Characteristics Of Sleep Disturbances Research Articles

Characteristics of sleep disturbance across two waves of the COVID-19 pandemic among nursing staffs

ObjectivesCOVID-19 has impacted human lifestyles, including sleep quality. For nursing staff, sleep disorders not only impact their health and daily lives but also have implications for patient safety. The objective of this study is to explore the impact of the COVID-19 pandemic on the psychological and social aspects of nursing staff and the factors influencing their sleep quality through a two-wave survey. MethodsNursing staff from a psychiatric hospital in southern Taiwan were recruited in two waves during the COVID-19 epidemic. The level of sleep disturbance and related variables, such as Lo's Healthy and Happy Lifestyle Scale (LHHLS) and Societal Influences Survey Questionnaire (SISQ), were collected through self-report questionnaires. Factors related to the level of sleep disturbance were examined using univariate linear regression and multilevel linear regression. Results508 nursing staff members were included in the study, with 254 members in each wave. A significant difference was found between the two waves in the positive thinking of LHHLS and all subscales of SISQ. During the second wave, sleep disturbances were mainly related to self-efficacy, positive thinking, social anxiety, and social desirability. At the fourth wave, sleep disturbances were mainly related to self-efficacy, positive thinking, and social anxiety. However, these effects change when the trend of the epidemic shifts, and other factors are taken into account. ConclusionsThis study analyzed the factors related to the sleep quality of nursing staff during the COVID-19 pandemic. We preliminarily explored the impact of the COVID-19 pandemic on the sleep quality of nursing staff. However, determining whether the end of the epidemic has reduced the impact on nursing staff requires further research.

Characteristics of Sleep Disturbance and Comparison Across Three Waves of the COVID-19 Pandemic Among Healthcare Workers.

Healthcare workers (HCWs) suffered from a heavy mental health burden during the coronavirus disease-2019 (COVID-19) pandemic. We aimed to explore the differences in sleep disturbance in three waves of the COVID-19 pandemic in Taiwan among HCWs. Moreover, factors associated with sleep disturbances in the third wave were investigated. This study, with three waves of cross-sectional surveys, recruited first-line and second-line HCWs. The level of sleep disturbance and related demographic variables were collected through self-report questionnaires. Differences in sleep disturbance across the three waves were compared with analysis of variance. Factors associated with the level of sleep disturbance were identified using univariate linear regression and further used for multivariate stepwise and bootstrap linear regression to identify the independent predictors. In total, 711, 560, and 747 HCWs were included in the first, second, and third waves, respectively. For first-line HCWs, sleep disturbance was significantly higher in the third wave than in the first wave. The level of sleep disturbance gradually increased across the three waves for all HCWs. In addition, sleep disturbance was associated with depression, posttraumatic stress disorder (PTSD) symptoms, anxiety about COVID-19, vaccine mistrust, and poorer physical and mental health among first-line HCWs. Among second-line HCWs, sleep disturbance was associated with younger age, depression, PTSD symptoms, lower preference for natural immunity, and poorer physical health. The current study identified an increase in sleep disturbance and several predictors among HCWs. Further investigation is warranted to extend the application and generalizability of the current study.

Polysomnographic study: characteristics of sleep disturbances in patients with Parkinson's disease

Polysomnographic study: characteristics of sleep disturbances in patients with Parkinson's disease

Characteristics of Sleep Disturbance in Patients with Long COVID: A Retrospective Observational Study in Japan.

