with insomnia (n=29). All participants were requested to complete the somatization subscores of the Symptom Checklist-90-Revised (SCL-90-R). Results: There were significant between-group differences in somatization score (F=25.30, p
Objectives: The purpose of this study is to evaluate the influence of depression symptom on the self-rated health status(SRHS), the outpatient health service utilization and quality of life(QOL) also the relationship depression symptom with socio-demographic and health related factors. Methods: We selected 9,550 participants without chronic diseases from a total of 18,104 in the '2009 community health survey in Gyeongnam. They were assessed by using a Korean version of the Center for Epidemiological Studies-Depression Scale(CES-D). Those with CES-D scores of 21 or greater were defined as having probable depression. Results: A probable depression were associated in bivariate analysis with gender, age, educational status, monthly household income, marital status, current smoking status, drinking habit, physical activities and body mass index. After adjustment for covariates, probable depression groups predicted a lower status in SRHS. Likewise probable depression groups predicted a higher utilization in outpatient health service. Also probable depression groups predicted a lower score in QOL. Conclusions: Probable depression influence SRHS, outpatient health service utilization and QOL even after adjusting for the socio-demographic, health related factors and chronic medical illness. Programs for prevention and management of depression will be helpful to promote health and QOL.
Background
This study was conducted to determine what symptom components or conditions of insomnia are related to subjective feelings of insomnia, low health-related quality of life (HRQOL), or depression. Method Data from 7,027 Japanese adults obtained using an Internet-based questionnaire survey was analyzed to examine associations between demographic variables and each sleep difficulty symptom item on the Pittsburgh Sleep Quality Index (PSQI) with the presence/absence of subjective insomnia and scores on the Short Form-8 (SF-8) and Center for Epidemiologic Studies Depression Scale (CES-D). Results Prevalence of subjective insomnia was 12.2 % (n = 860). Discriminant function analysis revealed that item scores for sleep quality, sleep latency, and sleep medication use on the PSQI and CES-D showed relatively high discriminant function coefficients for identifying positivity for the subjective feeling of insomnia. Among respondents with subjective insomnia, a low SF-8 physical component summary score was associated with higher age, depressive state, and PSQI items for sleep difficulty and daytime dysfunction, whereas a low SF-8 mental component summary score was associated with depressive state, PSQI sleep latency, sleeping medication use, and daytime dysfunction. Depressive state was significantly associated with sleep latency, sleeping medication use, and daytime dysfunction. Conclusion Among insomnia symptom components, disturbed sleep quality and sleep onset insomnia may be specifically associated with subjective feelings of the disorder. The existence of a depressive state could be significantly associated with not only subjective insomnia but also mental and physical QOL. Our results also suggest that different components of sleep difficulty, as measured by the PSQI, might be associated with mental and physical QOL and depressive status.
Morningness-Eveningness (ME) can be defined by the difference in individual diurnal preference observed from general behavioral patterns including sleep habits. The Horne & Östberg Morningness-Eveningness Questionnaire (MEQ) has been used for classifying ME types. We examined the reliability of a Korean version of the MEQ (Korean MEQ) and verified its validity by comparing responses on the Korean MEQ to objectively-recorded sleep-wake rhythms. After translating and back translating the MEQ from English into Korean, we examined the internal consistency of 19 items of the Korean MEQ in 91 subjects, and the test-retest reliability in 21 subjects who took the Korean MEQ twice, 4 weeks apart. The Korean MEQ was then administered to 1022 young adult subjects. A subset of 46 morning, neither, and evening type subjects took part in a validation study in which their rest-activity timing was collected by actigraphy for 7 days. Cosinor analyses on these data were done to obtain the acrophase and amplitude of the sleep-wake rhythm. Cronbach's alpha of the total scores from the Korean MEQ was 0.77, and the test-retest reliability intra-class correlation coefficient was 0.90 (p < 0.0001). There was a significant negative correlation between Korean MEQ score and reported sleep-wake timing among the entire cohort (p < 0.0001). There was a significant difference in bedtime and wake time (on both work and free days), and in the mean sleep-wake rhythm acrophase, between ME types (p < 0.01). In this study, the validity of the Korean MEQ was verified by illustrating the difference in acrophases of the sleep-wake rhythm between the ME types in young adults.
