Difficulty Maintaining Sleep Research Articles

Cross-sectional analyses of factors associated with the presence and aggravation of chronic insomnia by symptom subtypes.

The aim of this study was to investigate the association of psychological and chronobiological factors with the presence and severity of chronic insomnia by symptom subtypes and their impacts on daytime dysfunctions. Participants of the present web-based epidemiological study were classified as follows: difficulty initiating sleep (DIS) (n = 91); difficulty maintaining sleep (DMS) (n = 13); early morning awakening (EMA) (n = 48); DIS + DMS (n = 67); DIS + EMA (n = 23); DMS + EMA (n = 24); triplet of DIS, DMS, and EMA symptoms (TRP) (n = 69); and normal sleepers (n = 4590). The Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), Munich Chronotype Questionnaire (MCTQ), insomnia-related psychological measures (including the Ford Insomnia Response to Stress Test [FIRST] and the Dysfunctional Beliefs and Attitudes about Sleep Scale [DBAS]), and the cognitive and somatic domains of the Pre-Sleep Arousal Scale (PSAS) were evaluated. The presence of DIS and DIS + DMS were significantly associated with an evening preference, and EMA and EMA + DMS with a morning preference, while TRP showed no significant association with either chronotype. The increase in DBAS scores was associated with higher ISI scores in all subtypes. Meanwhile, the associations of each psychological measure varied among insomnia subtypes, with the association of PSAS cognitive arousal to DIS and PSAS somatic arousal to both DMS + EMA and TRP. Pathological HADS score was associated with all subtypes. Chronotypes may be associated with the presence of some insomnia subtypes; however, only psychological factors were speculated to contribute to the aggravation of all subtypes. All insomnia subtypes possibly contribute to the formation of depression.

Association of insomnia and daytime napping with metabolic syndrome and its components in a Korean population: an analysis of data from the Korean Genome and Epidemiology Study.

We investigated the association between metabolic syndrome (MetS) and the coexistence of insomnia and daytime napping, because limited data have been reported regarding this association. The study population was 8,440 participants aged 40-65 years, who were from the Korean Genome and Epidemiology Study. Self-reported information on insomnia symptoms and nap duration was used to define exposure variables. Data on waist circumference (WC), blood pressure (BP), and fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein cholesterol levels in blood were used to define MetS. Multivariate logistic regression analysis was performed to obtain odds ratio (OR) and 95% confidence interval (CI). In multivariate logistic regression analysis, the coexistence of insomnia and napping was not significantly associated with MetS. However, the insomnia and non-napping group showed higher ORs of high TG (OR, 1.19; 95% CI, 1.02 to 1.39) and high BP (OR, 1.28; 95% CI, 1.10 to 1.49) than the non-insomnia and non-napping group. The combination of non-insomnia and napping and that of insomnia and napping showed higher ORs of high TG (OR, 1.13; 95% CI, 1.00 to 1.29) and high FBG (OR, 1.59; 95% CI, 1.14 to 2.21), respectively. In analyses of insomnia symptoms, only the combination of difficulty in maintaining sleep (DMS) and non-napping showed a higher OR for MetS (OR, 1.25; 95% CI, 1.03 to 1.52) than the non-DMS and non-napping group. Individuals with insomnia, particularly those who do not take naps, were disproportionately likely to have MetS components, especially TG or BP. Information on these variables may help predict individuals' vulnerability to specific MetS components.

The association between polluted fuel use and self-reported insomnia symptoms among middle-aged and elderly Indian adults: a cross-sectional study based on LASI, wave 1

