Frequency Of Sleep Disturbances Research Articles

Changes in the Circadian Rhythm in Patients with Primary Glaucoma

PurposeThe current study was undertaken to investigate whether glaucoma affects the sleep quality and whether there is any difference between patients with primary glaucoma (primary open angle glaucoma, POAG and primary angle-closure glaucoma, PACG) and healthy subjects, using a validated self-rated questionnaire, the Pittsburgh Sleep Quality Index (PSQI).MethodsThe sleep quality of patients with POAG and PACG was tested against normal controls. Subjects were divided into three sub-groups according to age. Differences in the frequency of sleep disturbances (PSQI score >7) were assessed. The differences of sleep quality within the three groups and within the POAG group depending on the patients’ intraocular pressure (IOP) and impairment of visual field (VF) were also studied.Results92 POAG patients, 48 PACG patients and 199 controls were included. Sleep quality declined with age in control and POAG group (tendency chi-square, P<0.05). The prevalence of sleep disturbances was higher in POAG and PACG group than in the control group, the differences were statistically significant. The prevalence of sleep disturbances was higher in patients with PACG, compared to POAG patients in the age interval of 61–80. In POAG group, the ratio of patients with sleep disorders increased with augmented impairment of VF, but the differences were not statistically significant (χ2-test, P>0.05). No significant differences were found in POAG group between patients with a highest IOP in daytime and at nighttime (χ2-test, P>0.05).ConclusionsThe prevalence of sleep disorders was higher in patients with POAG and PACG than in controls. PACG patients seemed to have a more serious problem of sleep disorders than POAG patients between 61 to 80 years old. No correlation was found between the prevalence of sleep disorders and impairment of VF or the time when POAG patients showed a highest IOP.

Correlation between presence of allodynia and sleep quality in migraineurs

Cutaneous allodynia is a frequent complaint in migraine patients, possibly induced by central sensitisation of trigeminal nucleus. The objective of this study is to investigate if sleep quality is related to the presence of migraine-associated allodynia. A total of 175 consecutive migraineurs were included, 124 with episodic and 51 with chronic forms. As control group, 73 subjects free from any kind of headache were included (HC). The presence of allodynia and sleep disturbances was assessed by a set of semi-structured questions. Chi-square test was applied to compare frequencies among groups. Sleep quality was worse among migraineurs with respect to controls for each sleep item analysed. This difference was significant for all items but one (i.e. frequency in drug use to induce sleep). The frequency of sleep disturbances was higher than in controls in both allodynic and non-allodynic migraineurs, although statistical analysis showed that all these differences were still significant in allodynic migraineurs (also in this case for all the sleep items but one, i.e. frequency in drug use to induce sleep), whilst non-allodynic migraineurs were significantly different from controls only for one item (frequency of initial insomnia). These results suggest that allodynia is strongly related to sleep quality, in a bi-directional way: sleep disturbances may favour central sensitisation, and, in turn, allodynia may impair sleep.

Relación entre el trastorno por déficit de atención e hiperactividad y los trastornos del sueño. Resultados de un estudio epidemiológico en la población escolar de la ciudad de Gandía

The evaluation of comorbidity is an important factor in the treatment of children with attention-deficit/hyperactivity disorder. Sleep disturbances are one of the most common features of this disorder. To find out the frequency of sleep disturbances among children with attention-deficit/hyperactivity disorder. We used the Spanish version of the Paediatric Sleep Questionnaire, which was given out to a representative sample in Gandia (Spain). The questionnaire was answered by 887 (68 % of the sample). The sleep disturbances that showed a clear relationship with the three ADHD variables studied are: snoring, enuresis, rhythmic movement disturbances, night awakenings, and bedtime resistance. Sleep-disorder breathing, bruxism, somniloquy, day sleepiness, early awakenings and difficulty falling sleep are associated with only one of the three variables studied. Our study demonstrates that the population with attention-deficit/hyperactivity disorder has more sleep disturbances. The association with the enuresis is of particular interest due to the possible clinical implications.