In contrast to the association of insomnia with mental health, its association with physical health has remained largely unexplored until recently. Based on findings that insomnia with objective short sleep duration is associated with activation of both limbs of the stress system and other indices of physiological hyperarousal, which should adversely affect physical and mental health, we have recently demonstrated that this insomnia phenotype is associated with a significant risk of cardiometabolic and neurocognitive morbidity and mortality. In contrast, insomnia with normal sleep duration is associated with sleep misperception and cognitive-emotional arousal, but not with signs of physiological hyperarousal or cardiometabolic or neurocognitive morbidity. Interestingly, both insomnia phenotypes are associated with mental health, although most likely through different pathophysiological mechanisms. We propose that objective measures of sleep duration may become part of the routine evaluation and diagnosis of insomnia, and that these two insomnia phenotypes may respond differentially to biological versus psychological treatments.
The present study examined the relationship of anxiety sensitivity, dysfunctional beliefs about sleep and neuroticism on sleep disturbance. Previous research of these three related concepts-each describing a different kind of reactivity to interoceptive or environmental events-have served as predictors of insomnia and insomnia-related distress; however, it is not known how these concepts have distinctive prediction of sleep outcomes. We completed an Internet survey of 149 undergraduate student participants, a population with elevated risk for disturbed sleep. Participants completed a demographics questionnaire, the Anxiety Sensitivity Index (ASI), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the NEO Five-Factor Inventory, and the Pittsburgh Sleep Quality Index (PSQI). Results revealed a significant association between PSQI total score and the three variables of interest, ASI, DBAS, and neuroticism. However, in a stepwise regression, neuroticism was the statistically most important predictor of sleep disturbance. The DBAS was a statistically more important predictor than ASI total score; however, when the ASI was examined by subscale, DBAS was replaced in the model by the ASI Mental Incapacitation Concerns subscale. Our findings highlight the continued value of higher order concepts like neuroticism in the development of disorder-specific measures like the DBAS, as well as indicate that distress in response to cognitive symptoms (AS-mental incapacitation) may play a role in maintaining sleep dysfunction.
Purpose: The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen's behavioral model to examine quality of life (QOL) in a nationally representative sample of community-dwelling adults 65 years and older according to geographic location. Specifically, associations between 3 dimensions of QOL (health-related QOL [HQOL], social functioning, and emotional well-being) and needs and health behaviors were examined.
Methods: The 2005-2006 National Health and Nutrition Examination survey was linked with the 2007 Area Resources File via the National Center for Health Statistics’ remote access system. Frequencies and distribution patterns were assessed according to rural, adjacent, and urban locations.
Findings: Older adults reported high levels of QOL; however, rural older adults had lower social functioning than their urban counterparts. Older blacks and Hispanics had lower scores than whites on 2 dimensions of QOL. Associations between QOL and needs and health behaviors varied. Although activities of daily living were associated with all 3 dimensions, others were associated with 1 or 2 dimensions.
Conclusions: The lower scores on social functioning in rural areas suggest that rural older adults may be socially isolated. Older rural adults may need interventions to maintain physical and mental health, strengthen social relationships and support, and increase their participation in the community to promote QOL. In addition, older blacks and Hispanics seem more vulnerable than whites and may need more assistance.
Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co-occur.
Background:
Most elderly patients with cancer suffer from a multitude of intense physical and psychological symptoms regardless of the stage of disease. The current paper describes the prevalence of pain, fatigue, insomnia, and mood disturbance, alone and in combination in elderly cancer patients, as well as the inter-correlations among these four symptoms, and the relationship of the symptom cluster to functional status and quality of life (QoL) during cancer therapy.
Patients and methods:
This cross-sectional study used secondary data from a convenience sample of 120 patients, 65 years of age and older, with colorectal, lung, head/neck, breast, gynecological, prostate or esophageal cancer receiving chemotherapy or radiotherapy. Measuring instruments included the Karnofsky Performance Scale (KPS), the respective items from the Chinese version of the Symptom Distress Scale (SDS-C), and the Functional Assessment of Cancer Therapy-General (FACT-G [C]). The influence of the symptom cluster on patients' functional status and QoL was determined by hierarchical multiple regression.
Results:
Twenty percent and 29.2% of patients reported co-occurrence of any two and any three symptoms of pain, fatigue, insomnia, and mood disturbance, respectively. About one-third of patients (31.2%) reported co-occurrence of all of the four symptoms. The inter-correlations among pain, fatigue, insomnia, and mood disturbance were mild to moderate (r=0.29-0.43, p<0.01). In terms of functional status, the KPS showed a moderate negative correlation with the four symptoms (r=-0.29 to -0.55, p<0.01). Correlations between the FACT-G (C) subscale/total scores and symptom cluster showed moderate negative correlations (r=-0.23 to -0.55, p<0.01). About 8.7-52.9% of variance in functional status and QoL is explained by the symptom cluster of pain, fatigue, insomnia, and mood disturbance in elderly cancer patients receiving cancer therapy after adjustment for gender, age, co-morbidity, stage of disease, and treatment modality.
