Mean Pittsburgh Sleep Quality Index Research Articles

Factors affecting sleep quality in patients with systemic lupus erythematosus.

This study aimed to assess the sleep quality and the factors affecting the sleep quality in patients with systemic lupus erythematosus (SLE). This was a descriptive and cross-sectional study conducted in 105 patients with SLE who were admitted to the rheumatology polyclinic of a university hospital between May and July 2017. The data were collected using a "Patient Description Form" and the "Pittsburgh Sleep Quality Index (PSQI)." The total mean (standard deviation) PSQI score of the patients was 7.81 (3.11). Duration of disease, presence of comorbid diseases, side effects of drugs, and sleep disruption and related problems were identified as factors affecting sleep quality. The model of the regression showed that side effects of drugs, sleep disruption, and trouble falling asleep suffered higher PSQI score (bad sleep quality). Results of this study showed that the sleep quality was generally poor in patients with SLE. Sleep quality was affected by some disease and sleep variables. Therefore, comprehensive sleep evaluation is necessary in the planning of treatment and care of SLE patients and to implement initiatives to improve sleep patterns in these patients.

Assessment of Sleep among Patients with Chronic Liver Disease: Association with Quality of Life.

The present study aims to assess the sleep characteristics and health-related quality of life (HRQOL) among patients with chronic liver diseases (CLDs), as well as the relationship between them. We conducted a prospective cross-sectional study, over a period of eight months, on patients with CLDs. Sleep was assessed by subjective tools (self-reported validated questionnaires), semi-objective methods (actigraphy), and HRQOL by using the 36-Item Short Form Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). The results indicated that 48.21% of patients with CLDs had a mean Pittsburgh Sleep Quality Index (PSQI) score higher than five, suggestive of poor sleep; 39.29% of patients had a mean Epworth Sleepiness Scale (ESS) score ≥11, indicative of daytime sleepiness. Actigraphy monitoring showed that patients with cirrhosis had significantly more delayed bedtime hours and get-up hours, more awakenings, and more reduced sleep efficacy when compared to pre-cirrhotics. The CLDQ and SF-36 questionnaire scores were significantly lower in cirrhotics compared to pre-cirrhotics within each domain. Moreover, we identified significant correlations between the variables from each questionnaire, referring to HRQOL and sleep parameters. In conclusion, sleep disturbances are commonly encountered among patients with CLDs and are associated with impaired HRQOL. This is the first study in Romania that assesses sleep by actigraphy in a cohort of patients with different stages of CLD.

The association between sleep and cognitive pre‐frailty in community‐dwelling older adults: A two‐year cohort study

AbstractBackgroundSleep has been related to cognition and frailty, respectively. Cognitive frailty, the co‐existence of mild cognitive impairment (MCI) and physical frailty, has been proposed in 2013 and its relation with sleep remains unclear. To predict cognitive frailty in the preclinical stage, this study aimed to explore the relationship between sleep and cognitive pre‐frailty in non‐demented older adults.MethodThis study is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research. After exclusion of participants with specific conditions and loss to follow‐up, 324 older adults from the senior health checkup program of National Taiwan University Hospital were included at baseline (2015‐2017). Outcome of this study was the coexistence of MCI and pre‐frailty (cognitive pre‐frailty) and were assessed at baseline and two‐year follow‐up (2017‐2019). Global and domain‐specific cognition were assessed by Taiwanese version of Montreal Cognitive Assessment and a battery of neuropsychological tests, respectively. Pre‐frailty was defined as the existence of one or two out of five conditions using modified Fried’s frailty phenotype. Sleep variables was available at baseline, which included global sleep quality [assessed by Pittsburgh Sleep Quality Index (PSQI), score range: 0‐21)], sleep duration (in hours), and daytime sleepiness (assessed by Epworth Sleepiness Scale, ESS, score range: 0‐24). Generalized linear mixed model was utilized to assess the association between sleep and cognitive pre‐frailty over 2 years adjusting for age, sex, years of education and other important covariates.ResultParticipants’ mean age was 75.2 years at baseline. Prevalence of cognitive pre‐frailty was 1.85% at baseline and 2.55% at two‐year follow‐up. Instead of a linear relationship, we found a non‐linear association between sleep and cognition. When mean PSQI score and mean sleep duration deviated from the corresponding sample mean (PSQI score: 6.3; sleep duration: 6.2 hours), the severity of cognitive pre‐frailty increased [quadratic PSQI score: adjusted odds ratio (aOR)=1.02, 95% confidence interval (CI)=0.01‐0.04; quadratic sleep duration: aOR=1.15, 95% CI=0.04‐0.23]. No significant association was found between daytime sleepiness and cognitive pre‐frailty.ConclusionThis study found a nonlinear association of global sleep quality and sleep duration with cognitive pre‐frailty over two years in the community‐dwelling older adults.