The objective of this study was to determine the clinical and endocrinological features of sleep disturbance in patients with long COVID. This study was a single-center retrospective observational study for patients who visited the COVID-19 aftercare outpatient clinic (CAC) established in Okayama University Hospital in Japan during the period from 15 February 2021 to 29 July 2022. The long COVID patients were divided into two groups based on the presence or absence of sleep disturbance, and the clinical and laboratory characteristics of the patients were analyzed. Out of 363 patients with long COVID, after excluding 6 patients, 60 patients (16.5%) (55% males, median age of 38 years) complaining of sleep disturbance were compared with 303 patients (83.5%) (43% males, median age of 40 years) without sleep-related symptoms. Although there were no significant differences in clinical backgrounds and severities of COVID-19 between the two groups by the multivariate analysis, the percentage of long COVID patients with sleep disturbance was significantly increased among patients infected in the Omicron-dominant phase. In addition, the prevalence rate of sleep disturbance in patients when infected in the Omicron phase (24.8%) was two-times higher than that in patients infected in the Delta phase (12.8%). Of note, the percentages of patients with sleep disturbance who also complained of general fatigue, headache, concentration loss, anxiety, low-grade fever, and brain fog symptoms were higher than the percentages of patients without sleep disturbance who had the same complaints. Among the types of sleep disturbance, the percentage of patients who complained of loss of sleep induction (75%) was much higher than the percentage of patients with early-awakening sleep disturbance (6.7%), and many of the patients with mid-awakening types of insomnia had brain fog symptoms. Endocrine examinations revealed that long COVID patients with sleep disturbance had significantly higher levels of plasma adrenocorticotropin and lower levels of serum growth hormone, suggesting the presence of hypothalamic-pituitary stress. The prevalence of sleep disturbance has been increasing in long COVID patients infected in the Omicron phase with a certain clinical and endocrine trend.

Sleep Disturbances and Their Impact on Socio-Professional Capacities in Patients with Obstructive Sleep Apnea

As a prominent problem in the modern society and showing an increasing prevalence, sleep disorders including frequently obstructive sleep apnea (OSA) raises the issue of the multiple health and socio-professional debilitating effect. This study aimed to assess by Pittsburgh Sleep Quality Index (PSQI) questionnaire the sleep disturbances and their impact on socio-professional capacities in patients with OSA. We evaluated through the PSQI a group of 144 patients with suspected sleep disorders, whom 22 were diagnosed with OSA by polysomnography. For OSA patients, we analyzed the associated comorbidities and the characteristics of sleep disturbances and their influence on quality of socio-professional life. The main associated comorbidities to our OSA patients were the hypertension (90.90%), the type II diabetes (40.91%) and the metabolic syndrome (31.83%). We found that the most important sleep disturbances that affected the quality of life are the sleep interruptions, the waking up too early, the late falling asleep and snoring. The most significant problems induced by sleep disorders were communication problems and concentration disorders, with more than three times a week for at least 36.36% of patients. The work capacity was affected at least once a month in 77.27% of OSA patients, 40.91% reported at least one episode per week. Based on the results of PSQI and the characteristics of clinical OSA assessment, we can conclude that the patients with OSA present an impaired quality of socio-professional life.

Understanding the experience of sleep disturbance in psoriasis: a qualitative exploration using the Common-Sense Model of Self-Regulation.

Psoriasis is associated with significant morbidity, which negatively impacts upon quality of life. Sleep disturbance is reported to be common in patients with psoriasis and is associated with physical and psychological variables, although there is little published work in this area. Understanding sleep and the factors involved in its disturbance in psoriasis is a potentially important clinical area given the role of sleep in health and disease processes. To explore the experience of sleep and sleep disturbance in psoriasis using the Common-Sense Model of Self-Regulation (CS-SRM). Semistructured interviews were conducted with adults diagnosed with psoriasis. Interview questions were informed by the CS-SRM and previous research. Framework analysis was applied, including coding data into the CS-SRM dimensions and allowing additional inductive themes to emerge. Seventeen people with psoriasis (nine women, eight men; aged 19-86years) were interviewed about sleep and sleep disturbance. Seven themes emerged, with six accounted for by the CS-SRM: characteristics of sleep disturbance, change in sleep patterns, thoughts about and symptoms of disease disturbing sleep, impact of poor sleep on daily life, attempts to improve sleep, a daily battle for control and a seventh relating to metacognitive processes. A reciprocal relationship between sleep and psoriasis was evident across themes with interactions between key sleep-related thoughts, emotions and behaviours. This study showed that sleep disturbance is a persistent concern for people with psoriasis; it has a 24-h impact, and interacts with the psychological and physical aspects of psoriasis. The distress and frustration felt when managing sleep disturbance perpetuated problematic sleep. Addressing this with currently available sleep treatments may therefore confer sleep and psoriasis-related benefits for people living with this condition.

