Changes In Sleep Disturbances Research Articles

2196 Pre-treatment sleep disturbance as a risk factor for radiation therapy induced pain in 676 women with breast cancer

OBJECTIVES/SPECIFIC AIMS: The purpose of the present secondary data analysis was to examine the effect of moderate-severe disturbed sleep before the start of radiation therapy (RT) on subsequent RT-induced pain. METHODS/STUDY POPULATION: Analyses were performed on 676 RT-naïve breast cancer patients (mean age 58, 100% female) scheduled to receive RT from a previously completed nationwide, multicenter, phase II randomized controlled trial examining the efficacy of oral curcumin on radiation dermatitis severity. The trial was conducted at 21 community oncology practices throughout the US affiliated with the University of Rochester Cancer Center NCI’s Community Oncology Research Program (URCC NCORP) Research Base. Sleep disturbance was assessed using a single item question from the modified MD Anderson Symptom Inventory (SI) on a 0–10 scale, with higher scores indicating greater sleep disturbance. Total subjective pain as well as the subdomains of pain (sensory, affective, and perceived) were assessed by the short-form McGill Pain Questionnaire. Pain at treatment site (pain-Tx) was also assessed using a single item question from the SI. These assessments were included for pre-RT (baseline) and post-RT. For the present analyses, patients were dichotomized into 2 groups: those who had moderate-severe disturbed sleep at baseline (score≥4 on the SI; n=101) Versus those who had mild or no disturbed sleep (control group; score=0–3 on the SI; n=575). RESULTS/ANTICIPATED RESULTS: Prior to the start of RT, breast cancer patients with moderate-severe disturbed sleep at baseline were younger, less likely to have had lumpectomy or partial mastectomy while more likely to have had total mastectomy and chemotherapy, more likely to be on sleep, anti-anxiety/depression, and prescription pain medications, and more likely to suffer from depression or anxiety disorder than the control group (all p’s≤0.02). Spearman rank correlations showed that changes in sleep disturbance from baseline to post-RT were significantly correlated with concurrent changes in total pain (r=0.38; p<0.001), sensory pain (r=0.35; p<0.001), affective pain (r=0.21; p<0.001), perceived pain intensity (r=0.37; p<0.001), and pain-Tx (r=0.35; p<0.001). In total, 92% of patients with moderate-severe disturbed sleep at baseline reported post-RT total pain compared with 79% of patients in the control group (p=0.006). Generalized linear estimating equations, after controlling for baseline pain and other covariates (baseline fatigue and distress, age, sleep medications, anti-anxiety/depression medications, prescription pain medications, and depression or anxiety disorder), showed that patients with moderate-severe disturbed sleep at baseline had significantly higher mean values of post-RT total pain (by 39%; p=0.033), post-RT sensory pain (by 41%; p=0.046), and post-RT affective pain (by 55%; p=0.035) than the control group. Perceived pain intensity (p=0.066) and pain-Tx (p=0.086) at post-RT were not significantly different between the 2 groups. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings suggest that moderate-severe disturbed sleep prior to RT is an important predictor for worsening of pain at post-RT in breast cancer patients. There could be several plausible reasons for this. Sleep disturbance, such as sleep loss and sleep continuity disturbance, could result in impaired sleep related recovery and repair of tissue damage associated with cancer and its treatment; thus, resulting in the amplification of pain. Sleep disturbance may also reduce pain tolerance threshold through increased sensitization of the central nervous system. In addition, pain and sleep disturbance may share common neuroimmunological pathways. Sleep disturbance may modulate inflammation, which in turn may contribute to increased pain. Further research is needed to confirm these findings and whether interventions targeting sleep disturbance in early phase could be potential alternate approaches to reduce pain after RT.