BackgroundInsomnia predisposes the aging population to reduced quality of life and poor mental and physical health. Evidence of the association between polluted fuel use and insomnia symptoms is limited and is non-existent for the Indian population. Our study aimed to explore the link between polluted fuel use and insomnia symptoms in middle-aged and older (≥ 45 years) Indian populations.MethodsWe utilized data from nationally representative Longitudinal Aging Study in India (LASI) Wave 1. Participants with complete information on fuel use, insomnia symptoms, and covariates were included. Insomnia symptoms were indicated by the presence of at least one of three symptoms: difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), or early morning awakening (EMA), ≥ 5 times/week. Survey-weighted multivariable logistic regression analyses were conducted to evaluate the association between polluted fuel use and insomnia symptoms. We also assessed the interaction of association in subgroups of age, gender, BMI, drinking, and smoking status.ResultsSixty thousand five hundred fifteen participants met the eligibility criteria. Twenty-eight thousand two hundred thirty-six (weighted percentage 48.04%) used polluted fuel and 5461 (weighted percentage 9.90%) reported insomnia symptoms. After full adjustment, polluted fuel use was associated with insomnia symptoms (OR 1.16; 95%CI 1.08–1.24) and was linked with DIS, DMS, and EMA (OR 1.14; 95%CI 1.05–1.24, OR 1.12; 95%CI 1.03–1.22, and OR 1.15; 95%CI 1.06–1.25, respectively). No significant interactions for polluted fuel use and insomnia symptoms were observed for analyses stratified by age, sex, BMI, drinking, or smoking.ConclusionsPolluted fuel use was positively related to insomnia symptoms among middle-aged and older Indians. Suggestions are offered within this article for further studies to confirm our results, to explore underlying mechanisms, and to inform intervention strategies.

Association between dietary pattern and insomnia symptoms among independent older adults: A cross-sectional study based on JAGES

BackgroundPoor diet can cause sleep disorders; however, this association has not been established in older populations. This study investigated the association between dietary patterns and insomnia symptoms in independent older adults. MethodsThis cross-sectional study targeted independent older Japanese adults aged ≥74 years. We used insomnia symptoms classified into three domains: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and insomnia. These symptoms were assessed as dependent variables by a self-reported questionnaire. Dietary patterns (DP), identified by principal component analysis of a self-administered diet history questionnaire, were used as independent variables. Poisson regression analysis was used to estimate the prevalence ratios and 95% confidence intervals with adjustment for potential confounders. ResultsAmong 1,311 participants (mean age = 80.1; women, 48.5%), we identified three dietary patterns: DP1 was characterized by a high intake of vegetables, soy products, and fruits and a low intake of rice; DP2 was characterized by a high intake of fish, chicken, processed meat, and noodles and a low intake of soy products; and DP3 was characterized by a lower intake of fruits and confectionaries. Higher DP1 scores were significantly associated with a lower prevalence of DIS (p-for-trend = 0.012). A higher DP2 score was significantly associated with a higher prevalence of insomnia (p-for-trend = 0.032). There was no significant association between DP3 and insomnia symptoms (p-for-trend >0.05). ConclusionOur results highlighted that a dietary pattern with a high intake of vegetables, soy products, and fruits may contribute to reducing insomnia symptoms among independent older adults.

Sleep disturbance and quality of life among university freshmen in Qinghai-Tibet Plateau of China.

University freshmen are particularly vulnerable as they are undergoing the transition from high school to university with a range of changes. Sleep problems among this group in the Qinghai-Tibet Plateau of China were barely studied. This study aimed to explore sleep disturbance, and its association with quality of life (QoL) and demographic and clinical characteristics among university freshmen in Qinghai-Tibet Plateau, China. A multistage stratified cluster random sampling method was performed to recruit student participants with a structured questionnaire to collect sociodemographic and clinical characteristics, and lifestyle behaviors. Sleep disturbance including three aspects of sleep disturbance (i.e., difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA)) was assessed using standardized measurement. Multiple logistic regression models were applied to analyze the data. Among included 2,769 freshmen, the prevalence of sleep disturbance was 14.8% (95% CI: 14.2-15.5%), and corresponding prevalence of DIS, DMS, and EMA was 8.2% (95% CI: 7.7-8.7%), 8.3% (95% CI: 7.8-8.8%), and 4.2% (95% CI: 3.8-4.6%), respectively. Freshmen with sleeping disturbance had significantly lower QoL in physical [F (1, 2769) = 60.23, p < 0.001], psychological [F (1, 2769) = 46.18, p < 0.001], social [F (1, 2769) = 23.04, p < 0.001], and environment [F (1, 2769) = 6.07, p = 0.01] domains. Multiple logistic regression analyses revealed that having breakfast five times a week or less (less than three times, OR = 1.79, 95% CI: 1.34-2.40; 3-5 times, OR = 1.40, 95% CI: 1.09-1.79), self-perceived severe Internet dependence (OR = 1.71, 95% CI: 1.11-2.65), self-perceived poor health status (OR = 3.44, 95% CI: 2.06-5.74), high academic stress (OR = 1.42, 95% CI: 1.13-1.78), poor relationship with classmates (OR = 3.44, 95% CI: 1.53-7.71), and severe ADHD symptoms (OR = 1.08, 95% CI: 1.05-1.12) were positively associated with sleeping disturbance. Sleep disturbance was common among freshmen and is associated with poorer QoL. Prevention and intervention strategies should be developed and implemented, especially among the vulnerable university freshman groups.