Comparison of sleep quality between hemodialysis and peritoneal dialysis patients

Sleep disorders are common in patients with end-stage renal disease. Although studies have been conducted on the type and frequency of sleep disturbances in hemodialysis and peritoneal dialysis patients, there has been no study comparing the sleep quality between these two groups. Therefore, we aimed to compare sleep quality between hemodialysis and peritoneal dialysis patients. A total of 102 patients (52 hemodialysis and 50 peritoneal dialysis) were included in the study. The Pittsburgh sleep quality index (PSQI) was used for the assessment of sleep quality. Two groups were compared for seven components of the PSQI questionnaire and global score as well as for clinical and laboratory findings. We also assessed the independent predictors of sleep quality. There were 51 male and 51 female patients (29 male and 23 female in hemodialysis group versus 22 male and 28 female in peritoneal dialysis group). The mean age was 55.5+/-14.6 years in the hemodialysis and 51.5+/-18.1 years in the peritoneal dialysis group. The median dialysis duration was 36 (77.0) months. The sleep quality was poor in 88.5% of the hemodialysis patients and 78.0% of the peritoneal dialysis patients. However, this difference in sleep quality was not significant between the two groups (P>0.05). There was a significant association between the sleep quality and the age, presence of diabetes mellitus, and serum albumin. Among these variables, only age was found to be an independent predictor of sleep quality. Hemodialysis and peritoneal dialysis patients had a similar high rate of poor sleep quality. Further studies are necessary to investigate the causes of poor quality of sleep and to investigate methods to improve sleep quality in this population.

Influence of sleep disturbance on quality of life of patients with epilepsy

The frequency of sleep disturbances in patients with epilepsy and their impact on quality of life (QoL) have been documented in a few reports, and the results are conflicting. We identified 124 consecutive epilepsy out-patients who visited the epilepsy out-patient clinics at the University Hospital of Alexandroupolis, the AHEPA Hospital in Thessaloniki and the Aeginitio Hospital in Athens. We measured excessive daytime sleepiness (EDS) with the Epworth Sleepiness Scale (ESS), obstructive sleep apnea (OSA) with the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ), and insomnia with the Athens Insomnia Scale (AIS). We evaluated quality of life by the Quality of Life in Epilepsy Inventory (QOLIE-31). EDS was found in 16.9% (21/124) of epileptic patients, OSA in 28.2% (35/124), and insomnia in 24.6% (30/122). In multivariate analysis, we found that insomnia was an independent negative factor for Total score (p<0.001), Overall QoL (p=0.002), Emotional well-being (p<0.001), Energy/fatigue (p<0.001), Cognitive functioning (p=0.04) and Social functioning (p=0.03), and OSA only for Cognitive functioning (p=0.01). According to our findings, EDS, OSA, and insomnia are frequent in epileptic patients. Epileptic patients with sleep disturbance, mainly insomnia, have significant QoL impairment.

Premedication with buccal midazolam in children and in adults with learning disabilities

