Causes Of Sleep Disturbance Research Articles

Relationships between Nocturia, Obstructive Sleep Apnea, and Quality of Sleep

Background and ObjectiveaaNocturia is one of the common causes of sleep disturbance in adults, often associated with obstructive sleep apnea (OSA). The purpose of this study was to investigate the association between nocturia and OSA, and their effects on quality of sleep in adults. MethodsaaThis study included 107 patients who visited the urology outpatient due to lower urinary tract symptoms with or without sleep-related symptoms, assessed by using either the International Prostate Symptom Score in men or the Overactive Bladder symptoms in women. Based on these questionnaires, subjects were divided into nocturia and nocturia-free groups. In addition, all subjects completed detailed sleep questionnaires including the Global Sleep Assessment Questionnaire (GSAQ) and the Berlin Questionnaire (BQ), and provided details of voiding volumes and times. Night polysomnography (PSG) was performed in subjects with high risk of OSA, as indicated by the BQ. ResultsaaAmong the 107 study subjects (43 males, 64 females, mean age 59.2 ± 11.2 years), nocturia was present in 54.2% (58/107), self-reported sleep disturbance in 26.2% (28/107), and a high risk of OSA, with BQ > 10 points, was present in 29.0% (31/107) of subjects. The nocturia group had a significantly higher mean GSAQ total score than the nocturia-free group, indicating poorer sleep quality (p = 0.004). Nocturia was more frequent in patients with moderate or severe OSA than in patients with mild OSA (p = 0.006) based on PSG. ConclusionsaaNocturia was a clinically significant sleep disturbing factor, and it was more frequent in patients with more severe OSA. Sleep Med Res 2015;6(1):28-34

Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review.

Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients’ sleep.

Sleep in Women: A Review

Sleep complaints are common in women, and women are more likely to suffer from insomnia than men. Multiple factors across a woman's lifespan, including hormonal changes, age‐related physiological changes, psychosocial factors, the presence of sleep disorders, and physical and mental health conditions, can contribute to complaints of poor sleep in women. This article reviews the literature on the characteristics of, and contributing factors to, subjectively and objectively measured sleep during the menstrual cycle, pregnancy, and post‐partum period, as well as the menopausal transition and postmenopause. Evidence from both subjective and objective measurements supports the presence of chronic sleep fragmentation associated with pregnancy, acute sleep deprivation during labour and the immediate post‐partum periods, as well as disrupted sleep during the first few months after childbirth. While there is evidence for menstrual cycle and menopause related sleep disturbance based on women's self report, findings from objectively measured sleep have been mixed. Observational and intervention studies on the relationship between sleep and women's psychological well‐being suggest that underlying causes of sleep disturbance across a woman's lifespan are often multi‐factorial. Comprehensive assessments and targeted interventions are needed in managing sleep problems in women. Cognitive behavioural interventions have been shown to reduce sleep complaints during the perinatal and menopausal periods, and improvements in sleep are likely to lead to improvements in women's overall well‐being.

Children with cerebral palsy: why are they awake at night? A pilot study.

The purpose of this study was to assess acceptability of study design and utility of assessment tools for determining causes of sleep disturbance in children with cerebral palsy (CP) and their caregivers. This pilot study explored parental report (n = 8) of the child's sleep using a validated sleep questionnaire, a survey, and a time use diary. The selected tools were appropriate. Study design provided challenges for recruitment. Future research should include qualitative data. Although further research is required to confirm results, sleep problems for children with CP and resulting sleep disturbances for caregivers may be an important part of clinical assessment.

Environmental noise and sleep disturbances: A threat to health?