A survey based study on sleep disturbance in postural tachycardia syndrome

BackgroundPostural tachycardia syndrome (POTS) is an autonomic disturbance characterized by an excessive increase in heart rate when an individual moves from a sitting to an upright position. POTS patients often complain of fatigue, daytime sleepiness and insomnia, but there is limited evidence to elucidate the mechanism or the prevalence of sleep-related symptoms in POTS, as well as the effect on patient quality of life. Here, we investigated the prevalence of sleep disturbances in POTS patients, as well as the use of medication and effects on daily life. MethodsA survey was administered to 30 patients with POTS. The survey contained 22 questions on various characteristics of sleep disturbances in POTS. Answers were recorded on a five-point Likert rating scale. ResultsThe majority of the patients reported fatigue (96.7%) and low energy (93.3%) during the day. Most (83.3%) patients reported that they do not feel well rested when waking up in the morning. More than half of the patients reported trouble falling asleep at night (63.3%) and maintaining sleep through the night (62.1%). Despite the frequent complaint of sleep disturbance, a very low percentage of POTS patient actually report seeking treatment. ConclusionIn this study, we explored the prevalence of sleep disturbance in patients with POTS. Almost all POTS patients reported trouble with sleep and fatigue; however, there is major discrepancy between the high percentage of symptoms and small percentage of patients seeking medical assistance for better sleep quality.

Characteristics of Sleep Disturbances in Patients with Gastroesophageal Reflux Disease.

Objective Gastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances; however, the detailed differences in the characteristics of sleep disturbances between GERD and non-GERD patients are unknown. The aim of the present study was to analyze the clinical characteristics as well as health-related quality of life in GERD and non-GERD patients with sleep disturbances. Methods Three hundred and fifty patients, including 124 patients with GERD and 226 patients without GERD, completed a self-administered questionnaire that evaluated clinical information. The Pittsburg Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and 8-item Short-Form Health Survey (SF-8) were also used. Sleep disturbance was considered to be present if the PSQI was >5.5. Results The prevalence of sleep disturbances was significantly higher in the GERD patients (66/124, 53.9%) than in the non-GERD patients (89/226, 39.3%). Depression and anxiety were significantly more common in the subjects with sleep disturbances than in those without sleep disturbances, although there were no differences between the GERD and non-GERD patients. Among the subjects with sleep disturbances, daytime sleepiness was more common in the GERD patients than in the non-GERD patients. The subjects with sleep disturbances had a poorer health-related quality of life. The physical components of quality of life were impaired, particularly in the GERD patients with sleep disturbances. Conclusion GERD patients with sleep disturbances commonly experience daytime sleepiness and an impaired health-related quality of life, especially in terms of physical components.

Characteristics of sleep disturbance in 103 patients with Parkinson's disease and study on the clinical nursing strategy

Characteristics of sleep disturbance in 103 patients with Parkinson's disease and study on the clinical nursing strategy

An investigation of sleep disturbance and related factors in rheumatoid arthritis patients