Associations between sleep and Alzheimer’s disease biomarkers within the EPAD cohort

AbstractBackgroundChanges in sleep quality are common in Alzheimer’s Disease (AD) and may even play a role in the onset and accumulation of disease. However, in preclinical stages, it is unclear whether sleep quality or sleep disturbance relate to disease pathology after controlling for known covariates and AD risk factors. This study aimed to determine if self‐reported sleep quality is associated with AD biomarkers after accounting for such factors.MethodData were obtained from the European Prevention of Alzheimer’s Disease (EPAD) Longitudinal Cohort Study (LCS) data set (v1500.0). Cerebrospinal fluid (CSF) samples were collected for measurement of b‐amyloid (Ab42) and phosphorylated tau (p‐tau). Self‐reported sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Participants with Clinical Dementia Rating (CDR) scale scores greater than 0.5, indicative of dementia, were excluded. Linear regression models were used to determine whether the p‐tau/Ab42 ratio was associated with PSQI component scores when controlling for multiple potential confounders such as demographics, ApoE4 status, depressive symptoms, body mass index, vascular risks, smoking status, use of psychotropics, white matter lesions, and hippocampal volume. PSQI component scores of 2 or 3 were combined due to small numbers of participants with component scores of 3.ResultFrom the 1500 participants in the EPAD‐LCS v1500.0 data, a total of 1239 participants were included in the regression analysis (mean age=65.30 years, SD=7.11; mean PSQI total score=5.31, SD=3.38). After adjustment for all covariates, higher p‐tau/Ab42 ratio was found to be associated with longer self‐reported sleep latency (component score of 1: b=0.16, p=0.007; component score of 2/3: b=0.12, p=0.134; R2=0.22) and better self‐reported sleep efficiency (component score of 1: b=‐0.22, p=0.04; component score of 2/3: b=‐0.31, p=0.009; R2=0.22)ConclusionWithin the EPAD cohort, longer sleep latency and greater efficiency are associated with greater AD pathology after controlling for covariates. These findings contribute to growing evidence suggesting sleep is an important early marker of underlying neurodegeneration. Longitudinal assessment of EPAD‐LCS participants will allow for the evaluation of self‐reported sleep as a predictive marker of neurodegeneration.

The adverse impact of excessive smartphone screen-time on sleep quality among young adults: A prospective cohort.

IntroductionProblematic over usage of smartphones has led to various deteriorating effects including poor sleep quality. Screen exposure, especially near bedtime, directly leads to poor sleep quality. We aimed to measure smartphone screen-time (ST) statistics of the participants directly using a smartphone application. Furthermore, we aimed to assess sleep quality using the Pittsburgh sleep quality index (PSQI), and to investigate the association between ST & PSQI.Material and MethodsThis descriptive cohort study was conducted among 280 students of MBBS at Rawalpindi Medical University for a period of 1 month (30 days). Physically healthy students who owned Android smartphones were included in the study. Students with diagnosed sleep disorders and students taking sleep medication were excluded from the study. ST was recorded using a smartphone application. Sleep quality was assessed at the end of 30 days using the PSQI questionnaire. Data entry and analysis was done using SPSS v23.0.ResultsTotal and mean ST were calculated for every participant. The mean screen time of 242 individuals was 147.50±51.09 hours. The mean PSQI score was 6.68±2.3. 65.70% of the participants had a poor sleep quality (PSQI>5). Pearson’s correlation revealed that long total ST was associated with decreased sleep quality (R=0.356, p<0.001).ConclusionOur findings are in accordance with previous scientific literature largely based on self-reported ST measurements and affirm that excessive ST deteriorates sleep quality and hence has numerous adverse physical and psychological manifestations.

