Longer Time In Bed Research Articles

Effects of daytime secondarily generalized epileptic seizures on sleep during the following night

Nocturnal seizures may disturb sleep, but the effect of an epileptic seizure during daytime on sleep during the next night has been under investigated. In this proof-of-principle study, the sleep of 425 patients with epilepsy, who underwent long-term video-electroencephalography recordings, was analyzed. The sleep recordings were retrospectively divided into two groups: Seizure Free, no seizure occurred at least 24h before the start of the night sleep recording, and Daytime Seizure, at least one (secondarily) generalized seizure occurred during the day before. In Daytime Seizure, longer time in bed and latency to first REM and more NREM II were seen as well as a decrease of deep sleep and REM sleep compared to Seizure Free. As many participants underwent long-term recordings over a period longer than 48h, we had the opportunity to compare in individual patients the sleep architecture during nights with and without seizures on the day before the recording. Time in bed and WASO were longer, and sleep efficiency was less in the nights after a seizure on the day before the recording. These differences were statistically significant, but their clinical relevance is doubtful.

Sleep in Older Chronic Pain Patients

The relationship between chronic pain and sleep disturbances is not yet fully understood, despite much evidence linking them. Polysomnography is the gold standard for assessing sleep architecture, and in this naturalistic study, we wanted to compare both macrostructure and microstructure sleep variables in older chronic pain patients with healthy older persons using polysomnography. Sleep variables investigated in this study include sleep onset latency, total sleep time, wake time after sleep onset, sleep efficiency, sleep latencies to different sleep stages, number of awakenings, time spent in each sleep stage, and arousal index, as well as apnea-hypopnea index and periodic leg movement index. In addition, the power spectrum of the α and δ frequency bands was analyzed. The chronic pain group spent significantly longer time in bed and had poorer sleep than the control group in terms of sleep onset latency, sleep latency to N2, sleep efficiency, wake time after sleep onset, and number of awakenings. However, sleep duration and time spent in each sleep stage did not differ between the 2 groups. The composition of power spectrum frequencies revealed that older people with chronic pain have lower intensity in the δ frequencies (0.5 to 1.99 Hz and 2 to 4 Hz) throughout the whole night, especially in the first 6 hours. The findings are in accordance with the idea that the quality of sleep while in chronic pain is particularly characterized by difficulties with the wake-sleep transition and a lower intensity of the deep restorative sleep throughout the night.

Time in Bed, Sleep Sufficiency and Emotional and Behavioral Problems in a General Population of 10-12 Year Old Children

Objective: To examine the relationship between time in bed, sleep sufficiency and emotional and behavioral problems in a general population of children aged 10-12 years (N=5095). Methods: Emotional and behavioral problems were assessed using The Strength and Difficulties questionnaire, which was completed by children, parents and teachers. Data on time in bed, sleep sufficiency and potential confounders (gender, pubertal development, mother's education and family economy) were parent reported. Results: Controlling for gender, pubertal development and socioeconomic status, childrens emotional and behavioral problems as rated by parents were related to insufficient sleep. Self-reported emotional symptoms and parent-reported conduct problems were associated with both shorter time in bed and insufficient sleep. Teacher-reported hyperactivity was associated with long time in bed. Conclusions: Children with self-reported emotional symptoms or parent-reported conduct problems seem to spend too lit- tle time in bed and to obtain insufficient sleep.

Observation of curative effect on 37 gerontisms with thoracic & lumbar vertebral compression fracture treated by surgical therapy

Objective To discuss the clinical curative effect of the gerontism with thoracic &lumbar vertebral compression fracture treated by percutaneous vertebroplasty(PVP). Methods 7 gerontisms with thoracic &lumbar vertebral compression fracture were treated by PVP, preoperative and surgery after three days , to be gave the pain , visual sense and capacity for action mark. Results All patients successfully finished the operation, according to the curative effect assess, 20 cases were excellent , 11 cases were grade Ⅰ , 5 cases were grade Ⅱ , 1 case was grade Ⅲ, the effective rate was 97.30 percent, after surgery the early ache was lenitive a lot, marked after three days(2.09 ± 0.41)was lower than preoperative(6.32 ± 0.29)(P＜ 0.05), capacity for action marked after three days(1.28 ± 0.61)was more ameliorate than preoperative(P ＜ 0.05).Followed up for(16.8 ± 1.5)months, the patients was satisfied with the curative effect. ConclusionPVP is an ideal operation to egotism with thoracic &lumbar vertebral compression fracture, it is simple and convenient, safe and reliable, can be reduce the complication which from long time in bed , improve the patients quality of life. Key words: Old age; Thoracic l Percutaneous vertebroplasty

