Sleep Disturbance Factors Research Articles

The relationship between the frequency of suicidal ideation and sleep disturbance factors among adolescent earthquake victims in China.

This study aimed to examine the frequency of suicidal ideation (SI) and identify exposure variables, mental health, and sleep-related risk factors of SI among adolescents following the 2013 Ya'an earthquake. Participants consisted of 5563 adolescent students selected through random sampling from 11 primary and high schools in the counties most severely affected by the earthquake. They were asked to complete the Pittsburgh Sleep Quality Index, Children's Revised Impact of Event Scale-13, Short Mood and Feelings Questionnaire, and Screen for Child Anxiety-Related Emotional Disorders. Multinomial logistic analysis was used to identify possible relationships between SI and psychopathology, sleep problems, earthquake exposures or demographic characteristics. The mediation analysis was used to identify direct and indirect effects among sleep problems, psychopathology, earthquake exposures and SI. Our findings suggest that 29.5% of the sample experienced SI during the past year (12.9% once, 11.9% twice, 2.6% on 3-4 occasions and 2.1% on at least 5 occasions). Multiple sleeping problems, including trouble falling asleep, shorter sleep duration, and daytime dysfunction, showed independent associations with SI. The mediation analysis suggested that depression and anxiety mainly mediated the association of sleep with SI. This study was cross-sectional and did not include controls. No baseline data were collected prior to the earthquake. SI can be a serious problem among adolescents following a major earthquake, especially those who are older, who live in one-child households, or who are female. Years after a disaster, we found that exposure severity, psychopathology and sleep impairment all contributed to SI, and that earthquake exposure may have disrupted sleep and worsened mood, which in turn may have impacted SI. By enhancing teenagers' sleep management and shaping their activities, post-disaster intervention programs may help prevent SI among Chinese adolescents.

Gender differences in the prevalence and clinical correlates of sleep disturbance in general hospital outpatients

This study investigated gender differences in the prevalence of sleep disturbance and related demographic and clinical characteristics, including quality of life (QOL), in Chinese outpatients. Up to 4399 adult outpatients (2896 females, 1503 males) who visited the neurological, cardiovascular, gastrointestinal, and gynaecological outpatient clinics in four general hospitals were recruited. Demographic and clinical data including QOL were collected by using self-report questionnaires. The prevalence of sleep disturbance in female outpatients (671/2896, 23.2%) was significantly higher than in male outpatients (302/1503, 20.1%) and remained significant after adjusting for significant confounders in the regression analysis. In the regression analysis, divorced/widowed and unemployed status were independently associated with a higher frequency of sleep disturbance in females, while educational level was independently associated with males only. Among these factors, depressive symptoms and older age were the most common risk factors for sleep disturbance in both genders. Sleep disturbance was not associated with the mental domains of the QOL assessments in both genders. This study suggests that sleep disturbance is more frequent in female outpatients and is associated with multiple factors in both genders. A longitudinal study is warranted to confirm the current findings.

Post-traumatic stress disorder, anxiety and depression symptoms among adolescent earthquake victims: comorbidity and associated sleep-disturbing factors.

Our study aimed to examine the prevalence of psychiatric symptoms and their comorbidity and correlation with sleep problems among adolescent survivors 3years after the 2013 Ya'an earthquake. A representative sample of 6132 adolescent students was analysed from 11 primary and high schools in the three counties most severely affected by the earthquake. Students were invited to complete the Pittsburgh Sleep Quality Index, Children's Revised Impact of Event Scale-13, Short Mood and Feelings Questionnaire, the Adolescent Self-Rating Life Events Checklist, and Screen for Child Anxiety-Related Emotional Disorders. Three years after this major earthquake, 1-month prevalence of mental health problems was 13.1% for PTSD, 37.3% for anxiety, and 19.8% for depression. Among the participants who reported PTSD, 71.5% also reported anxiety, and 49.7% also reported depression. At least half of those with any type of mental health problem reported concurrent sleeping problems. Specific sleep risk factors were independently associated with increased risk of PTSD, depression or anxiety. Girls were more likely than boys to exhibit symptoms of PTSD, depression or anxiety. Older adolescents were more likely to have depression and anxiety. Mental health problems are prevalent with high comorbidity and are associated with sleep-related problems among adolescent survivors, even years after the occurrence of a major earthquake. Nightmares and difficulty initiating sleep are independently associated with PTSD. Insufficient sleep is independently associated with anxiety and depression. Sleep-related problems may be effective targets of preventive interventions, which may need to be optimised for gender and age.