Sleep Quality and Mental Health of Medical Students in Greece During the COVID-19 Pandemic.

Background-Aim: Medical students have been greatly affected by the COVID-19 pandemic due to their educational program, which comprises theoretical knowledge and also clinical duties, making them vulnerable to viral exposures and possibly affecting their everyday life. The aim of this study was to explore changes in sleep and mental health parameters among medical students in Greece during the second year of the pandemic.Methods: This cross-sectional study comprised students of all medical schools in Greece (n = 7), using an anonymous online survey. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Fatigue Severity Scale (FSS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9). Statistical analysis was conducted with the use of SPSS v.26 (IBM SPSS, Armonk NY, USA).Results: Out of the 562 received responses, 559 met the inclusion criteria. The largest proportion of the respondents came from 4th-year (27.8%) and the majority of the sample were females (69.8%). Only 5.9% of the participants reported having been infected by SARS-COV-2. Most of the respondents experienced insomnia (65.9%, mean AIS score: 7.59 ± 4.24), poor sleep quality (52.4%, mean PSQI score: 6.6 ± 3.25) and increased fatigue (48.5%, mean 35.82 ± 11.74). Moderate to severe symptoms of anxiety (mean 9.04 ± 5.66) and depression (mean 9.36 ± 6.15) were noted. Suicidal ideation was found in 16.7% of the sample, while use of sleeping pills in the previous month was reported by 8.8% (n = 47). Further analysis revealed independent associations between sleep and mental health parameters. Higher AIS score was associated with greater FSS score; higher PSQI scores with higher GAD-7 and PHQ-9 scores. Additionally, female students were found to be significantly more affected than males by the COVID-19 pandemic, displaying higher levels of insomnia, sleep disturbances, anxiety and depression. In addition, those with a history of COVID-19 infection or in close proximity with a positive case reported significantly more significant post-traumatic symptoms in IES-COVID-19 questionnaire.Conclusions: In the aftermath of the COVID-19 pandemic, prevalence of sleep and mental health disorders among Greek medical students is significant, highlighting the need for better surveillance of students' wellbeing and subsequent counseling, with special focus on female students and other affected groups.

Sleep Characterization of Adolescent and Young Adult Patients with Sickle Cell Disease Using the Pittsburgh Sleep Quality Index

