General Sleep Disturbance Scale Research Articles

Association of pruritus with sleep in patients with psoriasis and chronic spontaneous urticaria: A cross-sectional study.

Pruritus is a frequent complaint associated with various inflammatory dermatoses. Sleep is often disturbed because of pruritus but the impact of severity and diurnal pattern of pruritus has not been studied so far. To estimate the prevalence of nocturnal itch (NI) and its association with itch severity, sleep disturbance and quality of life (QoL) compared with non-NI in chronic plaque psoriasis (CPP) and chronic spontaneous urticaria (CSU). We performed a cross-sectional study in patients aged ≥18 years with CPP or CSU for at least 6 weeks. A comprehensive in-house questionnaire designed for study formed the basis for categorizing patients into NI and non-NI. Validated instruments like visual analog scale, pruritus grading system, General Sleep Disturbance Scale, and Dermatology life quality index were used to assess itch severity, sleep, and QoL. A total of 255 patients (CPP: 131; CSU: 124) were included in this study. Prevalence of NI was 43.5% (95% confidence interval: 34.9%-52.4%) in CPP and 29% (95% confidence interval: 21.2%-37.9%) in CSU. NI was strongly associated with higher pruritus grading system scores in CSU and CPP (regression coefficient = 1.5, P =0.004 and regression coefficient = 1.3, P =0.004, respectively), with impaired sleep (OR = 2.97, P = 0.025) in CPP and with itch-affected sleep in CSU. Itch severity was associated with impaired sleep; however, the association was modified by the presence of NI in CSU patients. Nocturnal itch is prevalent in chronic dermatoses and significant for sleep deficit and impaired QoL. Early screening and management of sleep disturbance among patients presenting with nocturnal itch should be routinely undertaken.

Study of the Effects of Melatonin on Sleep Disorders in Pulmonary Sarcoidosis Patients.

The symptoms of pulmonary sarcoidosis may lead to fatigue, excessive daytime sleepiness, poor sleep quality, and a decrease in quality of life in these patients. This study was designed to evaluate the effects of oral melatonin on sleep disorders of patients with pulmonary sarcoidosis. A randomized, single-blinded clinical trial was conducted on patients with pulmonary sarcoidosis. Eligible patients were randomly allocated into melatonin and control groups. Patients in the melatonin group were given 3 mg melatonin one hour before bedtime for three months. Sleep quality, daytime sleepiness, fatigue status, and quality of life were assessed applying General Sleep Disturbance Scale (GSDS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Assessment Scale (FAS), and the Patient-Reported Outcomes Measurement Information System (PROMIS), respectively, as well as the 12-item Short Form Survey (SF-12) scores at the baseline and three months after treatment. There was a significant change in the GSDS (P < 0.001), PSQI (P < 0.001), ESS (P = 0.002), and FAS (P < 0.001) scores, which were decreased, compared to those of the control group. After intervention¸ global physical health and global mental health raw scores were improved comparing to the control group (P = 0.006, P = 0.02, respectively). The 12-item Short Form Survey evaluation showed that there was a significant difference between the melatonin (3.38 ± 4.61) and control (0.55 ± 7.25) groups in PCS-12 score after three months of therapy (P = 0.02). Our findings showed that supplemental melatonin could significantly improve sleep problems, quality of life, and excessive daytime sleepiness in sarcoidosis patients.

Reliability and validity of the Turkish version of general sleep disturbance scale (GSDS-T) in stroke.

Stroke is a life-threatening condition with many complications. Sleep disturbances is one of them. Sleep disturbances effect quality of life, recovery and rehabilitation process. It is crucial to reveal sleep disturbances objectively in stroke patients. The aim of the study is to determine reliability and validity of the Turkish version of General Sleep Disturbance Scale (GSDS-T) in stroke patients. After translation and culture validation of the scale was done, Pittsburgh Sleep Quality Index (PSQI) and the Turkish version of the GSDS was applied at admission and at 24h to the 58 patients with stroke. Cronbach alpha coefficient of total score was found as 0.850 and test re-test reliability-related Cronbach alpha coefficient was 0.785. GSDS-T is a reliable and valid tool to assess sleep disturbance in stroke patients.