Conclusions:
Our results suggest that pain, fatigue, insomnia, and mood disturbance are highly prevalent in elderly patients who undergone cancer therapy. These four symptoms may occur in a cluster and may negatively influence elderly patients' functional status and QoL during cancer therapy.
The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL).
Three hundred and thirty-one elderly (71-87 years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36).
The HF group had higher mean apnoea-hypopnoea index (17.6 vs. 6.3, p<0.001). Moderate/severe SDB was found in 42% of those with HF vs. 8% in those without CVD (p=0.001). Those with HF had more difficulties maintaining sleep (DMS) (72% vs. 50%, p=0.05) and excessive daytime sleepiness (EDS) (25% vs. 8%, p=0.05) and scored worse Hr-QoL in five of eight SF-36 domains. In regression analysis SDB had no association to Hr-QoL. DMS associated to the physical-, and non restorative sleep to the mental domain of Hr-QoL. SDB had no correlations to insomnia or EDS.
SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly.
Insomnia is the most common sleep disorder affecting millions of people as either a primary or comorbid condition. Insomnia has been defined as both a symptom and a disorder, and this distinction may affect its conceptualization from both research and clinical perspectives. Whether insomnia is viewed as a symptom or a disorder, however, it nevertheless has a profound effect on the individual and society. The burden of medical, psychiatric, interpersonal, and societal consequences that can be attributed to insomnia underscores the importance of understanding, diagnosing, and treating the disorder.
The aim of this study was to evaluate quantitatively the presence and the characteristics of periodic leg movements during sleep (PLMS) in a group of consecutive patients presenting with daytime impairment related to insomnia of unknown etiology and whose polysomnographic features differ from those of healthy individuals only for a significantly increased arousal index in NREM sleep.
We recruited 20 consecutive adult patients with insomnia according to the ICSD-2 criteria, 20 patients with RLS, and 12 age-matched normal controls. The time structure of their polysomnographically recorded leg movements during sleep was analyzed by means of an approach particularly able to consider their periodicity.
A subgroup of 12 patients with a relatively high number of periodic LM activity was detected with a statistically based approach using two indexes: total LM index and Periodicity index. This subgroup had high PLMS index, Periodicity index was also high and PLMS showed a progressive decrease during the night, being highest in the first hours of sleep. The characteristics of PLMS were identical within this insomnia subgroup and RLS patients.
PLMS was a common finding in our patients with insomnia and a detailed analysis of their periodicity revealed that a subgroup of these patients had to be finally diagnosed with Periodic Limb Movement Disorder.
Polysomnography with the subsequent analysis of PLMS periodicity is able to differentiate between insomnia patient subgroups.
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
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.
A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative implications). In Study 1, a newly-constructed Anxiety Sensitivity Index (ASI) was shown to have sound psychometric properties for each of two samples of college students. The important finding was that people who tend to endorse one negative implication for anxiety also tend to endorse other negative implications. In Study 2, the ASI was found to be especially associated with agoraphobia and generally associated with anxiety disorders. In Study 3, the ASI explained variance on the Fear Survey Schedule—II that was not explained by either the Taylor Manifest Anxiety Scale or a reliable Anxiety Frequency Checklist. In predicting the development of fears, and possibly other anxiety disorders, it may be more important to know what the person thinks will happen as a result of becoming anxious than how often the person actually experiences anxiety. Implications are discussed for competing views of the ‘fear of fear’.
This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
In order to investigate the impact on breathing, during sleep, of alcohol ingestion and of sleep deprivation, two series of experiments were performed on male subjects with documented obstructive sleep apnea syndrome who had little complaint of excessive daytime somnolence. Four subjects were submitted to one night's sleep deprivation; four others ingested alcohol shortly before normal bedtime hours. In both studies, the apneic index of the patients was increased compared to baseline. There was a general trend toward longer apneic events during sleep and a lowering of blood oxygen saturation secondary to apneic events; both alcohol ingestion and sleep deprivation impair the arousal response normally induced by apneic events, thus increasing the duration of the episodes and the severity of their effect. As alcohol ingestion and moderate sleep deprivation are not uncommon in today's life-styles, the immediate impact of these on the ventilatory response to hypoxia during sleep deserves attention.
