Disturbed Night Research Articles

A decrease in the prevalence and improved control of allergic conditions in 13‐ to 15‐yr‐old Maltese children (ISAAC)

The International Study of Asthma and Allergies in Childhood (ISAAC) has produced a reliable global map of childhood allergies through the use of a validated standardized questionnaire. Phase 1 of the study was carried out in the Maltese Islands in 1995 and repeated in 2002 in phase 3. To investigate the trends in prevalence and severity of childhood allergies in Maltese schoolchildren, in this article, we compare the data obtained from 4184 children, 13- to 15-yr-olds (88.7% response rate) in phase 1, to that of phase 3 when 4139 (90% response rate) children participated. The cumulative (27.9% vs. 27.4%: p=0.6) and current (16% vs. 14.6% p=0.08) prevalence rates of wheezing remained quite static but wheezers were more likely to be diagnosed with asthma in 2002 (11.1% vs. 14.1% p<0.0001). Along the 7 yrs, these asthmatics were better controlled with less wheezing attacks (p<0.01), less disturbed nights (p<0.05) and less acute severe episodes (p<0.05). Nasal problems were present in 52.7% of participants in 1995 and in 50.4% in 2002 (p<0.05), and 47.4% vs. 42.8% (p<0.0001) persisted with these symptoms and associated itchy eyes (29% vs. 21.8%: p<000001). Though prevalence decreased, the children were labelled as hayfever sufferers more often (32.3 vs. 40.7%: p<0.00001). Rhinitis symptoms seemed to interfere less with daily activities (p<0.01). In 2002, an itchy rash suggestive of eczema was also less present 'ever' (12.8% vs. 11.2%: p<0.05) or currently (10.1% vs. 8.5%: p<0.05) but again more likely to be diagnosed as eczema (p<0.001). This rash caused less sleepless nights in phase 3 of the study (p<0.05). These results indicate that asthma prevalence has reached a plateau between 1995 and 2002 while rhinitis and eczema are less common. All these allergic conditions are better controlled and more likely to be diagnosed in these schoolchildren by Maltese doctors in 2002 than in 1995.

Effects observed in the ionospheric F-region in the South American sector during the intense geomagnetic storm of 14 December 2006

This investigation presents observations related to the generation of equatorial ionospheric irregularities (also known as equatorial spread F (ESF)) including ionospheric plasma bubbles and dynamic behavior of the ionospheric F-region in the South American sector during an intense geomagnetic storm in December 2006 (a period of low solar activity). In this work, ionospheric sounding observations and GPS data obtained between 13 and 16 December 2006 at several stations in the South American sector are presented. On the geomagnetically disturbed night of 14 and 15 December, ionospheric plasma bubbles were observed after an unusual uplifting of the F-region during pre-reversal enhancement (PRE) period. The unusual uplifting of the F-region during PRE was possibly associated with prompt penetration of electric field of magnetospheric origin. During the geomagnetic disturbance night of 14 and 15 December, strong oscillations due to the propagation of traveling ionospheric disturbances (TIDs) by the Joule heating in the auroral region were observed in the F-region at São José dos Campos (SJC, 23.2°S, 45.9°W; dip latitude 17.6°S), Brazil, and Port Stanley (PST, 51.6°S, 57.9°W; geom. latitude 41.6°S). The VTEC-GPS observations presented on the night of 14 and 15 December 2006 show both positive and negative storm phases in the South American sector, possibly due to changes in the large-scale wind circulation and changes in the O/N 2 ratio in the southern hemisphere, respectively.

The Effect of Active and Passive Household Cigarette Smoke Exposure on Pregnant Women With Asthma

