Athens Insomnia Scale Score Research Articles

Associations between nutritional adequacy and insomnia symptoms in Japanese men and women aged 18–69 years: a cross-sectional study

ObjectivesSleep and diet are important lifestyle factors for maintaining health. Although previous studies have suggested that sleep quality may be associated with specific nutrient and food intakes, the relationship between nutritional adequacy and sleep quality remains unclear. The purpose of this study was to examine the relationship between sleep quality (insomnia symptoms) and adequate nutrient intake among Japanese adults. DesignCross-sectional. SettingNationwide population survey conducted in 2013. Participants1,997 participants (940 men and 1,057 women) aged 18–69 years. MeasurementsInsomnia symptoms were assessed using the Athens Insomnia Scale (AIS) and participants were classified into three groups (absent, minor, and moderate-severe) based on the total AIS score. Dietary intake was estimated using a questionnaire and nutrient intake adequacy was evaluated by comparing the self-reported intake with two indices of the Dietary Reference Intakes for Japanese (2015): an estimated average requirement (EAR) and tentative dietary goal for preventing lifestyle-related disease (DG). ResultsA total of 205 men (21.8%) and 266 women (25.2%) were categorized as having moderate-severe insomnia symptoms. Among men, moderate-severe symptoms were associated with higher prevalences of inadequate intakes of total dietary fiber, vitamin C, and zinc. However, there was little association between inadequate nutrient intake and insomnia symptoms among women. The number of inadequate nutrients was significantly associated with insomnia symptoms in men (DG, P=0.004; EAR, P=0.003) but not in women. ConclusionsThis study suggested that insomnia symptoms may be associated with nutritional inadequacy in Japanese adults, especially among men.

Insomnia affects future development of depression in workers: a 6-year cohort study.

ABSTRACTThe purpose of this study was to investigate the relationship between insomnia and future risk of developing depression. This was a 6-year cohort survey from 2011 to 2017. A questionnaire was conducted with male workers in a manufacturing industry. The questions included the Center for Epidemiologic Studies Depression Scale (CES-D) for evaluating depression and the Athens Insomnia Scale (AIS) for rating insomnia. Data from 1,332 daytime workers aged less than 60 years who had no depressive symptoms at baseline were analyzed. The risk of developing depression in the future was associated with insomnia at baseline, after adjusting for age (hazard ratio [HR] 1.64). Even after adjusting for the covariances of job type, living with family, sleeping time, and undergoing treatment or taking medication, insomnia was associated with the onset of future depression (HR 1.58). In addition, the HR increased as the total AIS score increased: total AIS score 1–3 points (HR 1.99; 95% CI 1.23–3.22), 4–5 points (HR 3.58; 95% CI 2.18–5.89), and 6 points and above (HR 4.24; 95% CI 2.49–7.21). The risk of developing depression in the future increased in correlation with greater severity of insomnia at baseline, suggesting that even slight insomnia can be a risk of future developing depression. It may be important to measure the level of insomnia using an indicator such as AIS, and to improve sleep quality in workers to prevent depression.

School-based psychoeducation and storytelling: Associations with long-term mental health in adolescent survivors of the Wenchuan earthquake.

We explored the factors promoting long-term mental health among adolescent survivors of the 2008 Wenchuan earthquake in China. We examined the associations of their long-term mental health with disaster-related storytelling and school-based psychoeducation, and of school-based psychoeducation with disaster-related storytelling. A secondary school-based cross-sectional survey was conducted 6 years after the disaster. Participants with traumatic experiences such as injury, loss, witnessing someone's death/injury and home destruction (N = 1028, mean age 15, standard deviation 1.38, male 51%) were eligible. Mental health/disaster education (MHE/DE) was defined as taking one or more lessons in MHE and/or DE at school since the earthquake. Experiences of storytelling about the disaster involved expressing distressing memories and feelings regarding the earthquake since the disaster happened, according to four groups: never expressed distressing memories and feelings, expressed them through writing/drawing, expressed them through talking to lay supporters and expressed them through talking to health professionals. Analysis of covariance was used to compare mean scores on five selected subscales of the Symptom Checklist-90 (SCL-90), the Athens Insomnia Scale (AIS) and the Psychotic-Like Experiences (PLEs) scale among the four storytelling groups. Linear regression analysis was used to identify the relationships between MHE/DE and current mental health as measured by the SCL-90, AIS and PLEs. The relationship between education and storytelling was probed by χ2 test. The talked-to-lay-supporters group showed better mental health on the SCL-90 (p ⩽ 0.001), AIS (p < 0.001) and PLEs (p = 0.004), while the consulted-health-professionals group showed worse mental health on the three dimensions of the SCL-90: depression (p = 0.05), anxiety (p = 0.02) and fear (p = 0.04), and on PLEs (p = 0.02) compared with the never-expressed group. MHE and DE were inversely associated with SCL-90, AIS and PLE scores. Participants who received these forms of education talked about their disaster experiences to lay supporters more than those who did not. MHE and DE at school may promote adolescents' mental health after a disaster. Experience of storytelling about the disaster to lay supporters may be helpful for long-term psychological recovery, and may be a potential mediating factor for school-based education and better mental health. Because of the cross-sectional nature of this study, causality cannot be inferred; therefore, further prospective intervention studies are needed to elucidate the effect of these factors on adolescent survivors' mental health.