To explore the characteristics of sleep disturbance and its related factors in patients with rheumatoid arthritis (RA). A total of 71 patients with RA in Department of Rheumatology Huaxi Hospital have completed the following questionnaires, including Pittsburgh sleeping quality index (PSQI), visual analogue scale (VAS), disease activity score in 28 joints (DAS28), health assessment questionnaire(HAQ), hospital anxiety and depression scale (HADS), fatigue severity scale (FSS) and a self-designed general status questionnaire. The prevalence of sleep disturbance was 42.3% (30/71) in rheumatoid arthritis patients (68.4%). The scores of DAS28, VAS, PSQI, HAQ, FSS and HADS in patients with sleep disturbance were significantly higher than those in patients with good sleep, which were respectively 3.90±1.12 vs 2.92±1.92, (5.03±2.63) scores vs (2.41±1.84) scores, (10.87±2.42) scores vs (4.29±1.85) scores, 3.0(0.0,7.0) scores vs 2.0 (0.5, 4.0) scores, (39.17±14.02) scores vs (29.63±16.12) scores, (14.50±7.77) scores vs (9.49±6.57) scores (P<0.05 in all scales). According to the results of Pearson correlation analysis, PSQI had significantly positive correlation with DAS28 (r=0.462, P<0.01), VAS (r=0.556, P<0.01), HAQ (r=0.360, P<0.01), FSS (r=0.420, P<0.01) and HADS (r=0.447, P<0.01) respectively. The logistic regression analysis indicated that VAS was a predictor for poor sleep quality (P<0.01). The patients receiving biological agents had significantly (P<0.05) lower scores of DAS28 (2.86±1.39 vs 3.52±1.10), PSQI [(5.90±4.24) scores vs (8.53±3.78) scores], VAS (2.15±2.30 vs 4.05±2.46), HAQ [0.0 (0.0, 2.0) scores vs 3.0 (0.0, 6.0) scores] compared to those taking oral drugs. High prevalence of sleep disturbance in patients with RA is noted, which indirectly influences the activity of disease, quality of life, depression, fatigue and other physical and mental health. Biological agents can partly improve the sleep disturbance and functional status.

Poor sleep quality in systemic lupus eritematosus: does it depend on depression?

Introduction Sleep disturbances are frequently observed in rheumatic diseases and significantly affect the quality of life of patients. The prevalence and characteristics of sleep disturbances in Systemic Lupus Erythematosus (SLE) are poorly studied. Objectives This study aimed at evaluating both prevalence of sleep disorders and sleep quality in a cohort of SLE women in comparison with patients suffering from a chronic disease as hypertension (H). In addition we explored determinants of sleep quality in SLE. Materials and methods In this cross-sectional study, 86 consecutive SLE women patients were evaluated from January 2012 through December 2012. 81 Have been recruited. The Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI) and the Self-Rating-Anxiety Scale (SAS) were administered to all subjects. Poor sleep quality was defined as PSQI >5, insomnia as ISI >15, depressive symptoms as BDI >10, and trait anxiety as STAI-Y2 >40. Patients with other sleep disorders were excluded. Socio-demographic data were collected and a rheumatologic assessment was performed, including disease activity and damage scales, comorbidities and ongoing treatments. A control group of 53 H age matched women were also recruited. Results For the SLE cohort (mean age 44.0 ± 7.8 years; mean disease duration 15.5 ± 7.8 years, in disease remission) poor sleep quality resulted in 62.2% SLE patients versus 39.6% of H group (p Conclusion In this cohort of SLE women, insomnia and poor sleep quality were common. Especially poor sleep quality, difficulties in maintaining sleep and/or early morning awakening were more common in SLE than in H patients. In addition, depression was highly prevalent in SLE and was a major determinant of poor sleep quality.In addition poor sleep quality may be related to immunosuppressive therapy. These data highlight the importance of investigating sleep disorders, depressive symptoms and the role of therapy in SLE patients. Acknowledgements L. Carli, L. Ghiadoni.

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.