The role of eveningness in obsessive-compulsive symptoms: Cross-sectional and prospective approaches

Background: Eveningness may be defined as the tendency to be most active and alert during the evening. Previous research has linked eveningness with maladaptive psychological outcomes, and recent evidence has highlighted circadian dysregulation as a novel factor in psychopathology, including obsessive-compulsive disorder (OCD). However, limited research has examined the unique relationship between eveningness and OC symptoms. Two studies were conducted to thoroughly examine the links between eveningness and OC symptoms, while also considering the role of depression symptoms and sleep-related factors.Methods: Using a cross-sectional approach, Study 1 examined the association between eveningness and OC symptoms when controlling for depression symptoms. Study 2 then employed a prospective approach to examine the extent to which the relationship between eveningness and change in OC symptoms over 4 months is mediated by change in sleep disturbance and total sleep time when controlling for depression symptoms.Results: Results indicated that depression better accounts for the cross-sectional association between eveningness and OC symptoms. However, eveningness was found to be a more robust prospective predictor of change in OC symptoms in Study 2. Furthermore, sleep disturbance, but not total sleep time, partially mediated the relationship between eveningness and OC symptoms.Limitations: Single-method self-report approach, unselected sample, and lack of experimental manipulation.Conclusions:These findings suggest that eveningness may contribute to the development of OC symptoms over time, in part due to its effect on sleep disturbance. Future research examining the role of circadian dysregulation in OCD may uncover novel physiological mechanisms.

One-year longitudinal study found a bidirectional relationship between physical activity and sleep disturbance in teenage Estonian girls.

Studies have shown that physical activity (PA) declines during adolescence, especially among girls. We examined the relationship between changes in PA and sleep disturbance over the school year, including any bidirectional relationship between these two factors. This longitudinal study focused on teenage girls who had a mean age of 13.2 ± 0.2 years at baseline and were drawn from five randomly selected schools in the city of Tartu, Estonia. Sleep disturbance and PA were subjectively assessed using the self-reported 3-Day Physical Activity Recall and the Insomnia Severity Index, at four intervals throughout the school year. Latent growth curve analyses were used to evaluate longitudinal and bidirectional associations between PA and sleep disturbance. Assessments were carried out at three-monthly intervals from September 2015 to June 2016. Sleep disturbance increased and PA decreased over the school year. At baseline, higher PA was related to lower sleep disturbance. Changes in PA corresponded with changes in sleep disturbance. A negative bidirectional relationship between sleep disturbance and PA over time was also found. These results suggest that increasing PA may be an effective strategy for improving the quality of sleep in girls during early adolescence.

Relationship between sleep and exercise as colorectal cancer survivors transition off treatment.

The primary objective of this study was to evaluate the relationship between exercise and sleep disturbance in a sample of individuals diagnosed with stage I, II, and III colorectal cancer (CRC) as patients transitioned off first-line treatment. We also sought to identify heterogeneity in the relationship between sleep disturbance and exercise. Data were obtained from the MY-Health study, a community-based observational study of adults diagnosed with cancer. Patient-Reported Outcomes Measurement Information System® (PROMIS) measures (e.g., PROMIS Sleep) were administered, and participants self-reported demographics, comorbidities, cancer treatment, and exercise. Regression mixture and multiple regression models were used to evaluate the relationship between sleep disturbance and exercise cross-sectionally at an average of 10months after diagnosis, and the change in sleep disturbance over a 7-month period, from approximately 10 to 17months post-diagnosis. Patients whose exercise was categorized as likely at or above American College of Sports Medicine's guidelines did not report statistically better sleep quality compared to patients who were classified as not active. However, retirement (B = - 2.4), anxiety (B = 0.21), and fatigue (B = 0.24) had statistically significant relationships with sleep disturbance (p < 0.05). Increase in exercise was not significantly associated with a decrease in sleep disturbance. No statistical heterogeneity was revealed in the relationship between sleep and exercise. Further prospective research using an objective measure of exercise is warranted to confirm or refute the nature of the relationship between exercise and sleep disturbance in individuals diagnosed with CRC transitioning off first-line treatment.

Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV+ Women Following a Stress Management Intervention

ABSTRACTObjective: The burden of sleep disturbance and depressive symptomology is high for persons living with HIV and particularly so for women. While cognitive behavioral stress management (CBSM) is shown to reduce symptoms of depression and 24-hr urinary free cortisol output (CORT) in HIV+ men, less is known about the effects of CBSM on mood and concomitant sleep disturbance in HIV+ women. The study aim is to model longitudinal change in sleep disturbance, depressive symptomology, and CORT for HIV+ women exposed to a 12-week CBSM intervention or control condition. Methods: Self-reported sleep quality and depressive symptomology, along with CORT, was collected from surveys at baseline and approximately every three months thereafter for nine months from 130 HIV+ women (Mage = 38.44, SD = 7.73). The data was used to specify a parallel process latent growth model with CORT as a time-varying covariate. Results: The model showed acceptable fit. There was a linear decline in sleep disturbance (β = −0.32, p < .05) and logarithmic decline in depressive symptomology (β = −0.33, p < .05) for those receiving the intervention. Decline in sleep disturbance predicted lower CORT at nine months. Furthermore, having less depressive symptoms at baseline was associated with lower initial levels of sleep disturbance and greater improvement in sleep quality over time. There was no discernible association between sleep and mood disturbance in the control group. Across groups, there was a consistent association between older age and greater sleep disturbance (r = 0.34, p < .01). Conclusion: Sleep disturbance appears to be a behavioral target for CBSM in HIV+ women although older age, preintervention levels of depressive mood, and time-varying levels of CORT output may limit improvement in sleep quality over time.

Sleep Disturbance Is Associated with New Onset and Continuation of Lower Back Pain: A Longitudinal Study among Survivors of the Great East Japan Earthquake.

Lower back pain (LBP) is a common health problem after natural disasters. Although some related factors have been reported, the effect of sleep disturbances on LBP is not clear. The purpose of this study was to elucidate the influence of sleep disturbances on LBP after the Great East Japan earthquake (GEJE). A panel study was conducted with the survivors of the GEJE (n = 2,295) at three and four years after the disaster using self-reported questionnaires. The changes in the presence of LBP during the two periods were assessed; LBP was characterized as either new onset or continuation of LBP. The participants' sleep conditions were assessed, and the changes in sleep disturbances during the two periods were classified into four groups: absence, new onset, improvement, and continuation. Multivariate logistic regression models were used to analyze the association of the changes in sleep disturbance with new onset and continuation of LBP. The rates of new onset and continuation of LBP were 14.1% and 55.1%, respectively. The changes in sleep disturbances were significantly associated with new-onset and continuing LBP. Using "absence" as a reference for the change of sleep disturbance, the adjusted ORs (95% CI) for new-onset LBP were 2.19 (1.42-3.38) in "new onset," 1.38 (0.83-2.30) in "improvement," and 2.17 (1.50-3.15) in "continuation," and those for continuing LBP were 1.42 (0.71-2.84) in "new onset," 0.98 (0.55-1.74) in "improvement," and 1.60 (1.01-2.51) in "continuation." Careful attention should be paid to sleep disturbances to prevent and improve LBP after natural disasters.

Mindfulness Meditation Targets Transdiagnostic Symptoms Implicated in Stress-Related Disorders: Understanding Relationships between Changes in Mindfulness, Sleep Quality, and Physical Symptoms.

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study (n = 213) aimed to determine whether perseverative cognition, indicated by rumination and intrusive thoughts, and emotion regulation, measured by avoidance, thought suppression, emotion suppression, and cognitive reappraisal, partly accounted for the hypothesized relationship between changes in mindfulness and two health-related outcomes: sleep quality and stress-related physical symptoms. As expected, increased mindfulness following the MBSR program was directly correlated with decreased sleep disturbance (r = −0.21, p = 0.004) and decreased stress-related physical symptoms (r = −0.38, p < 0.001). Partial correlations revealed that pre-post changes in rumination, unwanted intrusive thoughts, thought suppression, experiential avoidance, emotion suppression, and cognitive reappraisal each uniquely accounted for up to 32% of the correlation between the change in mindfulness and change in sleep disturbance and up to 30% of the correlation between the change in mindfulness and change in stress-related physical symptoms. Results suggest that the stress-reducing effects of MBSR are due, in part, to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders.