Quality and Quantity of Sleep and Factors Associated With Sleep Disturbance in Hospitalized Patients

Although inadequate sleep has a proven negative association with health care outcomes, to date, no large-scale studies have examined sleep in general hospital wards. To assess the subjective quantity and quality of sleep and to identify the hospital-related factors associated with sleep disturbances in hospitalized patients. For this nationwide, single-day, multicenter, cross-sectional, observational study, which took place on February 22, 2017, all hospitals in the Netherlands were encouraged by word of mouth and conventional and social media to participate in this study. A total of 39 hospitals participated. Included patients were at least 18 years of age, were able to give informed consent, and had spent at least 1 night in a regular-care hospital ward. Hospitalization in a regular-care ward. Quantity and quality of last night's sleep in the hospital compared with habitual sleep at home the month before hospitalization. The Consensus Sleep Diary and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank were used. Complementary questions assessed sleep-disturbing factors. A total of 2005 patients were included (median age, 68 years; interquartile range, 57-77 years; 994 of 1935 [51.4%] were male [70 patients did not identify their sex]). Compared with habitual sleep at home, the total sleep time in the hospital was 83 minutes (95% CI, 75-92 minutes; P < .001) shorter. The mean number of nocturnal awakenings was 2.0 (95% CI, 1.9-2.1) times at home vs 3.3 (95% CI, 3.2-3.5) times during hospitalization (P < .001). Patients woke up 44 minutes (95% CI, 44-45 minutes; P < .001) earlier than their habitual wake-up time at home. A total of 1344 patients (70.4%) reported having been awakened by external causes, which in 718 (35.8%) concerned hospital staff. All aspects of sleep quality measured using PROMIS questions were rated worse during hospitalization than at home. The most reported sleep-disturbing factors were noise of other patients, medical devices, pain, and toilet visits. This study demonstrated that the duration and quality of sleep in hospitalized patients were significantly affected and revealed many potentially modifiable hospital-related factors negatively associated with sleep. Raising awareness about the importance of adequate sleep in the vulnerable hospital population and introducing interventions to target sleep-disturbing factors may improve healing.

Prevalence and factors associated with disturbed sleep in outpatients with ankylosing spondylitis.

Sleep disturbance is prevalent among patients with ankylosing spondylitis (AS) and is considered a multifactorial issue. The study was designed to investigate sleep disturbance and its associated factors in AS outpatients in Southwest China. Patients were recruited by convenience sampling in this cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), the Bath AS Patient Global Score (BAS-G), and the Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality, disease activity, function status, global well-being, depression, and anxiety. Spearman's correlation, t test, ANOVA, and multiple linear regression analysis were used to explore the associated factors of sleep disturbance. Of the 281 outpatients included in the study, 190 (67.6%) patients had sleep disturbance. The married patients, the patients with extra-spinal manifestation, depression and anxiety, longer duration of diagnostic delay, higher disease activity, worse functional status and global well-being, high level of pain, and fatigue, had poorer sleep quality (P < 0.05). Multiple linear regression analysis revealed age (β = 0.087, P = 0.102), BAS-G (β = 0.181, P = 0.003), fatigue (β = 0.170, P = 0.002), anxiety (β = 0.151, P = 0.002) and nocturnal back pain (β = 0.192, P = 0.001), extra-spinal manifestation (β = 0.120, P = 0.012), and duration of diagnostic delay (β = 0.174, P = 0.001) were the contributors to PSQI. Sleep disturbance is common in AS patients in Southwest China. It may be useful to keep regular exercise, strengthen the management of pain, relieve anxiety, and prevent and treat extra-spinal manifestation for improving sleep quality.

An evaluation of sleep disturbance on in-patient psychiatric units in the UK.

We recruited 20 patients; 15% were high risk for obstructive sleep apnoea. Nineteen participants reported poor sleep quality on the Pittsburgh Sleep Quality Index, and 90% had significant sleep fragmentation with objective measures. Inside light levels were low (day <200 lux and night <10 lux). Night sound levels were 40-90 db.Clinical implicationsSleep disturbance was highly prevalent. Increased awareness of sleep disorders is needed. Modifiable environmental factors on the ward were implicated, therefore increased awareness and a change of approach to sleep disturbance in in-patient psychiatry is recommended.Declaration of interestNone.

Short sleep duration and poor sleep quality predict next-day suicidal ideation: an ecological momentary assessment study.