The Effects of Magnesium - Melatonin - Vit B Complex Supplementation in Treatment of Insomnia.

Insomnia means difficulty in falling asleep and/or stays asleep. Insomnia commonly leads to daytime sleepiness, lethargy, and a general feeling of being unwell. The most common treatment of insomnia includes GABAA receptor positive allosteric modulators or Melatonin agonists. Our study aimed to evaluate the efficacy of Magnesium- melatonin-vitamin B complex supplement in the treatment of insomnia. The study included 60 patients diagnosed with insomnia. The patients were randomly divided into study group (N = 30), and control group (N = 30), and study group was treated with Magnesium-melatonin-vitamin B complex (one dose contains 175 mg liposomal magnesium oxide, 10 mg Vit B6, 16 μg vit B12, melatonin 1 mg, Extrafolate-S 600 μg) once a day 1 hour before sleep, during the 3 months. The severity of insomnia symptoms was measured by self-reported Athens insomnia scale (AIS), with a cut-off score by Soldatos (AIS score ≥ 6). Mean AIS score at zero points was 14.93 ± 3.778 in the study group and 14.37 ± 4.081 in the control group (p = 0.476), indicating the compatibility of the groups, and both scores correspond to mild to moderate insomnia. Mean AIS score after 3 months of the Magnesium- melatonin- vitamin B complex supplementation was 10.50 ± 4.21 corresponding to mild insomnia, while median AIS score in the control group was 15.13 ± 3.76 which is referred to moderate insomnia, and difference among groups was significant (p = 0.000). Our founding’s indicating that 3 months of the Magnesium- melatonin-vitamin B complex supplementation has a beneficial effect in the treatment of insomnia regardless of cause.

Efficacy of Polygonatum sibiricum on Mild Insomnia: A Randomized Placebo-Controlled Trial.

Polygonatum sibiricum (PS) rhizome, which contains glyceryl-1-monolinoleate as its primary active component, has been shown to improve insomnia in animal models. Based on these findings, we aimed to investigate the safety and efficacy of PS rhizome extract in improving sleep quality in individuals with mild insomnia. Eighty individuals with mild insomnia were enrolled in a four-week, randomized, double-blind, placebo-controlled trial of PS rhizome extract (500 mg/day, n = 40, PS group) or placebo (n = 40, placebo group). The primary outcome measure was change in total score on the Athens Insomnia Scale (AIS) to indicate sleep quality. The secondary outcome measures included change in actigraphy data and perfusion levels in the brain regions within the default mode network (DMN), which is known to play a key role in insomnia. The PS group showed greater improvement in the total AIS score with a significant increase in total sleep time, relative to the placebo group. In addition, significant group-by-visit interactions were observed in the perfusion level of the medial prefrontal cortex within the DMN. Findings of the current study provide first evidence that PS rhizome extract could be an effective natural ingredient for improving sleep in mild insomnia using a human model.