Sleep quality in individuals diagnosed with colorectal cancer: Factors associated with sleep disturbance as patients transition off treatment.

To identify patient characteristics associated with sleep disturbance and worsening of sleep in individuals diagnosed with localized colorectal cancer and assess heterogeneity in these relationships. Data were from the MY-Health study, a community-based observational study of adults diagnosed with cancer. Patient-Reported Outcomes Measurement Information System® Sleep Disturbance, Anxiety, Depression, Fatigue, and Pain Interference measures were administered. Participants self-reported demographics, comorbidities, and treatment information. Regression mixture and multiple regression models were used to evaluate the relationship between sleep disturbance and patient characteristics cross-sectionally at an average of 10months after diagnosis (n=613) as well as change in sleep disturbance over a 6-month period (n=361). Pain, anxiety, fatigue, and the existence of multiple comorbid conditions had statistically significant relationships with sleep disturbance (B=0.09, 0.22, 0.29, and 1.53, respectively; P<0.05). Retirement (B=-2.49) was associated with sleep quality in the cross-sectional model. Worsening anxiety (B=0.14) and fatigue (B=0.20) were associated with worsening sleep disturbance, and more severe sleep disturbance 10months after diagnosis (B=-0.21) was associated with improvement in sleep quality after diagnosis (P<0.05). No evidence of latent subgroups of patients (heterogeneity) was present. Pain, anxiety, fatigue, employment, and comorbid conditions were associated with sleep disturbance, but regression coefficients were small (< |2.5|). Results suggest that screening for anxiety, depression, fatigue, or pain is not sufficient for identifying sleep disturbance. Given the negative consequences of sleep disturbance, sleep disturbance screening may be warranted.

Informal Care and Sleep Disturbance Among Caregivers in Paid Work: Longitudinal Analyses From a Large Community-Based Swedish Cohort Study.

Study ObjectivesTo examine cross-sectionally and prospectively whether informal caregiving is related to sleep disturbance among caregivers in paid work.MethodsParticipants (N = 21604) in paid work from the Swedish Longitudinal Occupational Survey of Health. Sleeping problems were measured with a validated scale of sleep disturbance (Karolinska Sleep Questionnaire). Random-effects modeling was used to examine the cross-sectional association between informal caregiving (self-reports: none, up to 5 hours per week, over 5 hours per week) and sleep disturbance. Potential sociodemographic and health confounders were controlled for and interactions between caregiving and gender included. Longitudinal random-effects modeling of the effects of changes in reported informal caregiving upon sleep disturbance and change in sleep disturbance was performed.ResultsIn multivariate analyses controlling for sociodemographics, health factors, and work hours, informal caregiving was associated cross-sectionally with sleep disturbance in a dose–response relationship (compared with no caregiving, up to 5 hours of caregiving: β = 0.03; 95% CI: 0.01, 0.06, and over 5 hours: β = 0.08; 95% CI: 0.02, 0.13), results which varied by gender. Cessation of caregiving was associated with reductions in sleep disturbance (β = −0.08; 95% CI: −0.13, −0.04).ConclusionsThis study provides evidence for a causal association of provision of informal care upon self-reported sleep disturbance. Even low-intensity care provision was related to sleep disturbance among this sample of carers in paid work. The results highlight the importance of addressing sleep disturbance in caregivers.