Environmental noise, especially that caused by transportation means, is viewed as a significant cause of sleep disturbances. Poor sleep causes endocrine and metabolic measurable perturbations and is associated with a number of cardiometabolic, psychiatric and social negative outcomes both in adults and children. Nocturnal environmental noise also provokes measurable biological changes in the form of a stress response, and clearly affects sleep architecture, as well as subjective sleep quality. These sleep perturbations are similar in their nature to those observed in endogenous sleep disorders. Apart from these measurable effects and the subjective feeling of disturbed sleep, people who struggle with nocturnal environmental noise often also suffer the next day from daytime sleepiness and tiredness, annoyance, mood changes as well as decreased well-being and cognitive performance. But there is also emerging evidence that these short-term effects of environmental noise, particularly when the exposure is nocturnal, may be followed by long-term adverse cardiometabolic outcomes. Nocturnal environmental noise may be the most worrying form of noise pollution in terms of its health consequences because of its synergistic direct and indirect (through sleep disturbances acting as a mediator) influence on biological systems. Duration and quality of sleep should thus be regarded as risk factors or markers significantly influenced by the environment and possibly amenable to modification through both education and counseling as well as through measures of public health. One of the means that should be proposed is avoidance at all costs of sleep disruptions caused by environmental noise.

Sleep disorders in asthma and chronic obstructive pulmonary disease (COPD)

Sleep disturbances (SD) are a frequent finding in patients with asthma and chronic obstructive pulmonary disease (COPD) and have a negative impact on quality of life and the clinical course of the disease. The causes of SD are multiple and include for example respiratory symptoms and comorbidities. On the other hand sleep goes along with multiple physiological changes in respiration, so that sleep itself interacts with asthma and COPD. This interaction favors respiratory symptoms and may lead to hypoxemia and hypercapnia. A further complication of the respiratory situation and the clinical course can be found in asthma and COPD patients with coexisting obstructive sleep apnea syndrome (OSAS). Due to the heterogeneity of SD in asthma and COPD, a detailed patient survey is the most important diagnostical tool. Based on the survey further technical examinations should be considered. Treatment strategies for the reduction of SD in asthma and COPD include an optimized medication and treatment of comorbidities. If indicated oxygen therapy, positive pressure breathing and pulmonary rehabilitation can contribute.

Sleep Disturbances During the Menopausal Transition

Sleep plays a central role in women's health, and sleep disturbances can significantly affect quality of life, worsen the prognosis of medical comorbidities, and increase risk for mood and anxiety disorders. Fragmented sleep is twice as prevalent in women as in men, regardless of age.1 Moreover, epidemiologic surveys have suggested that prevalence of perceived sleep disturbances rises from 12% to 40% during the age interval coinciding with the menopausal transition.2 In this overview of common causes of sleep disturbance, we discuss several etiologic factors and therapeutic interventions for disrupted sleep in women as they cope with the menopausal transition. Causative and Correlative Factors The etiology of sleep disturbances during the menopausal transition is complex; therefore, organizing the potential causative factors into clinically useful categories may be helpful. Hormonal Flux Decreases in estradiol and increases in follicle-stimulating hormone, progesterone, and testosterone across the menopausal transition have been correlated with sleep difficulties during this midlife stage.3 Hot Flashes Several epidemiologic studies have shown associations between hot flashes and perceived sleep disturbances such as frequent awakenings and lack of restorative sleep,3 and polysomnography studies have confirmed that hot flashes result in an increase in objectively measured awakenings and time spent awake after sleep onset.4 Medical Factors Medical conditions: Several clinical conditions (some more widespread during midlife) adversely affect sleep; these …

Sleep disturbance in Parkinson's disease

Many patients with Parkinson's disease (PD) complain about sleep disturbances. These symptoms originate from motor symptoms, nocturnal problems, psychiatric symptoms, and other sleep disorders including Excessive daytime sleepiness (EDS), REM sleep behavior disorder (RBD), Restless legs syndrome (RLS), and Sleep apnea syndrome (SAS). Especially, RBD is paid attention to prodromal symptoms of PD. Also, one third of patients with PD have RBD symptoms. Moreover, RBD is one of aggravating factors of motor symptoms, autonomic dysfunctions, and dementia. Now, the evidence based medicine for sleep disturbances is lack in patients with PD. We need to evaluate various causes of sleep disturbances in detail and deal with individuals.