Sleep problems are a modifiable risk factor for suicidal thoughts and behaviors. Yet, sparse research has examined temporal relationships between sleep disturbance, suicidal ideation, and psychological factors implicated in suicide, such as entrapment. This is the first in-the-moment investigation of relationships between suicidal ideation, objective and subjective sleep parameters, and perceptions of entrapment. Fifty-one participants with current suicidal ideation completed week-long ecological momentary assessments. An actigraph watch was worn for the duration of the study, which monitored total sleep time, sleep efficiency, and sleep latency. Daily sleep diaries captured subjective ratings of the same sleep parameters, with the addition of sleep quality. Suicidal ideation and entrapment were measured at six quasi-random time points each day. Multi-level random intercept models and moderation analyses were conducted to examine the links between sleep, entrapment, and suicidal ideation, adjusting for anxiety and depression severity. Analyses revealed a unidirectional relationship whereby short sleep duration (both objective and subjective measures), and poor sleep quality, predicted the higher severity of next-day suicidal ideation. However, there was no significant association between daytime suicidal ideation and sleep the following night. Sleep quality moderated the relationship between pre-sleep entrapment and awakening levels of suicidal ideation. This is the first study to report night-to-day relationships between sleep disturbance, suicidal ideation, and entrapment. Findings suggest that sleep quality may alter the strength of the relationship between pre-sleep entrapment and awakening suicidal ideation. Clinically, results underscore the importance of assessing and treating sleep disturbance when working with those experiencing suicidal ideation.

Investigating the application of motion accelerometers as a sleep monitoring technique and the clinical burden of the intensive care environment on sleep quality: study protocol for a prospective observational study in Australia

IntroductionSleep is a state of quiescence that facilitates the significant restorative processes that enhance individuals’ physiological and psychological well-being. Patients admitted to the intensive care unit (ICU) experience substantial sleep...

Sleep Disturbances in Hospitalized Children

Sleep provides physical and psychological rest. Sleep disturbance impinges on recovery. Sleep disturbances in hospitalized children is on the rise, and therefore it is essential to identify the various causes of sleep disturbances in order to rectify and enhance the quality of sleep in hospitalized children. This study used a descriptive design to identify the causes of sleep disturbances and to associate various factors affecting sleep in hospitalized children and selected demographic and clinical variables. A convenience sampling technique was used to recruit 30 parents whose children were admitted in the pediatric medical wards of a tertiary care hospital in South India. Demographic variable proforma and an investigator prepared questionnaire were used to identify the causes of sleep disturbance in children. The results revealed 40 % had severe sleep disturbances, 50% had moderate sleep disturbances and 10% had no sleep disturbances. Also the study revealed that there was significant association between sleep disturbance and number of days of hospitalization. The study showed that there was no significant association between causes of sleep disturbances and demographic variables. There is a need for identifying the causes of sleep disturbances in acute care settings and it is imperative for nurses to be able to identify the triggering factors of sleep disturbances and to eliminate them to ensure quality sleep in hospitalized children.

Sleep Disturbance in Smokers with Preserved Pulmonary Function and with Chronic Obstructive Pulmonary Disease.

Sleep disturbance frequently affects patients with chronic obstructive pulmonary disease (COPD), and is associated with reduced quality of life and poorer outcomes. Data indicate that smokers with preserved pulmonary function have clinical symptoms similar to those meeting spirometric criteria for COPD, but little is known about the driving factors for sleep disturbance in this population of emerging interest. To compare the magnitude and correlates of sleep disturbance between smokers with preserved pulmonary function and those with airflow obstruction. Using cross-sectional data from the COPD Outcomes-Based Network for Clinical Effectiveness and Research Translation multicenter registry, we identified participants clinically identified as having COPD with a smoking history of at least 20 pack-years and either preserved pulmonary function or airflow obstruction. We quantified sleep disturbance by T-score measured in the sleep disturbance domain of the Patient-Reported Outcomes Information System questionnaire, and defined a minimum important difference as a T-score difference of two points. We performed univariate and multivariable linear regression to evaluate correlates within each group. We identified 100 smokers with preserved pulmonary function and 476 with airflow obstruction. The sleep disturbance T-score was 4.1 points greater among individuals with preserved pulmonary function (95% confidence interval [CI], 2.0-6.3). In adjusted analyses, depression symptom T-score was associated with sleep disturbance in both groups (airflow obstruction: β, 0.61 points; 95% CI, 0.27-0.94; preserved pulmonary function: β, 0.25 points; 95% CI, 0.12-0.38). Of note, lower percent predicted FEV1 was associated with greater sleep disturbance among those with preserved pulmonary function (β, -0.19 points; 95% CI, -0.31 to -0.07), whereas higher FEV1 was associated with greater sleep disturbance among individuals with airflow obstruction (β, 0.06 points; 95% CI, 0.01-0.10). Among smokers with clinically identified COPD, the severity of sleep disturbance is greater among those with preserved pulmonary function compared with those with airflow obstruction. Nonrespiratory symptoms, such as depression, were associated with sleep disturbance in both groups, whereas the relationship of sleep disturbance with FEV1 differed.