Longitudinal changes in sleep disturbances, mental toughness, and physical activity in patients with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a chronic progressive autoimmune disease. Fatigue, depression and cognitive impairments are the most common symptoms of patients with MS. Whereas there is extant research on fatigue, depression, and cognitive impairment of patients with MS during the clinical course, no research focused on the long term changes of psychological functioning, sleep problems, and physical activity on these patients. The aims of the present study were therefore to examine changes in physical activity, sleep disturbances, and mental toughness over a 1.5-year period of time in people with multiple sclerosis after the onset their MS.MethodsA total of 18 patients with diagnosed MS (mean age: M = 33.61 years) took part in this study. They completed a booklet of questionnaires covering socio-demographic data, mental toughness, sleep disturbances, and physical activity, at the onset of disease and 1.5 years later.ResultsIn total, 1.5 years after the onset of MS, patients had lower levels of vigorous physical activity, but not statistically significant change in moderate physical activity. Patients with sleep disturbances at the onset of disease had statistically significant sleep disturbances also 1.5 years later.ConclusionsCompared to the onset of disease, 1.5 years later, patients with MS reported similar mental toughness traits, sleep disturbances and levels of moderate physical activity. The pattern of results of the present pilot study suggests that the onset of MS is not an obstacle for doing moderate physical activity. Based on the result of this study, sleep disturbances remains stable by time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Innovations in Practice: The relationship betweensleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression.

Sleep disturbance is frequently comorbid with depression and sleep complaints are the most common residual symptoms after treatment among adolescents with depression. The present analyses investigated the effect of sleep disturbance in depressed adolescents treated with Interpersonal Psychotherapy for Adolescents (IPT-A) versus Treatment as Usual (TAU) in school-based mental health clinics. 63 adolescents participated in a randomized clinical trial of IPT-A versus TAU for adolescent depression. Participants were diagnosed with a DSM-IV depressive disorder and assessed for symptoms of depression, interpersonal functioning and sleep disturbance. Measures were assessed at baseline, session 4 and 8 of treatment, and session 12 for post-acute treatment follow-up. Hierarchical linear modeling (HLM) was used to model change in depression, interpersonal functioning and sleep disturbance. Ongoing sleep disturbance was significantly associated with worse depression scores as rated by clinician (γ = 1.04, SE = 0.22, p < .001) and self-report (γ = 1.63, SE = 0.29, p < .001), as well as worse interpersonal functioning across the course of treatment (γ = 0.09, SE = 0.02, p < .001). Treatment condition did not predict change in sleep disturbance (γ = -0.13, SE = 0.14, p = ns). For all patients in the study, sleep disturbance was a predictor of depression and interpersonal functioning for depressed adolescents. Sleep disturbance predicted more depression and interpersonal stress across treatments and led to a slower improvement in depression and interpersonal functioning. This data suggests that sleep disturbance should be a target for future treatment development research among depressed adolescents.

Modeling the longitudinal latent effect of pregabalin on self-reported changes in sleep disturbances in outpatients with generalized anxiety disorder managed in routine clinical practice

BackgroundAnxiety disorders are among the most common psychiatric illnesses, with generalized anxiety disorder (GAD) being one of the most common. Sleep disturbances are highly prevalent in GAD patients. While treatment with pregabalin has been found to be associated with significant improvement in GAD-related sleep disturbance across many controlled clinical trials, mediational analysis has suggested that a substantial portion of this effect could be the result of a direct effect of pregabalin. Thus, the objective of this study was to model the longitudinal latent effect of pregabalin or usual care (UC) therapies on changes in sleep in outpatients with GAD under routine clinical practice.MethodsMale and female GAD outpatients, aged 18 years or above, from a 6-month prospective noninterventional trial were analyzed. Direct and indirect effects of either pregabalin or UC changes in anxiety symptoms (assessed with Hamilton Anxiety Scale) and sleep disturbances (assessed with Medical Outcomes Study-Sleep Scale [MOS-S]) were estimated by a conditional latent curve model applying structural equation modeling.ResultsA total of 1,546 pregabalin-naïve patients were analyzed, 984 receiving pregabalin and 562 UC. Both symptoms of anxiety and sleep disturbances were significantly improved in both groups, with higher mean (95% confidence interval) score reductions in subjects receiving pregabalin: −15.9 (−15.2; −16.6) vs −14.5 (−13.5; −15.5), P=0.027, in Hamilton Anxiety Scale; and −29.7 (−28.1; −31.3) vs −24.0 (−21.6; −26.4), P<0.001, in MOS-S. The conditional latent curve model showed that the pregabalin effect on sleep disturbances was significant (γ =−3.99, P<0.001), after discounting the effect on reduction in anxiety symptoms. A mediation model showed that 70% of the direct effect of pregabalin on sleep remained after discounting the mediated effect of anxiety improvement.ConclusionA substantial proportion of the incremental improvements in anxiety-related sleep disturbances with pregabalin vs UC were explained by its direct effect, not mediated by improvements in anxiety symptoms.

