Chronic Sleep Disturbance Research Articles

Health issues for menopausal women: The top 11 conditions have common solutions

Multiple health issues affect women throughout the life course differently from men, or do not affect men at all. Although attention to women's health is important in all stages in life, health among middle-aged and elderly women has not received sufficient attention by scientists and policy-makers. Related to the menopausal transition and the experiences accumulated until that age, many diseases occur or further develop in middle-aged and elderly women. To improve women's quality of life and guarantee a long lasting and active role for middle-aged and elderly women in society, prevention of chronic diseases and disability is a key aspect. In a recent review paper we give an overview of the major health issues for peri- and postmenopausal women, we summarize risk factors and interventions to improve menopausal health. Based on the available scientific literature and the global burden of disease endeavor, we have selected and herein describe the following top 11 key health issues, selected in terms of burden exerted in women's mortality, morbidity, disability and quality of life: cardiovascular disease, musculoskeletal disorders, cancer, cognitive decline and dementia, chronic obstructive pulmonary disease, diabetes mellitus, metabolic syndrome, depression, vasomotor symptoms, sleep disturbances and migraine. The presentation will highlight the key findings of the review.

Disminución del influjo parasimpático en fibromialgia: Su relación con la Psiquiatría en un centro especializado de referencia nacional

Resumen Antecedentes. La fibromialgia (FM) se caracteriza por dolor crónico generalizado, fatiga, alteraciones del sueño, depresión, ansiedad y disautonomía (hiperactividad simpática). Objetivo. Comparar la variabilidad de la frecuencia cardiaca (VFC) en mujeres: 20 pacientes con FM vs. 20 controles, mediante Holter de 24 hrs. Método. La medición consistió en segmentos de cinco minutos. El dominio de la frecuencia se determinó por logaritmo natural de la razón LF/HF (Low/High Frecuencies). Se utilizó ANOVA simple para dos grupos de variables dimensionales. Resultados. El rango de edad fue de 30 a 60 años. Nueve mujeres presentaron comorbilidad psiquiátrica: depresión (77.7%) y ansiedad (22.3%). Hubo diferencias (F=24.45, p

Anxiety sensitivity and sleep-related problems in anxious youth

Anxiety disorders constitute the most common mental health disturbance experienced by youth. Sleep-related problems (SRPs) are highly prevalent among anxious youth and encompass a variety of problems including nighttime fears, insomnia, and refusal to sleep alone. Given that chronic sleep disturbance is associated with a range of behavioral and physical problems in youth and predicts future psychopathology, it is important to elucidate the nature of SRPs in anxious youth. The present study investigated the relationship between sleep problems and anxiety sensitivity in a sample of 101 anxious youth, ages 6–17. Heightened anxiety sensitivity significantly predicted prolonged sleep onset latency across the sample, even after accounting for severity of anxiety, depression, and age. Results support previous research indicating that SRPs are common among anxious youth and suggest that anxiety sensitivity may play a particularly important role in sleep onset latency.

The cardiovascular effects of noise on man

Noise is pervasive in everyday life and induces both auditory and non-auditory health effects. Systematic research of the effects of noise on the cardiovascular system has been carried out for more than 50 decades. Noise is a stressor that affects the autonomic nervous system and the endocrine system. Animal experiments, laboratory and field studies carried out on humans provide evidence that persistent exposure to environmental noise affects physiological endpoints, which in turn are adversely associated with cardiovascular diseases. These include hypertension, coronary heart disease, and stroke. New endpoints have been studied, including clinical states of metabolic syndrome such as diabetes mellitus. Chronic sleep disturbance is considered as an important mediator of the effects. Public health policies rely on quantitative risk assessment to set environmental quality standards and to regulate the noise exposure that is generated by environmental noise sources in the communities. Meta-analyses were carried out to derive exposure-response relationships between noise and cardiovascular health. Most of the epidemiological studies refer to road traffic and aircraft noise. No biologically determined threshold values can be determined. Cardiovascular effects due to noise and traffic-related air pollutants are largely independent of one another due to different biological mechanisms.

Central obesity and high blood pressure in pediatric patients with atopic dermatitis.

