Difficulty In Initiating Sleep Research Articles

The association between sleep disturbance and second-hand smoke exposure: a large-scale, nationwide, cross-sectional study of adolescents in Japan

ObjectiveThis study investigated the association between secondhand-smoke (SHS) exposure and sleep disturbance symptoms. MethodsThis study was a cross-sectional survey of junior and senior high school students throughout Japan. A total of 85,931 adolescents responded, and 84,988 questionnaires were included in the analysis. ResultsAdolescents who had never smoked accounted for 88.0% of respondents; among that group 39.1% reported having been exposed to SHS over the previous week. The results of multiple logistic regression analyses indicated that the adjusted odds ratios for insomnia symptoms such as difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA), as well as sleep disturbance symptoms such as subjectively insufficient sleep and short sleep duration (<6 h), tended to be higher both among never-smoking adolescents with SHS exposure and among smoking adolescents, as compared with never-smoking adolescents without SHS exposure. When adolescents with one or more of DIS, DMS, and EMA were defined as having insomnia, the adjusted odds ratio for insomnia was highest for adolescents who smoked, followed in descending order by those exposed to SHS both inside and outside the home, those exposed to SHS only inside the home, those exposed to SHS only outside the home, and never-smoking adolescents without SHS exposure (p < 0.001). ConclusionsThe present study has revealed that SHS exposure is associated with sleep disturbance. Thus, in addition to smoking cessation programs, it is also necessary to endorse measures to protect adolescents from SHS exposure in order to promote good sleep in this population.

Association of depressive symptoms with health care service utilization in adults with chronic disease: A nationally representative sample

Increased cardiovascular risk associated with sleep-onset insomnia has been reported, but the patterns of heart rate (HR) transitions during sleep onset in individuals with sleep-onset insomnia remain uncertain. This study explored the HR dynamics during objective and subjective sleep onset transitions among sleep-onset insomnia.Seventeen good sleepers and 17 individuals with sleep-onset insomnia had their night-time HR measured. HR and heart rate variability (HRV) were analyzed within 8-min periods of pre- and post-transition of stage N1, stage N2 and subjective sleep onset.A significantly higher low-frequency percentage of HRV was observed in pre-N1 period among insomnia group, compared with good sleepers. Decline in HR begins in 160 s prior to N1 onset among good sleepers, whereas the HRs of insomnia group were reduced only after N1 onset in comparison to their HRs at the time of N1 onset. The good sleepers and insomnia group both had their HRs dropped to a level comparable to their HRs at respective stage N2 onset at 220 s and 80 s prior to N2 onset. No differences in HR was found during subjective sleep onset transition in both groups.During the wake-to-sleep transition, a low and stable HR was observed before cortical alternations in good sleepers; however, a consistently high HR until N1 onset was shown among sleep-onset insomnia. This finding suggests a state-dependent and failure to de-arouse from the high arousal level of wakefulness into light sleep is associated with sleep initiation difficulty.

Attention deficit hyperactivity disorder symptom severity and sleep problems in adult participants of the Netherlands sleep registry

BackgroundWe examined whether current overall attention deficit hyperactivity disorder (ADHD), inattention, or hyperactivity symptom severities are associated with the current presence and persistent history of sleep problems. MethodsN = 942 participants of the Netherlands Sleep Registry filled out online several validated questionnaires. Regression analyses were performed to assess the association between (1) current overall ADHD symptom severity and the current presence of sleep problems, (2) current ADHD symptom-severity groups and the persistent history of sleep problems, and (3) current inattention or hyperactivity symptom severities and the current presence of sleep problems. Results(1) Current overall ADHD symptom severity was associated with the odds of suffering from probable obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), insomnia disorder (ID) with predominant difficulties initiating sleep (DIS) and maintaining sleep (DMS), but not with the odds of suffering from narcolepsy or ID with predominant early-morning awakening (EMA). Current overall ADHD symptom severity was also associated with an extreme evening chronotype but not with short sleep. (2) The group with the most severe current ADHD symptoms was more likely to have a history of persistent OSAS, RLS, and ID. (3) The severity of symptoms of hyperactivity, but not of inattention, was specifically associated with probable RLS, PLMD, ID with DIS or DMS, and short sleep. Inattention symptom severity was only related to the probability of being an extreme evening chronotype. ConclusionADHD severity, especially the severity of hyperactivity, is associated with the current presence and persistent history of sleep problems.