Actigraphic monitoring of activity and rest in schizophrenic patients treated with olanzapine or risperidone

Metabolic disturbances are a growing concern for the treatment of schizophrenia. As decreased activity and poor sleep quality are risk factors for metabolic disturbances, we investigated the activity and sleep patterns of schizophrenic patients using actigraphy. Seventy-three patients with schizophrenia spectrum disorder (mean age 29.2 ± 10.2 years, 27 females) treated with olanzapine (n = 54) or risperidone (n = 19) and 36 age- and sex-matched healthy controls were examined. Actigraphic recordings were obtained throughout seven consecutive days. The Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS) were used to assess sleep and daytime sleepiness. Drug side effects were evaluated with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Barnes Akathisia Rating Scale (BARS). Mental status was rated with the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS). The patients had lower mean 24 h-activity (p < 0.001) and mean 10 h-daytime-activity (p < 0.001), and longer time in bed (p < 0.001). Higher PANSS scores, especially in the negative symptoms scale, were related to lower activity (rs = −0.508, p < 0.001). Higher depressive symptoms were related to lower mean 24 h-activity (rs = −0.233, p = 0.049), longer time in bed (rs = 0.315, p = 0.007) and higher AIS (rs = 0.377, p = 0.001) and ESS scores (rs = 0.321, p = 0.006). Healthy females presented higher activity than healthy males (p < 0.001). Similar but not significant gender differences were observed in the patients. These findings show that patients with schizophrenia treated with olanzapine or risperidone exhibit low physical activity and altered sleep pattern which may promote metabolic side effects. These changes are linked to negative and depressive symptoms.

LONG SLEEP A GREATER MORTALITY RISK THAN SHORT SLEEP IN OLDER ADULTS

To the Editor: We commend Mesas and colleagues for their excellent article, “Sleep Duration and Mortality According to Health Status in Older Adults.”1 Although the sleep field and the popular literature has focused a great amount of attention on the risks of short sleep, Mesas and colleagues' study is consistent with many other epidemiological studies that indicate that mortality and morbidity risks are even greater for long sleep.2–4 Moreover, as observed before,2 Mesas and colleagues found a greater prevalence of long than short sleep; the average respondent reported a sleep duration of 8 hour, which was associated with significant mortality, suggesting greater public health relevance of long than short sleep. Other strengths of the report are inclusion of a representative sample, consideration of combined nocturnal sleeping and daytime napping, and an extensive in-home interview with participants, which allowed more-definitive assessment of reported sleep duration and other factors (e.g., current medication use) than is typical in similar studies. Notwithstanding rapidly accumulating evidence from perhaps 100 studies showing associations of long sleep with mortality and morbidity, discussion of similar studies has typically focused on the mortality and morbidity risks of short sleep while dismissing the association with long sleep as some sort of artifact.5,6 For example, it has been argued that the opposite direction of putative causality (morbidity causing long sleep) is likely to explain the associations of long sleep with mortality and morbidity. Contrary to this argument are findings that the associations of long sleep with mortality and morbidity are just as apparent after controlling for multiple morbidities.2 The Mesas study goes one step further in showing that the association with mortality is observed even in samples restricted to apparently healthy individuals at initial assessment. Moreover, recent research with long sleepers7,8 found equal tolerance of chronic sleep restriction in apparently healthy individuals and those with existing morbidities, for whom more adverse effects would be expected if morbidity were truly the cause of their long sleep. Rather, the participants almost unanimously reported a long history of long sleep, which presumably preceded their morbidity. Critics of the association between long sleep and mortality have also raised the concern that data are limited to self-reported sleep duration, but recent studies have shown similar associations between objectively recorded sleep duration, mortality, and morbidity.9,10 We agree with Mesas and colleagues that the risks of long sleep might be related to time in bed and poor sleep quality. Studies that have distinguished between time in bed and sleep duration have found similar risks associated with these variables.9,10 The authors caution that “21.3% of persons aged 60 and older in Spain sleep at least 10 hours per day.” Moreover, nearly two-thirds of the sample reported 8 hours or more of sleep, and 8 hours was associated with significant mortality. However, against the current zeitgeist that we are a sleep-deprived society, this point is far from the message that older adults commonly receive.11 The message they hear is that 8 hour of sleep is necessary for health and that they ought to be able to sleep that long.11 This fear might partly explain why older adults often spend more time in bed but sleep less than young adults.12,13 We know that excessive time in bed can lead to greater sleep fragmentation, which has been associated with morbidity in epidemiological studies14 and in studies involving experimental induction of fragmentation.15 The argument that long sleep (or long time in bed) could not possibly be harmful is becoming more difficult to justify. The Mesas and colleagues results point to a need for more randomized controlled trials of sleep restriction or extension in older adults. Conflict of Interest: The authors have no financial or personal conflicts of interest. Paper supported by VA Merit Award (SDY), R01MD004113 (GJL), and R25HL105444 (GJL). Author Contributions: Shawn Youngstedt formulated the idea and wrote most of the letter. Girardin Jean-Louis agreed on the interpretation, gave significant feedback, and helped write the letter. Sponsor's Role: None.