Atopic dermatitis (AD) is associated with multiple potential risk factors for obesity and high blood pressure (BP), including chronic inflammation, sleep disturbance, and mental health comorbidity. Previous studies found associations between general obesity and AD. However, it is unknown whether AD is associated with central obesity and/or high BP. To determine whether central obesity and high BP are increased in pediatric AD. This case-control study performed in multicenter pediatric dermatology practices in the United States recruited 132 children (age range, 4-17 years) with active moderate to severe AD and 143 healthy controls from April 1, 2009, through December 31, 2012. Diagnosis and severity of AD assessed by a pediatric dermatologist. Body mass index, waist circumference, waist to height ratio, systolic BP, and diastolic BP. Moderate to severe AD was associated with body mass index for age and sex of 97th percentile or greater (logistic regression; odds ratio [OR], 2.64; 95% CI, 1.15-6.06), International Obesity Task Force obesity cutoffs (OR, 2.38; 95% CI, 1.06-5.34), waist circumference in the 85th percentile or greater (OR, 3.92; 95% CI, 1.50-10.26), and waist to height ratio of 0.5 or greater (OR, 2.22; 95% CI, 1.10-4.50). Atopic dermatitis was associated with higher BP for age, sex, and height percentiles (systolic BP: OR, 2.94; 95% CI, 1.04-8.36; diastolic BP: OR, 3.68; 95% CI, 1.19-11.37), particularly a systolic BP in the 90th percentile or higher (OR, 2.06; 95% CI, 1.09-3.90), in multivariate models that controlled for demographics, body mass index and waist circumference percentiles, and history of using prednisone or cyclosporine. Atopic dermatitis was associated with higher systolic BP in Hispanics/Latinos (general linear model; β, .23; 95% CI, .04-.43) and Asians (β, .16; 95% CI, .03-.30). Severe to very severe AD was associated with systolic BP in the 90th percentile or higher (adjusted OR, 3.14; 95% CI, 1.13-8.70). Atopic dermatitis was associated with a family history of hypertension (adjusted OR, 1.88; 95% CI, 1.14-3.10) and type 2 diabetes mellitus (adjusted OR, 1.64; 95% CI, 1.02-2.68) but not obesity or hyperlipidemia. Moderate to severe pediatric AD may be associated with central obesity and increased systolic BP.

Restorative Yoga for Symptom Management in Fibromyalgia: Results of an 8-week Intervention

Objective: The aim of this study was to determine the feasibility of an 8-week restorative yoga intervention and to collect preliminary data on its effects on the fibromyalgia-related symptoms of chronic widespread pain, sleep disturbance, and fatigue, and health-related quality of life. In a mixed methods, single-arm, feasibility study, participants completed pre- and post-intervention semi-structured interviews and self-report assessments at baseline, weeks 4 and 8, and at a 1-month follow-up telephone interview. Results: In this group of participants (N = 12), recruitment, retention, and adherence rates were comparable to those of other fibromyalgia yoga studies: recruitment 57.14%; retention 75%; adherence to group class 87.5%; and home practice adherence 93.33%. A ratio of 1:2 yoga instructor to participants was required for the five-posture 90-minute class sequence as compared with a ratio of 1-2:10-25 yoga instructors to study participants reported in other fibromyalgia yoga studies. Statistically significant trends and minimal clinically important differences were found at week 8 when comparing participant baseline to week 8 self-report questionnaire scores for the Revised Fibromyalgia Impact Questionnaire total score (p = 0.01; 18.51%), the Pain Numeric Rating Scale for the subscales pain now (p = 0.04; 36.36%) and average pain over the past week (p = 0.04; 19.61%), the General Sleep Disturbance Scale total score (p = 0.04; 17.40%), and the Pittsburgh Sleep Quality Index total score (p = 0.02; 27.06%). Conclusion: Although the 8-week, five-posture, 90-minute restorative yoga group class was found not to be feasible as a symptom self-management strategy in this study, the findings support the need for further investigation of the home practice format. Future longitudinal, randomized, controlled trials of a restorative yoga home practice format to establish intervention efficacy and symptom-self management potential as well as those examining restorative yoga intervention resource utilization in persons with fibromyalgia are recommended

Assessment of physical health status and quality of life among Saudi older adults.