Sleep disturbance is associated with perturbations in immune-inflammatory pathways in oncology outpatients undergoing chemotherapy

Objective/backgroundSleep disturbance is a common problem in patients receiving chemotherapy. Purpose was to evaluate for perturbations in immune-inflammatory pathways between oncology patients with low versus very high levels of sleep disturbance. Patients/methodsSleep disturbance was evaluated using the General Sleep Disturbance Scale six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles. Pathway impact analyses were performed in two independent samples using gene expression data obtained from RNA sequencing (n = 198) and microarray (n = 162) technologies. Fisher's combined probability test was used to identify significantly perturbed pathways between Low versus Very High sleep disturbance classes. ResultsIn the RNA sequencing and microarray samples, 59.1% and 51.9% of patients were in the Very High sleep disturbance class, respectively. Thirteen perturbed pathways were related to immune-inflammatory mechanisms (i.e., endocytosis, phagosome, antigen processing and presentation, natural killer cell mediated cytotoxicity, cytokine-cytokine receptor interaction, apoptosis, neutrophil extracellular trap formation, nucleotide-binding and oligomerization domain-like receptor signaling, Th17 cell differentiation, intestinal immune network for immunoglobulin A production, T-cell receptor signaling, complement and coagulation cascades, and tumor necrosis factor signaling). ConclusionsFirst study to identify perturbations in immune-inflammatory pathways associated with very high levels of sleep disturbance in oncology outpatients. Findings suggest that complex immune-inflammatory interactions underlie sleep disturbance.

Relationship between serum 25 hydroxyvitamin D (25(OH)D) levels and mental health in shift female nurses

The nurses work long hours and in various shifts, and often accompanied by depression, fatigue, and sleep disorders. Many studies have found that 25 hydroxyvitamin D (25(OH)D) is related to mental health. We aimed to investigate the relationship between depression, sleep problems, fatigue, and serum 25(OH)D levels in shift nurses. We recruited 34 day-shift, 30 evening-shift and 31 night-shift nurses. The Beck Depression Inventory II (BDI-II), Numerical Rating Scale and General Sleep Disturbance Scale to evaluate the levels of depression, sleep problems, fatigue. Blood samples (20 ml) were collected under a fasting state to determine basic biochemistry and inflammatory parameters. In central of Taiwan, approximately 96.1% of shift nurses had deficient (< 20 ng/ml) (45 females and 1 male) and inadequate (20–29 ng/ml) (39 females and 2 male) 25(OH)D levels. Approximately 84.2% of shift nurses experienced fatigue. In sleep disturbance, night-shift nurses experienced significantly more severe sleep disturbance than day-shift and evening-shift nurses. However, no significant correlation was observed between 25(OH)D levels and mental health when the 25(OH)D level was categorized. 25(OH)D deficiency, sleep disturbance, depression, and fatigue were common in shift female nurses, but it was not possible to demonstrate the impact of 25(OH)D deficiency on the mental health of shift nurses in Taiwan.

Sleep Disturbance Scale for Children: Italian Validation in Autism Spectrum Disorder Population.

Sleep disorders in children with autism spectrum disorders (ASDs) are well-described. However, there is a lack of specific assessment tools to investigate sleep disturbance in this target population. The present investigation reports the Italian validation of the Sleep Disturbance Scale for Children (SDSC) in the ASD population, also investigating the correlation between sleep disorders In both children and parents. Internal consistency and test–retest reliability were investigated using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Concurrent validity was analyzed by comparing the score of the SDSC with the Pittsburgh Sleep Quality Index (PSQI), while the correlation between the SDCS score and the General Sleep Disturbance Scale (GSDS) was used to analyze the correlation between sleep disorders in children and sleep disorders in their parents. In total, 99 children with a diagnosis of ASD participated in the study. Cronbach’s alpha revealed satisfactory value (0.853), as well as reliability (ICC 0.972) and concurrent validity (0.745). Our results also revealed a significant linear correlation between children’s and parents’ sleep disorders (p < 0.05). In conclusion, we found the SDSC to be a useful tool for measuring sleep disorders in ASD children. Our findings offer concrete inputs to achieve adequate pathways for taking care of children with ASDs and their parents.