Examining the relationship between subjective sleep disturbance and menopause: a systematic review and meta-analysis.

The purpose of this study was to conduct a systematic review and meta-analysis of the relationship between menopausal stages and sleep disturbance reported using subjective methods. Secondary aims included examining the influence of culture/ethnicity on the relationship between menopausal stages and sleep disturbance. Multiple electronic databases were searched from the first available year to November 2013, and a manual search of the reference lists of review articles identified was also conducted. Twenty-four studies with a total of 63,542 midlife women were identified, coded, and analyzed. The crude and adjusted odds of experiencing sleep disturbance were small but statistically significant for perimenopausal and postmenopausal women, using premenopause as the reference group. The ethnicity of the samples influenced effect sizes; Asian and white women both experienced an increased rate of sleep disturbance at the perimenopausal and postmenopausal stages compared with the premenopausal stage, whereas Hispanic women experienced no change in sleep disturbance across the menopausal transition. The prevalence of sleep disturbance is higher in perimenopausal, postmenopausal, and surgical menopausal women than in premenopausal women. There is an independent relationship between menopausal stages and sleep disturbance beyond the effects of aging and other confounders, although the magnitude of the relationship is small. Culture, ethnicity, or both might affect the levels of sleep disturbance at various menopausal stages.

Sleep Problems Among Adolescent Survivors Following the 2008 Wenchuan Earthquake in China

To examine sleep problems and associated risk factors among adolescent survivors following the 2008 Wenchuan earthquake, the deadliest earthquake to strike China in 30 years. A cohort of students (N = 1,573) in the 7th and 10th grades from Dujiangyan City, 21 kilometers from the epicenter, was followed up periodically for 2 years. Participants were assessed at 12 months (n = 1,398; May 18-22, 2009), 18 months (n = 1,288; November 23-27, 2009), 24 months (n = 1,313; May 17-21, 2010), and 30 months (n = 1,038; November 22-26, 2010) after the earthquake. Adolescents were asked to complete the Pittsburgh Sleep Quality Index (PSQI; cutoff for sleep problems: total score of ≥ 8), Post-Traumatic Stress Disorder Self-Rating Scale (cutoff for probable posttraumatic stress disorder: ≥ 50), Depression Self-Rating Scale for Children (cutoff for depressive disorder: ≥ 15), Screen for Child Anxiety Related Emotional Disorders (cutoff for clinical anxiety: ≥ 25), Social Support Rate Scale, and Adolescent Self-Rating Life Events Checklist and provide demographic information. Trajectory analysis was used to examine sleep disturbance changes and associated risk factors. Twelve months after the earthquake, 48.90% of participants reported sleeping less than 7 hours per night, 27.68% disclosed difficulties initiating sleep, 8.82% experienced problems staying sleep, 22.60% felt their sleep quality was poor, and 40.01% had difficulties functioning during daytime hours. Overall sleep problems, as assessed by the PSQI global scale, were stable from 18 months to 30 months following the earthquake, and the prevalence rates were between 28.79% and 30.18%. The risk of sleep issues was significantly increased in senior high school students (OR = 2.29) and in those who witnessed the tragic events directly (OR = 1.21). Depression (OR = 1.69), anxiety (OR = 1.57), poor social support (OR = 1.83), and negative life events (OR = 2.62) were also associated with increased risk and persistence of sleep problems. Sleep disturbances are common and persistent in adolescent earthquake survivors. Multiple demographic, psychosocial, and earthquake-related factors are associated with the increased risk of sleep difficulties.