Prevalence and Correlates of Insomnia Symptoms in Older Chinese Adults During the COVID-19 Outbreak: A Classification Tree Analysis.

ObjectiveTo examine prevalence and correlates of insomnia symptoms in older Chinese adults (OCAs) during the COVID-19 outbreak.BackgroundDuring the COVID-19 pandemic, insomnia is a major health concern of elderly individuals, but its subtypes have not been investigated.MethodsAltogether, 590 OCAs (50+ years) were recruited via snowball sampling during the COVID-19 outbreak. Standardized self-report questions were used to assess the presence of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA). Classification tree analysis (CTA) was used to identify correlates of insomnia.ResultsThe one-month prevalence (95% confidence interval) of any subtype of insomnia symptoms was 23.4% (20.0–26.8%), with DIS, DMS, and EMA being 15.4% (12.5–18.3%), 17.1% (14.1–20.2%), and 11.2% (8.64–13.7%), respectively. Worry about being infected with COVID-19 emerged as the most salient correlate of insomnia (P < .001); compared to participants who were not worried about being infected, those who were worried and very worried were 3.2-fold (24.3% vs 7.5%) and 5.5-fold (24.3% vs 7.5%) more likely to have insomnia, respectively. Among participants in the “very worried” branch, those residing in Wuhan were 1.8-fold more likely to have insomnia than those residing in other places (50.0% vs 27.5%, P = .011). Among participants in the “worried” branch, unemployed persons were 2.0-fold more likely to have insomnia than employed persons (37.0% vs 18.1%, P < .001).ConclusionsInsomnia symptoms were prevalent among OCAs during the COVID-19 outbreak. Selective intervention programs targeting elderly individuals who are worried about being infected, living in the epicenter of COVID-19, and unemployed might be effective.

Prevalence and clinical correlates of insomnia symptoms and their association with quality of life in Chinese patients with HBV-related liver disease.

ObjectiveThis study aimed to describe the one-month prevalence of insomnia symptoms (insomnia hereafter) and the demographic and clinical correlates, and its association with quality of life (QOL) in Chinese patients with HBV-related liver disease.MethodA total of 689 patients with HBV-related liver disease in Beijing, China formed the study sample. Three forms of insomnia including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA) were assessed using standardized questions. QOL was measured using the Medical Outcomes Study Short Form 12 (SF-12).ResultsThe one-month prevalence of at least one type of insomnia was 69.5%, while DIS, DMS and EMA were 60.4%, 54.7% and 50.9%, respectively. Only 4.8% of patients suffering from insomnia received treatment. Multiple logistic regression analyses revealed that pre-existing medical conditions were positively associated with DIS and EMA; patients with more severe depressive symptoms were more likely to have DIS, DMS and EMA; local residents were less likely to have DIS; and those who were married and older were more likely to have DMS. Insomnia was not independently associated with QOL.ConclusionsInsomnia is common in Chinese patients with HBV-related liver disease with a very low rate of treatment. Greater attention should be given to identify and treat insomnia in this patient population.

Sleep disturbance and its association with quality of life among psychiatric nurses in China.