Nocturia among elderly men living in a rural area in Egypt, and its impact on sleep quality and health‐related quality of life

Nocturia is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. The aim of the present study was to evaluate the prevalence of nocturia among elderly men living in a rural area in Egypt, and its impact on sleep quality and health-related quality of life (HRQoL). This was a cross-sectional study. A total of 1200 elderly men participated in the survey. The Pittsburgh Sleep Quality Index (PSQI) Arabic version and the short form-36 (SF-36) were used in this survey. The prevalence of nocturia in the studied participants (≥ 1 void/night) was 63.5%. With the criterion (≥ 2 voids/night) the prevalence was 46.0%. Multivariate logistic regression analysis showed that nocturia is an independent risk factor of poor sleep quality (OR 5.08), and poor sleep is an independent risk factor of the poor physical component of QoL (OR 17.6) and the mental component of QoL (OR 3.2). Nocturia is widely prevalent among elderly men living in a rural area in Egypt. The adverse effect of nocturia on QoL is related to poor sleep.

No snooze button on treating sleep disorders

[thereby] treating the patient’s whole well-being just like [the recommendations for] nutrition and exercise.” Many of the advances of modern life contribute to the different sleep problems clinicians fi nd in an estimated 30% to 40% of Americans. Air travel, shift work, smartphones buzzing and vibrating in the night, television and the internet—all contribute to insomnia, hypersomnia (sleeping during the day), parasomnia (disruptive sleep), circadian rhythm disturbances, narcolepsy, or sleep apnea. One-half of patients have chronic sleep disturbance. For people who sleep for far less than 8 hours each night or who have jobs or lifestyles that require them to sleep during the day, physiologic or psychological problems may ensue eventually in the form of fatigue, headache, irritability, inattentiveness, or narcolepsy. More serious health problems can also develop, including hypertension and other cardiovascular disorders.

Restless leg syndrome is a treatable cause of sleep disturbance and fatigue in primary biliary cirrhosis

Primary biliary cirrhosis (PBC) patients frequently describe sleep problems. The cause remains unclear and treatment is challenging. Restless leg syndrome (RLS) is a common sleep disorder. In this study, we systematically screened PBC patients for the presence of RLS. Participants were recruited from our specialist PBC clinical service. Subjects completed the International Restless Leg Syndrome Study Group rating scale (IRLSS) a validated measure of the presence of RLS and its severity. Those fulfilling diagnostic criteria for RLS underwent foot actigraphy (CamNtech Actiwatch) to objectively assess periodic limb movement index (PLMI) (normal <5/h). Restless leg syndrome was assessed in 42 consecutive early stage PBC patients. Twelve (29%) fulfilled the IRLSS criteria for RLS. Scores were significantly higher in PBC compared to controls (P = 0.005). Twenty-four patients were further assessed with foot actigraphy for 3 nights (12 with subjective RLS symptoms and 12 with no RLS symptoms). Thirteen of twenty-four subjects had PLMI >5/h and four had moderate or severe PLMI >15/h. All moderate or severe PLMI subjects had subjective symptoms of moderate or severe RLS. No patients had PLMI >10 in the absence of RLS symptoms. Eleven PBC patients with symptomatic RLS went on to have treatment. Sixty-three per cent had clear benefit in restless leg symptoms and associated symptoms of fatigue. Restless leg syndrome symptoms are common and underdiagnosed in PBC patients. RLS represents a potential therapy for PBC patients with daytime sleepiness, fatigue and unpleasant lower limb symptoms and this is worthy of further studies in larger cohorts.