Sleep disturbances in Taiwanese patients with Parkinson's disease.

IntroductionSleep disturbance is a common nonmotor symptom of Parkinson's disease (PD) and strongly affects patients’ quality of life. The relationship between excessive daytime sleepiness (EDS) and nighttime problems remains uncertain. Arguments persist regarding the risk factors for sleep disturbance among patients with PD. Furthermore, the prevalence of EDS appears to be lower in Asian countries. Herein, we conducted the study to describe the characteristics of sleep problems in a sample of Taiwanese PD patients and delineate the difference with reported sleep disturbances in Caucasian PD patients from the literature.MethodsPatients with PD were recruited from the outpatient clinic of a tertiary medical center and were evaluated using standardized assessment protocols, including the Parkinson's Disease Sleep Scale (PDSS), the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 39‐Item Parkinson's Disease Questionnaire (PDQ‐39).ResultsA total of 225 patients with PD were recruited. The mean age of patients with PD was 65.7 years old and the mean disease duration was 8.18 years. Among the patients, 53.8% were defined as poor sleepers (PSQI > 5) and 26.3% had EDS. Seventy‐one percent of the poor sleepers used hypnotic medications. The poor sleepers were worse in the scores of Unified Parkinson's Disease Rating Scale (UPDRS), PDSS, and the PDQ‐39, and received higher levodopa daily dosage. A PDSS score of <126 indicate that a patient with PD was a poor sleeper. EDS was positively correlated with advanced Hoehn and Yahr stages and use of dopamine agonists but not with levodopa daily dosage and levodopa equivalent daily dosage.ConclusionsTaiwanese patients with PD had a lower prevalence of EDS compared with the literatures reported in Caucasian patients. We identify and suggest that PDSS total score, rather than subcategory items, should be used to predict poor sleep among patients with PD.

Sleep Disturbance after Hospitalization and Critical Illness: A Systematic Review.

Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful. This Systematic Review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors. PubMed (January 4, 2017), MEDLINE (January 4, 2017), and EMBASE (February 1, 2017). Databases were searched for studies of critically ill adult patients after hospital discharge, with sleep disturbance measured as a primary outcome by standardized questionnaire or objective measurement tools. From each relevant study, we extracted prevalence and severity of sleep disturbance at each time point, objective sleep parameters (such as total sleep time, sleep efficiency, and arousal index), and risk factors for sleep disturbance. A total of 22 studies were identified, with assessment tools including subjective questionnaires, polysomnography, and actigraphy. Subjective questionnaire studies reveal a 50-66.7% (within 1 mo), 34-64.3% (>1-3 mo), 22-57% (>3-6 mo), and 10-61% (>6 mo) prevalence of abnormal sleep after hospital discharge after critical illness. Of the studies assessing multiple time points, four of five questionnaire studies and five of five polysomnography studies show improved aspects of sleep over time. Risk factors for poor sleep varied, but prehospital factors (chronic comorbidity, pre-existing sleep abnormality) and in-hospital factors (severity of acute illness, in-hospital sleep disturbance, pain medication use, and ICU acute stress symptoms) may play a role. Sleep disturbance was frequently associated with postdischarge psychological comorbidities and impaired quality of life. Sleep disturbance is common in critically ill patients up to 12 months after hospital discharge. Both subjective and objective studies, however, suggest that sleep disturbance improves over time. More research is needed to understand and optimize sleep in recovery from critical illness.