BackgroundSleep disturbance is associated with a number of negative adverse outcomes. This study examined the prevalence of sleep disturbance and its association with demographic and clinical characteristics and quality of life (QOL) in psychiatric nurses in China.MethodsThis is a multi-center, cross-sectional study involving 11 psychiatric hospitals in China. Three types of sleep disturbance (difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early-morning awakening (EMA)) and QOL were measured by standardized questions or instruments.ResultsA total of 1,847 psychiatric nurses participated. The overall prevalence of at least one type of sleep disturbance was 71.5% (95% CI [69.3–73.5]); the prevalence of DIS, DMS and EMA was 58.5% (95% CI [56.2–60.8]), 53.7% (95% CI [51.4–56.0]) and 54.6% (95% CI [52.3–56.9]), respectively. Nurses with sleep disturbance had significantly lower QOL in physical (F(1, 1,846) = 219.12, P < 0.001), psychological (F(1, 1,846) = 72.18, P < 0.001), social (F(1, 1,846) = 37.57, P < 0.001) and environmental domains (F(1, 1,846) = 95.45, P < 0.001). Multivariable logistic regression analyses revealed that shift work (DIS, OR = 1.6, 95% CI [1.28–1.98]; DMS, OR = 1.2, 95% CI [1.001–1.54]; EMA, OR = 1.3, 95% CI [1.02–1.58]) and alcohol use (DIS, OR = 1.8, 95% CI [1.46–2.32]; DMS, OR = 1.8, 95% CI [1.43–2.23]; EMA, OR = 1.7, 95% CI [1.33–2.07]) were positively associated with sleep disturbance, while higher monthly income (DIS, OR = 0.5, 95% CI [0.38–0.75]; DMS, OR = 0.7, 95% CI [0.51–0.98]) was negatively associated with sleep disturbance.ConclusionSleep disturbance was common among nurses in psychiatric hospitals in China, particularly those on shifts and having alcohol use. Health authorities should develop effective measures to reduce risk of sleep disturbance in this population.

Identification of comprehensive geriatric assessment-based risk factors for insomnia in elderly Chinese hospitalized patients.

ObjectiveInsomnia is a common problem in older persons and is associated with poor prognosis from a functional or clinical perspective. The purpose of this study was to investigate the prevalence of insomnia and identify comprehensive geriatric assessment (CGA) based clinical factors associated with insomnia in elderly hospitalized patients.MethodsStandardized face‐to‐face interviews were conducted and CGA data were collected from 356 Chinese hospitalized patients aged 60 years or older. Insomnia was defined as self‐reported sleep poor quality according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐Ⅴ). Multivariate logistic regression analysis was applied to assess the association between patient clinical factors together with domains within the CGA and insomnia.ResultsAmong the 365 patients, insomnia was found in 48.31% of the participants. Difficulty in initiating sleep (DIS), early morning awakening (EMA), difficulty in maintaining sleep (DMS), and snoring were found in 33.99%, 9.55%, 13.48%, and 1.69% of patients, respectively. Significant associations were found between insomnia and several covariates: female gender (P = 0.034), depression (P = 0.001), activities of daily living (ADL) (P = 0.034), instrumental activities of daily living (IADL; P = 0.009), falling (P = 0.003), chronic pain (P = 0.001), and poor nutritional status (P = 0.038). According to the results of the adjustment multivariate logistic regression analysis, female sex (odds ratio [OR] = 2.057, confidence interval [CI] = 1.179‐3.588, P = 0.011), depression (OR = 1.889, CI = 1.080‐3.304, P = 0.026), and chronic pain (OR = 1.779, CI = 1.103‐2.868, P = 0.018) were significant independently predictors associated with insomnia.ConclusionsOur study revealed that female sex, depression, and chronic pain were independently predictors of insomnia in hospitalized patients. Early identification of elderly patients with these risk factors using the CGA may improve the quality of life and treatment outcomes.

Circadian Rhythm Disorders and Risk of Subsequent Depression: A Systematic Review and Meta-Analysis of Longitudinal Studies