A cross-sectional study on sleep disturbances and associated factors among nurses

BackgroundMany studies have measured sleep disturbances among nurses globally, but none have addressed this issue in Vietnam. Therefore, this study aimed to assess the prevalence of sleep disturbance and identify associated factors among staff nurses in Vietnam.To identify sleep disturbances and associated factors among staff nurses in Vietnam.MethodsA cross-sectional design was used in this study. Participant nurses (n = 420) completed a general information questionnaire, the Vietnamese version of the General Sleep Disturbance Scale (GSDS), the Perceived Stress Scale, and the Short Form 12. Data were collected between July and September 2019 from three public hospitals located in southwestern Vietnam. Data were analyzed using Chi-square, independent Student’s t-test, and multivariate logistic regression analysis.ResultsThe average GSDS score was 41.10 (SD = 19.48), indicating sleep disturbances among 46.9% of nurses. Age, health condition, stress, and quality of life had an impact on sleep disturbance. Multivariate logistic regression analysis confirmed that nurses with high stress and poor physical health status were more likely to experience sleep disturbances.ConclusionVietnamese nursing staff suffers from a high rate of sleep disturbances. Significant predictors included high stress and poor physical health status. Administrators of healthcare services should carefully consider how to conduct interventions to help the nurses handle their sleep disturbances such as stress management and physical health promotion.

Distinct sleep disturbance profiles among patients with gynecologic cancer receiving chemotherapy

ObjectiveIn a sample of patients with gynecologic cancer receiving chemotherapy, we sought to identify subgroups of patients with distinct sleep disturbance profiles and assess for differences in patient characteristics and the severity of co-occurring symptoms among these subgroups. MethodsAdults with gynecologic cancer (n = 232) completed questionnaires six times over two chemotherapy cycles. Sleep disturbance was assessed using the General Sleep Disturbance Scale (GSDS). Clinically meaningful sleep disturbance was defined as a GSDS total score of ≥43. Subgroups of patients with distinct sleep disturbance profiles were identified using latent profile analysis. Differences in patient characteristics and co-occurring symptoms were assessed using Chi-square, Kruskal Wallis, and one-way analysis of variance. ResultsFour distinct sleep disturbance profiles were identified: Low (18.5%), Moderate (43.6%), High (29.3%), and Very High (8.6%). Compared to the Low class, patients in the other three classes had lower functional status scores and higher levels of depressive symptoms, trait anxiety, and morning and evening fatigue. Compared to the Low class, patients in the Very High class were younger, had a higher body mass index, and were more likely to report a diagnosis of depression or back pain. ConclusionsOver 80% of the patients with gynecologic cancer reported sleep disturbance that persisted over two cycles of chemotherapy. Patients in the Very High class experienced problems with both sleep initiation and maintenance. Clinicians should routinely assess sleep disturbance alongside depression, anxiety, and fatigue. Interventions that target the underlying mechanisms of these co-occurring symptoms are warranted.

Factors Influencing Mothers’ Quality of Sleep during Their Infants’ NICU Hospitalization

ABSTRACT Study Objectives The purpose of this study is to identify factors associated with Neonatal Intensive Care Unit (NICU) mothers’ quality of sleep as measured with the General Sleep Disturbance Scale (GSDS). Methods Recruitment took place in a level 3 NICU. At enrollment, mothers completed a socio-demographic questionnaire, described their presence in the unit and their breast milk expression behavior. They also completed online or paper questionnaires about NICU-related stress, symptoms of postpartum depression, family-centered care, perception of noise and light in the unit, and sleep disturbances. Data regarding the infant’s clinical condition were collected from their medical file. Pearson correlations were performed to identify associations between mothers’ quality of sleep and other study variables. Subsequently, to compare mothers with a clinically significant GSDS score to mothers with a non-significant score, a binary logistic regression model was conducted. Results 132 mothers participated. Sleep disturbances of mothers with an infant hospitalized in the NICU was positively correlated with stress (r = 0.40; p = .00), depressive symptoms (r = 0.51; p = .00), and breast milk expression (r = 0.23; p = .01). In addition, for mothers with significant levels of depressive symptoms (OR = 1.19; p = .00), with greater presence in the unit (OR = 1.36; p = .04), or with other children at home (OR = 3.12; p = .04), the likelihood of clinically significant sleep disturbances was increased. Conclusions These results improve our understanding of the factors influencing the quality of sleep of mothers whose premature infant is hospitalized for 2 weeks or more in the NICU. In addition, these results allow the identification of mothers having a higher possibility for sleep disturbance, which enables the implementation of targeted interventions to promote adequate sleep.

Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy.

The purposes of this study, in a sample of oncology patients (n = 1326) receiving chemotherapy, were to identify subgroups of patients with distinct anxiety profiles and evaluate for differences in demographic and clinical characteristics, stress and resilience measures, and severity of co-occurring symptoms (i.e., depression, sleep disturbance, attentional function, fatigue, pain). Patients completed self-report questionnaires a total of six times over two cycles of chemotherapy. Severity of state anxiety was evaluated using the Spielberger State Anxiety Inventory and resilience was assessed using the Connor-Davidson Resilience Scale. Symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, General Sleep Disturbance Scale, Lee Fatigue Scale, Attentional Function Index and Brief Pain Inventory. Based on the findings from the latent profile analysis that utilized the six assessments of state anxiety, 47.7% of the patients were classified as "Low," 28.3% as "Moderate," 19.5% as "High," and 4.5.% as "Very High." Anxiety levels remained relatively stable across the six timepoints. Compared to the Low class, membership in the Moderate, High, and Very High classes was associated with a number of characteristics (e.g., younger age, female gender, lower functional status, more comorbidities). Those patients with higher levels of anxiety reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms. Our findings suggest that a substantial number of oncology patients may warrant referral to psychological services. Clinicians need to perform systematic assessments of anxiety, stress, and common symptoms and initiate appropriate interventions to enhance resilience and coping.

A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines

We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women. We searched four databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least one psychometric measurement property of a PROM. An overall performance rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM. We identified 15 validation studies of eight PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by five PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS), and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for noncommercial research, that achieved a Class A recommendation. The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.

Assessing the effect of a mind-body exercise, qigong Baduanjin, on sleep disturbance among women experiencing intimate partner violence and possible mediating factors: a randomized-controlled trial.

To evaluate the effects of a mind-body exercise, qigong Baduanjin, on sleep disturbances in women experiencing intimate partner violence and explore the mediating role of depressive symptoms, perceived stress, and inflammation in producing the effects. A subgroup of a parent randomized controlled trial was randomized for a 22-week Baduanjin intervention (n = 94) or wait-list control (n = 92). Questionnaires, including the General Sleep Disturbance Scale, Perceived Stress Scale, and Beck Depression Inventory version II, were administered at baseline, posttraining (6 weeks), and postintervention (22 weeks), and blood samples were collected to assess tumor necrosis factor and interleukin 6 levels at baseline and postintervention only. Of the 186 participants, 170 completed the study. Results indicate that the total sleep disturbance scores for the intervention group were significantly lower than those for the wait-list control group at week 6 (difference = -7.96; 95% confidence interval [CI], -13.63 to -2.30; P = .006) and week 22 (difference = -7.17; 95% CI, -12.58 to -1.76; P = .01). Mediation analysis showed a statistically significant indirect effect of the intervention on sleep improvement through reducing depressive symptoms (β = 2.58, 95% CI, 0.69 to 5.09), while the mediating effects of perceived stress and inflammation were not significant. Qigong Baduanjin can be recommended for women who experience intimate partner violence and report sleep disturbances. More research is needed to understand the clinical significance of the observed sleep improvements. Registry: ClinicalTrials.gov; Name: Qigong Intervention Program for Abused Chinese Women; URL: https://clinicaltrials.gov/ct2/show/NCT02060123; Identifier: NCT02060123.