Introduction: Poor sleep quality is common across the lifespan in patients with sickle cell disease (SCD) and has been associated with pain, mood disruption, and fatigue. The Pittsburgh Sleep Quality Index (PSQI) examines sleep quality in both pediatric and adult patients with chronic health conditions, including in adolescents and young adults (AYAs) with SCD. The AYA period is particularly salient for patients with SCD given the potential onset of chronic pain during this developmental period and increased risk for complications during transition. Previous studies have relied on the PSQI total score rather than examining specific domains of sleep quality. In addition, prior studies have mostly focused on either pediatric or adult patients rather than examining AYAs as a group. This study examined specific PSQI sleep domains to identify characteristics that may be impaired in AYAs with SCD. This approach may allow for a multidimensional understanding of sleep in AYAs with SCD and may identify specific targets for intervention.Methods: We performed a retrospective chart review of AYA patients with SCD who completed the PSQI as part of a clinical pilot program. Patients included all types of SCD between 13-25 years. We recorded the PSQI and demographic and medical characteristics (age, sex, SCD type, CBC, and SCD treatments). Descriptive data from PSQI subdomains (sleep duration, latency, efficiency, needing medication to sleep, subjective sleep quality, and mid-sleep time [mid-point between sleep onset and offset]) were examined for adolescents (ages 13 to 18) and young adults (ages 19 to 25) to identify sleep characteristics (table 1). A mean PSQI score > 5 is categorized as having poor sleep quality. Chi-square and Fisher's exact test were used to compare age differences in characteristics for adolescents versus young adults.Results: Eighty-nine AYAs with SCD (mean age: 18.9±3.5 years; 51 female, 38 male) completed the PSQI. Patients were evenly distributed across adolescent (n = 46) and young adult groups (n = 43). SCD genotypes included: HbSS (n = 58), HbSC (n = 15), HbSb + (n = 9), HbSb 0 (n = 3), HbSO-Arab (n = 2), and unknown (n = 2). Adolescents and young adults did not significantly differ for sex, SCD genotype, CBC, or current therapies (all p .3). Average total PSQI scores for adolescents and young adults were 6.26 and 9.02, respectively. Most adolescents (52%) and young adults (84%) reported poor sleep quality (total PSQI score > 5). Thirty nine percent of adolescents rated their sleep duration as less than 7 hours compared to over half of young adults (56%). Many adolescents (59%) and young adults (44%) endorsed a mild to moderate amount of sleep disturbance, with many young adults (47%) also reporting a high amount of sleep disturbance. A large percentage of young adults (68%) and some adolescents (37%) reported prolonged sleep latency and subsequent daytime dysfunction due to sleepiness [adolescents (63.0%) and young adults (77%)]. Sleep efficiency was inadequate in 59% of adolescent and 72% of young adults. More young adults (35%) than adolescents (7%) reported needing medication to sleep. Despite noted sleep deficiencies, subjective sleep quality was frequently rated as “very good” or “fairly good” by adolescents (91%) and young adults (72%). Midsleep time serves as a proxy for chronotype (morning or night person). Mean midsleep time was 4.75 and 4.95 in young adult and adolescent participants, indicating a late chronotype. Among sleep domains, sleep latency, subjective sleep quality, needing medication to sleep, and overall sleep quality were worse among young adults versus adolescents (p = .002 to .012).Conclusion: Adolescents and young adults with SCD had poor sleep quality across multiple PSQI domains. Young adults also reported poorer sleep quality in certain domains versus adolescents, suggesting that some sleep characteristics may worsen during transition. Results highlight the need to be vigilant for sleep problems and the need for sleep education for AYAs with SCD. Future studies focused on the efficacy of behavioral sleep medicine interventions that target sleep deficiencies in AYAs with SCD are also important. This study was limited by using a convenience sample rather than a random sample of patients from the clinic. This study is also cross-sectional and longitudinal efforts are needed to better understand the evolution of sleep difficulties during the AYA developmental period. [Display omitted] DisclosuresLebensburger: Bio Products Laboratory: Consultancy; Novartis: Consultancy. Kanter: Fulcrum Therapeutics, Inc.: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Forma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beam: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Graphite Bio: Consultancy; GuidePoint Global: Honoraria; Fulcrum Tx: Consultancy.

The Impact of Mobile Devices on Sleep Quality among Subjects of Primary Health Care Settings in Riyadh, Saudi Arabia

Introduction: Smartphone use has been related to health problems. Studies have indicated that the use of smartphones is associated with Sleep disturbances. However, little is known about the association between Smartphone addiction and sleep quality in Saudi Arabia.Objective: To determine the relationship between sleep quality and the use of a smartphone, specifically before sleep.Method: A cross-sectional study was conducted at four primary healthcare centers with a total of 205 patients participated in the study using a convenience sampling technique. The Pittsburgh Sleep Quality Index (PSQI) and Smartphone Addiction Scale – Short Version (SAS-SV) were used to measure association of Sleep Quality and Smartphone addiction.Results: Two-hundred-fiveparticipants enrolled in the study, of which 99 were female (51%) with a response rate of 84%. Mean age was 36 ±13 years for all participants. Mean PSQI scores were higher among females, single, frequent smartphone users, and unemployed sub- categories; thus, they indicated poorer sleep quality. There was also a significant negative association between age and PSQI scores t(193)= -2.45, p=0.015. Finally, there was a significant positive association between mean SAS-SV score and categorical global PSQI scores t(193)= 3.4, p=0.001.Conclusion: Our study showsahigh prevalence of smartphone addiction and poor sleep quality. Younger age, being single, heavy usage hours of smartphones, and high SAS-SV are significant factors associated with poorer sleep quality.