The article was designed to estimate the effect of active and passive household cigarette smoke exposure on asthma severity and obstetric and neonatal outcomes in pregnant women with asthma. We used a secondary observational analysis of pregnant women with mild and moderate-severe asthma enrolled in a prospective observational cohort study of asthma in pregnancy and a randomized clinical trial (RCT) comparing inhaled beclomethasone and oral theophylline. A baseline questionnaire detailing smoking history and passive household smoke exposure was given to each patient. Smoking status was confirmed in the RCT using cotinine levels. Data on asthma severity and obstetric and neonatal outcomes were collected and analyzed with respect to self-reported tobacco smoke exposure. Kruskal-Wallis and Pearson chi(2) statistics were used to test for significance. A total of 2,210 women were enrolled: 1,812 in the observational study and 398 in the RCT. Four hundred and eight (18%) women reported current active smoking. Of the nonsmokers, 790 (36%) women reported passive household smoke exposure. Active smoking was associated with more total symptomatic days (P < .001) and nights of sleep disturbance (P < .001). Among the newborns of active smokers, there was a greater risk of small for gestational age < 10th percentile (P < .001), and a lower mean birth weight (P < .001). There were no differences in symptom exacerbation or outcome between nonsmokers with and without passive household cigarette smoke exposure. Among pregnant women with asthma, active but not passive smoking is associated with increased asthma symptoms and fetal growth abnormalities.

A community-based vasectomy service in Leicestershire and Rutland – The patients' perspective

Objectives To evaluate the community-based vasectomy service from the patients' perspective and consider service provision in terms of access, process, quality and outcome.Method A prospective questionnaire was handed to 150 consecutive men attending for vasectomy from February to June 2007, for completion two weeks after surgery. Postal reminders were sent at four and eight weeks.Results The response rate was 73%, with 93% (n = 102) of the respondents considering the vasectomy unit to be of high quality. The comprehension of written information (93%) and the approachability of staff (83%) were both considered highly satisfactory. Most men were equivocal regarding proposed ‘holistic’ changes to the service. Men under 40 were more likely to be neutral or agree that vasectomy was embarrassing and preferred a male surgeon. The occurrence of complications did not affect satisfaction but increased the mean number of disturbed nights sleep and days taking analgesia. Suggestions for improvement pertained to the pre-operative information and the use of skin sutures.Conclusions The patients' evaluation of our vasectomy unit identified areas for improvement and reinforced good clinical practice. More research is needed to clarify the impact of age, ethnicity and other factors on the accessibility, acceptability and experience of vasectomy.

The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: a prospective study from the Whitehall II cohort.

Short sleep duration is associated with increased CHD (coronary heart disease) mortality and morbidity, although some evidence suggests that sleep disturbance is just as important. We investigated whether a combination of short sleep duration and sleep disturbance is associated with a higher risk of CHD than their additive effects. The Whitehall II study. The Whitehall II study recruited 10,308 participants from 20 civil service departments in London, England. Participants were between the ages of 35 and 55 years at baseline (1985-1988) and were followed up for an average of 15 years. N/A. Sleep hours and sleep disturbance (from the General Heath Questionnaire-30) were obtained from the baseline survey. CHD events included fatal CHD deaths or incident nonfatal myocardial infarction or angina (ICD-9 codes 410-414 or ICD-10 120-25). Short sleep duration and sleep disturbance were both associated with increased hazards for CHD in women as well as in men, although, after we adjusted for confounders, only those reporting sleep disturbance had a raised risk. There was some evidence for an interaction between sleep duration and sleep disturbance. Participants with short sleep duration and restless disturbed nights had the highest hazard ratios (HR) of CHD (relative risk:1.55, 95% confidence interval:1.33-1.81). Among participants who did not report any sleep disturbance, there was little evidence that short sleep hours increased CHD risk. The effect of short sleep (< or = 6 hours) on increasing CHD risk is greatest among those who reported some sleep disturbance. However, among participants who did not report any sleep disturbance, there was little evidence that short sleep hours increased CHD risk.

Narcolepsia con y sin cataplejia: una enfermedad rara, limitante e infradiagnosticada