Nocturia: Impact on quality of life in an Egyptian adult population

OBJECTIVE: To estimate the effects of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems. Background: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. Methods: The current study was carried out to assess the prevalence of nocturia in elderly males and its impact on sleep quality and QoL. The study enrolled 200 elderly males aged 60 years old and above. All participants were recruited from geriatric clubs in Cairo. All participants in the study were subjected to: comprehensive geriatric assessment, American Urological Association (AUA) score used to measure the severity of nocturia ,assessment of sleep quality using Pittsburgh Sleep Quality Index (PSQI) and assessment of QoL using “SF-12 Short Form Health Survey”. Results: The study showed that the prevalence of nocturia in elderly males aged ≥60 years old was 68% with significant association between nocturia and diabetes mellitus, heart failure, stroke, prostatism, recurrent UTI and diuretic use. As regard sleep quality, the current study showed that the prevalence of poor sleep in the studied subjects is 70.5% with significant association between nocturia and poor sleep quality. Nocturia significantly affects sleep latency, sleep efficiency and daytime dysfunction, high significantly affecting sleep disturbance. Also diabetes mellitus, ischemic heart disease, heart failure, prostatism, recurrent UTI, osteoarthritis and diuretic use are significantly associated with poor sleep quality. As regard quality of life, the current study showed significant association between nocturia and physical and mental health components of HRQL in the univariate analysis. But after multivariate analysis, nocturia is not an independent risk factor for poor quality of life. Nocturia affects QoL through its effect on sleep quality which is an independent risk factor for poor physical and mental health components of QoL. Conclusion: Nocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients’ who contact them for sleep problems also have nocturia.

Primary sleep disorders can cause long-term sleep disturbance in patients with autoimmune mediated limbic encephalitis

ObjectivesAntibody mediated limbic encephalitis causes a sub acute encephalopathy with an amnestic syndrome, seizures and often an affective prodrome. Sleep disturbance including abnormal dream sleep and insomnia are described in a percentage of long-term survivors but there are very few detailed assessments of sleep disturbance in patients beyond the acute phase of illness. The objectives of this study were to understand the causes of sleep disturbance in the long-term survivors of antibody mediated limbic encephalitis. Patients and methodsWe screened twelve patients under long-term follow up with sleep questionnaires and went on to perform detailed sleep studies (polysomnography) in those who reported sleep disturbance. ResultsTwo were found to have persistent, severe central and obstructive sleep apnoea and two others to have restless legs and periodic limb movements of sleep. ConclusionsThis highlights the need to investigate sleep disturbance in this group of patients. Effective treatments may be available to improve quality of life and daytime function.

Sleep disturbance at altitude

The aim is to describe the impact of altitude upon sleep, the physiology that underpins these changes and the therapeutic solutions that are currently in place. On ascending to altitude, lowland residents commonly experience some degree of sleep disturbance. Occasionally, this can prove very uncomfortable and impact upon daytime activities. Historically, the underlying cause of sleep disturbance was thought to be due to the effect of periodic breathing. However, recent research has shown that the link between periodic breathing, lighter stages of sleep and arousals is far from convincing. Instead, it appears that hypoxia has a far wider effect upon sleep at altitude than was previously thought. A number of new approaches to the treatment of sleep disturbance at altitude have recently been identified. Whereas some treat the underlying hypoxia through pharmacological or technological means, others seek to address the symptoms of sleep disturbance more directly. Many of the current approaches to treating sleep disturbance at altitude have been shown to be well tolerated and successful, although few comparisons have been made. Future research is likely to focus upon matching the safest and most successful approach to the individual and their environment.

Sleep and allergic disease: A summary of the literature and future directions for research

Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. Asummary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research.

Nighttime Activity in Individuals with Dementia: Understanding the Problem and Identifying Solutions

Sleep disturbances may occur in more than 50% of individuals with dementia, and nighttime activity can lead to unsafe situations and serious consequences for both the person and his or her caregivers. Nighttime awakenings expose individuals with dementia to two major dangers: falls and unattended home exits. This article is a review of the current research on the causes of sleep disturbances and interventions for nighttime activity in individuals with dementia living at home.