[Purpose] This study investigated physical health status and quality of life among older Saudi adults. [Subjects and Methods] Participants included older adults (N = 55) aged 60–90 years (mean = 67.9± 7.71) from a major hospital in Jeddah. Subjects completed surveys and evaluations including assessments of personal and socio-demographic characteristics, caregiver presence, personal habits, perceived health, primary physical and psychological complaints, physician-diagnosed chronic diseases, and functional capacity (i.e., activities of daily living). [Results] Results showed a significant positive correlation between age and ADL; age and memory problems, anxiety, and loneliness; and sleep disturbance and falls. Main factors contributing to quality of life decline were chronic disease, falls, sedentary lifestyle, sleep disturbances, and financial concerns. Participants with diabetes mellitus (58.18%) and hypertension (29.0%) had a very high fall rate. Participants engaged in minimal physical activity (63%), often due to bone and joint pain (90.0%), and led sedentary lives (69%). Single sensory impairments were significantly and independently linked to high depression risk and decreased self-sufficiency. [Conclusion] Healthy lifestyle and behavioral changes should be promoted through community-based health education programs for older Saudi adults. Chronic disease screening programs for the elderly population (especially diabetes and hypertension) are recommended.

Sleep disorders and circadian rhythm in epilepsy revisited: a prospective controlled study

ObjectiveSleep disturbance is reported to be frequent in epilepsy. The role of comorbidity, which is frequently accompanied by sleep disturbance, has not been investigated. The present study assessed sleep disorders and circadian rhythm in patients with epilepsy, in whom relevant comorbidity was carefully excluded. MethodsTwo hundred patients with epilepsy (100 generalized, 100 partial), without relevant psychiatric, neurological or internal comorbidity, were compared with 100 matched controls. The questionnaire contained specifically tailored questions to address the association between epilepsy and sleep disturbance, and validated questionnaires aimed at sleep quality, excessive daytime sleepiness (EDS), circadian rhythm, sleep disorders, and quality of life. ResultsForty-one percent of the participants reported on the acute effects of present or past seizures on sleep-wake rhythm, whereas chronic effects were not evident. Participants and controls did not differ in the rates of chronic sleep disturbance, EDS, and presence of sleep disorders (all p-values non-significant or n.s.). Apart from earlier sleep times on workdays (p = 0.001) in those with epilepsy, circadian variables were similarly distributed. Epilepsy was well controlled, with 75.9% being seizure free for ≥1 year. Longer durations of epilepsy showed a negative correlation with sleep quality (rho = −0.256, p < 0.001). Participants with generalized and partial epilepsies did not differ in rates of sleep disturbance, EDS, sleep disorders, and variables of circadian rhythm (all p-values n.s.). ConclusionThe present study demonstrated that chronic sleep disturbance is not increased in patients with well-controlled epilepsy without relevant comorbidity. This supports comorbidity and insufficient seizure control as major contributors of sleep disturbance in epilepsy.

Sleep restoration is associated with reduced plasma C-reactive protein and depression symptoms in military personnel with sleep disturbance after deployment

BackgroundDeployed military personnel are vulnerable to chronic sleep disturbance, which is highly comorbid with post-traumatic stress disorder (PTSD) and depression, as well as declines in health-related quality of life (HRQOL). Inflammation is associated with HRQOL declines and sleep-related comorbidities; however, the impact of sleep changes on comorbid symptoms and inflammation in this population is unknown. MethodsIn this observational study, we examined the relationship between reported sleep changes and concentrations of inflammatory biomarkers, interleukin 6 (IL-6), and C-reactive protein (CRP) in peripheral blood. The sample was dichotomized into two groups: (1) decrease in Pittsburgh Sleep Quality Index (PSQI; restorative sleep) and (2) no change or increase in PSQI (no change). Mixed between–within subjects analysis of variance tests were used to determine group differences on changes of inflammation and comorbid symptoms. ResultsIn our sample of 66 recently deployed military personnel with insomnia, 34 participants reported restorative sleep whereas 32 reported no sleep changes. The two groups did not differ in demographic or clinical characteristics, with the exception of PTSD diagnosis at baseline. The restorative sleep group had significant reductions in CRP concentrations and depression symptoms, as well as reduced fatigue and improvements in emotional well-being, social functioning, and physical functioning at follow-up. ConclusionsMilitary personnel who report sleep restoration after deployment have reduced CRP concentrations, decreased severity of depression, and improved HRQOL. These findings suggest that treatment for sleep disturbances may be associated with improvements in mental and physical health, thereby supporting continued study in this line of research.

An insight into the gastrointestinal component of fibromyalgia: clinical manifestations and potential underlying mechanisms.