Burden of Moderate to Severe Depression in the US Adult Population

To better understand the characteristics and burden of moderate/severe depression in the United States(US). A random stratified sampling framework was used in a 2016 survey of the US adult population to assess health conditions and impact on health related quality of life(HRQoL). Validated HRQoL and screening questionnaires for depression and anxiety were employed. Respondents with no/mild depression were compared to respondents with moderate/severe depression. Chi-squares for categorical data and general linear models were used to analyze comorbidities, age, race, medication use, productivity and resource utilization. Logistic regressions were used to assess predictors of moderate/severe depression. Approximately 16% of the US adult population reported PHQ-9 scores above 14(moderate/severe depression). Respondents with moderate/severe depression compared to those with no/mild depression had a significantly lower Physical Health Composite Score(PCS)(40.26 vs. 48.84; p<0.01) and Mental Health Composite Score(MCS)(30.96 vs. 53.77; p<0.01), as well as a lower health utility(0.56 vs. 0.78 p<0.01). Those with moderate/severe depression reported significantly lower levels of restorative sleep, as measured with the Restorative Sleep Questionnaire(36.85 vs. 72.38; p<0.01), and were more likely to report difficulty initiating sleep(DIS) (47.32 vs. 4.90; p<0.01) and difficulty maintaining sleep(DMS)(53.93 vs 9.53; p<0.01). Those with moderate/severe depression had more hours lost over the last week due to health problems(7.35 vs. 1.10; p<0.01) and were more likely to visit the emergency department (36.50% vs 10.19%; p<0.01) or have a hospital visit(23.84% vs. 6.67%; p<0.01) over the last 6 months. A logistic regression predicting moderate/severe depression(PHQ-9 < 4 vs. > 14) found age (OR 0.95; p<0.01), high blood pressure(OR=1.54; p=0.04), kidney disease(OR 6.20; p<0.01), anxiety(OR 5.02; p<0.01), DIS(5.29; p<0.01), DMS(4.55; p<0.01) predictive of moderate/severe depression. This study identifies factors predicting moderate/severe depression in US. Understanding these factors may provide direction on best practices to help improve care benefiting both patients and society.

Predictors of sleep difficulties in college students

IntroductionCollege students are known for their variable sleep schedules. Such schedules, along with other common student practices are associated with poor sleep hygiene. The persistence of the precipitating stressor is one of the factors involved in the persistence of insomnia.AimsTo examine the role of the perceived stress, perseverative thinking, strategies of cognitive emotion regulation and negative affect as predictors of sleep difficulties.MethodsThe sample comprises 549 college students.MeasuresPSS-10, PTQ, CERQ and POMS-58. Three questions were used to access difficulties in initiating sleep (DIS), maintaining sleep (DMS) and early morning wakening (EMA). A Sleep Difficulties Index (SDI) was calculated by summing DIS, DMS and EMA scores.ResultsIn total sample, the multiple linear regression explained 27.7% of the SDI total variance (R2 = .277, F(9, 375) = 15,942, P &lt; .0001). The significant predictors of the total variance of SDI were perceived distress (B = .246, P = .0001), repetitive thought (B = .189, P = .005), cognitive interference and unproductiveness (B = −.188, P = .006), rumination (B = .130, P = .044) and negative affect (B = .156, P = .018).ConclusionsPreventive interventions focused on predictor factors (perceived stress, perseverative thinking, rumination and negative affect) should be considered in order to promote better mental health in college students.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia

ObjectivesThe aims of this study were to compare the effects of acute morning or evening exercise on nocturnal sleep in individuals with two subjective insomnia symptoms: difficulty in initiating sleep (DIS), and early morning awakening (EMA), separately for the first vs the second halves of the night. MethodsOlder individuals (55–65 years old) with DIS (N = 15) or EMA (N = 15) and age- and sex-matched controls (N = 13) participated in this non-randomized crossover study. Participants were assigned to two exercise conditions (morning exercise and evening exercise) in counterbalanced order following the baseline condition with a two-week interval between conditions. A single session of aerobic step exercise was performed during each exercise condition. Nocturnal polysomnography was carried out to evaluate objective sleep quality. Patient global impression of change scale scores for nocturnal sleep were obtained to subjectively evaluate the different groups. ResultsAcute physical exercise did not improve subjective sleep quality. Morning exercise decreased the number of stage shifts over the whole night. The arousal index and the number of stage shifts were decreased especially during the second half of the night in all groups. Furthermore, morning exercise decreased the number of wake stages during the second half of the night in the DIS group, but not in the EMA group. ConclusionsAcute morning exercise can improve nocturnal sleep quality in individuals with difficulty initiating sleep, especially during the later part of the night.

The relationship between sleep disturbances and depression in daytime workers: a cross-sectional structured interview survey.

The aim of this study was to clarify the relationship between sleep disturbances and depression in daytime workers using a structured interview. A total of 1,184 daytime workers were enrolled. We evaluated difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and global insomnia scores (ISs) in all participants. As a result, the prevalences of DIS, DMS, and EMA were 16%, 46%, and 22%, respectively. IS was significantly correlated with depression score. Additionally, although all IS subscales (i.e., DIS, DMS, and EMA) were significantly associated with depression score, the main factor contributing to depression score was DIS. Thus, the present study reveals that sleep disturbances and especially DIS are associated with depression in daytime workers.

The course of insomnia in Parkinson's disease

IntroductionInsomnia is a debilitating symptom in Parkinson's disease (PD) that has been scarcely investigated in a longitudinal design. Knowledge of factors associated with occurrence of insomnia may provide clues for an increased understanding of underlying pathophysiology and facilitate early detection.The objective of this study is to examine the course and factors associated with longitudinal changes in insomnia severity in patients with PD. MethodsAnalyses were performed in data of the SCOPA-PROPARK cohort, a 5-year longitudinal cohort study (2003–2011) of 421 PD patients who have been examined annually. Linear mixed models were used to identify factors associated with longitudinal changes in scores of the SCOPA-SLEEP-Nighttime sleep (NS) problems section. A generalized estimating equations (GEE) analysis was performed to determine which baseline variables were associated with the different aspects of insomnia (sleep initiation or maintenance difficulty). ResultsBaseline SCOPA-SLEEP-NS scores were available for 412 patients, of whom 110 (27%) had insomnia (i.e. score ≥ 7). Of the remaining 302 patients, 99 (33%) developed insomnia at some point during follow-up. More severe depressive symptoms, motor fluctuations, higher dopamine agonist doses and sleep medication use were independently associated with higher SCOPA-SLEEP-NS scores over time. GEE analysis did not identify an unique set of determinants that affected specific aspects of insomnia. ConclusionThe presence of depressive symptoms, motor fluctuations and the use of higher doses of dopamine agonists are associated with more severe insomnia. Attention to these aspects could potentially contribute to a better management of insomnia symptoms in PD.

Emergence of Sex Differences in Insomnia Symptoms in Adolescents: A Large-Scale School-Based Study.