Characteristics of Sleep Disturbance in Patients with Carpal Tunnel Syndrome

Sleep disturbance is common in carpal tunnel syndrome (CTS), and we hypothesize that it has an important impact on the quality of life of CTS patients. The characteristic of sleep problems associated with CTS has not been evaluated. We performed a case-control study to measure the association between a variety of sleep disturbances and CTS. Sixty-two cases with clinically diagnosed CTS and a probable or classic hand diagram were compared to 138 primary care patients without CTS. In addition to demographic features, we collected the nature of sleep disturbance experienced by the patients from a categorical list and the nature, impact, and severity of sleep disturbance using the Insomnia Severity Index. Patients with CTS complained of significantly more severe problems with sleep than the control population and had multiple sleep complaints compared to the control group. Sixty-three of the 138 control patients indicated that they had one cause of sleeping disturbance with no control patient choosing more than one. In contrast, in CTS patients, 44 of 63 patients indicated they had two or more causes of sleep disturbance. The Insomnia Severity Index was significantly higher in CTS patients and the impact of sleep disturbance on quality of life was higher in the cases. Sleep disturbance in CTS patients is characterized by a broad array of physical symptoms that have a significant impact on quality of life.

Sleep Disturbances Associated with Parkinson's Disease

Sleep disturbances are common problems affecting the quality life of Parkinson's disease (PD) patients and are often underestimated. The causes of sleep disturbances are multifactorial and include nocturnal motor disturbances, nocturia, depressive symptoms, and medication use. Comorbidity of PD with sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, or circadian cycle disruption also results in impaired sleep. In addition, the involvement of serotoninergic, noradrenergic, and cholinergic neurons in the brainstem as a disease-related change contributes to impaired sleep structures. Excessive daytime sleepiness is not only secondary to nocturnal disturbances or dopaminergic medication but may also be due to independent mechanisms related to impairments in ascending arousal system and the orexin system. Notably, several recent lines of evidence suggest a strong link between rapid eye movement sleep behavior disorder and the risk of neurodegenerative diseases such as PD. In the present paper, we review the current literature concerning sleep disorders in PD.

The Efficacy and Safety of Long-Term Use of Hypnotics

Received November 30, 2010 Revised December 13, 2010 Accepted December 13, 2010 Address for correspondence Kwang Ik Yang, MD Department of Neurology, College of Medicine, Soonchunhyang University, Cheonan Hospital, 23-20 Bongmyeong-dong, Cheonan 330-721, Korea Tel: +82-41-570-2290 Fax: +82-41-579-9021 E-mail: kiyang@sch.ac.kr Insomnia may present with a variety of complaint and etiology, making the evaluation and management of chronic insomnia demanding on a clinician’s time. Long-term use of hypnotics and sedatives has been discouraged for a number of reasons, including tolerance, abuse liability, and the belief that insomnia is a symptom that remit with treatment of the underlying medical or psychiatric disorder. Moreover, pharmacotherapy produces only moderate improvement during drug administration and returns toward baseline after discontinuation. Although efficacy and safety have been established for benzodiazepine receptor agonists when used for short-duration therapy, there are few data that establish their continued efficacy and safety in long-term use. Benzodiazepine hypnotics have been implicated as a cause of numerous adverse events, including dependency, withdrawal, rebound symptom, daytime sedation, fall, and hip fracture, especially in older people. In order to use hypnotic properly, correct diagnosis of the underlying causes of sleep disturbance is acquired at first and extreme caution of hypnotics use to primary sleep disorders is needed, especially in sleep related breathing disorders. Physicians and patients should be cautioned about the potential adverse effects and using of hypnotics. After initial treatment, clinical efficacy and side effect should be observed regularly. Easy accessibility of cognitive behavior therapy for patient can be also a coping with long-term use of hypnotics. J Korean Sleep Res Soc 2010;7:25-31

The effect of nocturia on sleep

Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.