Effect of insomnia after acute ischemic stroke on cerebrovascular reactivity: a prospective clinical study in China

ObjectiveTo evaluate the effect of insomnia after acute ischemic stroke on cerebrovascular reactivity (CVR). MethodsA total of 158 eligible patients with acute ischemic stroke were enrolled prospectively. Of these, six patients were lost to follow-up, and 152 were included in the final analysis. The patients were divided into the insomnia (N = 24) and non-insomnia (N = 128) groups based on the Athens Insomnia Scale. The insomnia group was further divided into benzodiazepine (BDZ) and non-BDZ treatment groups according to BDZ use status after ischemic stroke. The transcranial doppler ultrasound (TCD) breath-holding test was performed to calculate the breath-holding index (BHI) of the responsible cerebral middle artery, which was used to evaluate CVR. Then, univariate and multivariate linear regression analyses were carried out to determine the effect of insomnia after acute ischemic stroke on CVR. ResultsAt one month after the onset of acute ischemic stroke, TCD-BHI was significantly higher in the non-insomnia group compared with the insomnia group (p = 0.027). In patients with insomnia, TCD-BHI was significantly higher in the BDZ treatment group compared with non-BDZ treatment group (p = 0.039). With age, hypertension, diabetes, hyperlipidemia, long-term smoking, blood homocysteine, and Athens Insomnia Scale score as independent variables, and TCD-BHI at one month after onset as a dependent variable, univariate and multivariate linear regression analyses indicated that the Athens Insomnia Scale score was an independent factor affecting TCD-BHI (regression coefficient, −0.013; 95% confidence interval (CI) −0.024 to −0.003). ConclusionInsomnia after acute ischemic stroke is an independent risk factor for CVR.

The onset of sleep disturbances and their associations with anxiety after acute high-altitude exposure at 3700\u2009m

Sleep disturbances and psychiatric repercussions pose great challenges at high altitude; however, few studies have investigated sleep disturbance and anxiety profiles and their associations after acute exposure in consecutive patients. Thus, we aimed to study the profiles of sleep disturbances in consecutive patients after high-altitude exposure and the association of such disturbances with anxiety. A total of 668 participants were recruited at sea level and 3700 m. The trials were performed at sea level (1 week prior to a 2-h flight to a high-altitude destination) and at 3700 m (24, 72, and 168 h). Sleep disturbances were assessed by self-reported sleep patterns and scores on the Athens Insomnia Scale (AIS). State anxiety was assessed using the Self-Rating Anxiety Scale (SAS). In our study, the incidence of sleep disturbances increased significantly after acute high-altitude exposure (65.3%, 434/668) and then gradually decreased after 72 h (50%, 141/282) and 168 h (44%, 124/282). The sleep assessments AIS [2.0 (4.0) vs. 4.0 (5.0)] and ESS [4.0 (4.0) vs. 5.0 (5.0)] increased significantly (p < 0.05). Also, the SAS increased significantly from 26.25 (3.75) to 28.75 (7.5). The SAS was significantly high in sleep disturbance group [31.25 (7.5) vs. 27.5 (5), p < 0.001] than in the non-sleep- disturbance group. The baseline SAS and AIS scores were significantly higher in participants with sleep disturbances than in those without (p < 0.01). Age, baseline insomnia, sleepiness, fatigue, and higher SAS were predictors of sleep disturbances in univariate regression (all p values < 0.05). However, only an older age (p = 0.045) and a higher baseline SAS (p = 0.018) remained independent predictors of sleep disturbances. Our findings indicated that acute high-altitude exposure triggers the onset of sleep disturbances, which are closely associated with anxiety. Furthermore, baseline state anxiety and age are independent predictors of sleep disturbances at high altitude.

Sleep problems in subacute myelo-optico neuropathy (SMON)

Subacute myelo-optico neuropathy (SMON) patients typically suffer from sequelae that cause sleep disturbances. We sought to examine the prevalence of sleep problems among SMON patients. We conducted a questionnaire-based survey concerning sleep problems among 106 SMON patients, and 110 age- and gender-matched control participants. The prevalence of subjective insomnia (6 ≤ Athens Insomnia Scale score) was 89.6% among SMON patients, which was significantly higher than among control participants 54.4%. Sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) revealed that the prevalence of poor sleepers (6 ≤ PSQI score) was higher among SMON patients than control participants (75.6% vs 39.6%, respectively). Subscale analyses of rapid eye movement sleep behavior disorder screening questionnaire revealed that scores on two items (“dreams match nocturnal behavior” and “limb movements”) were significantly higher among SMON patients than control participants. In addition, daytime sleepiness scores were significantly higher among SMON patients than control participants (4 ≤ Epworth Sleepiness Scale scores: 54.0% vs 29.0%, respectively). The current study revealed that most SMON patients suffer from insomnia with dissatisfactory sleep quality, likely due to their long-term physical sequelae. Moreover, SMON patients showed higher rates of daytime sleepiness and sleep medication intake, which could be related to reduced activity during the day, as well as insomnia.