Although narcolepsy is a relatively uncommon condition, its impact on a child's life can be dramatic and disabling. Narcolepsy is characterized by excessive daytime sleepiness (EDS), with brief "sleep attacks" at very unusual times and usually associated with cataplexy (sudden loss of muscle control while awake, resulting in a fall, triggered by laughter). Other symptoms frequently reported are sleep paralysis (feeling of being unable to move or speak, even totally aware), hypnagogic hallucinations (vivid dreamlike experiences difficult to distinguish from reality) or disturbed night time sleep. Some children also experience depression or overweight-obesity. Although narcolepsy has been thoroughly studied, the exact cause is unknown. It appears to be a disorder of cerebral pathways that control sleep and wakefulness, involving dorsolateral hypothalamus and hypocretin. A genetic factor has been suggested, but narcolepsy in relatives is rare. Researchers have suggested that a set of genes combines with additional factors in a person's life to cause narcolepsy. The effective treatment of narcolepsy requires not only medication (usually stimulants, antidepressants and sodium oxybate), but also adjustments in life-style (scheduled naps). Management of this condition in children demands a comprehensive approach to the patient, that includes a correct diagnosis, pharmacological and non-pharmacological treatment and adjustments in the environment. These strategies can improve the child's self-esteem and ability to obtain a good education.

Kickin’ Asthma: School‐Based Asthma Education in an Urban Community

In urban communities with high prevalence of childhood asthma, school-based educational programs may be the most appropriate approach to deliver interventions to improve asthma morbidity and asthma-related outcomes. The purpose of this study was to evaluate the implementation of Kickin' Asthma, a school-based asthma curriculum designed by health educators and local students, which teaches asthma physiology and asthma self-management techniques to middle and high school students in Oakland, CA. Eligible students were identified through an in-class asthma case identification survey. Approximately 10-15 students identified as asthmatic were recruited for each series of the Kickin' Asthma intervention. The curriculum was delivered by an asthma nurse in a series of four 50-minute sessions. Students completed a baseline and a 3-month follow-up survey that compared symptom frequency, health care utilization, activity limitations, and medication use. Of the 8488 students surveyed during the first 3 years of the intervention (2003-2006), 15.4% (n = 1309) were identified as asthmatic; approximately 76% of eligible students (n = 990) from 15 middle schools and 3 high schools participated in the program. Comparison of baseline to follow-up data indicated that students experienced significantly fewer days with activity limitations and significantly fewer nights of sleep disturbance after participation in the intervention. For health care utilization, students reported significantly less frequent emergency department visits or hospitalizations between the baseline and follow-up surveys. A school-based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants.

Exercise to reduce cancer fatigue in adults

“We did this review to look at the effects of exercise on fatigue levels in people with cancer. Fatigue is the most common side effect of cancer treatment, affecting a very high percentage of patients. The fatigue experienced by people with cancer can be very different to what the general population are used to after, for example, a disturbed night’s sleep or a hard day’s work. Cancer-related fatigue might not be relieved by rest and may continue for a long time even after the cancer treatment has finished. It may affect the person mentally, physically, emotionally, and spiritually and these effects are not always appreciated by friends and family or even by the healthcare professionals caring for the patient. Finding interventions that can help people to manage their fatigue is therefore an important goal. We identified exercise as one such intervention that was worthy of review, as it would be easy to implement and may increase the sense of control that a person with cancer has over their fatigue experience. We included 28 studies investigating the effect of exercise on cancer-related fatigue in adults. There were nearly 3000 participants who were receiving or had previously received treatment for cancer. We found that the people in these trials who received an exercise intervention reported less fatigue than those who did not receive it. Exercise reduced fatigue when carried out during the cancer treatment as well as after the treatment. The types of exercise varied between the included studies but the majority included walking or cycling. Most of the studies in this review were fairly small. This is not surprising as fatigue has only recently been recognized by healthcare professionals as an important consequence of cancer and most of studies done so far have taken place in single cancer centres with little funding. Despite this, when looked at together, this body of research provides convincing support for the benefits of exercise in reducing cancer-related fatigue. Adding exercise to a person’s cancer management could make a difference to their ability to function on a daily basis. It could mean the difference between lying in bed most of the day and being able to get up and make a cup of tea or, even cook dinner. These differences may sound small but could be very important to someone receiving treatment for cancer. Exercise is a cheap and simple option that could be implemented into all cancer services to help patients cope with fatigue. It is a flexible intervention that can be tailored to suit the individual. Our review also showed it often has other benefits such as improving quality of life, and reducing levels of depression and anxiety. In conclusion, we might not yet know how much exercise is best for each person but our review does suggest that physical exercise can help to reduce fatigue both during and after treatment for cancer. It highlights the need for all patients with cancer to have access to professional support and advice regarding exercise.”