Sleep Variability, Health-Related Practices, and Inflammatory Markers in a Community Dwelling Sample of Older Adults

To explore relationships between wake- and sleep-related health behaviors and circulating concentrations of inflammatory markers (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) in a cohort of community dwelling older adults. Low-grade chronic inflammation is an important risk factor for age-related morbidity. Health behaviors, including average aggregate measures of sleep, have been linked to increased inflammation in older adults. Variability in sleep timing may also be associated with increased inflammation. Participants were community dwelling older adults ≥ 60 years (n = 222: 39 bereaved, 55 caregivers, 52 with insomnia, and 76 good sleepers). Mean values and intraindividual variability in sleep, as well as caffeine and alcohol use, exercise, and daytime napping, were assessed by sleep diaries. Blood samples were obtained in the morning. Several interactions were noted between sleep behaviors, inflammatory markers, and participant group. Greater variability in wake time and time in bed was associated with higher IL-6 among good sleepers relative to caregivers and older adults with insomnia. Good sleepers who consumed moderate amounts of alcohol had the lowest concentrations of IL-6 compared with the other three groups who consumed alcohol. Insomnia subjects, but not good sleepers, showed increased concentrations of IL-6 associated with caffeine use. Caregivers showed increased concentrations of TNF-α with alcohol use relative to good sleepers. Greater variability in bedtime, later wake times, and longer time in bed was associated with higher TNF-α regardless of group. Moderation and regularity in the practice of certain health behaviors, including sleep practices, were associated with lower plasma levels of inflammatory markers in older adults. Life circumstances and specific sleep disorders may modify these associations.

Pulmonary embolism in cancer: clinical analysis of 60 cases

To enhance the understanding of pulmonary thromboembolism (PTE) in patients with cancer. from January 2005 to July 2008, sixty patients diagnosed as pulmonary thromboembolism in Peking Union Medical College Hospital were retrospectively reviewed. The primary cancers were from respiratory system (36.7%), digestive system (26.7%), urogenital system (10.0%), hematological system (8.3%) and nervous system (5.0%), respectively, especially from such organ as lung (30.0%), stomach (8.3%), pancreas (6.7%), liver (5.0%) and so on. 12 of 18 patients (66.7%) with lung cancer were adenocarcinoma. There were 47 patients (78.3%) with advanced cancer. Deep venous thrombosis (DVT) occurred in 30 patients (50.0%). Of them 24 patients (80.0%) occurred in the lower limb, and 3 patients (10%) in the upper limb, 5 patients (16.7%) in other sites including 2 cases with thrombi in both upper and lower limbs, respectively. There were 2 patients (3.3%) accompanied with femoral artery embolism. PTE before tumor diagnosed occurred in 5 patients (8.3%) with an average time of 5.5 months. 22 patients underwent cancer-related operation and 17 patients (77.3%) had PTE in the later 2 weeks. 15 patients (25.0%) showed no symptoms. Arterial oxygen partial pressure was reduced in 49 patients (84.5%). 13 patients (21.7%) died and 6 cases of them were sudden death. 8 patients (13.3%) aggravated. 39 patients (65.0%) improved. PTE is one of the major complications and leading causes of death in patients with cancer. Of which lung cancer is most commonly, pulmonary adenocarcinoma in particular. PTE is often accompanied by DVT in the lower extremity. Risk factors may be old age, cancer progression and cancer-related operation. Other factors include long time in bed, chemotherapy and central vein catheterization, and so on. It should be watchful of PTE in cancer patients undergoing operation, especially within the first two postoperative weeks. Its clinical manifestation is often atypical. Sometimes venous thromboembolism (VTE) is the first signal of malignancy. In patients with unexplained PTE and/or DVT, attention should be paid to the possibility of malignancy. The first choice of anticoagulants is low molecular weight heparin.