The Effect of Auricular Plaster Therapy on Insomnia in Patients with Rheumatoid Arthritis.

Objective: This research was conducted to observe the effects of auricular plaster therapy on insomnia in patients with rheumatoid arthritis (RA). Materials and Methods: This study involved 76 patients with insomnia caused by RA, who were admitted to Foshan Chancheng Central Hospital-in Foshan, Guangdong, China-from August 2017 to August 2018. The patients were randomized, with 38 to the intervention group and another 38 to the control group. The intervention group was treated with auricular plaster therapy with beans, while the control group was treated with estazolam orally before going to bed. Curative effects were compared between the 2 groups. The Pittsburgh Sleep Quality Index scale (PSQI) and the Athens Insomnia Scale (AIS) were used to assess and evaluate the sleep quality of patients. Result: Scores of the PSQI dimensions all fell in both groups after treatment. Scores for sleep quality, sleep latency, sleep efficiency, sleep disorder, and daytime dysfunction in the observation group were lower than those in the control group (P < 0.05). AIS scores in all dimensions decreased in both groups, and, after treatment, scores and total points of sleep latency, night-time revival, overall sleep quality, and the dimensionality of daytime body function in the intervention group were lower than those in the control group (P < 0.05). Conclusions: Auricular plaster therapy has a marked effect on insomnia in patients with RA, and the therapy is easy and simple to apply.

The relationship between sleep disturbances and quality of life in elderly patients with hypertension.

PurposeSleep disorders, such as insomnia with objective short sleep duration, are associated with increased risk of hypertension. The objective of the study was to evaluate the effects of insomnia and daytime sleepiness on the quality of life (QOL) among elderly hypertensive patients.Patients and methodsThis cross-sectional study covered 100 patients with hypertension. All participants completed standardized questionnaires, such as the Epworth Sleepiness Scale (ESS), the Athens Insomnia Scale (AIS), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF), and clinical data were obtained from patients’ medical records.ResultsWe showed that more than half of the patients experienced insomnia (AIS score ≥6) and 39% experienced daytime sleepiness. Daytime sleepiness was negatively associated with perceived QOL (r=−0.478, P<0.001). It was also shown that insomnia might be influenced by older age (P<0.001), occupational activity (P=0.011), overweight (body mass index [BMI] 25–30) (P=0.042), and longer duration of illness (P=0.049) among hypertensive patients.ConclusionSleep problems have a significant negative impact on the QOL in patients with hypertension, especially in the physical domain of the QOL questionnaire. The occurrence of sleep problems in patients with hypertension is influenced by older age, primary education, overweight, occupational activity, and longer duration of illness.

Effect of Fast Shift Rotation and Slow Shift Rotation on the Nurses&amp;apos; Fatigue and Sleep Quality

Objective: The objective of this study was to investigate whether the three-shift fast rotation, two-shift fast rotation and night-shift slow rotation led to any differences in fatigue and sleep quality. Method: The study was conducted as a before–after study and 17 nurses participated in the study. Nurses on three-shift fast rotation were allocated to the pre-group, and two-shift fast rotation and night-shift slow rotation were allocated to the post-group. In the study period, all of the subjects experienced the three patterns of rotation. Occupational Fatigue Exhaustion/Recovery Scale (OFER15) and Athens Insomnia Scale were used to measure the participants’ work-related fatigue and sleep quality three times. Results: Athens Insomnia Scale scores showed significant differences between the three types of shift rotation; two-shift fast rotation was 3.88±2.35, three-shift fast rotation was 8.63 ± 3.50, and night-shift slow rotation was 13.75 ± 4.23 (P < 0.05). Therefore, the nurses’ sleep quality through working on the two-shift rotation was better than the other two types of rotation. However, there were no significant differences in chronic fatigue, acute fatigue, and inter-shift [recovery] between the three types of rotations. Conclusion: Nurses who worked on the two-shift fast rotation had a better sleep quality than those who worked on the three-shift fast rotation and night-shift rotations. As sleep quality relates to the performance and alertness of nurses, greater attention should be paid to the use of different shift combinations to increase sleep quality and alertness. Considering sleep quality, a three-shift system arranged by two-shift fast rotation and combined with night-shift slow rotation is superior to the three-shift fast rotation.