Frye and Rossignol reply

SIR–We appreciate the comments of Drs Guenole and Baleyte regarding our meta-analysis on the effectiveness of melatonin for sleep-disturbed individuals with autism spectrum disorder (ASD) and their commentary regarding the inclusion of individuals with Rett syndrome. We, too, were concerned with the inclusion of this group and thus specifically addressed this in the results section of the article where we state that ‘The inclusion or exclusion of the one study containing syndromic ASD did not significantly change the results of the meta-analysis.’ Since we did not present the changes in the meta-analysis with the exclusion of children with Rett syndrome, we present them below. The only study of the five double-blind placebo-controlled studies included in the meta-analysis that included patients with Rett syndrome was the study of McArthur et al. This study contained nine (16%) of the 57 participants in the metaanalysis. Removing the McArthur et al. study from the metaanalysis increases the Hedge’s g and Glass’s D effect sizes of sleep duration from 1.08 to 1.20 and 0.94 to 1.02 respectively, with virtually no change in the z-scores of the effect sizes (Hedge’s g z-score did not change from 3.58 and Glass’s delta z-score decreased slightly from 3.01 to 2.96). Similarly, removing the McArthur et al. study from the meta-analysis increases the Hedge’s g and Glass’s D effect sizes of sleep onset from 2.52 to 2.86 and 1.30 to 1.87 respectively, with a small increase in the z-scores (Hedge’s g z-score increased from 9.60 to 10.01 and Glass’s delta z-score increased from 4.12 to 5.18). Finally, removing the McArthur et al. study from the meta-analysis examining the number of night-time awakenings increases the Hedge’s g effect size from 0.50 to 0.57 and the Glass’s D effect size from 0.33 to 0.35, with small changes in the z-scores (Hedge’s g z-score increased from 1.74 to 1.79 and Glass’s delta z-score decreased from 1.11 to 1.06). The decision to include the study with participants with Rett syndrome within the meta-analysis was difficult since, as Drs Guenole and Baleyte point out, the characteristics of sleep disturbances as well as the neuropathology in Rett syndrome are different from those in children with idiopathic ASD. However, according to the current version of the DSM-IV, children with Rett syndrome are still considered to be within the category of pervasive developmental disorders. Removing the patients with Rett syndrome appears to increase the effect sizes of all of the variables analysed in our meta-analysis, suggesting that children with Rett syndrome may have a different and more difficult-to-treat sleep disorder. Our revised analysis supports the removal of Rett syndrome as a pervasive developmental disorder in the forthcoming version of the DSM. Finally, we also agree that further research on melatonin in individuals with both ASD and Rett syndrome is needed.

The characteristics of sleep disturbance in patients with comorbid anxiety and depression after cerebral infarction and their related factors

Objective To investigate the factors influencing sleep disturbance and comorbid anxiety and depression after cerebral infarction.Methods A total of 216 patients with first onset of cerebral infarction were enrolled and divided into a post-stroke comorbid anxiety and depression (PSCAD) group, a pure anxiety group, a pure depression group and a non-anxiety and no-depression group. Smoking, alcohol intake, educational background, life or work pressure and exercise frequency were compared among the four groups along with ultrasound images of the carotid artery and brain blood vessels. The subjects' sleep quality was evaluated with the Pittsburgh sleep quality index (PSQI).Results The conditions studied showed no significant difference among the four groups. There were significant differences among the four groups in HAMA and HAMD scores. HAMD overall scores were higher in the PSCAD group than in the other three groups. HAMA overall scores were higher in the PSCAD group than in the pure depression group or the non-anxiety and no-depression groups. The PSCAD group showed significantly higher scores on all the dimensions and in their overall scores than those in the non-anxiety and no-depression group. Subjective sleep quality, sleep latency, sleep duration, sleep efficiency, day-time dysfunction and the overall PSQI score were all significantly higher in the PSCAD group than in the pure anxiety group. Sleep latency, sleep duration, day-time dysfunction and the overall PSQI scores were significantly higher in the PSCAD group than in the pure depression group. Age, life or work pressure, smoking, alcohol intake were the main factors influencing sleep quality in the PSCAD group.Conclusions The sleep quality of anxious and depressed patients after cerebral infarction is worse than that of those suffering only anxiety or depression alone, especially in terms of subjective sleep quality, sleep latency, sleep duration, sleep efficiency and day-time dysfunction. Age, life or work pressure, smoking and alcohol intake are the main factors influencing sleep quality in such comorbid individuals after cerebral infarction. Key words: Cerebral infarction; Anxiety; Depression; Sleep quality; Comorbidity