The Italian version of the General Sleep Disturbance Scale (GSDS-IT): Psychometric properties in a sample with hip and knee replacement

ABSTRACT Objective To use the Italian version of the General Sleep Disturbance Scale (GSDS-IT) to assess the psychometric properties in a sample of orthopedic patients. Methods Participants were divided into sleepless and non-sleepless according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). Reliability was assessed with Cronbach’s alpha. To evaluate responsiveness, the scale was administered a second time after the rehabilitation program. Results The scale was administered to the 158 patients recruited. The GSDS-IT had good internal consistency (Cronbach’s α of 0.752) and good responsiveness (ICC of 0.78). The optimal cut-off point for the GSDS-IT was 48.5. Conclusion The GSDS-IT was demonstrated to be a valid and rapid tool to detect the presence of sleep disorders in a clinical setting in patients admitted to an intensive care unit and allowed the detection of the onset one week after admission and persisting until the time of discharge.

General Sleep Disturbance Scale (GSDS-IT) in people with spinal cord injury: a psychometric study.

Psychometric study. This study sought to analyze the psychometric properties of the Italian version of the General Sleep Disturbance Scale (GSDS-IT) in a population of individuals with spinal cord injury (SCI). Italy. Its reliability was assessed using the Cronbach's alpha and intraclass correlation coefficient (ICC), while its concurrent validity was assessed using the Pearson's correlation coefficient in relation to the Pittsburgh Sleep Quality Index (PSQI). The obtained scores were compared with the cut-off score for the GSDS-IT among a healthy Italian population (38.5). The GSDS-IT was administered to 57 participants with SCI who were recruited from all over Italy. The GSDS-IT was found to have good internal consistency (Cronbach's α of 0.76) and good test-retest reliability (ICC of 0.7), and it showed positive and significant values for all the PSQI domains. Based on the cut-off score of 38.5, 56% of participants tested positive for sleep disturbances upon admission (t0), while among the randomized participants submitted for the test-retest after 24 h (t1), 75% tested positive for sleep disturbances. The GSDS-IT is a valid, reliable, and time-efficient tool for measuring sleep disturbances over the past week in a population with SCI.

Novice nurses’ sleep disturbance trajectories within the first 2 years of work and actual turnover: A prospective longitudinal study

BackgroundNovice nurses experience radical changes in their sleep-wake cycle and sleep difficulties after exposure to a rotating shift work schedule. The link between workplace hardship and employee turnover may be dependent on factors at the individual level, e.g., individual health. Nurses with sleep disturbance are more vulnerable to stressful stimuli and lack resilience at work compared with those without sleep disturbance. ObjectivesTo classify novice nurses according to sleep disturbance trajectories during the first 2 years of work, to compare turnover rates according to trajectory classification, and to compare levels of sleep disturbance between stayers and leavers within each trajectory class. DesignProspective longitudinal design. SettingsA tertiary hospital in Seoul, South Korea. ParticipantsA total of 465 newly graduated nurses who started work between September 2014 and December 2015. MethodsData were collected 6 times within the first 2 years of work (on the first day of orientation before ward placement, at 6 weeks after starting work, and at 6, 12, 18, and 24 months of work). Sleep disturbance was assessed using the General Sleep Disturbance Scale. Turnover information was retrieved from the hospital's administrative data system to determine whether anyone had left the hospital at each data collection point. Unconditional latent growth curve analysis was performed to identify latent classes of trajectories of sleep disturbance among novice nurses during the first 2 years of work. ResultsThe 2-year trajectories of sleep disturbance were classified into two distinct groups: the high symptomatic group (Class 1: 57.4%) and the low symptomatic group (Class 2: 42.6%). In comparison with Class 2, Class 1 consistently showed a higher turnover in each period. In Class 1, leavers who left the hospital at the next measurement point tended to report more severe sleep disturbance at prior measurements. This pattern was also observed for the overall sample. However, in Class 2, an inconsistent pattern between stayers and leavers was observed. ConclusionsThis study identified two distinct classes of sleep disturbance among novice nurses during the first 2 years of work. Given that many nurses experience sleep problems at pre-employment and during the early career period, a comprehensive approach to address this issue should be implemented in nursing schools and hospitals. The basic nursing curriculum should include self-care management strategies for sleep difficulties to ensure retention at work. At-risk nurses should receive organizational support and early monitoring to prevent the adverse effects of poor sleep.

Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study

ObjectivesTo investigate the association between measures of sleep quality, sleep duration and sleep disorder symptoms in late pregnancy and likelihood of emergency caesarean section. DesignPopulation-based prospective cohort study SettingNew Zealand Participants310 Māori (Indigenous New Zealanders) and 629 non-Māori women MeasurementsMultivariable logistic regression models were used to investigate the association between type of delivery (emergency caesarean section vs. spontaneous vaginal delivery) and self-reported sleep duration, sleep quality and sleep-related symptoms, (e.g. snoring, breathing pauses during sleep, legs twitching/jerking) in the third trimester of pregnancy. Models were adjusted by ethnicity (ref=non-Māori), age (ref=16–19 y), parity (ref=nulliparous), clinical indicators (any vs. none), area deprivation (ref=least deprived quintile), BMI and for some models smoking. ResultsWomen who reported poor quality sleep as measured by the General Sleep Disturbance Scale in later pregnancy had almost twice the odds of delivering via emergency caesarean than women with good sleep quality (OR=1.98, 95% CI 1.18–3.31). Reporting current breathing pauses during sleep (OR=3.27, 95% CI 1.38–7.74) or current snoring (OR=1.65, 95% CI 1.00–2.72) were also independently associated with a higher likelihood of an emergency caesarean. Short sleep duration and leg twitching/jerking were not independently associated with emergency caesarean section in this study. ConclusionsSupporting healthy sleep during pregnancy could be a novel intervention to reduce the risks associated with emergency caesarean section. Research on the effectiveness of sleep interventions for reducing caesarean section risk is required.

A 4-Month Whole-Systems Ayurvedic Medicine Nutrition and Lifestyle Intervention Is Feasible and Acceptable for Breast Cancer Survivors: Results of a Single-Arm Pilot Clinical Trial.

PurposeOngoing symptoms and impairments in quality of life (QOL) among breast cancer survivors remain a significant problem. We tested the feasibility and acceptability of a manualized Ayurvedic nutrition and lifestyle intervention for breast cancer survivors.MethodsEligible participants had Stage I–III breast cancer, underwent treatment within the past year that included chemotherapy, and were without active disease. The 4-month individualized Ayurvedic intervention included counseling on nutrition, lifestyle, yoga, and marma (like acupressure) during 8 one-on-one visits with an Ayurvedic practitioner. Feasibility and acceptability were the primary outcomes. QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ C30]) and symptoms—sleep disturbance (General Sleep Disturbance Scale [GSDS]), fatigue (Lee Fatigue Scale [LFS]), depressive symptoms (Center for Epidemiological Studies—Depression Scale [CES-D]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI-S, STAI-T]), and stress (Perceived Stress Scale [PSS])—were measured prior to, at midpoint, and at the end of the 4-month intervention. Effect sizes (Cohen’s d) were calculated along with paired t tests comparing baseline to end of month 4 time points. Mixed effects models were used for repeated measures analyses.ResultsParticipants (n = 32) had a mean age of 48 years (SD = 10). Retention at the end of the intervention was 84%. Among those who completed the intervention (n = 27), adherence was high (99.5% of visits with practitioners attended). Large improvements were seen in QLQ-C30 emotional functioning (d = 0.84, P < 0.001), QLQ-C30 cognitive functioning (d = 0.86, P < 0.001), GSDS (d = –1.23, P < 0.001), and CES-D (d = –1.21, P < 0.001). Moderate improvements were seen in QLQ-C30 global health (d = 0.65, p = 0.003), LFS (d = –0.68, P = 0.002), and PSS (d = –0.75, P < 0.001). No adverse events were observed due to the intervention.ConclusionThis 4-month Ayurvedic whole-systems multimodal nutrition and lifestyle intervention was feasible and acceptable for breast cancer survivors. Promise of clinical benefit was seen in terms of improvements in symptoms and QOL that warrants further investigation.

Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms.