Is dietary melatonin supplementation a viable adjunctive therapy for chronic periodontitis?—A randomized controlled clinical trial

Melatonin is synthesized naturally by pineal gland and responsible for regulation of sleep/waking cycle. It showed appreciated anti-inflammatory and antioxidant properties. The aim of this randomized clinical trial (RCT) was to assess the additive effect of melatonin supplementation in insomniac individuals with generalized chronic periodontitis (gCP) after scaling and root planing (SRP). Seventy-four gCP patients with primary insomnia participated in this 6-month RCT and randomized into two groups. Melatonin group included 38 patients who were subjected to SRP with a 2-month regimen of 10mg oral melatonin capsule once daily before bedtime. In the control group, SRP was performed for 36 participants provided with matching placebo capsules. The primary treatment outcome was the measurement of clinical attachment level gain (CAL gain) after 3 and 6months of therapy, whereas the measurements of pocket depth reduction (PD reduction), bleeding on probing (BOP %), and the changes in salivary TNF-α levels and Athens insomnia scale (AIS) scores represented the secondary endpoints. Melatonin group showed significantly greater CAL gain and PD reduction measurements compared to the control group at 3 and 6months of therapy, P<0.01. Likewise, salivary TNF-α levels and AIS scores were significantly lower in the melatonin group compared to placebo group. BOP% improved significantly in both groups without any difference. However, salivary TNF-α levels exhibited no correlation with other clinical variables in both melatonin and placebo groups. Daily dietary 10mg of melatonin supplementation might serve as a viable adjunct to SRP that yielded significantly greater CAL gain and PD reduction and lower salivary TNF-α levels and AIS scores in gCP patients with primary insomnia.

Effects of cognitive behavioral therapy for depression on improving insomnia and quality of life in Chinese women with breast cancer: results of a randomized, controlled, multicenter trial.

PurposeCognitive behavioral therapy (CBT) for depression had been found to be effective in reducing depressive and anxiety symptoms in breast cancer survivors. It is not known whether CBT for depression would also improve insomnia and quality of life (QOL). The aim of this study was to investigate whether CBT for depression would improve insomnia and QOL in a randomized controlled multicenter trial.Patients and methodsIn this study, breast cancer survivors (n=392) were randomly allocated to the following three groups: CBT (n=98), self-care management (SCM, n=98), and usual care (UC, n=196) in a ratio of 1:1:2. CBT and SCM received a series of nine sessions for 12 weeks, whereas UC received UC only. Insomnia and QOL were evaluated using Athens Insomnia Scale (AIS) and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire at baseline, 4, 12, and 24 weeks.ResultsThere was a significant intergroup difference in AIS and FACT-B scores (both P<0.01). CBT showed less insomnia problems and better overall QOL compared with those in SCM and UC (both P<0.01). No significant differences were found between SCM and UC in insomnia problems and overall QOL. Moreover, the effects of CBT on insomnia and QOL were maintained during the follow-up period.ConclusionCBT for depression can be effective in improving insomnia problems and QOL in the Chinese breast cancer survivors.

Prevalence and socio-economic correlates of insomnia among older people in Anhui, China.

To measure the prevalence of insomnia and identify the socio-economic correlates of insomnia among older people of Anhui Province of China. A cross-sectional study was conducted among 3045 randomly selected consenting residents aged 60 and older from Anhui Province during 2013. Insomnia was assessed using the Athens Insomnia Scale (AIS). Data collected included: (i) demographics; (ii) socio-economic status; (iii) social support; (iv) social contact; and (v) social capital. Overall, 24% were found to have insomnia and 9% were found to have suspected insomnia according to the AIS score. After adjusting for potential confounders, participants having no fixed income, less social contact, less social capital and living alone were more likely to suffer from insomnia. A high prevalence of insomnia was found among older people in Anhui Province of China. Socio-economic determinants should be addressed in devising policies aimed at improving sleep quality for older people in this region.