Background: Patients with depression often suffer from circadian rhythm disruptions, such as insomnia and a lower amplitude of daily rhythms of locomotor activity. However, whether circadian disorders precede depression and act as a predictor for subsequent depression have not been unanimously approved. In light of increasing evidence of an association between disrupted circadian rhythms and affective symptoms, a meta-analysis was conducted to examine the effect of circadian disruptions on incident depression. Methods: A systematic search was performed in PubMed, Embase, Web of Science, PsycINFO, PsycArticles, CINAHL database. The search results were restricted to be published in English up to April 10, 2020.Reference lists from included studies and relevant reviews were also screened. We included longitudinal cohort studies that examined the predictive role of all various types of circadian disruption in incident depression. Two reviewers independently extracted information on study design, participants’ characteristics and diagnostic criteria for circadian disruption and depression. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect models were applied to all meta-analyses given potential heterogeneity. For insomnia, subgroup analyses were performed based on subject’s characteristics, insomnia symptom domains and numbers and the investigated methods. Pool-effect estimates of relative risks to develop incident depression in groups with circadian disruption compared to groups without. This study is registered with PROSPERO, CRD42020179135. Findings: A total of 49 studies were eligible for this meta-analysis. Of 49 eligible studies, included types of circadian disruption were sleep disturbances (n = 45), chronotype (n = 2), cortisol awakening response (n = 1) and rest - activity rhythm (n = 1). Insomnia, hypersomnia, excessive daytime sleepiness (EDS), short sleep duration, obstructive sleep apnea (OSA), restless legs syndrome (RLS), an evening preference, heightened levels of cortisol in awakening response and low robustness of rest - activity rhythm all acted as significant predictors of occurrence of depression. Among insomnia subtypes, difficulty initiating sleep (DIS) and difficulty maintaining sleep (DMS) predicted future depression. Of note, persistent insomnia (OR: 5.02) contributed to more than two - fold risk of incident depression compared to insomnia (OR: 2.34). Moreover, insomnia symptom numbers were associated with incident depression in a gradient trend. Interpretation: Different types of circadian disorders act as risk factors of onset of depression, which clinicians should be informed of. Future research should be aimed to determine the casual relationship between other types of circadian disorders and onset of depression, and moreover to further elucidate the underlying mechanisms. Funding Statement: This work was supported in part by the National Natural Science Foundation of China (no. 81871071 and 81171251) and Beijing Municipal Natural Science Foundation (no. 7162101). Declaration of Interests: All of the authors declare no conflict of interest.

The Effect of Repetitive Transcranial Magnetic Stimulation on Meta-Worry and Neuropsychological Functions among Patients with Depression

Background and Objective: Repetitive transcranial magnetic stimulation (rTMS) is recommended as an effective treatment for both major depressive disorder (MDD) and treatment-resistant depression. According to the possible impact of rTMS on cognitive psychological characteristics, this study aimed to determine the effectiveness of rTMS in meta-worry and neuropsychological functions among MDD patients. Materials and Methods: This quasi-experimental study was conducted on 30 patients with MDD referring to Atieh Clinical Neuroscience Center, Tehran, Iran, in 2019. The participants were randomly divided into two groups of intervention and control (n=15 each). The data collection tools included the Beck Depression Inventory, meta-worry subscale of the Anxious Thoughts Inventory, and Cambridge Neuropsychological Test Automated Battery. Results: The comparison between the two groups showed that the scores of the meta-worry scale improved after the intervention in patients undergoing rTMS, compared to those in the control group (Z=-3.41; P=0.002); however, no difference was observed between the two groups in the follow-up (Z=-2.02; P=0.053). The assessment of neuropsychological functions among the patients undergoing rTMS and those in the control demonstrated that neuropsychological functions (i.e., Minimum Spanning Tree, Rapid Visual Information Processing, and Spatial Working Memory) were significantly different immediately after the intervention and in the follow-up (P&lt;0.05) except for the Difficulty Maintaining Sleep (DMS) subtest. In addition, the mean depression score was significantly different between the two groups (Z=-4.17; P&lt;0.005). There was a significant relationship between depression and all the subtests of neuropsychological functions except for DMS (P&gt;0.05). Conclusion: In summary, the results of the current study indicated that the use of rTMS was an effective method in the improvement of neuropsychological functions except for DMS in patients with depression. However, the obtained findings did not demonstrate the persistent effect of multiple rTMS on meta-worry.

In-Depth Characterization of Sleep Patterns Among People with Insomnia During the Pandemic of COVID-19.