Fibromyalgia syndrome is characterized by chronic generalized pain accompanied by a broad symptomatologic spectrum. Besides chronic fatigue, sleep disturbances, headaches and cognitive dysfunction that are extensively described in the literature, a considerable proportion of patients with fibromyalgia experience gastrointestinal symptoms that are commonly overlooked in the studies that are not specifically dedicated to evaluate these manifestations. Nevertheless, various attempts were undertaken to explore the gastrointestinal dimension of fibromyalgia. Several studies have demonstrated an elevated comorbidity of irritable bowel syndrome (IBS) among patients with fibromyalgia. Other studies have investigated the frequency of presentation of gastrointestinal symptoms in fibromyalgia in a nonspecific approach describing several gastrointestinal complaints frequently reported by these patients such as abdominal pain, dyspepsia and bowel changes, among others. Several underlying mechanisms that require further investigation could serve as potential explanatory hypotheses for the appearance of such manifestations. These include sensitivity to dietary constituents such as gluten, lactose or FODMAPs or alterations in the brain-gut axis as a result of small intestinal bacterial overgrowth or subclinical enteric infections such as giardiasis. The gastrointestinal component of fibromyalgia constitutes a relevant element of the multidisciplinary pathophysiologic mechanisms underlying fibromyalgia that need to be unveiled, as this would contribute to the adequate designation of relevant treatment alternatives corresponding to these manifestations.

Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry.

Despite compelling evidence from animal studies indicating hippocampal subfield-specific vulnerability to poor sleep quality and related cognitive impairment, there have been no human magnetic resonance imaging (MRI) studies investigating the relationship between hippocampal subfield volume and sleep disturbance. Our aim was to investigate the pattern of volume changes across hippocampal subfields in patients with primary insomnia relative to controls. Pointwise morphometry allowed for volume measurements of hippocampal regions on T1-weighted MRI. University hospital. Twenty-seven unmedicated patients (age: 51.2 ± 9.6 y) and 30 good sleepers as controls (50.4 ± 7.1 y). N/A. We compared hippocampal subfield volumes between patients and controls and correlated volume with clinical and neuropsychological features in patients. Patients exhibited bilateral atrophy across all hippocampal subfields (P < 0.05 corrected). Cornu ammonis (CA) 1 subfield atrophy was associated with worse sleep quality (higher Pittsburgh Sleep Quality Index and higher arousal index of polysomnography) (r < -0.45, P < 0.005). The volume of the combined region, including the dentate gyrus (DG) and CA3-4, negatively correlated with verbal memory, verbal information processing, and verbal fluency in patients (|r| > 0.45, P < 0.05). Hemispheric volume asymmetry of this region (left smaller than right) was associated with impaired verbal domain functions (r = 0.50, P < 0.005). Hippocampal subfield atrophy in chronic insomnia suggests reduced neurogenesis in the dentate gyrus (DG) and neuronal loss in the cornu ammonis (CA) subfields in conditions of sleep fragmentation and related chronic stress condition. Atrophy in the CA3-4-DG region was associated with impaired cognitive functions in patients. These observations may provide insight into pathophysiological mechanisms that make patients with chronic sleep disturbance vulnerable to cognitive impairment. Joo EY, Kim H, Suh S, Hong SB. Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry.

The influence of job stress, social support and health status on intermittent and chronic sleep disturbance: an 8-year longitudinal analysis

ObjectiveTo determine the role of health status and social support in the relationship between job stress and sleep disturbance, for both intermittent and chronic sleep disturbance. MethodsA total of 1946 mid-life adults completed three questionnaires spanning an 8-year time frame. Sleep disturbance was assessed at each time point, and participants were classified as experiencing intermittent, chronic or no sleep disturbance across this 8-year period. Independent variables included a range of job stress measures, social support, physical and mental health, and demographic characteristics. ResultsAfter controlling for physical and mental health, perceived lack of job marketability increased risk of intermittent sleep disturbance (odds ratio (OR)=1.33, p=0.012). No other job stress measures were associated with either intermittent or chronic sleep disturbance after adjusting for years of education, social support, and employment status. Poorer mental and physical health status, although significantly increasing odds for intermittent sleep disturbance, represented a significantly greater increase in the odds for chronic sleep disturbance over and above intermittent disturbance (OR=0.96, p<0.001 for both SF-12 mental and physical health). ConclusionThis population-based cohort study found little evidence that job stress had an independent effect on chronic or intermittent sleep disturbance independent of health, social support, and education. Risk profiles for intermittent and chronic sleep disturbance did not differ with regard to job stress; however, various demographic and social support factors were distinguishing factors. Health status, both physical and mental, also showed a significantly greater impact on chronic sleep disturbance than intermittent sleep disturbance. Karasek’s model of job strain had little value in predicting sleep disturbance outcomes.