This study aimed to explore the moderation of pubertal status on the onset of sex differences in the prevalence of insomnia symptoms and their health correlates. A total of 7,507 children and adolescents (weighted percentage of female: 48.5%) aged between 6-17 y were recruited from thirty-one primary and secondary schools. Participants with difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and/or early morning awakening (EMA) ≥ 3 times/week in the past month were considered as having insomnia symptoms. The severity of insomnia was measured by the Insomnia Severity Index (ISI). The prevalence of insomnia symptoms increased from 3.4% to 12.2% in girls (3.6-fold) and from 4.3% to 9.1% in boys (2.1-fold) from Tanner stage 1 to 5. There was a significant interaction between sex and Tanner stage in the prevalence of insomnia (P < 0.001) with an emergence of female preponderance at Tanner stage 4 even after controlling for age, family income, and school start time. Similar sex-Tanner stage interactions were found in DIS, DMS, and ISI total score but not EMA. Insomnia symptoms were strongly associated with behavioral problems, poor mental health, and poor general health in both sexes. Boys with insomnia would report more maladaptive lifestyles (smoking, alcohol, and energy drinks) whereas girls with insomnia were more susceptible to emotional and relationship difficulties. Pubertal maturation was associated with a progressive increase in the prevalence of insomnia symptoms with the emergence of female preponderance in both the prevalence and severity of insomnia symptoms at late puberty. Chinese Clinical Trial Register, http://www.chictr.org.cn, ID: ChiCTR-TRC-12002798.

The Link of Self-Reported Insomnia Symptoms and Sleep Duration with Metabolic Syndrome: A Chinese Population-Based Study.

The aims of this study are to investigate the relationships of metabolic syndrome (MetS) with insomnia symptoms and sleep duration in a Chinese adult population. Data from a nationwide epidemiological survey conducted on residents from randomly selected districts in Taiwan in 2007 were used for this cross-sectional population-based study. A total of 4,197 participants were included in this study. Insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), were assessed using the Insomnia Self-Assessment Inventory questionnaire. Subjects were divided into 3 groups based upon their reported sleep duration (< 7, 7-8, and ≥ 9 h per night). Odds ratios (ORs) and 95% confidence intervals (CIs) derived from multivariable logistic regression were used to evaluate the study aims. The endorsement of DIS and DMS were cross-sectionally associated with the MetS after adjustment for sleep duration (OR [95% CI] was 1.24 [1.01-1.51] and 1.28 [1.02-1.61], respectively). In addition, short sleep duration was significantly associated with the prevalence of MetS independent of insomnia symptoms (OR [95% CI] was 1.54 [1.05-2.47]). However, there was no significant combined effect of insomnia symptoms and sleep duration on the prevalence of MetS. The current investigation shows that short sleep duration and insomnia symptoms, specifically DIS and DMS, were significant correlates of MetS. These findings should be replicated in prospective studies using both sleep duration and sleep quality measures.

The association between prolonged sleep onset latency and heart rate dynamics among young sleep-onset insomniacs and good sleepers

A blunting of heart rate (HR) reduction during sleep has been reported to be associated with increased all-cause mortality. An increased incident of cardiovascular events has been observed in patients with insomnia but the relationship between nighttime HR and insomnia remains unclear. Here we investigated the HR patterns during the sleep onset period and its association with the length of sleep onset latency (SOL). Nineteen sleep-onset insomniacs (SOI) and 14 good sleepers had their sleep analyzed. Linear regression and nonlinear Hilbert-Huang transform (HHT) of the HR slope were performed in order to analyze HR dynamics during the sleep onset period. A significant depression in HR fluctuation was identified among the SOI group during the sleep onset period when linear regression and HHT analysis were applied. The magnitude of the HR reduction was associated with both polysomnography-defined and subjective SOL; moreover, we found that the linear regression and HHT slopes of the HR showed great sensitivity with respect to sleep quality. Our findings indicate that HR dynamics during the sleep onset period are sensitive to sleep initiation difficulty and respond to the SOL, which indicates that the presence of autonomic dysfunction would seem to affect the progress of falling asleep.

Insomnia and daytime neuropsychological test performance in older adults

Objectives/BackgroundThere is good documentation of the impact of insomnia on daytime cognitive function based on self-reports, but not on neuropsychological test performance. The study investigated the association of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) complaints with daytime domain-specific neuropsychological performance in older adults. Participants/MethodsParticipants were 859 older adults (mean 71.9 years) in the Singapore Longitudinal Ageing Studies. They were interviewed and assessed at community-based eldercare activity centres and completed a sleep survey questionnaire and a battery of neuropsychological tests (Digit span, Rey Auditory Verbal Learning Test, Story memory, Brief Visuospatial Memory Test-Revised, Color Trails Test (1 and 2), Block design, and Verbal fluency). ResultsInsomnia complaints were present in 18.0% (n = 155) of participants. Controlling for the presence of other insomnia complaints, psychosocial and medical variables, and depression, EMA was independently and significantly associated with worse executive functioning (p = 0.031). DIS and DMS were not independently associated with poorer performance on any cognitive domain. ConclusionThe association of EMA among older adults with decreased executive functioning and underlying mechanistic factors should be further investigated.