Daytime polysomnography (DPG) has been suggested for diagnosis of obstructive sleep apnea syndrome (OSAS), because it is less expensive than whole-night polysomnography investigation (NPG). To ensure sleep during day recordings, patients are often instructed to stay awake the night preceding DPG. This procedure has been validated against NPG, and also against apnea mattress recordings combined with ear oximetry (AMO). Twenty patients with OSAS symptoms were examined with NPG and simultaneous AMO and 2 to 3 weeks later with DPG 3 to 4 h in the morning after 1 nights sleep deprivation. Median apnea-hypopnea index (AHI) of DPG was 37 (95% confidence interval [CI], 19 to 44), significantly higher than median AHI of NPG (14; 95% CI, 12 to 27), whereas median nocturnal oxygen desaturation index (ODI) (11; 95% CI, 9 to 25) did not differ significantly from median AHI of NPG. Sensitivity values for DPG increased from 81 to 100% when the criteria AHI greater than 5, greater than 10, greater than 15, and greater than 20 were used, respectively. Specificity values also increased with the AHI used as cutoff point, from 50% (AHI>5) to 75% (AHI>20). In AMO, there were one false-negative case and four nonclassifiable borderline cases. If these types of simplified tests for OSAS are used for diagnosis, the risk of both false-negative and positive results (DPG) or nonclassifiable borderline cases (AMO) must be considered. Since there was a significant increase in AHI in DPG after sleep deprivation in comparison to conventional NPG, the former procedure should not be used for staging of the disease. These results also stress the importance of advice to OSAS patients concerning regular sleeping habits.
To determine whether subjects with insomnia report greater reductions in quality of life (QoL) than subjects without insomnia when assessed with self-report instruments.
Questionnaires were completed by individuals recruited through media advertisements and screened with a structured telephone interview. Data obtained from 261 individuals with insomnia (INS group) were compared with those of 101 individuals with no sleep complaint, or controls (CTL group).
Subjects in the INS group obtained lower mean sum scores on the Medical Outcomes Study Cognitive Scale than did subjects in the CTL group (25.34 +/- 0.34 vs 31.91 +/- 0.58, t = 9.53, p < 0.0001). The INS group also obtained lower mean scores on all subscales of the SF-36 Questionnaire compared with those in the CTL group (each, p < 0.0001 or lower), indicating impairments across multiple QoL domains. Psychiatric assessment revealed that subjects in the INS group obtained significantly higher mean item scores than subjects in the control group on the Zung Depression Scale (2.22 +/- 0.03 vs. 1.52 +/- 0.03, p < 0.0001) and the Zung Anxiety Scale (1.96 +/- 0.02 vs. 1.40 +/- 0.04, p < 0.0001). In addition, subjects in the INS group reported significantly greater impairments in specific QoL domains on the QoL inventory, and the Work and Daily Activities Inventory. No differences were observed between subjects in the INS group who were receiving treatment for insomnia versus those who were untreated.
The results of this study indicate that significant QoL impairments are associated with insomnia.
Despite many studies, the impact of chronic insomnia on daytime functioning is not well understood. The aim of our study was to detect this impact by evaluating quality of life (QoL) using a validated instrument, the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36), in three matched groups of severe insomniacs, mild insomniacs, and good sleepers selected from the general population.
Three matched groups of 240 severe insomniacs, 422 mild insomniacs, and 391 good sleepers were recruited from the general French population after eliminating those with DSM-IV criteria for anxiety or depression. All subjects were asked to complete the SF-36. Scores for each QoL dimension were calculated and compared statistically among the three groups.
Severe insomniacs had lower QoL scores in eight dimensions of the SF-36 than mild insomniacs and good sleepers. Mild insomniacs had lower scores in the same eight dimensions when compared with good sleepers. No dimension was significantly more altered than the other.
The mental health status and role of emotional QoL dimensions were worse in severe and mild insomniacs than in good sleepers. This result held even though we screened for psychiatric diseases, which shows a clear interrelation between insomnia and emotional state. General health status was also worse in severe and mild insomniacs than in good sleepers. However, we could conclude only that insomnia was related to a worse health status and not whether it was a cause or consequence of this worse health status. Finally, the degradation of QoL scores was correlated with the severity of insomnia.