뇌졸중 노인의 신체적, 환경적, 정서적, 수면 방해 요인에 따른 수면 위생의 차이

This study was intended to research the difference of sleep hygiene depending on whether patients staying in care hospitals have sleep disturbance factors and to suggest the necessity of intervention on sleep disturbance factors. The subjects were total 120, who completed survey with the help of occupational therapists after questionaries were distributed. Total 80 copies except unanswered and unfaithful 40 copies were analyzed with the use of SPSS 21.0 mac version by characteristics of each item. To research the difference of sleep hygiene depending on whether they have sleep disturbance factors, independent sample T test was used. The result of the study showed that when they had all disturbance factors including physical factor, environmental factor and mental factor, the sleep hygiene was not good. Based on the result, it was confirmed that the sleep disturbance factors of patients staying in care hospitals are negative elements of sleep hygiene, and the intervention to reduce sleep disturbance factors is needed. Thus, there should be active future research about reduction of sleep disturbance factors of patients staying in care hospitals.

Acupuncture combined with auricular point sticking therapy for post stroke depression:a randomized controlled trial

To observe the clinical effects of acupuncture combined with auricular point sticking based on the western medication for post stroke depression (PSD). Sixty patients with PSD were randomly assigned into an acupuncture plus auricular application group (a combination group) and a medication group, 30 cases in each one. 20 mg paroxetine hydrochloride was prescribed orally in the medication group, once a day for continuous 8 weeks. Based on the above treatment, 30-minute acupuncture was used in the combination group for 8 weeks at Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), Yintang (GV 29), Shenmen (HT 7), Neiguan (PC 6), Taichong (LR 3), Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Fenglong (ST 40), once the other day and three times a week. Auricular point sticking therapy for 8 weeks was applied at shenmen (TF4), pizhixia (AT4), xin (CO15), and gan (CO12), with pressing 3 times a day and once 3-5 days. The total score and each factor scores of Hamilton's depression scale (HAMD) were observed in the two groups before and after treatment, and Asberg's antidepressant side-effect rating scale (SERS) and clinical effect were evaluated. After treatment, the total HAMD scores of the two groups decreased compared with those before treatment (both P<0.05), with better effect in the combination group (P<0.05). The scores of the combination group after treatment were lower than those in the medication group, including the anxiety/somatization factor, sleep disturbance factor, hopelessness factor (all P<0.05). The total effective rate of the combination group was 86.7% (26/30), which was better than 66.7% (20/30) of the medication group (P<0.05). The SERS score of the combination group was lower than that of the medication group (P<0.05). Acupuncture combined with auricular point sticking can improve the clinical symptoms and are effective and safe for PSD.

Lifestyle factors and internet addiction among school children

AimThe aim was to determine the association between internet addition [IA] and fatigue, sleep disturbance, depression, and life style factors among school children.Subjects and methodsA cross-sectional survey based on multistage stratified random sampling and 1188 students (73.3%) gave consent during October 2011 to December 2012. Data including socio-demographic details, lifestyle and dietary habits Internet Addiction Test (IAT), Fatigue Scale, Epworth Sleepiness Scale [ESS] and Beck Depression Inventory (BDI) test. Univariate and multiple logistic regression analysis were performed.ResultsThe overall prevalence of IA among school children was 19.8%. The proportion of IA was significantly more among males (56.4%) as compare to females (43.6%; P = 0.035), school performance (P &lt; 0.001) and family income (P = 0.032). Those with IA had significantly less number of sleep hours (6.16 ± 0.80 vs. 6.58 ± 1.29; P &lt; 0.001) as compared to normal. Those with IA had significantly high number of hours internet use (3.82 ± 1.64 vs. 3.03 ± 1.64; P &lt; 0.001) as compared to normal. A significantly larger proportion of IA than normal subjects reported having headaches (P = 0.010), double vision (P = 0.037), eye hurt (P = 0.021), eye tired (P = 0.005), dizziness (34.4% vs. 27.3%; P = 0.002), fatigue, and hearing problem (P = 0.048). A significantly larger proportion of students with IA most frequently gratifying site (19.9% vs. 11.6%; P &lt; 0.001), browsed games (38.6% vs. 29.9%; P = 0.010), chat sites (29.7% vs. 22%; P = 0.013), email (54.2% vs. 63.1%; P = 0.36), and research (61.0% vs. 69.2%; P = 0.017).ConclusionThe current study confirmed the of evidence linking problematic internet use with negative fatigue, greater numbers of symptoms, anxiety, sleeping disturbances, depressive and lifestyle risk factors, among vulnerable young children.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Lifestyle Factors and Internet Addiction among School Children