Nocturnal Aspects of Narcolepsy with Cataplexy

The four classic symptoms of narcolepsy consist of excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic/ hypnopompic hallucinations. Tow of them is related directly to night sleep. And also a significant number of patients have trouble sleeping except sleep paralysis and hypnagogic/hypnopompic hallucinations at night. The aim of this review is to increase awareness on this issue, thereby enhancing the care of narcoleptic patients by more specific approaches to their disturbed night sleep.

Nocturnal aspects of narcolepsy with cataplexy

Even though the most impressive manifestation of narcolepsy is excessive sleepiness, paradoxically a significant number of patients have trouble sleeping at night. A wide array of alterations can affect the night-time sleep of a narcoleptic patient, and the aim of this review is to increase awareness on this issue, thereby enhancing the care of narcoleptic patients by more specific approaches to their disturbed night sleep. This review covers a broad variety of nocturnal sleep features in narcolepsy. Starting from animal models and the clinical features of patients, the paper then discusses the many comorbid conditions found in narcolepsy at night, the most advanced methods of analysis and the few recent advances in the specific treatment of night sleep in narcoleptic patients.

Two main subtypes of wheezing illness? Evidence from the 2004 Aberdeen schools asthma survey

To compare risk factors for wheezy bronchitis (WB) and multi-trigger wheeze (MTW) in pre-pubertal children along the spectrum of disease severity. Cross-sectional survey of children aged 7-12 yr in Aberdeen city primary schools in 2004 using parent-completed questionnaires as used in surveys in 1964, 1989, 1994, and 1999. Children were grouped into five categories: no wheeze in the past three years, non-severe wheeze triggered only by a cold (non-severe WB), non-severe wheeze triggered by other factors (non-severe MTW), severe WB, or severe MTW. Severe wheeze was defined as greater than four wheezing attacks, greater than or equal to one disturbed night per week, or speech limitation in the last 12 months. Questionnaires were returned by 3271 children (57.3%), of whom 7.4% had WB (6.1% non-severe and 1.3% severe) and 17.2% had MTW (9.4% non-severe and 7.8% severe). Severe disease was more frequent in children with MTW (31.8%) than in those with WB (5.1%). Whereas the prevalence of MTW had increased since 1964, the prevalence of WB had remained stable over this period. After adjustment for confounders, age had no influence on either wheeze type, and male sex was only associated with non-severe WB [OR 1.44, 95% confidence intervals (1.03-2.02)]. In the WB group eczema or/and hay fever in the child were more strongly associated with severe wheeze [OR 3.28(1.49-7.23) vs. OR 1.84(1.31-2.60)]. In the MTW group, this association was noticeably higher than in the WB group, but did not differ much between non-severe and severe wheeze [OR 5.46(3.70-7.20) and OR 6.01(4.1-8.75) respectively]. The presence of any allergic diseases in either parent increased the odds for non-severe and severe MTW at the same level of magnitude [OR 1.92(1.38-2.68) and OR 1.92(1.34-2.76) respectively], and statistically non-significantly for severe WB [OR 1.75(0.78-3.94)]. Living in a deprived area increased both severe WB and severe MTW, reaching statistical significance only for severe MTW [OR 1.96(1.39-2.78)]. Smoking in the house was associated with increased risk of WB and MTW of any severity. WB and MTW differ in prevalence trends and severity. Within severity levels, the influence of age, allergic diseases in children and parents also differed between these two wheezing subtypes.

Is eczema really on the increase worldwide?

It is unclear whether eczema prevalence is truly increasing worldwide. We sought to investigate worldwide secular trends in childhood eczema. Children (n = 302,159) aged 13 to 14 years in 105 centers from 55 countries and children aged 6 to 7 years (n = 187,943) in 64 centers from 35 countries were surveyed from the same study centers taking part in Phase One and Three of the International Study of Asthma and Allergies in Childhood by using identical validated and translated questionnaires. Eczema was defined as an itchy, relapsing, flexural skin rash in the last 12 months, and it was termed severe eczema when it was associated with 1 or more disturbed nights per week. Annual prevalence changes in relation to average prevalence across Phase One and Three were generally small and differed in direction according to the age of the participants and world region. For children 13 to 14 years old, eczema symptom prevalence decreased in some previously high-prevalence centers from the developed world, such as the United Kingdom and New Zealand, whereas centers with previously high prevalence rates from developing countries continued to increase. In the children 6 to 7 years old, most centers showed an increase in current eczema symptoms. Similar patterns to these were present for severe eczema at both ages. The epidemic of eczema seems to be leveling or decreasing in some countries with previously high prevalence rates. The picture elsewhere is mixed, with many formerly low-prevalence developing countries experiencing substantial increases, especially in the younger age group.