Long Sleep Duration is Associated With Serum Cholesterol in the Elderly: The Rotterdam Study

Epidemiological studies have repeatedly found increased mortality associated with both habitual short and long sleep duration. The mechanisms behind these associations are unclear. We investigated whether objectively measured sleep duration, time in bed, and sleep fragmentation were associated with total cholesterol and high density lipoprotein (HDL) cholesterol in community-dwelling elderly. This cross-sectional study was conducted among 768 participants of the Rotterdam Study, aged 57 to 97 years. Sleep parameters were assessed with actigraphy, a validated method that infers wakefulness and sleep from arm movement. Cholesterol levels in serum were determined in fasting blood samples. All regression analyses were adjusted for age, gender, body mass index, smoking, depressive symptoms, and heart failure. Sleep duration was positively associated with total cholesterol level: beta = 0.11 (95% confidence interval = 0.03-0.18) mmol/l per hour of sleep. Persons who slept longer, and spent more time in bed, also had a higher total/HDL cholesterol ratio. A less fragmented sleep was also associated with higher total cholesterol. Some of these associations showed significant interactions with age. The association between time in bed and total/HDL ratio was mainly driven by persons aged <65, whereas the relationship between sleep fragmentation and total cholesterol level was most prominent in persons aged >or=70. A longer sleep duration was related to higher total cholesterol level and a higher total/HDL cholesterol ratio. Two separate mechanisms, a longer time in bed and sleep fragmentation, seem to explain these associations in different age categories.

The Relationship Between Objectively Measured Sleep Disturbance and Dementia Family Caregiver Distress and Burden

The aim of this study was to determine whether distress and burden were associated with objective measures of sleep disturbance in dementia caregivers. Using wrist actigraphy, sleep was measured in 60 female, Caucasian dementia family caregivers (mean age, 64.8 years). Caregivers completed questionnaires about demographics, health, depression, duration of caregiving and care recipient nighttime behavior. Care recipients completed a mental status exam. We investigated whether these measures were associated with actigraphic sleep parameters. Greater depressive symptoms among caregivers were associated with poorer sleep efficiency. Older caregiver age and poorer self-rated health were associated with longer time in bed. Sleep disturbance, which is common among dementia caregivers, might be an important index of caregiver distress (ie, depression) but might not be associated with burden (based on the care recipient's general cognitive impairment or nighttime awakenings.).

Alterations of the Characteristics of the Circadian Rest‐Activity Rhythm of Cancer In‐Patients

The aim of the present study was to evaluate the characteristics of the circadian rest‐activity rhythm of cancer patients. Thirty‐one in‐patients, consisting of 19 males and 12 females, were randomly selected from the Regional Cancer Center, Pandit Jawaharlal Nehru Medical College, Raipur, India. The rest‐activity rhythm was studied non‐invasively by wrist actigraphy, and compared with 35 age‐matched apparently healthy subjects (22 males and 13 females). All subjects wore an Actiwatch (AW64, Mini Mitter Co. Inc., USA) for at least 4–7 consecutive days. Fifteen‐second epoch length was selected for gathering actigraphy data. In addition, several sleep parameters, such as time in bed, assumed sleep, actual sleep time, actual wake time, sleep efficiency, sleep latency, sleep bouts, wake bouts, and fragmentation index, were also recorded. Data were analyzed using several statistical techniques, such as cosinor rhythmometry, spectral analysis, ANOVA, Duncan's multiple‐range test, and t‐test. Dichotomy index (I<O) and autocorrelation coefficient (r24) were also computed. The results validated a statistically significant circadian rhythm in rest‐activity with a prominent period of 24 h for most cancer patients and control subjects. Results of this study further revealed that cancer patients do experience a drastic alteration in the circadian rest‐activity rhythm parameters. Both the dichotomy index and r24 declined in the group of cancer patients. The occurrence of the peak (acrophase, Ø) of the rest‐activity rhythm was earlier (p<0.001) in cancer patients than age‐ and gender‐matched control subjects. Results of sleep parameters revealed that cancer patients spent longer time in bed, had longer assumed and actual sleep durations, and a greater number of sleep and wake bouts compared to control subjects. Further, nap frequency, total nap duration, average nap, and total nap duration per 1 h awake span were statistically significantly higher in cancer patients than control subjects. In conclusion, the results of the present study document the disruption of the circadian rhythm in rest‐activity of cancer in‐patients, with a dampening of amplitude, lowering of mean level of activity, and phase advancement. These alterations of the circadian rhythm characteristics could be attributed to disease, irrespective of variability due to gender, sites of cancer, and timings of therapies. These results might help in designing patient‐specific chronotherapeutic protocols.