Background. The effects of the COVID-19 pandemic on sleep duration and insomnia have been well studied in different studies. However, there is no study available on the characteristics of insomnia during the pandemic. This study aimed to evaluate the characteristics of insomnia experienced by the general Iranian population during the COVID-19 pandemic. Methods. A cross-sectional community-based study was designed. We designed an online questionnaire and sent it to Iranian people via available social platforms. The questionnaire contained questions on the socio-demographic characteristics of the participants. We used Fear of COVID-19 scale (FCV-19), Insomnia Severity Index (ISI), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder Scale-2 (GAD-2) for detailed characterization of insomnia and its symptoms. Results. In total, 675 people with insomnia with the mean age of 40.28 years (SD=11.15) participated in our study. Prevalence of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 91.4%, 86.7%, and 77%, respectively. DIS, DMS, and EMA were more common in people with depression and anxiety. FCV-19 score was higher in those with more severe types of DIS, DMS, and EMA (P<0.001). FCV-19 was a risk factor for all patterns of insomnia (OR=1.19, 1.12, 1.02 for DIS, DMS, and EMA, respectively). Conclusion. Fear of COVID-19 is a major contributing factor to insomnia patterns. Investigation of COVID-19 fear in people with insomnia and the addition of attributed relieving or management strategies to conventional management of insomnia are reasonable approaches to improve the sleep condition of people in the pandemic.

Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study.

The aim of this study was to investigate the prevalence of sleep problems, depression and anxiety symptoms among conscripted frontline nurses fighting coronavirus disease 2019 (COVID-19) in Wuhan.This study was a cross-sectional study conducted with 100 frontline nurses. Sleep quality, depression, and anxiety symptoms were measured using the Pittsburgh sleep quality index (PSQI), the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively.Mean sleep duration was 5.71 hours (SD = 1.09) and mean sleep latency was 33.49 minutes (SD = 28.87). A total of 76%, 81%, 45%, and 19% reported difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) or early morning awakening (EMA), nightmares and using hypnotics respectively. Among 100 participants in this study, 60 (60%) had poor sleep quality, 46 (46%) suffered depression symptoms and 40 (40%) reported anxiety symptoms. Sleep quality (OR = 3.16, 95% CI: 1.17–8.52) and anxiety symptoms (OR = 8.07, 95% CI: 2.92–22.33) were significantly associated with depression symptoms. Depression symptoms (OR = 7.92, 95% CI: 2.89–21.73) were related to anxiety symptoms. Similarly, depression symptoms (OR = 3.24, 95% CI: 1.19–8.79) were associated with poor sleep quality.Sleep disturbance, depression, and anxiety symptoms are very common among frontline nurses who treating patients with COVID-19 in Wuhan, China. Comprehensive measures that involve psychosocial and personal behaviors should be implemented to improve sleep quality and prevent depression and anxiety symptoms.

Dampness and mold at home and at work and onset of insomnia symptoms, snoring and excessive daytime sleepiness

AimTo investigate whether exposure to dampness and mold at home and at work induce sleep disturbances and daytime sleepiness among adults. Materials and methodsAssociations between onset of sleep disturbances and dampness, mold and mold odor at home and at work were investigated in a cohort of 11,318 adults from the population in Iceland, Norway, Sweden, Denmark and Estonia. The participants answered a questionnaire at baseline and 10 years later, with questions on sleep disturbances, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), insomnia symptoms, snoring and excessive daytime sleepiness (EDS). Multiple logistic regression models were applied to estimate associations adjusting for potential confounders including gender, age, smoking habit at baseline, change of smoking habit from baseline to follow up, BMI at baseline, change of BMI from baseline to follow up, education level at follow up, allergic rhinitis at baseline, doctor diagnosed asthma at baseline and chronic bronchitis at baseline. ResultsBaseline floor dampness, visible mold and mold odor at home increased onset of DIS, DMS, EMA, insomnia symptoms and snoring during follow up (OR 1.29–1.87). Any sign of dampness at baseline increased onset of DIS (OR 1.28, 95%CI 1.06–1.55), DMS (OR 1.17, 95%CI 1.02–1.34) and insomnia symptoms (OR 1.18, 95%CI 1.03–1.36). Dampness at home during follow up increased onset of DIS, DMS, EMA, insomnia symptoms and EDS (OR 1.17–1.36). Dampness at work during follow up increased onset of DIS, EMA, insomnia symptoms and EDS (OR 1.16–1.34). Combined dampness at home and at work during follow up increased the risk of onset of DIS, DMS, EMA, insomnia symptoms and EDS (OR 1.29–1.74). ConclusionsDampness and mold at home and at work can increase the development of insomnia symptoms, snoring and EDS among adults.