Symptoms of Depression and Difficulty Initiating Sleep from Early Adolescence to Early Adulthood: A Longitudinal Study.

To assess the direction of the relationship and degree of shared associations between symptoms of depression and difficulty initiating sleep (DIS) from early adolescence to early adulthood. Cross-sectional and longitudinal assessment of the symptoms of depression-DIS association from early adolescence (age 13 y) to early adulthood (age 23 y). Hordaland, Norway. There were 1,105 individuals (55% male) who took part in the Norwegian Longitudinal Health Behaviour Study (NLHB) and participated at least once across seven data collection waves during the years 1990-2000. N/A. Characteristic data were obtained during the first assessment. Symptoms of depression and instances of DIS were assessed during each data collection wave. Symptoms of depression and DIS were associated in all data waves, and one-step cross-lagged bivariate correlations were significant and comparatively high for both factors. Structural equation modelling indicated that DIS and symptoms of depression at wave 1 remain relatively stable across waves (all P < 0.001), and a significant and consistent unidirectional cross-lagged effect was noted running from symptoms of depression to DIS from early adolescence to early adulthood. DIS is only marginally and inconsistently associated with the lagged symptoms of depression score across waves. These results suggest that symptoms of depression established in early adolescence are a moderate predictor of difficulty initiating sleep (DIS) in early adulthood, whereas the reverse association of DIS predicting depression was not convincingly supported. These findings are in contrast to previous findings that suggest sleep problems as a risk factor for the later development of depression.

Parkinson's disease and insomnia.

There is a broad spectrum of sleep disturbances observed in Parkinson's disease (PD). The prevalence of symptoms of insomnia and chronic inability to sleep and their association with other sleep disorders were studied. Altogether 1447 randomly selected Parkinson patients, aged 43-89years, participated in a questionnaire study. A structured questionnaire with 207 items was based on the Basic Nordic Sleep questionnaire. Questions on demographics, PD, REM Sleep Behavior Disorder, and other issues were included. The response rate was 59% (N=854), and of these 81% returned fully answered questionnaire (N=689). Prevalence of chronic inability to sleep was 36.9% (95% CI 33.3-40.5). Difficulty of initiating sleep was 18.0% (95% CI 15.1-20.9), disrupted sleep 81.54% (78.5-84.4), awakenings during night 31.3% (27.8-34.8), early morning awakenings 40.4% (36.8-44.1) and non-restorative sleep 38.5% (34.8-42.1). In the logistic regression models, poor quality of life and restless legs syndrome correlated significantly with chronic insomnia disorder. Disrupted sleep and early morning awakenings were the most common insomnia symptoms. PD patients do not seem to have difficulties in sleep initiation. Insomnia symptoms including disruptive sleep and non-restorative sleep are common in patients with Parkinson's disease. Inability to sleep is more common as comorbidity than a single sleep problem.

Sleep variability and fatigue in adolescents: Associations with school-related features.

This study aims to evaluate the influences of sleep duration and sleep variability (SleepV), upon adolescents' school-related situations. The Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants were 3164 pupils (53.7% girls), attending the 8th and 10th grades, 14.9 years old, and were inquired about subjective sleep duration during the week and weekends, SleepV, fatigue, difficulties in sleep initiation, school achievement, feelings towards schools, pressure with school work and skipping classes. Multiple regression models used, as dependent variables: (a) school achievement, (b) disliking school, (c) pressure with school work and (d) skipping classes, using as independent variables, each of the remaining school-related variables, fatigue, total sleep duration and difficulties in sleep initiation. The average sleep duration in the week and during weekdays was lower than recommended for these age groups, and almost half of students had high SleepV between weekdays and weekends. A logistic model revealed that the absence of SleepV was associated with lower perception of school work pressure, less frequent skipping classes, more infrequent fatigue and more infrequent difficulties in sleep initiation. Poor sleep quality, SleepV and insufficient sleep duration affected negatively school-related variables.