PMH43 Modelling the Longitudinal Latent Effect of Pregabalin on Self-Reported Changes in Sleep Disturbances and Disability in Outpatients With Generalized Anxiety Disorder (GAD) Treated in Routine Clinical Practice in Spain

PMH43 Modelling the Longitudinal Latent Effect of Pregabalin on Self-Reported Changes in Sleep Disturbances and Disability in Outpatients With Generalized Anxiety Disorder (GAD) Treated in Routine Clinical Practice in Spain

Naproxen reduces chemotherapy and pegfilgrastim-induced sleep disturbance possibly mediated through reduced bone pain

Cancer treatment-related pain can cause sleep disturbance (SD). Recently, we reported that co-administration of the NSAID, naproxen, reduces pegfilgrastim-induced bone pain. The purpose of this secondary analysis was to determine if naproxen decreased SD and if this effect was mediated through changes in pain. The University of Rochester Cancer Center Community Clinical Oncology Program Research Base randomized 510 patients to receive naproxen or placebo simultaneously with pegfilgrastim administration. Patients recorded pain severity (0-10 VAS) for the subsequent 5 days. The area under the curve was calculated as the primary pain outcome. Both prior to and 5 days post PEG treatment, patients rated their SD (0-10 VAS). The mean post-treatment SD score was 3.74 [95% CI: 3.33, 4.15] in the placebo group and 2.92 [2.51, 3.32] in the naproxen group, representing a 22% decrease in the naproxen group. There was no difference in SD prior to treatment. NSAIDs have proven analgesic efficacy but no efficacy in SD prevention outside of painful contexts. Structural equation modeling was performed to assess the mediation effect of pain changes on naproxen-induced changes in SD. In this model, naproxen intervention was significantly predictive of decreased pain (path coefficient (PC) = −0.143 [−0.240, −0.045]), and changes in pain significantly predicted changes in SD (PC = 0.180 [0.123, 0.236]). The mediation effect of pain on SD was significant (indirect effect -0.026 [-0.048, −0.009]) while the direct effect of naproxen on sleep was not (PC = −.067 [−0.125, 0.008]). However, results were similar when SD was modeled as a mediator of pain; therefore, no definitive cause and effect relationship can be established statistically. These data suggest that co-administration of naproxen with pegfilgrastim can simultaneously reduce bone pain and SD. This treatment combination has the potential to minimize the damaging effects of pegfilgrastim on QOL and promote chemotherapy adherence.

Identification of distinct subgroups of breast cancer patients based on self-reported changes in sleep disturbance

The purposes of this study were to identify distinct subgroups of patients based on self-reported sleep disturbance prior to through 6 months after breast cancer surgery and evaluate for differences in demographic, clinical, and symptom characteristics among these latent classes. Women (n = 398) who underwent unilateral breast cancer surgery were enrolled prior to surgery. Patients completed measures of functional status, sleep disturbance (i.e., General Sleep Disturbance Scale (GSDS); higher scores indicate higher levels of sleep disturbance), fatigue, attentional fatigue, depressive symptoms, and anxiety prior to surgery and monthly for 6 months. Three distinct classes of sleep disturbance trajectories were identified using growth mixture modeling. The high sustained class (55.0%) had high and the low sustained class (39.7%) had low GSDS scores prior to surgery that persisted for 6 months. The decreasing class (5.3%) had high GSDS score prior to surgery that decreased over time. Women in the high sustained class were significantly younger, had more comorbidity and poorer function, and were more likely to report hot flashes compared to the low sustained class. More women who underwent mastectomy or breast reconstruction were in the decreasing class. Decreasing and high sustained classes reported higher levels of physical fatigue, attentional fatigue, depressive symptoms, and anxiety compared to the low sustained class. A high percentage of women has significant sleep disturbance prior to surgery that persists during subsequent treatments (i.e., radiation therapy and chemotherapy). Clinicians need to perform routine assessments and initiate appropriate interventions to improve sleep prior to and following surgery.