Characteristics of sleep/wake problems and delivery outcomes among pregnant Japanese women without gestational complications

BackgroundFrequently observed sleep/wake problems among pregnant women need comprehensive evaluation. This study was conducted to clarify the sleep/wake problems among pregnant women without gestational complications during the second and third trimester and the effects of sleep/wake problems on delivery outcomes.MethodsA total of 88 Japanese pregnant women participated in this study. In their second and third trimester, subjective sleep quality, insomnia severity, excessive daytime sleepiness (EDS), and restless legs syndrome/Willis-Ekbom disease (RLS/WED) were assessed using questionnaires; also, sleep disordered breathing (SDB) was screened using a pulse oximeter.ResultsFrom the second to the third trimester, an increasing tendency of sleep/wake problems was observed. During the third trimester, the percentages of women experiencing decreased subjective sleep quality, difficulty maintaining sleep (DMS), EDS, RLS/WED, and 3% oxygen desaturation index (ODI) values ≥5/h were 62.5, 45.5, 48.9, 9.1, and 29.5%, respectively. In a logistic regression analysis for EDS in the third trimester, the adjusted odds ratio (95% confidence interval) of total sleep duration < 6 h, moderate to severe DMS, and 3% ODI values ≥5/h were 3.25 (1.16–9.10), 4.74 (1.60–14.00), and 0.90 (0.28–2.89), respectively. Although short sleep durations, decreased subjective sleep quality, EDS, and SDB did not affect delivery outcomes or the infant’s condition, the percentage of women undergoing cesarean sections in the severe insomnia group was significantly higher (p = 0.008).ConclusionsSleep/wake problems were frequent during pregnancy, especially during the third trimester. EDS among pregnant women was associated with shorter sleep durations and DMS rather than SDB. The effect of factors related to insomnia on delivery outcomes should thus be considered a crucial problem among pregnant Japanese women without gestational complications in clinical practice.

Disrupted sleep maintenance is associated with altered circadian phase and phase angle in community-dwelling adults

ObjectiveWe aimed to compare the sleep onset, dim light melatonin onset (DLMO) and phase angle (PA) between sleep onset and DLMO of insomnia patients with those of controls, and to examine the difference in these parameters in relation to objective sleep quality. MethodsParticipants were recruited from three Public Health Centers in Korea. Actigraphy recordings were conducted for seven days. Five hourly saliva samples were obtained from three hours prior to sleep onset. A total of 48 controls and 64 insomnia patients were analyzed. Nocturnal sleep parameters, DLMO, and PA were compared between the controls and insomnia patients, and between the controls and patients with difficulty in maintaining sleep (DMS). These sleep and circadian parameters were compared among the subgroups divided by wake after sleep onset (WASO) amount. ResultsThere were no significant differences in sleep parameters between the control and insomnia groups, and between the controls and DMS subgroup. The sleep onset, DLMO, and PA of the insomnia group or those of DMS subgroup were not different from those of controls. There were significant differences in the sleep onset and DLMO (p < 0.05) among mild, moderate, and severe WASO groups. A regression analysis revealed the earlier DLMO and shorter PA predicted the severity of WASO (p < 0.0001) in total participants. ConclusionsInsomnia patients exhibited no difference in their sleep timing and melatonin rhythm compared to controls. However, these circadian parameters varied depending on the severity of WASO, and advanced melatonin phase and its shortened phase angle were associated with worsening of sleep maintenance.

Sleep time and sleep-related symptoms across two generations – results of the community-based RHINE and RHINESSA studies

Study objectivesTo analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations. MethodThe participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS. ResultsAll sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents' total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20–1.93), DMS (1.34, 1.15–1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15–2.37), insomnia (1.39, 1.13–1.73), short sleep time (<6 h/night) (2.51, 1.72–3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9 h/night). ConclusionThe familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems.

Gender differences influence over insomnia in Korean population: A cross-sectional study.