Sleep differences among children with autism spectrum disorders and typically developing peers: a meta-analysis.

Sleep problems such as difficulties in sleep initiation, nighttime awakening, and shortened sleep time are often subjectively reported in children with autism spectrum disorder (ASD). However, results of objective studies have been mixed. Our goal was to evaluate the existing data from objective measures using a systematic approach to identify and describe the differences in sleep parameters by comparing total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) in children with ASD with those of typically developing (TD) peers. Studies that used objective measures such as actigraphy or polysomnography (PSG) to describe the sleep parameters of TST, SL, and SE in children with ASD compared with children with TD were identified. A meta-analysis was performed for the 10 studies that met inclusion criteria with evaluation of differences in means using random effects models. A total of 343 children with ASD and 221 children with TD were included. Assessments for sources of heterogeneity and publication bias were undertaken. TST for children with ASD was on average 32.8 minutes less per day (95% confidence interval [CI]: 16.6-49.0 minutes) than their TD peers. Average SL was 10.9 minutes longer (95% CI: 6.7-15.0 minutes), and average SE was 1.9% less (95% CI: 0.7%-3.1%) than their TD peers. Notable heterogeneity was found within studies for TST, and mild heterogeneity was found for SE. Concurrent intellectual disability was a moderator of TST. Children with ASD and normal intelligence had a small and nonsignificant decrease in TST as compared with TD peers, whereas those with ASD and intellectual disability (ID) had a significant decrease in TST as compared with TD peers. The magnitude of the difference in mean SL and SE increased as compared with TD peers as age increased. Studies that used PSG and those that did not include children on medications were more likely to report mean decreases in SE. Children with ASD have small but measurable objective differences in their sleep parameters that are consistent with subjective reporting. Children with ASD have shorter TST, longer SL periods, and decreased SE as compared with TD peers. Concurrent ID, medication use, method of data collection, and age of subjects significantly moderated these results. The decrease in TST in children with ASD and normal intelligence was not significant as compared with TD peers, suggesting that ID may help explain the shortened TST in children with ASD.

The Association between Insomnia Symptoms and Diet Quality and Energy Intake

Insomnia, characterized by difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early‐morning awakenings (EMA), or nonrestorative sleep (NRS), is the most common sleep disorder. While some small clinical studies have shown potential impact of sleep on eating habits, the relationship between insomnia and diet remains unclear. We thus conducted a longitudinal analysis to examine whether men with insomnia symptoms had a lower diet quality and greater energy intake 2 years later. Analysis included 15,005 US men (mean age 67.3 ± 8 y) participating in the Health Professionals Follow‐up Study and free of cancer, diabetes, and cardiovascular diseases. Insomnia was assessed in 2004 via questionnaires by asking participants how often (rarely/never, sometimes, or most of the time) they experienced insomnia symptoms. Dietary intake was assessed by a validated food frequency questionnaire in 2002 and 2006; the Alternative Healthy Eating Index (AHEI) was utilized as the measure of diet quality. Analyses adjusted for age, smoking, body mass index, AHEI and total energy intake in 2002, and other potential confounders. Men with DIS in 2004 tended to have a lower diet quality score (P‐trend&lt;0.0001) and higher energy intake (P‐trend=0.07) in 2006, in a dose‐dependent manner. Reporting DMS and NRS were associated with higher energy intake (P‐trend&lt;0.01 for both). In contrast, we did not observe significant associations between other insomnia symptoms and diet quality or energy intake. In conclusion, certain insomnia symptoms could have potential unfavorable impact on diet.