Insomnia and depressive symptoms in relation to unhealthy eating behaviors in bariatric surgery candidates

BackgroundAlongside obesity, insomnia and depression are common public health problems. Sleep problems are currently believed to be associated with excessive food intake and metabolic disturbances. Therefore, we aimed to explore a relationship between insomnia, depressive symptoms and eating habits as well as metabolic parameters in bariatric surgery candidates.MethodsA total of 361 unrelated obese subjects were included in this study. Severity of sleep problems was measured with Athens Insomnia Scale (AIS) and the severity of depressive symptoms was assessed with the Beck Depression Inventory (BDI-II). Obstructive sleep apnea (OSA) was assessed by the Apnea Hypopnoea Index (AHI). Information was obtained about demographics, eating habits and lifestyle. Blood samples were collected to measure concentration of lipids (cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol), and glucose.ResultsThe median (interquartile range) score for AIS in the study participants was 5 (3–8) with a range of 0–24 and 47% (171) participants scored ≥6 (met criteria for diagnosis of insomnia). Statistically significant correlations were found between the AIS scores and serum triglycerides and glucose concentrations, and BDI-II total scores. The highest scores on AIS and BDI-II were found in participants with high frequency of snack food consumption, in physically inactive individuals as well as in those who self-reported eating at night or who declared more than 3 intense emotions associated with a desire-to-eat. Adjusted multivariate logistic regression analysis revealed that clinical insomnia was most strongly associated with daily consumption of snack foods, with the odds ratio of 3.26 (95% CI: 1.74–6.11), while depressive symptoms were strongly associated with both eating in response to ≥3 specific emotions with OR = 2.93 (95% CI: 1.26–6.78) as well as with daily consumption of snack foods with OR = 2.87 (95% CI: 1.16–5.14).ConclusionsThe results indicate that insomnia and depression in obese individuals are associated with eating habits, and suggest that in some patients these associations appears as major factors affecting obesity development.

The Correlation of Serum Total Testosterone, Sex Hormone Binding Globulin and Free Androgen Index with Athens Insomnia Scale Score in Polycystic Ovary Syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS), a common reproductive endocrinologic disorder in woman, was considered to be related to sleep disturbance. This study is aimed to analyze the correlation between excess androgen markers and Athens Insomnia Scale (AIS) in PCOS.METHODS: This observational, cross-sectional study of PCOS was conducted to 31 subjects to evaluate the correlation between serum total testosterone, sex hormone binding globulin (SHBG) and free androgen index with the incidence of sleep disturbance using AIS. Sleep disturbance was present if the score ≥6. The correlation between excess androgen markers and sleep disturbance was analyzed using Pearson’s coefficient of correlation or Spearman’s rho test. Correlation coefficient more than 0.5 with p&lt;0.05 was considered significant.RESULTS: Out of 31 PCOS subjects aged 20-40 years, 39% subjects had AIS score ≥6. Mean serum testosterone in AIS score &gt;6 group was higher than AIS score &lt;6 group but not statistically significant (46.68 vs. 28.49 ng/mL, p&gt;0.05). No significant correlation was found between serum total testosterone, SHBG and free androgen index with AIS score. After adjusting for AIS score, there was the moderate positive correlation between serum total testosterone level although not statistically significant (r=0.54, p=0.07).CONCLUSION: The serum total testosterone level might influence the occurrence of sleep disturbance in PCOS.KEYWORDS: PCOS, androgen excess, testosterone, sleep disturbance, Athens Insomnia Scale

Reliability and validity of the Athens Insomnia Scale in chronic pain patients.

PurposeTo confirm the psychometric properties of the Athens Insomnia Scale (AIS) among Japanese chronic pain patients.Patients and methodsIn total, 144 outpatients were asked to complete questionnaires comprising the AIS and other study measures. According to the original article, the AIS has 2 versions: the AIS-8 (full version) and the AIS-5 (brief version). To validate the AIS-8 and AIS-5 among chronic pain patients, we confirmed: 1) factor structure by confirmatory factor analysis; 2) internal consistency by Cronbach’s a; 3) test–retest reliability using with interclass correlation coefficients; 4) known-group validity; 5) concurrent validity; and 6) cut-off values by receiver operating characteristic analysis. In addition, semi-structured interviews were conducted to assess the participants’ sleep disturbance. If the participants had any sleep complaints, including difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening, they were defined as insomnia symptoms.ResultsA 2-factor model of the AIS-8 and 1-factor model of the AIS-5 demonstrated good fit. The AIS had adequate internal consistency and test–retest reliability. Patients with insomnia had a higher AIS score than those without insomnia. The sleep disturbance measured by the AIS was positively associated with pain intensity, disability, depression, anxiety, and pain catastrophizing, and negatively associated with pain-related self-efficacy. The cut-off values for detecting insomnia were estimated at 8 points in the AIS-8 and 4 points in the AIS-5.ConclusionThe AIS-8 and AIS-5 had adequate reliability and validity in chronic pain patients.