Effects of Chronic Suppression or Oversuppression of Thyroid-Stimulating Hormone on Psychological Symptoms and Sleep Quality in Patients with Differentiated Thyroid Cancer.

In differentiated thyroid cancer (DTC), the standard treatment includes total thyroidectomy and lifetime levothyroxine (LT4) replacement. However, long-term exogenous LT4 has become controversial due to the adverse effects of oversuppression. The study included 191 patients (aged 18-76 years) with a prospective diagnosis of non-metastatic DTC and 79 healthy individuals. The patients with DTC were stratified into three groups according to their TSH levels: suppressed thyrotropin if TSH was below 0.1 μIU/ml, mildly suppressed thyrotropin if TSH was between 0.11 and 0.49 μIU/ml, and low-normal thyrotropin if THS was between 0.5 and 2 μIU/ml. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Short Symptom Inventory (SSI), and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants. It was found that the BDI, BAI, SSI and PSQI scores were worse in patients with DTC (p=0.024, p=0.014, p=0.012, and p=0.001, respectively). According to theTSH levels, the mean ASI was found to be higher in the suppressed and mildly suppressed thyrotropin groups (19±14.4 vs. 10.6±11.1; 16.4±14.9 vs. 10.6±11.1, p=0.024, respectively), the mean SSI was found higher in the suppressed group (61.0±55.5 vs. 35.1±37.0, p=0.046), and the mean PSQI was higher in all three groups (7.94±3.97 vs. 5.35±4.13; 7.21±4.59 vs. 5.35±4.13; 7.13±4.62 vs. 5.35±4.13, p=0.006) when compared with the controls. No significant difference was found between the groups. A positive correlation was detected in the duration of LT4 use and BDI and SSI, and a weak, negative correlation was detected between TSH levels and ASI and PSQI. Based on our study, it was found that depression, anxiety disorders, and sleep problems were more prevalent in patients with DTC, being more prominent in the suppressed TSH group. These results were inversely correlated with TSH values and positively correlated with the duration of LT4 use. Unnecessary LT4 oversuppression should be avoided in patients with DTC.

Comparison of sleep quality before and after chemotherapy in locally advanced non-small-cell lung cancer patients

Background Outcome of sleep disturbances in lung cancer patients before and after treatment is not much reported. Their intensity and their correlation to quality of life or to humor disturbances were not widely studied. The aim of this study was to report precisely sleep disturbances in advanced stage lung cancer patients, their outcome after chemotherapy and/or radiotherapy, and their correlation to anxiodepressive humor. Patients and methods It was a prospective study including 64 patients with stage 3 or 4 non-small-cell lung cancer. Patients answered the Tunisian dialectal version of the following questionnaires: Pittsburgh sleep quality index and hospital anxiety depression scale in order to evaluate, respectively, the sleep quality and anxiodepressive troubles. The questionnaires took place before chemotherapy and then were repeated after chemotherapy was over. Results The mean age was 62.9 years. All patients were active smokers. Before chemotherapy, there were 10 (15%) patients with poor sleep quality. Most frequent complaints were daily sleepiness (70%) and nocturnal arousals (100%). Sixteen (25%) patients had depressive humor. Depression was statistically more frequent among patients with poor sleep quality (80 vs 15%, P&lt;0.001). After chemotherapy, the mean Pittsburgh sleep quality index score increased from 2.9 to 5.4 and 45% of all patients had poor sleep quality. Most frequent complaints were extension of sleep latency (69%), daily sleepiness (98%), and nocturnal arousals (100%). After chemotherapy, depressive humor was reported in 34.3% of all patients, with higher prevalence among patients with poor sleep quality (58 vs 14%, P&lt;0.001). Anxious humor was reported in 17% of all patients. A higher prevalence was correlated with poor sleep quality (31 vs 6%, P&lt;0.001). The predicting factors of sleep disturbance according to statistical univariate analysis were delayed diagnosis confirmation (P=0.05), delayed start of treatment (P&lt;0.001), and anxious (P=0.001) or depressive humor (P=0.001). Multivariate analysis confirmed the correlation of sleep disturbance to delayed diagnosis confirmation and treatment onset. Conclusion This study insisted on the persistence and potential intensity worsening of sleep disturbances in advanced stage non-small-cell lung cancer patients. The authors, hereby, reported a statistical correlation between sleep quality and humor quality in patients.