Sleep maintenance difficulties in insomnia are associated with increased incidence of hypertension

Study objectivesWe examined the relative contributions of sleep onset and sleep maintenance difficulties in insomnia as predictors of incidence and development of hypertension. DesignThis study is cross-sectional and longitudinal. ParticipantsThere were 967 adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition–based current insomnia. Measurements and resultsAt baseline, participants were divided into 2 groups based on current diagnosis of hypertension. Prevalence of hypertension in this sample was 34.7%, which is higher than the prevalence in the general population previously documented at approximately 28%. Participants completed a follow-up assessment 1 year later that revealed a 5.4% incidence of hypertension. Analyses revealed that increases in sleep maintenance difficulties, not sleep initiation difficulties, between baseline and follow-up significantly predicted increased risk for incidence of hypertension. Analyses at baseline also revealed that sleep maintenance rather than sleep initiation difficulties marginally predicted increased severity of hypertension. Results suggest that risk for hypertension may be conferred through disruptions to blood pressure with nightly repeated or prolonged awakenings. ConclusionsThis study provides novel information regarding the risk of hypertension in insomnia via sleep maintenance difficulties. Findings from this study provide preliminary evidence for examining nighttime fluctuations of blood pressure and concomitant physiological changes (ie, catecholamines, heart rate, and sympathetic activation) due to wake during sleep as a mechanism for subsequent hypertension.

The impact of obesity and weight gain on development of sleep problems in a population-based sample

ObjectivesThe objective of this study was to investigate the role of obesity and weight gain in the development of sleep problems in a population-based cohort. Material and methodsA population-based sample of men (n = 1896, aged 40–79 years) and women (n = 5116, age ≥20 years) responded to questionnaires at baseline and follow-up after 10–13 years. Sleep problems were assessed through questions about difficulties initiating sleep (DIS), difficulties maintaining sleep (DMS), excessive daytime sleepiness (EDS), and insomnia. Body mass index (BMI) was calculated from self-reported weight and height at both baseline and follow-up, while confounding factors (physical activity, tobacco and alcohol use, somatic disease, and snoring) were based on responses at baseline. ResultsAlthough overweight and obese subjects reported more sleep problems at baseline, there was no independent association between BMI level at baseline and development of new sleep problems. Subjects in the quartile with the highest rise in BMI with a weight gain exceeding 2.06 kg/m2 had a higher risk of developing DMS [adjusted odds ratio (OR) 1.58; 95% confidence interval (CI) 1.25–2.01), EDS (2.25; 1.65–3.06], and insomnia (2.78; 1.60–4.82). Weight gain was not associated with the development of DIS. ConclusionsWeight gain is an independent risk factor for developing several sleep problems and daytime sleepiness. The presence of overweight and weight gain should be considered when treating patients with sleep problems.

Sleep deprivation in adolescents: correlations with health complaints and health-related quality of life

ObjectivesThe present study aimed to evaluate the influences of sleep duration, sleep deprivation, and weekend variability of sleep upon other adolescents' features, namely those related to health and health-related quality of life. MethodsThe Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants in the present study were 3476 students (53.8% were girls) in the 8th and 10th grades at school; the mean age was 14.9 years (range 12.5–19.0). Subjective sleep duration during the weeknights and weekends was collected; sleep deprivation (SD) was considered whenever the difference was greater than 3 h. Health complaint frequency and health-related quality of life (with the Kidscreen 10) were collected. ResultsSleep deprivation was present in 18.9% of the students. It was negatively correlated with sleep duration on weeknights. There were no gender differences, but SD increased with age and grade. Higher school grades were mainly associated with fatigue. A considerable number of adolescents had sleep problems (37.2%); 25.5% had difficulties in sleep initiation, which was more prevalent in adolescents with SD. The sleep duration on weeknights was decreased in the SD group. The average health-related quality of life was reduced in adolescents with SD. The frequency of health complaint was higher is adolescents with SD. Girls had significantly more health complaints than boys, with special focus on headaches. ConclusionsSleep deprivation is associated with the perception of health-related quality of life and perceived physical and mental health.