Rheumatoid Arthritis Patients’ Experiences of Night Pain

Night pain is a significant problem for many patients with rheumatoid arthritis (RA), but clinicians often overlook it. This study aimed to explore the issue of night pain among patients with RA both at home and in the hospital setting. This was a qualitative study involving in-depth interviews among 8 hospital inpatients with established RA. Each interview was recorded, transcribed, and underwent framework analysis. The following themes were identified: Night pain in RA is a significant problem both at home and in hospital. All patients had established routines that they used in the home setting when disturbed by night pain. This often included getting out of bed and walking around, making hot drinks, and/or taking extra painkillers. These activities were often curtailed in the hospital setting for fear of disturbing other patients or the nurses. The effect of disturbed sleep and night pain on other people, be it partners or family members at home or patients and nurses in the hospital, was raised by all interviewees. Night pain in particular appears harder to control in the hospital setting than at home, and some of this may stem from lack of a tailored routine and fears of disturbing others. Information could be provided when patients are first admitted to the ward. This could describe or orient patients to the facilities available, which may be beneficial in the management of night pain. Further work on identifying influences upon night pain needs to be undertaken.

Response of nighttime equatorial and low latitude F-region to the geomagnetic storm of August 18, 2003, in the Brazilian sector

This paper presents an investigation of geomagnetic storm effects in the equatorial and low latitude F-region in the Brazilian sector during the intense geomagnetic storm on 18 August, 2003 (SSC 14:21 UT on 17/08; ΣKp = 52+; Ap = 108; ∣Dst∣ max = 168 at 1600 UT on 18/08). Simultaneous ionospheric sounding measurements from two stations, viz., Palmas (10.2°S, 48.2°W; dip latitude 5.7°S) and Sao Jose dos Campos (23.2°S, 45.9°W; dip latitude 17.6°S), Brazil, are presented for the nights of 16–17, 17–18 and 18–19 August, 2003 (quiet, disturbed and recovery phases). Both stations are equipped with the Canadian Advanced Digital Ionosonde (CADI). Quiet and disturbed conditions of the F-region ionosphere are compared using data collected from the two stations. The relationship between magnetospheric disturbance and low-latitude ionospheric dynamics, and generation of ionospheric irregularities are discussed. On the disturbed nights (17–18 and 18–19 August), the low latitude station S. J. Campos showed strong enhancements in the F-region critical frequency (foF2), whereas the near equatorial station Palmas showed strong uplifting of the F-layer about 1 h earlier. Normally during the June solstice months (May–August) in the Brazilian sector, large-scale ionospheric irregularities in form of plasma bubbles are rarely observed. On the night of 17–18 August, ionsospheric sounding observations at Palmas showed the presence of bottomside spread-F, whereas on the night of 18–19 August, the observations at Palmas and S. J. Campos showed the presence of plasma bubbles when the storm recovery phase had just started. The complementary GPS data available from several stations in the “Rede Brasileira de Monitoramento Continuo de GPS (Brazilian Network for Continuous GPS Monitoring)” are used to obtain the vertical total electron content (VTEC) and the rate of change of TEC per minute on UT days 18 and 19 August, 2003 and presented. Also, several global ionospheric TEC maps from the worldwide network of GPS receivers are presented, showing widespread latitudinal and longitudinal TEC changes during the different phases of the storm. All the observations (local ionospheric sounding and GPS network measurements, and global GPS measurements) presented in this investigation related to the geomagnetic storm on 18 August indicate that the equatorial and low latitude region in the Brazilian sector had much stronger effect during the recovery phase compared with the main phase. A comparison of the observed disturbance drifts with the Fejer–Scherliess storm-time model drifts indicate that the modeled drifts are not consistent with the present observations.