The routine use of premedication for both children and patients with learning disabilities has been questioned [1]. The drugs routinely used for premedication help to calm the patient but may cause problems in the postoperative period. Oral midazolam 0.5 mg.kg−1 remains the most commonly used drug, but can be associated with unpleasant sequelae. Abnormal postoperative behaviour (negativism, food rejection, nightmares, night terrors and anxiety) have been seen after oral midazolam premedication in children [2]. The injectable preparation is normally used, which has a bitter taste and, despite adding a sweetening agent to the mixture, the drug may be refused. The absorption rate is not standard and effects are unpredictable after oral administration. Oral transmucosal delivery of midazolam was reported in 1988 [3]. Transmucosal application avoids first-pass metabolism in the liver and increases bioavailability from 36% to 78%[3–5]. Different routes for transmucosal application – sublingual, intranasal, buccal – have been tested since then [4, 5]. The fastest onset of action is after intranasal application, but this route is poorly tolerated [4, 5]. Nasal administration is associated with intense burning or stinging [1]. Buccal administration of midazolam is recommended but is limited by both the low concentration (1, 2 or 5 mg.ml−1) of available midazolam preparations and the bitter taste of the drug [4, 5]. An unlicensed liquid preparation containing midazolam 10 mg.ml−1 for buccal administration (Epistatus®, Special Products Ltd, Woking, UK) was introduced into clinical practice in the UK in 2002. A similar preparation specifically indicated for sedation prior to surgical and diagnostic procedures (Consed®, Special Products Ltd) was introduced in May 2006. No relevant data regarding the use of buccal midazolam in the UK as a premedication agent has been published before. However, buccal midazolam has been used in the emergency treatment of epileptic seizures and status epilepticus [6]. McIntyre et al. compared buccal midazolam with rectal diazepam used for treatment of seizures in children and concluded that buccal midazolam was more effective and was not associated with an increased incidence of respiratory depression. We have used buccal midazolam since June 2006 in approximately 30 patients. The patients were children above 2 years of age scheduled for ENT or dental procedures (n = 22) and eight adult patients with learning disabilities undergoing dental treatment under general anaesthesia. Buccal midazolam was usually given in the anaesthetic room to patients who did not co-operate sufficiently. The total dose given was in accordance with manufacturer's recommendations of up to 0.2 mg.kg−1. The drug was prepared in the syringe supplied as part of the commercially prepared solution. An anaesthetist, or a parent or carer inserted their index finger into the patient's mouth and the tip of syringe was placed on the mucosa between patient's gum and cheek and the half the dose applied on each side. The first signs of sedation appeared usually within 5 min and within 10 min all patients were able to undergo either inhalational or intravenous induction. One child refused to take buccal midazolam on the first attempt and two patients reported the taste as unpleasant. Recovery appeared smoother than after oral midazolam and no patient was discharged later than were the unpremedicated patients. We found that the application of buccal midazolam is technically easy, takes up to 10 s, and is very well tolerated by patients. Prospective, randomised studies are needed to assess all aspects of buccal midazolam premedication (onset, co-operation, retrograde amnesia, emergence, acute postoperative behaviour and frequency of sleep disturbance in the first week after surgery).

Frequency of sleep disturbance in major depression

Frequency of sleep disturbance in major depression

Sleep complaints in chronic postconcussion syndrome.

This study was designed to identify the incidence of sleep complaints in 39 patients with chronic postconcussion syndrome compared to those of a control group of 27 patients with orthopedic injuries. Patients with orthopedic injuries were selected as a comparison group to control for the effects of traumatic injury or chronic pain. There were no differences in age, sex distribution, or time from injury between the patient groups. Type and frequency of sleep disturbances in a mean two-year postinjury period were evaluated. Patients with chronic postconcussion syndrome reported more difficulty in initiating and maintaining sleep at night and greater difficulty with sleepiness during the day.

Preventing morphological disturbances in burn-scarred children wearing compressive face garments

Continuous external compression in the form of elasticized garments is a well-accepted and substantiated form of management for postburn hypertrophic scarring. Children who have sustained deep partial thickness and/or full skin thickness burns to the face and head are frequently prescribed elasticized compressive face garments in the post-acute stage of their recovery. Recurrent concerns expressed by parents prompted investigation into the frequency of sleep disturbances, such as snoring subsequent to the application of face garments, and the possibility of changes to the developing dentition. This preliminary study utilized a single case design to demonstrate the effectiveness of a bimaxillary mouthguard in circumventing such problems.

EFFECTS OF SUGGESTED TIME PERSPECTIVE AND ORDER OF PRESENTATION ON RESPONSES TO QUESTIONS ABOUT DREAMING.

In response to the wide-spread use of the questionnaire method to obtain estimates of subjective dream experiences, the present study was undertaken to evaluate the effects of formal question characteristics on responses to these questions. 316 undergraduate students were administered a questionnaire containing questions on frequency of dream recall, quality of dream affect, and frequency of sleep disturbance. Each variable was measured by questions asked from three suggested time perspectives. These were presented in six orders and the influence of order of presentation, time perspective, and question wording on responses was evaluated. Order was found to influence the response distributions of two questions (2–2 and 2–3). It was also found that question wording had considerable impact. Estimates of frequency of dream recall were consistent across time perspectives. Estimates of sleep disturbance, however, appeared quite vulnerable to the influence of question wording, order, and time perspective.