Impact of COVID-19 Infection on Quality of Sleep.

Introduction: Some studies have highlighted the effect of COVID-19 infection on the quality of sleep; however, the data is limited. In this study, we investigated the prevalence of insomnia in patients who recently recovered from the COVID-19 infection to evaluate the prevalence and extent of its impact.Methods: This longitudinal study was conducted from January 2021 to March 2021. A total of 500 patients admitted to the intensive care unit or isolation unit of COVID-19 were included in the study at the time of their discharge. The pre-COVID-19 sleep quality of the participants was inquired using the Pittsburgh Sleep Quality Index (PSQI). Post-COVID sleep quality was assessed at a 30-day follow-up. Sleep quality was considered poor if the global score was ≥5. Participants that failed to follow up were not included in the study.Results: The mean PSQI score was significantly higher in the post-COVID-19 group compared to the pre-COVID-19 group (6.28 ± 2.11 vs. 3.22 ± 0.80; p-value <0.0001). The percentage of participants with a PSQI score of ≥5 was significantly higher in the post-COVID-19 group compared to the pre-COVID-19 group (45.1% vs. 12.1%; p-value <0.0001).Conclusion: Insomnia has a significant prevalence in recovered COVID-19 patients after 30 days of follow-up. Hence, patients need to be counseled to follow up in case they experience poor sleep. To avoid the long-term negative impact on patients experiencing insomnia, timely identification and treatment are important.

Sleep Quality and Cancer-Related Fatigue in Patients with Cancer.

Introduction: Sleep problems and fatigue are common symptoms reported by cancer patients. In this study, the researchers used a specialized tool to measure fatigue in cancer patients and its relationship with sleep quality in Yazd, Iran. Methods: This descriptive correlational study included 149 cancer patients (age range: over 18 years) referred to Shahid Sadoughi Hospital in Yazd, Iran. Data were collected by the Pittsburgh Sleep Quality Index (PSQI) and Cancer-Related Fatigue Questionnaire. A PSQI score of ≥5 indicated a poor sleep. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA), Pearson’s correlation, t test, analysis of variance (ANOVA), and linear regression. Results: The mean (SD) PSQI score of patients was 13 (4.85) out of 21. About 69.3% of patients had a poor sleep quality. While the mean (SD) of sleep duration was 5.57 (0.54) hours, it was 69.44 (46.58) minutes for sleep latency. Also, with increasing the mean of sleep quality, the mean of fatigue significantly increased (P < 0.001, R=0.63). Conclusion: According to the results, there was a relationship between the sleep quality and fatigue in cancer patients, so that patients with better sleep quality had less fatigue.

The association between sleep quality, health status and disability due to breathlessness in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) increases susceptibility to sleep disturbances. This study aimed to evaluate the association between COPD severity criteria with sleep quality. One hundred fifty-eight patients in Rasul Akram Hospital of Iran University of Medical Sciences, Tehran, Iran, from April 2019 to March 2021 diagnosed with COPD were examined using the Pittsburgh Sleep Quality Index (PSQI), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnoea scale, spirometry and pulse oximetry. Of 158 subjects, 125 patients were male (79%), and 33 were female (21%). The mean subject's age and FEV1/FVC ratio were 62.6± 11.5 and 65.6± 14.9%, respectively. The mean CAT scoring and Spo2 saturation reported 16.2±7 and 91.5±10.8%, respectively. The mean PSQI score was 8.2±3.8. The association between PSQI score with FEV1 and FEV1/FVC ratio was not statistically significant (p=0.64 and 0.58, respectively), whereas the association between PSQI scores with CAT score (p˂0.0001, r2 =0.51) and dyspnoea severity (p˂0.0001, r2 =0.29) were statistically significant. The patients with higher CAT score demonstrated poor sleep quality, particularly in longer sleep latency (p=0.001, r2 =0.056), bad subjective sleep quality (p˂0.0001, r2 =0.286), lower sleep efficiency (p=0.002, r2 =0.077), higher sleep disturbance (p˂0.0001, r2 =0.225), daytime dysfunction (p˂0.0001, r2 =0.259) and sleep medication intake times a week (p=0.01, r2 =0.069). Dyspnoea severity was attributed to bad subjective sleep quality (p˂0.0001, r2 =0.069), higher sleep disturbances (p=0.005, r2 =0.08), and daytime dysfunction (p˂0.0001, r2 =0.108). The PSQI has a significant association with the CAT and mMRC for COPD patients and is linked to the disease's severity.