Impact of environmental exposures on asthma control in pregnancy

JUDETTE LOUIS, NICHD MFMU Network, Bethesda, Maryland OBJECTIVE: To evaluate the impact of avoidance of environmental exposures on asthma control and treatment in pregnancy. STUDY DESIGN: This is a secondary analysis of a multicenter; prospective, observational cohort study conducted over 4 years at 16 academic hospital centers. The NAEPP classification was used to stratify patients by asthma severity. Environmental exposures included household smoking, pets, and use of a mattress cover. Indices of asthma control included percentage of symptomatic days and nights, activity restriction, and sleep disturbance. Indices of treatment included number of unscheduled visits, hospital admissions, asthma exacerbations, and use of steroids. Data were analyzed by chi-square, Wilcoxon rank sum and Cochran-Armitage trend test where appropriate. P!0.05 was significant. RESULTS: There were 1,812 asthmatics, 50% (906), were mild, 47% (851) were moderate and 3% (55) were severe asthmatics. Severe asthmatics that could identify 1 or R 2 asthma triggers had a lower rate of symptomatic days compared to those who did not know their triggers. (22.9% and 26.6% vs. 48.6%, p = 0.04) They also had less nights of sleep disturbance (7.3% and 19.2% vs. 28.8%, p = 0.02), were less likely to have an unscheduled visit (21.4% and 0.0% vs. 36.4%, p = 0.03 for trend) and less likely to have an asthma exacerbation during pregnancy (50% and 50% vs. 81.8%, p = 0.02 for trend). This association was not evident for mild and moderate asthmatics. In mild and moderate asthmatics, use of a mattress cover was associated with a decrease in sleep disturbance and fur bearing pets were associated with an increase in symptomatic days. Among mild and moderate asthmatics, avoidance of environmental exposures was not associated with any treatment indices. CONCLUSION: Avoidance of asthma triggers may improve daily symptoms and need for treatment for severe asthmatics. The findings are not as consistent for mild and moderate asthmatics.

A placebo-controlled study to investigate the effect of Dog Appeasing Pheromone and other environmental and management factors on the reports of disturbance and house soiling during the night in recently adopted puppies ( Canis familiaris)

Disturbance and house soiling during the night are common problems faced by the new puppy dog owner. They may result as consequence of a mismatch between the developmental status of the puppy and its new environment and/or separation distress in a typically social animal. The aim of this study was to examine the effect of Dog Appeasing Pheromone (DAP, Ceva Santé Animale) as well as a range of other management and environmental factors that might affect this process. It has been suggested that DAP may help the puppy settle into the new home by continuing the provision of the maternal appeasing pheromone. In order to test this, a double-blind, placebo-controlled trial of DAP was conducted with 60 pedigree puppies, aged between 6 and 10 weeks, as they entered their new home. A few days prior to the puppy's arrival, volunteer owners were supplied with either a verum or placebo plug-in diffuser designed for the slow release of the pheromone analogue over 4 weeks. Owners reported daily on disturbance and house soiling during the previous night over the following 8 weeks from the puppy's first night in the new home. The effect of the treatment together with the gender of the puppy, its maternal environment, the use of a puppy crate, sleeping with other dogs at night and the experience of the owner were included in a general linear model to explain the total number of nights spent disturbing and house soiling. Sleeping with another dog reduced the puppies’ tendency to disturb at night to almost zero. Over 70% of puppies sleeping alone disturbed during the first night. The mean total number of nights of disturbance over the 2 months was between five and six nights, mostly in the first week in the home. A significant effect of DAP treatment was found in the case of the gundog breeds only ( p = 0.003), gundogs receiving placebo cried for a median of nine nights, those receiving verum cried for a median of three nights. No effect of DAP treatment was observed on the total number of nights that the puppy soiled the house ( p > 0.05). However, puppies that were placed in crates during the night ( p = 0.004) or had come from domestic maternal environments ( p = 0.006) had significantly fewer reports of house soiling over the first 2 months in the new home.

Subjective and objective evaluation of alertness and sleep quality in depressed patients.