Insomnia is the most common sleep disorder with significant psychiatric/physical comorbidities in the general population. The aim of this study is to investigate whether socioeconomic and demographic factors are associated with gender differences in insomnia and subtypes in Korean population. The present study used data from the nationwide, cross-sectional study on sleep among all Koreans aged 19 to 69 years. The Insomnia Severity Index (ISI) was used to classify insomnia symptoms and their subtypes (cutoff value: 9.5). The Pittsburgh Sleep Quality Index (PSQI), Goldberg Anxiety Scale (GAS) and Patient Health Questionnaire-9 (PHQ-9) were used to measure sleep quality, anxiety and depression. A total of 2695 participants completed the survey. The overall prevalence of insomnia symptoms was 10.7%, including difficulty in initiating sleep (DIS) (6.8%), difficulty in maintaining sleep (DMS) (6.5%) and early morning awakening (EMA) (6.5%), and these symptoms were more prevalent in women than in men. Multivariate analysis showed that female gender, shorter sleep time and psychiatric complications were found to be independent predictors for insomnia symptoms and subtypes. After adjusting for covariates among these factors, female gender remained a significant risk factor for insomnia symptoms and their subtypes. As for men, low income was related to insomnia. Approximately one-tenth of the sample from the Korean general population had insomnia symptoms. The prevalence of insomnia symptom and the subtypes were more prevalent in women than men. Gender is an independent factor for insomnia symptoms.

Association between reduced serum BDNF levels and insomnia with short sleep duration among female hospital nurses

ObjectivePrevious studies have suggested that brain-derived neurotrophic factor (BDNF) is associated with sleep regulation in humans. However, its relationship with self-reported sleep problems has not been clarified. The aim of the present study was to examine the association between serum BDNF levels and sleep problems among hospital nurses. MethodsParticipants were enrolled from among nurses working at a general hospital in Tokyo, Japan. Data from 577 women (age: 35.45 ± 10.90 years) were analyzed. This cross-sectional survey was conducted from November to December 2015. Serum BDNF concentrations were evaluated. Participants completed a self-reported questionnaire on sleep including the presence or absence of insomnia symptoms (ie, difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening [EMA]), and sleep duration. Insomnia with short sleep duration (ISS) was defined as: DIS, or DMS, or EMA; and <6 h sleep duration. ResultsAmong 577 participants, 21.3% reported insomnia, 41.4% slept less than 6 h, and finally 12.5% suffered from ISS. Serum BDNF levels were significantly lower in subjects with ISS than in those without ISS. The serum BDNF levels in insomniacs were significantly lower than in non-insomniacs for short sleep duration (<6 h), while serum BDNF levels did not differ between insomniacs and non-insomniacs for normal sleep duration (≥6 h). ConclusionThis is the first documented study to indicate that ISS is associated with reduced serum BDNF levels. These results may lead to clarification of the underlying pathophysiological relationship between BDNF and poor sleep.

Sleep disturbance is associated with not only shorter sleep duration, but also longer time in bed: a Japanese general population survey

Individuals with chronic insomnia tend to increase their amount of time in bed (TIB) to secure more opportunity for sleep, which in turn, may aggravate and perpetuate the condition. It remains unclear whether this behavioral feature of clinical insomniacs, which are targets of cognitive–behavioral therapy for insomnia, can be generalized to individuals with sleep disturbance in the general population. To investigate the relation between TIB and sleep disturbance in the general adult population, we conducted a cross-sectional survey with face-to-face interviews in August and September 2009. Data from 2559 randomly-sampled adults living in Japan were analyzed. Participants were asked about difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), sleep duration, and TIB. Any sleep difficulties (ASDs) were defined as having DIS, DMS, and/or EMA. The associations between sleep difficulties (DIS, DMS, EMA, and ASDs) and hourly-stratified sleep duration and TIB were examined using logistic regression analyses. DIS, DMS, EMA, and ASDs were found to be associated with a sleep duration < 6 h. Furthermore, DIS, DMS, and ASDs were associated with a TIB ≥ 9 h. Sufferers of DIS, DMS, EMA, or ASDs had shorter sleep duration and longer wakefulness in bed compared with non-sufferers. To our best knowledge, this is the first epidemiological study reporting an association between prolonged TIB and sleep disturbance in the general population. Our findings suggest that optimizing TIB may be an important tactic to improve sleep disturbance in the general population.