Sleep disturbance and psychological distress in adult patients with tinnitus

Sleep disturbance and psychological distress are among the most prevalent comorbidities of tinnitus. We aimed to clarify the dose-response effects of these phenomena with tinnitus severity. This study enrolled adult patients with subjective tinnitus for more than 6 months was conducted from January 2017 to December 2018 in one tertiary medical center and one local hospital. Data collected included demographic data and questionnaires, namely Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Hospital Anxiety and Depression Scale (HADS). In total, 1610 patients with tinnitus (1105 male, 68.6%) with mean age of 48.3±14.3 years completed all questionnaires. The average THI score was 9.2±19.4, and 82.4% of patients reported to have slight tinnitus (THI ranged 0-16). The mean PSQI score was 8.4±4.3, and 70.8% of participants had sleep difficulty (PSQI>5). Compared with patients with slight tinnitus, those with catastrophic tinnitus were mostly old women with lower body mass index, and had higher scores in ESS, PSQI, and HADS (all P<0.05). In 1140 patients with sleep difficulty, independent factors influencing THI were age, ESS, and HADS, and positive correlations were observed between age-adjusted THI and ESS, HADS-A, and HADS-D (all P<0.001). Old age, daytime sleepiness, and psychological distress are highly associated with tinnitus severity among patients with sleep difficulty. Management of sleep disturbance and psychological distress is necessary to control tinnitus.

Association Between Central Sensitization and Increasing Prevalence of Nocturnal Knee Pain in the General Population with Osteoarthritis from the Iwaki Cohort Study.

PurposeKnee pain is associated with osteoarthritis (OA) and increases during this condition; however, its correlation with central sensitization (CS) in arthritis patients requires greater understanding. The present cross-sectional cohort study to explore the prevalence of knee OA, nocturnal knee pain and disability in general population and to examine the association of CS with sleep quality in Japanese general population.Patients and MethodsFrom among 1056 community-dowelling volunteers, 942 were enrolled as participants in this study. Bilateral weight-bearing anterior-posterior knee radiographs were classified by the Kellgren–Lawrence grade. Nocturnal knee pain and disability were assessed with self-reported questionnaires. Using the CS inventory with nine items (CSI-9), CS was defined as 10 points or higher. Sleep quality was scored using the Pittsburgh Sleep Quality Index (PSQI). Linear regression analysis, adjusted by age, sex, body mass index, Kellgren-Lawrence grade, nocturnal knee pain, and lifestyle habits, was performed to investigate the association of CS with PSQI.ResultsThe prevalence of OA, nocturnal knee pain, and disability was 37.9%, 7.6%, and 6.2%, respectively. The mean CSI-9 score was 4.9 ± 4.4, with a CS prevalence of 14.0%. The mean PSQI score was 3.9 ± 2.4, which was correlated with the CSI-9 value. CS was not correlated with OA severity; however, nocturnal knee pain prevalence increased from 13.3% to 25.5% in knee OA patients with CS. The CSI-9 value correlated with PSQI total score and subscales.ConclusionKnee OA severity correlated with nocturnal pain and disability; however, its association with CS was unproven. The combined effect of knee OA and CS elevated nocturnal pain and disability, resulting in diminished sleep quality.