BackgroundThe reliability of the subjective statements reports on disturbed night sleep and alertness in the daytime was assessed by their correlation to the objective indicators in patients with mild deprsssion.MethodAmong patients with depression, altogether 28 patients with insomnia were examined. Their answers to typical questions, as they are used during a psychiatric interview, were scored. In parallel, night sleep quality and alertness level in the daytime were objectively estimated by means of polygraphic recording.ResultsThe subjective statements on the type of insomnia, the estimated time of falling asleep, frequent awakenings and occurrence of disturbing dreams seem to be unreliable. Similarly, the results were disappointing when the patients were asked about alertness disturbances in the daytime. An unexpected finding was the lack of any significant correlation to the scores obtained by means of Epworth's scale. Among the factors possibly influencing the patients' reports, age, sex, coffee intake and also chronic administration of sedatives or hypnotics showed a low correlation with the sleep and alertness indicators.ConclusionThe statistical evaluation indicated rather poor agreement between the subjective and objective items. The statistical evaluation suggested that anxiety and depression significantly influence reports on sleep quality and alertness disturbances in the daytime.

Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis

Objective To determine the effectiveness of educational programmes for the self management of asthma in children and adolescents.Data sources Databases of the Cochrane Airways Group, PsychINFO, reference lists of review...

The effect of sleep disruption on performance of anaesthetists--a pilot study.

Fatigue has been implicated in the occurrence of critical incidents. Using a driving simulator to assess vigilance, we investigated the effect of sleep disruption on the ability of anaesthetists to maintain vigilance after a night on-call. Following an undisturbed night of sleep, subjects demonstrated a significant improvement in their vigilance scores. Subjects failed to demonstrate this following a disturbed night. The timing of disturbance had a bearing on performance. Subjects' performance was worse if their sleep had been disturbed in the first third of the night. The effect of sleep disruption on vigilance has implications for patient safety during anaesthesia.

Efficacy and Safety of Inhaled Zanamivir for the Treatment of Influenza in Patients with Asthma or Chronic Obstructive Pulmonary Disease

Background: Influenza in patients with asthma can cause acute exacerbation and in patients with chronic obstructive pulmonary disease (COPD) it can lead to respiratory distress. Zanamivir is an effective treatment for both influenza A and B. However, controlled studies with zanamivir specifically in asthma or COPD patients with influenza illness are limited. Objective: To investigate the clinical efficacy and safety of inhaled zanamivir for the treatment of influenza in patients with asthma or COPD. Design and Setting: This randomised, double-blind, placebo-controlled, multi-centre study was conducted at 159 sites in 15 countries. Patients and Participants: 525 patients with asthma or COPD aged ≥12 years and with influenza-like illness were enrolled; 313 (60%) of these had laboratory-confirmed influenza virus infection and were included in the primary efficacy analysis. Methods: Patients were randomised to inhaled zanamivir 10mg or matching placebo via Diskhaler™ twice daily for 5 days. Patients recorded symptoms and pulmonary function twice daily in diary cards. The primary end-point in both patient groups was time to alleviation of symptoms of influenza. Results: Zanamivir significantly reduced the median time to alleviation of influenza symptoms compared with placebo (5.5 days vs 7.0 days; difference 1.5 days; 95% confidence interval 0.50 to 3.25 days; p = 0.009). Zanamivir significantly reduced the mean overall influenza assessment score compared with placebo (p = 0.004) over days 1 to 5. Patients recorded fewer nights of sleep disturbance with zanamivir compared with placebo (median 2 nights vs 3 nights; p = 0.042) during treatment. Zanamivir reduced the incidence of complications (requiring antibiotics and a change in respiratory medication) compared with placebo by 58% (p = 0.064). Zanamivir did not adversely affect pulmonary function, as determined by measurements of forced expiratory volume in 1 second and peak expiratory flow rate, compared with placebo. Zanamivir was well tolerated, with a safety profile similar to placebo. Compliance with treatment was high, with 495 (94%) patients successfully completing at least 4 days of treatment (8 doses). Furthermore, 90% of patients felt that the Diskhaler™ was easy or very easy to use. Conclusion: Zanamivir is an effective treatment for influenza in patients with asthma or COPD, and has a safety profile similar to that of placebo. Importantly, zanamivir does not adversely affect pulmonary function in this high-risk population.