Aim:The current study aimed to determine the association between Internet Addition [IA] and fatigue, sleep disturbance, depression, and life style factors among school children. Subjects & Methods:A cross-sectional survey based on Public and Private intermediate and secondary School students in Doha- Qatar. A total of 1624 students 12-18 years of age were approached using multistage stratified random sampling and 1,188 students (73.3%) gave consent during October 2011 to December 2012. Data collection was based on a structure questionnaire including socio-demographic details, lifestyle and dietary habits Internet Addiction Test (IAT), Fatigue Scale, Epworth Sleepiness Scale [ESS] and Beck Depression Inventory (BDI) test. Univariate and multiple logistic regression analysis were performed. Results:The overall prevalence of IA among school children was 19.8%. The proportion of IA was significantly more among males (56.4%) as compare to females (43.6%; p=0.035), school performance (p<0.001) and family income (p=0.032). Those with IA had significantly less number of sleep hours (6.16±0.80 vs. 6.58±1.29; p<0.001) as compared to normal. Those with IA had significantly high number of hours internet use (3.82±1.64 vs. 3.03±1.64; p<0.001) as compared to normal. A significantly larger proportion of IA than normal subjects reported having headaches (p=0.010), double vision (p=0.037), eye hurt (p=0.021), eye tired (p=0.005), dizziness (34.4% vs. 27.3%; p=0.002), and hearing problem (p=0.048). A significantly larger proportion of students with IA most frequently gratifying site (19.9% vs. 11.6%; p<0.001), browsed games (38.6% vs. 29.9%; p=0.010), chat sites (29.7% vs. 22%; p=0.013), email (54.2% vs. 63.1%; p=0.36), and research (61.0% vs. 69.2%; p=0.017). Those with IA had significantly high number fatigue disorders, because significantly high number of hours internet use (p<0.001) as compared to normal. Conclusion:The current study confirmed the of evidence linking problematic internet use with negative fatigue, greater numbers of symptoms, anxiety, sleeping disturbances, depressive and lifestyle risk factors, among vulnerable young children.

Influencing Factors of Sleep Disturbance in Pregnant Women

Influencing Factors of Sleep Disturbance in Pregnant Women

Progress in elucidating the pathophysiological basis of nonrapid eye movement parasomnias: not yet informing therapeutic strategies.

Nonrapid eye movement (NREM) or arousal parasomnias are prevalent conditions in children and young adults, apparently provoked by any medical, physical, mental, or pharmacologic/toxic agent disturbing normal biorhythm and causing sleep fragmentation or abundant amount of slow wave sleep. The nadir and the ascending slope of the first sleep cycle of night sleep are the typical periods when NREM parasomnias, especially sleepwalking may occur on sleep-microstructural level; microarousals are the typical moments allowing NREM parasomnias. While sleep-disturbing factors have a clear precipitating effect, a genetic predisposition appears necessary in most cases. A candidate gene for sleepwalking has been identified on chromosome 20q12-q13.12 in one sleepwalking family. NREM parasomnias have a genetic and clinical link with nocturnal-frontal lobe epilepsies; possibly through an abnormality of the acetylcholine-related sleep-control system. The association of NREM parasomnias with the human leukocyte antigen system might be the sign of an autoimmune background to be further clarified. In the treatment of arousal parasomnias, the main tools are adequate sleep hygiene and the management of underlying conditions. Their pharmacotherapy has remained unresolved; the best options are clonazepam and some of the antidepressants, while a psychotherapy approach is also justified.

Abstract NS8: Prevalence and Relating Factors of Sleep Disturbances at 3 Months Post Stroke

Background: Post-stroke sleep disturbances (PSSD) are common and associated with various adverse outcomes. However, PSSD in the subacute stages of stroke have been scarcely studied. We aimed to evaluate the characteristics of and the factors related to PSSDs in stroke patients 3 months post-stroke. Methods: A total of 199 patients were evaluated for PSSD at 3 months after stroke. The quality of nighttime sleep and excessive daytime sleepiness (EDS) were assessed using the Verran Snyder-Halpern sleep scale and Epworth Sleepiness Scale, respectively. Presence of motor dysfunction and post-stroke pain, post-stroke depression, fatigue, and social support were evaluated. Results: Eighty eight patients (44.2%) had poor quality of night time sleep. Twenty eight patients (14.4%) reported EDS. Poor quality of sleep was independently associated with depression (p = 0.044) and EDS (p = 0.041) whereas fatigue (p = 0.000) and poor nighttime sleep (p = 0.045) were independently associated with EDS. Post-stroke pain and social support showed no association with PSSD. Conclusions: We found that PSSD 3 month post-stroke is common. Although causality remained to be determined, depression and nighttime sleep disturbances were related, whereas fatigue and nighttime sleep disturbances were related to EDS.

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

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