Long-lasting sleep patterns of adult patients with minor traumatic brain injury (mTBI) and non-mTBI subjects

Background Sleep disturbance is a common subjective complaint of minor traumatic brain-injured (mTBI) patients, but little is known about the characteristics of sleep disturbance in adults years after the injury. Methods Polysomnographic (PSG) and multiple sleep latency test (MSLT) records of 26 mTBI adult patients with normal brain computerized tomography and negative encephalographic studies, no past history of CNS pathology, no premorbid or present major psychiatric diagnosis, and no sleep apnea syndrome were compared to a matched group of apparently healthy individuals (controls). Results Sleep patterns were disturbed in the mTBI patients. Their sleep architecture was altered, with significantly higher light-sleep non-rapid eye movement (NREM) stage 2 scores compared to controls (54.5 ± 13.4% vs. 46.6 ± 10.4%, respectively, p = 0.03) and significantly lower REM sleep scores (21.2 ± 8.4% vs. 25.4 ± 4.5%, respectively, p = 0.05). The MSLT findings documented significant excessive daytime episodes of falling asleep. Conclusions Sleep disturbances of adult patients with chronic mTBI may manifest characteristic alterations in both timing and architecture of their sleep patterns. Sleep lab evaluations may help identify subgroups of mTBI patients who would probably benefit from treatment.

Characteristics of sleep disturbances in Japanese patients with Parkinson's disease. A study using Parkinson's disease sleep scale

The present multicenter cross-sectional study was performed using semistructured questionnaires to determine the contributing factors of sleep disturbances in Japanese patients with Parkinson's disease (PD). We used the Parkinson's disease sleep scale (PDSS, Japanese version). All data were obtained by means of interviewed questionnaire and physical examination by neurologists. The study was carried out between April 2005 and December 2005 at eight university hospitals and affiliated facilities in the Kanto area of Japan. A total of 188 (85 men and 103 women) PD patients and 144 controls (64 men and 80 women) were included. Stepwise regression analysis identified complications of treatment, depression, age, and disease duration as significant risk factors of sleep disturbances in PD. Significant differences in total PDSS score were observed between Hoehn & Yahr (H&Y) Stages 1 and 4, between H&Y Stages 2 and 4, and between H&Y stages 3 and 4 (Bonferroni test). The results of this survey suggested that complications due to treatment (dyskinesia, wearing off, on-off), depressive state, and disease stage are significant determinants of sleep disorders in Japanese patients with PD. We speculate that the reduction of neurotransmitters involved in the sleep-wakefulness mechanism and degeneration of neurons progress together in parallel with deterioration of motor function.

Characteristics of sleep disturbances in Poland - results of the National Health Interview Survey.

Apart from insomnia, poor quality of sleep, decreased sleep duration, tiredness after awakening and frequency of using sleeping drugs are important indicators of sleep problems. The aim of this study was to assess the prevalence of indicators of sleep disturbance, such as quality of sleep, sleep duration, feeling of restfulness in the morning and drug utilization in a randomly selected Polish adult population. A stratified scheme of sampling involving two steps was used. A representative Polish population sample of 47 924 non-institutionalized adults was interviewed. Assessments of sleep-related problems were based on six questions. Standardized prevalence ratios (SPRs and their 95% confidence intervals) were calculated. Almost one-tenth of Polish inhabitants usually slept badly or very badly, a problem that was more common among women than men. Quality of sleep decreased together with ageing and this process was more rapid in women than in men over 40 years of age. Highly educated respondents had the highest quality of sleep. Up to one-fifth of the general Polish population usually woke up tired in the morning. Mean sleep duration was 7.7 h, with no gender differences. Usage of over-the-counter (OTC) medications was significantly lower than usage of those prescribed by the physician (5 vs. 16%). Women used OTC drugs twice as often as men. It would appear to be necessary to introduce educational programmes for the community as well as for general practitioners in order to correct improper attitudes.