Variability in the Relationship Between Sleep and Pain in Patients Undergoing Interdisciplinary Rehabilitation for Chronic Pain

Chronic pain and sleep disturbance frequently coexist and often complicate the course of treatment. Despite the well-established comorbidity, there are no studies that have investigated concurrent changes in sleep and pain among patients participating in an interdisciplinary chronic pain rehabilitation program (ICPRP). The goal of this study was to investigate the daily changes in sleep and pain among patients participating in an ICPRP. Multilevel modeling techniques were used to evaluate the daily changes in total sleep time (TST) and pain among a sample of 50 patients with chronic noncancer pain participating in the ICPRP. Increases in TST were predictive of less pain the following treatment day, although daily pain ratings were not predictive of that night's TST. Time in treatment was a significant predictor of both TST and pain reduction, even while controlling for age, gender, anxiety, and depression. Additional analyses revealed significant individual variability in the relationship between TST and next day pain. Individuals with stronger associations between previous night's TST and next day pain were found to experience the greatest treatment benefits overall, in terms of pain reduction and TST. Our results provide compelling support for individual variability of the pain-sleep relationship in patients with intractable pain conditions participating in an ICPRP. Importantly, these findings suggest that when pain and sleep are comorbid, both must be addressed to reap the maximum response to treatment programs such as an ICPRP. This study demonstrates the utility of treating sleep problems in patients participating in an interdisciplinary chronic pain rehabilitation program. Results highlight the benefits of accounting for individual variability in the pain-sleep relationship in a clinical setting and targeting sleep interventions for those individuals whose pain and sleep problems are comorbid.

Combat-related blast exposure and traumatic brain injury influence brain glucose metabolism during REM sleep in military veterans

Traumatic brain injury (TBI), a signature wound of Operations Enduring and Iraqi Freedom, can result from blunt head trauma or exposure to a blast/explosion. While TBI affects sleep, the neurobiological underpinnings between TBI and sleep are largely unknown. To examine the neurobiological underpinnings of this relationship in military veterans, [18F]-fluorodeoxyglucose positron emission tomography (FDG PET) was used to compare mTBI-related changes in relative cerebral metabolic rate of glucose (rCMRglc) during wakefulness, Rapid Eye Movement (REM) sleep, and non-REM (NREM) sleep, after adjusting for the effects of posttraumatic stress (PTS). Fourteen veterans with a history of blast exposure and/or mTBI (B/mTBI) (age 27.5±3.9) and eleven veterans with no history (No B/mTBI) (age 28.1±4.3) completed FDG PET studies during wakefulness, REM sleep, and NREM sleep. Whole-brain analyses were conducted using Statistical Parametric Mapping (SPM8). Between group comparisons revealed that B/mTBI was associated with significantly lower rCMRglc during wakefulness and REM sleep in the amygdala, hippocampus, parahippocampal gyrus, thalamus, insula, uncus, culmen, visual association cortices, and midline medial frontal cortices. These results suggest that alterations in neurobiological networks during wakefulness and REM sleep subsequent to B/mTBI exposure may contribute to chronic sleep disturbances and differ in individuals with acute symptoms.

A chronic fatigue syndrome model demonstrates mechanical allodynia and muscular hyperalgesia via spinal microglial activation.

Patients with chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) display multiple symptoms, such as chronic widespread pain, fatigue, sleep disturbance, and cognitive dysfunction. Abnormal pain sensation may be the most serious of these symptoms; however, its pathophysiology remains unknown. To provide insights into the molecular basis underlying abnormal pain in CFS and FMS, we used a multiple continuous stress (CS) model in rats, which were housed in a cage with a low level of water (1.5 cm in depth). The von Frey and Randall-Seritto tests were used to evaluate pain levels. Results showed that mechanical allodynia at plantar skin and mechanical hyperalgesia at the anterior tibialis (i.e., muscle pain) were induced by CS loading. Moreover, no signs of inflammation and injury incidents were observed in both the plantar skin and leg muscles. However, microglial accumulation and activation were observed in L4-L6 dorsal horn of CS rats. Quantification analysis revealed a higher accumulation of microglia in the medial part of Layers I-IV of the dorsal horn. To evaluate an implication of microglia in pain, minocycline was intrathecally administrated (via an osmotic pump). Minocycline significantly attenuated CS-induced mechanical hyperalgesia and allodynia. These results indicated that activated microglia were involved in the development of abnormal pain in CS animals, suggesting that the pain observed in CFS and FMS patients may be partly caused by a mechanism in which microglial activation is involved.