Upper Airway Length Decreases Following Maxillomandibular Advancement in Patients With Obstructive Sleep Apnea

Upper Airway Length Decreases Following Maxillomandibular Advancement in Patients With Obstructive Sleep Apnea

Upper Airway Length Decreases After Maxillomandibular Advancement in Patients With Obstructive Sleep Apnea

Most reports on airway anatomy after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) have focused on changes in airway diameter, ie, posterior airway space (PAS), rather than airway length. The purpose of this study was to evaluate changes in cephalometrically measured upper airway length (UAL) after MMA. This was a retrospective cohort study. The sample was composed of subjects who underwent MMA for OSA. The primary outcome measurement was change in UAL measured on lateral cephalograms. Predictor variables included patient demographic and cephalometric characteristics. Secondary outcome measurements were changes in sleep disturbance. Descriptive, bivariate, and regression statistics were computed. For all analyses, P ≤ .05 was considered statistically significant. The sample included 23 adult subjects (mean age, 39.3 ± 12.1 years; 6 women). Subjects had average maxillary and mandibular advancements of 9.8 ± 2.0 and 10.8 ± 2.2 mm, respectively. Mean pre- and postoperative UALs were 75.8 ± 7.0 and 67.0 ± 5.7 mm, respectively (P < .001). Mean pre- and postoperative respiratory disturbance indexes were 53.2 ± 22.4 and 19.0 ± 12.0 events/hour, respectively (P = .003). All patients had improvement in OSA symptoms, but 3 (13%) required continuous positive airway pressure. The results of this study suggest that UAL decreases as a result of MMA. In addition, these results support the observation that MMA is associated with objective and subjective improvements in patients with OSA.

Sleep Disturbances in Pregnancy

A number of studies have reported associations between sleep disorders and adverse outcomes in both elderly and younger populations, but because few included pregnant women it is unclear whether sleep abnormalities during pregnancy are associated with adverse health consequences. Previous reports on sleep and pregnancy have focused only on specific sleep disturbances such as snoring, and most have studied a very heterogeneous population and included women with preexisting medical conditions. Few investigators have evaluated changes in sleep disturbances across pregnancy, or in women without chronic medical conditions that could independently affect sleep. This prospective observational study evaluated the prevalence of sleep disturbances among a population of healthy nulliparous women and quantified changes in sleep during pregnancy. Between February 2007 and June 2008, a total of 189 study subjects completed a sleep survey questionnaire at baseline early in pregnancy at 6 to 20 weeks and again in the third trimester at 28 to 40 weeks. The questionnaire was self-administered and contained items from several validated sleep surveys including the Berlin Questionnaire for Sleep-Disordered Breathing, the Epworth Sleepiness Scale, the National Institutes of Health/International Restless Legs Syndrome Question Set, the Women's Health Initiative Insomnia Rating Scale, and the Pittsburgh Sleep Quality Index. Overall changes in sleep characteristics between the baseline and third-trimester surveys were estimated through the use of the paired t-test for continuous variables and the McNemar test for categorical data. The mean gestational age of the participants at the first and second surveys was 13.8 ± 3.8 and 30.0 ± 2.2 weeks. The data showed that mean sleep duration was shortened from 7.4 ± 1.2 hours in the initial survey to 7.1 ± 1.3 in the third trimester survey (P < 0.001). Compared to baseline assessment, the percentage of patients with frequent snoring (at least 3 nights per week) was significantly increased in the third trimester (11.1% vs. 16.4%, P = 0.03). The proportion of women with test results positive for restless leg syndrome increased from 17.5% to 31.2% (P = 0.001). In addition, the overall poor sleep quality defined as a Pittsburgh Sleep Quality Index score above 5 was more common in the third trimester (39.0% vs. 53.5% (P = 0.001). These findings show that sleep disturbances are common in healthy nulliparous pregnant women, especially in the third trimester.