Occurrence of insomnia among patients with diagnosed obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common problem. Excessive daytime sleepiness raises a suspicion of OSA, which can be confirmed by polysomnography (PSG). Insomnia, in patients with OSA, often manifests itself as excessive daytime drowsiness. The incidence of insomnia among patients with OSA differs in different studies. Thus, we investigated the incidence of insomnia among our patients. We included 120 patients who underwent a workup due to a suspicion of OSA in the Polysomnography Laboratory, Department of Otolaryngology, Medical University of Warsaw, Poland. Patients completed the Athens Insomnia Scale (AIS). All-night PSG was done with 14-channel recordings (Grass®, USA). The severity of OSA was classified according to the apnea-hypopnea index (AHI) values. There were 96 patients with OSA and 24 patients without OSA who served as controls (their sleep disorders and daytime drowsiness were not caused by OSA). The total AIS scores tended to indicate insomnia in the entire sample and in all different subgroups. The mean AIS score was significantly different between the subgroups differing in the severity of apnea. The mean AIS score correlated significantly with sleep latency, latent sleep, and N2 latency. The mean AIS score did not correlate significantly with the AHI. In conclusion, in patients with OSA, insomnia, measured with the AIS, was associated with the severity of apnea, although this relationship was weak.

Influence of Itch and Pain on Sleep Quality in Patients with Hidradenitis Suppurativa.

There is a lack of data evaluating the influence of hidradenitis suppurativa-related subjective symptoms on sleep quality. The aim of this study was to assess the influence of itch and pain on sleep quality in 108 patients with hidradenitis suppurativa compared with 50 controls. The Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate a spectrum of sleep disturbances. Mean ± standard deviation AIS and PSQI scores among patients with hidradenitis suppurativa vs. controls were assessed as 5.4 ± 4.3 vs. 5.5 ± 3.4 and 6.5 ± 3.6 vs. 3.1 ± 1.9 points, respectively. The presence of both itch and pain had a significant impact on the frequency of insomnia. Pain was a crucial factor responsible for poor sleep quality among patients with hidradenitis suppurativa; its presence significantly affected subjective sleep quality, sleep duration and daytime dysfunction. Itch and pain have an important impact on insomnia and sleep quality in patients with hidradenitis suppurativa.

Factors associated with insomnia in pregnancy: A prospective Cohort Study

ObjectiveTo quantify insomnia and their components in a longitudinal cohort of pregnant women and factors associated with insomnia. Study designA prospective cohort of 486 healthy singleton pregnancies assembled before the 14th gestational week (February 2013 to March 2016). Insomnia data were collected pre-gestationally, in each trimester and six months post-partum, analysing five different moments. Multiple logistic regression analysis was performed to generate adjusted Odds Ratios (aOR) with 95% confidence intervals (CI) of determinants of insomnia in each trimester, defined using Athens Insomnia Scale (AIS) as score ≥8. ResultsInsomnia prevalence was 6.1% (3.9–8.9) pre-gestational, 44.2% (39.3–49.6) in first trimester (T1), 46.3% (41.9–51.3) in second (T2) and 63.7% (57.7–67.8) in third trimester (T3). Post-gestational insomnia was 33.2% (28.2–37.9) (p < 0.001 pre-gestational vs T1, T2 vs T3 and T3 vs after pregnancy). There was worsening mean AIS score, from: 2.34 before pregnancy to 9.87 in T3 because the deterioration of nighttime sleep, in absolute terms, but daytime impact was higher in T1. Previous trimester insomnia was associated with insomnia in T2 (aOR = 4.21, 95% CI 2.78–6.37) and T3 (aOR = 4.43, 95% CI 2.77–7.08). Pre-gestational insomnia was determinant of insomnia in T1 (aOR 12.50, 95% CI 3.58–43.60) and obesity was associated with insomnia in T3 (aOR = 2.30, 95% CI 0.99–5.32). On the contrary, moderate physical activity reduced the odds of insomnia in T3 (aOR 0.65, 95% CI 0.40–1.03). ConclusionsInsomnia prevalence was high from the beginning of pregnancy, associated with pre-gestational insomnia. In late pregnancy, two out of three pregnant women suffering insomnia. Insomnia prevention should be targeted particularly to those with high body mass index and pre-gestational insomnia.