Sleep/Wake Patterns Derived from Activity Monitoring and Maternal Report for Healthy 1- to 5-Year-Old Children

To describe behavioral sleep/wake patterns of young children from actigraphy and mothers' reports, assess age-group and sex differences, describe daytime napping, and investigate the impact of family demographic variables on sleep-wake measures. Cross-sectional sample of children wore actigraphs for 1 week; mothers kept concurrent diaries. Children studied in their homes. 169 normal healthy children in 7 age groups (12, 18, 24, 30, 36, 48, and 60 months old); 84 boys and 85 girls. N/A. Nocturnal sleep/wake measures estimated from activity recordings using a validated algorithm; mothers' reports of nocturnal sleep/wake patterns and daytime naps obtained from concurrent diaries. Bedtimes and sleep start times were earliest and time in bed and sleep period times were longest for 12-month-old children. Rise time, sleep end time, and nocturnal sleep minutes did not differ across age groups. Actigraphic estimates indicated that children aged 1 to 5 years slept an average of 8.7 hours at night. Actigraph-based nocturnal wake minutes and wake bouts were higher than maternal diary reports for all age groups. Daytime naps decreased monotonically across age groups and accounted for most of the difference in 24-hour total sleep over age groups. Children in families with lower socioeconomic status had later rise times, longer time in bed, more nocturnal wake minutes and bouts, and more night-to-night variability in bedtime and sleep period time. Children with longer naps slept less at night. Individual differences in sleep/wake measures reflect characteristics of children, parents, or parent-child interactions.

Sleep of Primary Enuretic Children and Controls

To look for differences between the sleep of enuretic children and controls. In addition to standard polysomnographic features, body movement data and nocturnal micturitions were recorded. The children's homes. Twenty-one children with primary nocturnal enuresis and 6 controls of similar age. None. Sleep of the enuretic children did not diverge to a large extent from that of the controls. The only significant differences were that the enuretic children spent a slightly longer time in bed and had an increased number of sleep cycles. Although there was a trend for an increased number of short movements in enuretics, this was not statistically significant. Fifteen children experienced enuresis during the recording night. Micturition occurred during the first half of the night for most of the children and was not linked to any specific sleep stage. Children who voided during rapid-eye movemnt (REM) sleep were found to have more REM sleep than the others. Tachycardia was often seen to precede the enuretic event. In some subjects a short EEG arousal was observed before micturition. Sleep of enuretic children is polysomnographically normal, but the children exhibit signs of autonomous arousal prior to micturition.

Insomnia in Older Adults: Relations to Depression and Anxiety

The authors examine the relations between insomnia and depression using the Beck Depression Inventory and between insomnia and anxiety using the State-Trait Anxiety Inventory and the Neuroticism Extroversion Openness-Personality Inventory (NEO) in a sample of 27 community-dwelling older patients with insomnia (mean age = 70.1 years). Sleep parameters were measured using both subjective (daily sleep logs) and objective (wrist actigraph) methods. Results varied according to the method used to measure sleep: with sleep logs, longer wake after sleep onset was related to both greater depression and anxiety (NEO), and longer time in bed was related to greater anxiety (NEO); with the actigraph, longer total sleep time was related to both greater depression and anxiety, and shorter sleep onset was related to greater depression.

Sleep Need in Adolescents: A Longitudinal Approach

A sample of 190 male and female "high school" students completed a sleep questionnaire for the first time when they were 10 to 14 years old. The survey was repeated five times at 2 year intervals. Ninety-three subjects answered the questionnaire each time. Subjective sleep need was assessed by the indicated wish for more sleep. The wish for more sleep was very pronounced, varying between 54.3% and 74.5% across the years. Individual consistency, however, was low since only 14.5% of the adolescents indicated the wish for more sleep in each survey, emphasizing the state dependency of this variable. Within each total sample, subjects with the wish for more sleep (MSL) and with sufficient sleep (SSL) were compared. Subjective sleep need was consistently validated by a syndrome of morning-tiredness. In the last two surveys, there was reduced time in bed (TIB) on weekdays in MSL subjects and longer TIB during vacation in surveys 2 through 5. Furthermore, MSL subjects more often showed irregular sleep habits. The previous sleep history of the MSL subjects in the last survey indicated that concomitants of the wish for more sleep were already experienced earlier in adolescence. The desired sleep duration of these subjects was 1.7 h longer than their current sleep on weekdays, an amount they had not obtained on weekdays since early adolescence. It is concluded that a substantial proportion of the adolescents seem to have had difficulties adapting to the general sleep time reduction occurring in adolescence.