The objectives of this study were to describe the prevalence of insomnia and depressive symptoms in patients with Parkinson's disease (PD) and to relate those symptoms to health-related quality of life. A total of 102 patients living at home, most of them moderately to severely disabled, were interviewed. Of them 43 patients were women with a mean age of 70 (range 58-79). The mean age for the men was 71 (range 56-80). Time since diagnosis was <2 years for 57%, 2-10 years for 31% and >10 years for 12%. The geriatric depression scale (GDS) and Livingston's insomnia scale were used. The results were related to quality of life as measured with the SF-36 health survey. The prevalence of insomnia was 80%. Moderate depressive symptoms were found in 47% and severe depressive symptoms in 5%. Patients with insomnia or with depressive symptoms had a significantly impaired quality of life on all eight scales of the SF-36. In a stepwise regression analysis the presence of pain and ache and depressive symptoms were significantly related to insomnia. The variables most related to depressive symptoms were Hoehn and Yahr group and insomnia. Hoehn and Yahr groups (more disability) were significantly related to insomnia and depressive symptoms. Thus, insomnia and depressive symptoms are prevalent in PD and influence quality of life and should, therefore, be considered when evaluating patients with PD.
Hyperarousal Scale scores for certain self-reported behaviors reportedly correlate with EEG arousal measures. We tested whether an insomnia subject group had different Hyperarousal Scale scores compared with hypersomnia, delayed sleep phase syndrome, procrastinator or normal subject groups. Compared with 139 normal subjects, mean scores for a group of 256 insomnia subjects was significantly 1.2 S.D. higher on Hyperarousal total scale score, 0.82 S.D. higher on React subscale score and 0.85 S.D. higher on Introspectiveness subscale score. The insomnia group median Extreme score was 2.25 times that of the normal group. These self-report findings suggest that insomnia subjects may be more responsive generally. All sleep disorder groups had increased total Hyperarousal scores, although these increases were accounted for by different scale items. The procrastinator group had Hyperarousal score patterns that generally differed from those of the other groups.
To determine the association between insomnia and health-related quality of life (HRQOL) in patients with chronic illness after accounting for the effects of depression, anxiety, and medical comorbidities.
We used a cross-sectional analysis of Medical Outcomes Study (MOS) data.
The sample consisted of 3445 patients who completed a self-administered questionnaire and who were given a diagnosis of 1 or more of 5 chronic medical and psychiatric conditions by an MOS clinician. Patients were recruited from the offices of clinicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in 3 US cities.
Outcomes were sleep items, health-related quality of life as measured by the Medical Outcomes Study Short Form Health Survey (SF-36), chronic medical comorbidity, depression, and anxiety. Insomnia was defined as the complaint of difficulty initiating or maintaining sleep.
Insomnia was severe in 16% and mild in 34% of study patients. Patients with insomnia demonstrated significant global decrements in HRQOL. Differences between patients with mild insomnia versus no insomnia showed small to medium decrements across SF-36 subscales ranging from 4.1 to 9.3 points (on a scale of 0 to 100); the corresponding decrements for severe insomnia (versus no insomnia) ranged from 12.0 to 23.9 points.
Insomnia is independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression.
Depression and anxiety are associated with substantially reduced health-related quality of life (HRQoL) in healthy and medically ill adults. The authors examined the association between these conditions, as indicated by the use of antidepressant, anxiolytic, or hypnotic medications, and HRQoL parameters in older men and women.
This is a cross-sectional study of white, middle-class, older (median age 75 years) men (n=533) and women (n=826) within a defined community setting. Short Form-36 Health Survey (SF-36) scores were compared between persons currently taking medicine(s) for depression, anxiety, and/or insomnia or none of these.
The chronic physical illness summary score (dichotomized into scores of less than 2 versus 2 or more) was associated with significantly greater odds of perceiving oneself as ill and was also significantly correlated with poorer HRQoL in both men and women. Taking a psychotropic medication for anxiety, depression, or sleep was associated (in men and in women) with significantly greater odds of perceiving oneself as ill, before and after adjusting for age and chronic physical disorder scores. After these adjustments, use of medications remained significantly associated with lower scores on both the Physical and Mental Composite Scales of the SF-36 in women; a similar but nonsignificant association was seen in men.
Among older, community-dwelling adults, anxiety, depression, and insomnia that require pharmacological treatment are associated with reductions in HRQoL that extend beyond the impact of comorbid physical illnesses.