Sleep disturbances in patients with Addison's disease.

The standard replacement therapy in Addison's disease does not restore normal nocturnal levels of the hormones of the hypothalamic-pituitary-adrenal axis. The aim of the study was to describe the prevalence and characteristics of sleep disturbances in patients with Addison's disease. Sixty patients completed a self-administered sleep questionnaire and the Epworth Sleepiness Scale (ESS) questionnaire. Activity-based monitoring (actigraph recordings) and sleep diaries were obtained from eight patients. Thirty-four percent reported weekly sleep disturbances (difficulties falling asleep in 13%; repeated awakenings in 14%; early morning awakenings in 20%). The sleep need was 8.21 h (s.d. 1.34; range 6-14 h), and sleep onset latency was 29 min (s.d. 29, range 2-150 min). Forty percent of the patients were tired during daily activities more than once a week, but the scores of the ESS were 6.0 (s.d. 3.5), which is not higher than normal. The actigraph recordings showed higher sleep efficiency than the subjective recordings. We did not identify specific sleep disturbances which were characteristic for patients with Addison's disease. Patients with Addison's disease have increased daytime fatigue, but no more daytime sleepiness than normal.

Sleep disturbances among nursing home residents

This study assesses the prevalence and characteristics of sleep disturbances among an entire nursing home population, consisting of 29, mainly demented, long-term patients. Sleep was evaluated for 14 consecutive days using actigraphic measurements and nursing staff observations. No alterations were made in every-day routines or medications during the observation period. Actigraphy showed a mean sleep onset latency of one hour and a mean wake after sleep onset of more than two hours, while there was no findings of early morning awakening. Mean sleep efficiency was 75%, and more than 13 hours were spent in bed. 72% of the subjects had sleep efficiency below 85%. Nursing staff reported sleep onset latency of more than 30 minutes in 158 of the 203 analysed days, while early morning awakening was reported in only 12 of 203 days. Actigraphical measurements and nursing staff observations gave similar results. The validity of actigraphy in this population is discussed. Sleep disturbances were common among the residents in this nursing home. Sleep onset latency was prolonged, and the patients experienced frequent wake bouts after sleep onset. The diminished ability of sustained sleep may have been influenced by the prolonged time in bed.

Sleep disturbance and obesity: changes following surgically induced weight loss.

Obesity causes sleep disturbance and is the most significant risk factor for sleep apnea. Only surgical methods provide substantial sustained weight loss for most severely obese subjects. To study sleep disturbance in patients undergoing laparoscopic adjustable gastric banding with a commercially available product (Lap-Band). In this study, 313 consecutive patients with severe obesity (body mass index [calculated as weight in kilograms divided by the square of height in meters] >35) completed a preoperative sleep questionnaire and clinical assessment. One hundred twenty-three patients completed the same assessment 12 months after surgery. The characteristics of sleep disturbance and changes in responses to weight loss have been assessed. There was a high prevalence of significantly disturbed sleep in men (59%) and women (45%), with women less likely to have had their sleep disturbance investigated. Observed sleep apnea was more common in men, but daytime sleepiness was not affected by sex. Waist circumference was the best clinical measure predicting observed sleep apnea (R = 0.36; P<.001). The group lost an average of 48% (SD, 16%) of excess weight by 12 months. There was a significant improvement in the responses to all questions at follow-up, with habitual snoring reduced to 14% (preoperative value, 82%), observed sleep apnea to 2% (preoperative value, 33%), abnormal daytime sleepiness to 4% (preoperative value, 39%), and poor sleep quality to 2% (preoperative value, 39%) (P<.001 for all). Obesity-related sleep disorders improve markedly with weight loss. Sustainable weight loss should be a primary aim in the management of severely obese patients with significant sleep disturbance, including sleep apnea. Low-risk laparoscopic obesity surgery should be considered for selected patients with this important comorbidity.