Diffuse brain injury does not affect chronic sleep patterns in the mouse

Primary objective: To test if the current model of diffuse brain injury produces chronic sleep disturbances similar to those reported by TBI patients.Methods and procedures: Adult male C57BL/6 mice were subjected to moderate midline fluid percussion injury (n = 7; 1.4 atm; 6–10 minutes righting reflex time) or sham injury (n = 5). Sleep–wake activity was measured post-injury using a non-invasive, piezoelectric cage system. Chronic sleep patterns were analysed weekly for increases or decreases in percentage sleep (hypersomnia or insomnia) and changes in bout length (fragmentation).Main outcomes and results: During the first week after diffuse TBI, brain-injured mice exhibited increased mean percentage sleep and mean bout length compared to sham-injured mice. Further analysis indicated the increase in mean percentage sleep occurred during the dark cycle. Injury-induced changes in sleep, however, did not extend beyond the first week post-injury and were not present in weeks 2–5 post-injury.Conclusions: Previously, it has been shown that the midline fluid percussion model used in this study immediately increased post-traumatic sleep. The current study extended the timeline of investigation to show that sleep disturbances extended into the first week post-injury, but did not develop into chronic sleep disturbances. However, the clinical prevalence of TBI-related sleep–wake disturbances warrants further experimental investigation.

Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain.

Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P<0.0001). The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls (P<0.0001). The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide.

Inflammation, sleep disturbances, and depressed mood among community-dwelling older men

ObjectiveHigh rates of sleep disturbances occur in depression. Sleep disturbances are linked to heightened inflammation. We sought to determine if sleep disturbances explain a portion of the putative inflammation — depression association among older adults. In late life, age-related immunoregulation changes may modify the inflammation–depression relationship. MethodsCross-sectional associations of a panel of serum inflammatory markers with probable depression (measured with the Geriatric Depression Scale) were assessed among 2560 community-dwelling older men. We tested whether inflammatory marker — probable depression associations were independent of chronic diseases, as well as objective and subjectively measured sleep disturbances. We also tested whether inflammation-probable depression associations were moderated by age. ResultsInflammatory markers were not independently associated with higher odds of probable depression. A significant age by C-reactive protein (CRP) interaction (p=0.01) was detected such that the strength of the CRP-probable depression association decreased with age. When stratifying by the median age of 76, elevated odds of probable depression were found for men with CRP levels above the median only among the younger group (OR=2.08, 95% CI 1.18–3.69). In the final adjusted model, independent effects of chronic diseases and subjective sleep disturbances contributed to a total of 37% attenuation of the original OR (adjusted OR=1.68, 95% CI 0.911–3.10, p=.09). ConclusionsIn late-life, associations between inflammatory markers and mood may be explained by both chronic diseases and subjectively reported sleep disturbances. Our findings indicate that the association of CRP with probable depression diminishes in strength with age.

Do 12-hour shifts put patients first?