Purposes of this study were to identify subgroups of patients with distinct sleep disturbance profiles and to evaluate for differences in demographic, clinical, and various sleep characteristics, as well for differences in the severity of co-occurring symptoms among these subgroups. Outpatients with breast, gynecological, gastrointestinal, or lung cancer (n = 1331) completed questionnaires six times over two chemotherapy cycles. Self-reported sleep disturbance was evaluated using the General Sleep Disturbance Scale (GSDS). Latent profile analysis was used to identify distinct subgroups. Three latent classes with distinct sleep disturbance profiles were identified (Low [25.5%], High [50.8%], Very High [24.0%]) across the six assessments. Approximately 75% of the patients had a mean total GSDS score that was above the clinically meaningful cutoff score of at least 43 across all six assessments. Compared to the Low class, patients in High and Very High classes were significantly younger, had a lower functional status, had higher levels of comorbidity, and were more likely to be female, more likely to have childcare responsibilities, less likely to be employed, and less likely to have gastrointestinal cancer. For all of the GSDS subscale and total scores, significant differences among the latent classes followed the expected pattern (Low < High < Very High). For trait and state anxiety, depressive symptoms, morning and evening fatigue, decrements in attentional function, and decrements in morning and evening energy, significant differences among the latent classes followed the expected pattern (Low < High < Very High). Clinicians need to perform in-depth assessments of sleep disturbance and co-occurring symptoms to identify high-risk patients and recommend appropriate interventions.

General Sleep Disturbance Scale: Translation, cultural adaptation, and psychometric properties of the Italian version

ABSTRACT Objective: The aim of this study was to translate, culturally adapt, and test the psychometric characteristics of the General Sleep Disturbance Scale (GSDS) and to detect and explore the presence of sleep disorders in the healthy Italian population. Methods: Reliability was assessed through Cronbach’s alpha and intraclass correlation coefficient; concurrent validity was assessed with the Pittsburgh Sleep Quality Index (PSQI). Results: The scale was administered to 426 subjects recruited all over Italy. The Italian GSDS was found to have good internal consistency (Cronbach’s α was 0.77) and a good test-retest reliability (ICC of 0.78). The optimal cut-off point for the GSDS-IT was 38.5. Conclusion: The GSDS-IT is a valid and reliable tool, which can be completed in less than five minutes and is a noninvasive method for measuring sleep disturbances consistent with the DSM-V insomnia criteria, during a past week.

Postpartum Sleep and Breastfeeding Outcomes Among First-Time Mothers of Full-Term Newborns

To examine the impact of impaired sleep and its related health consequences (fatigue, hormone disruption, and mood changes) on two breastfeeding outcomes: milk volume and discontinued breastfeeding during the early postpartum period. A descriptive, correlational design was used. Participants were recruited via childbirth classes held at a large community hospital in the southeastern United States. The sample included 29 healthy women who were first-time mothers (ages 22–35 years) and exclusively breastfeeding healthy, full-term newborns. A home visit was conducted at 2-weeks postpartum. Data were collected using a sleep diary, General Sleep Disturbance Scale (GSDS), 7-item Lee Fatigue Scale (LFS-7), Edinburgh Postnatal Depression Scale (EPDS), Perceived Stress Scale (PSS-10), and State-Trait Anxiety Index (STAI). A test weight was performed during the visit, immediately before and after breastfeeding, and was repeated for two consecutive feedings. A follow-up phone interview was conducted to determine breastfeeding status at 1-month postpartum. All women were exclusively breastfeeding at 2-weeks postpartum, and most (90%) were breastfeeding exclusively at 1 month. At 2 weeks, participants in this study were sleep disturbed (69.2%), fatigued (82.8%), experiencing symptoms of anxiety (27.6%), and expressing more symptoms of depression (27.6%) compared with low-risk postpartum women in the United States. Stress was a significant predictor of poor sleep quality (β = .597, p = .001). Poor sleep quality was a significant predictor for lower breast milk production during the 2nd postpartum week (β = –.695, p = .02). Findings highlight a need to develop stress-reduction interventions that might lead to improved sleep during the postpartum period. Improved sleep may have a positive impact on breast milk production. Appropriate screening for depression symptoms and anxiety are also needed for early detection and assistance for postpartum women who develop mood disorders.