Interest in 12-hour nursing shifts has been come about via two main routes; staff choice and 2 for improved cost-effectiveness in the NHS, however, the effects of this shift on the delivery of patient and family-centred care are unclear. Todd et al (1993) describe the results of a repeated-measures study of 10 wards, using activity analysis to describe patterns of care under an 8-hour compared to a 12-hour shift system. Significant reductions in the amount of direct patient care were found under the 12-hour shift, with corresponding increases in unofficial work breaks. These findings, which were consistent over all study wards and throughout the whole 12-hour day, demonstrate a ‘pacing’ effect by nurses who face 12 hours on duty. It is unclear what the effects of 12-hour shifts are on nursing education and the learning environment. Todd, et al reported surveys of the attitudes of student nurses and nurse educators towards 12-hour shifts. Learners are reasonably positive about 12-hour shifts, but this preference is based on social rather than professional benefits. A reported effect of fatigue on home study is evident. Very negative views about the 12-hour shift are held by the group of educators. Their criticisms appear to be primarily organisational, but they are unequivocal that learning is detrimentally affected. Thus, even if students appear to like this shift pattern, serious concerns are raised by these findings about the impact on nursing education. It is generally agreed that some features of shift systems can influence the extent of wellbeing and health problems experienced by the workers involved. Extended working days (9-12 hour shifts) have been found to aggravate some problems associated with shift work, especially when the work is mentally and emotionally demanding. The aim of the study was to compare measures of health, sleep, psychological and social wellbeing, job satisfaction and burnout of intensive care unit nurses on 12and 8-hour shifts. In a study that matched nurses for age, length of shift work experience, marital status and number of hours worked, the 12-hour shift nurses, when compared to their 8-hour shift colleagues, experienced more chronic fatigue, cognitive anxiety, sleep disturbance and emotional exhaustion (Todd et al, 1991). Job satisfaction seems to be independent of the shift duration. The nurses on 12-hour shifts reported less social and domestic disruption than those on 8-hour shifts. The 12-hour shift nurses showed worse indices of health, wellbeing and burnout than the 8-hour shift nurses. This may be associated with their longer daily exposure to the stress of work. The increased number of rest days of 12-hour shift nurses seems to be insufficient to dissipate the adverse health and wellbeing effects that built up over their longer shifts. In 2000 Wooten discussed the implementation Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division of 12-hour shifts using a locally devised nursing development unit (NDU) framework. and the results of a survey to evaluate the 12-hour shifts, the problems encountered during the implementation of 12-hour shifts, the solutions and the NDU framework as described in the first part of the article. A qualitative design to the postal survey was chosen with the resulting data being subjected to a content analysis. Data triangulation compared survey results with incident reports and sickness records. The limitations of the survey included having the change agent analysing the data, the sampling method and being unable to pilot the questionnaire. This piece of work concluded that it is difficult to measure whether there was an improvement in the quality of patient care as nursing workload throughout a 12 hour shift is variable. Other results centred on staff morale, social life, student nurses’ experience and night shifts. The solutions to identified problems included the employment of two twilight nurses to help the night staff during the busy early evening period. As a requirement of the NDU framework, standards were produced from the survey results, as this would allow subsequent audit of the 12-hour shift system. NHS organisations will have systems to look at clinical and non-clinical incidents and patient safety issues, however, a lot of these systems do not have the ability to pick up on whether the practitioners involved were on an 8-hour or 12-hour shift and how long into the shift the incident happened. In March 2014 Grimsby’s Hospital are aiming to cut the length of nursing shifts from 12 hours to 7.5 expecting that it would bring ‘immense benefits to the quality and safety of patient care’, according to Chief Nurse Karen Dunderdale. Following a consultation period with 400 nurses since October 2013, the changes will bring the hospital’s shift patterns in line with others in the Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, as well as national guidelines. As Karen Dunderdale said in October 2013:

Suicidal Ideation in Patients with Fibromyalgia: A Cross‐Sectional Study

Chronic pain, sleep disturbances, and depression, which are relevant symptoms of fibromyalgia syndrome, have been demonstrated to be associated with an increased likelihood of suicidal behaviors. Mortality from suicide has been shown to be greater among patients with fibromyalgia. This study aimed to assess the prevalence of suicidal ideation among a sample of patients with fibromyalgia and to evaluate its relationship with the clinical symptomatology of fibromyalgia. Baseline data from fibromyalgia patients willing to participate in different clinical studies were collected. Outcome measures included the Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the Pittsburgh Sleep Quality Index, the Brief Pain Inventory, and the SF-12 Health Survey. The scores for these scales were compared between patients with and without suicidal ideation. The presence of suicidal ideation was assessed using the answer provided to item 9 of the Beck Depression Inventory. The results were adjusted by age, sex, total comorbidity, and time since diagnosis with multiple linear regression. The sample comprised 373 patients of whom one hundred and seventy-nine (48%) reported suicidal ideation: 148 (39.7%) reported passive suicidal ideation and 31 (8.3%) active suicidal ideation. Suicidal ideation was markedly associated with depression, anxiety, sleep quality, and global mental health, whereas only weak relationships were observed between suicidal ideation and both pain and general physical health.