Sleep Quality and Fatigue in Women with Overactive Bladder: A Case-Control Study

Background: Overactive bladder (OAB) syndrome, a condition with urgency, is often characterized by increased daytime frequency and nocturia. Overactive bladder is a highly prevalent condition that drastically impacts the quality of patients’ life. Objectives: This study was conducted to investigate sleep disturbance and fatigue in women with OAB by reliance on two validated questionnaires. Methods: This case-control study was performed among 70 patients recognized with OAB and 70 women in a control group. We employed validated questionnaires, namely Pittsburgh sleep quality index (PSQI) and Fatigue Severity Scale (FSS), to comparatively assess sleep disturbance and fatigue symptoms, respectively. Results: The participants’ mean age was 44.50 ± 12.64 years old. The mean PSQI score was 13.24 ± 3.67 (range: 6 to 22), and the mean FSS score was 39.05 ± 15.12 (range: 9 to 63). Furthermore, the mean scores of PSQI (P &lt; 0.001) and FSS (P &lt; 0.001) were significantly higher in OAB women compared to the control group. In women with OAB, there was a significant positive correlation (P = 0.007) between PSQI and FSS scores. Furthermore, this correlation was observed between urgency urinary incontinence at night and PSQI (P = 0.047) and sleep disturbance (P = 0.023) and between nocturia and sleep efficiency (P = 0.012), sleep disturbance (P = 0.001), sleep latency (P = 0.007), and FSS score (P = 0.032). In addition, a significant direct correlation (P = 0.022) was found between urgency urinary incontinence during the day and daytime dysfunction. Conclusions: The study shows that sleep disorder is common in patients with OAB, and it seems that urinary problem assessment is a prerequisite for any sleep medication prescription.

Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency.

To evaluate the clinical utility of actigraphy as compared with sleep questionnaires prior to the Multiple Sleep Latency Test (MSLT) in a sleep disorders clinic population. Twenty-eight clinically referred participants (mean age: 42.3 ± 18.8 years) completed the study protocol. On day 1, participants completed the following questionnaires: Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (affect, vigor), Patient Health Questionnaire, and Multidimensional Fatigue Symptom Inventory-Short Form. On days 1-8, participants wore an actigraph and completed a sleep diary to assess mean nighttime and mean daytime total sleep time and sleep efficiency or sleep percentage. On day 9, participants repeated the ESS and completed an MSLT. Correlations assessed mean MSLT sleep-onset latency (MSLT-SOL) vs actigraphy, sleep diary, and questionnaires. Chi-square analyses assessed abnormal MSLT-SOL (≤ 8 minutes) or daytime sleepiness (ESS ≥ 10) and referral question (ie, sleep-disordered breathing vs hypersomnolence disorder). Mean MSLT-SOL was correlated with nighttime total sleep time assessed via both actigraphy and diary, but not with questionnaires. Significant correlations emerged for ESS score on day 1 vs 9, actigraphy vs sleep diary mean nighttime total sleep time, and PSQI vs mean sleep diary sleep efficiency. There was no significant relationship between mean MSLT-SOL and referral question. Our finding that total sleep time measured by actigraphy was associated with MSLT-SOL suggests it is useful in informing the interpretation of MSLT findings; however, it does not appear to be a viable substitute for MSLT for the measurement of objective sleepiness in clinical settings. Kelly MR, Zeidler MR, DeCruz S, et al. Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency. J Clin Sleep Med. 2022;18(1):161-170.

Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors

BackgroundSleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure.MethodsA convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis.ResultsThe Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70.ConclusionThe Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost.Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.

Assessment of quality of life, anxiety, depression, and sleep quality in women with fibromyalgia and their spouses.

Fibromyalgia syndrome (FMS) is a chronic disease that is more common in adult women and is characterized by widespread pain in the body, especially in the musculoskeletal system. Fatigue, sleep disturbance, anxiety disorder, and depression can be observed in this syndrome alongside pain. The aim of our study was to investigate the effect of FMS on the quality of life, psychological condition, and sleep quality of affected female patients and their spouses compared to women without FMS and their spouses. Thirty female patients diagnosed with fibromyalgia and their spouses and 38 healthy women and their spouses similar in age to these patients voluntarily participated in our study (136 participants total). The diagnosis of the patients was made according to the American College of Rheumatology. Turkish versions of the Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale, and the Pittsburgh Sleep Quality Index (PSQI) questionnaires with validity and reliability were applied to all participants. The statistical analyses were carried out using SPSS 24.0 for Windows (SPSS Inc., Chicago, IL, US). Differences with p-values of ≤0.05 were statistically significant, and all results are expressed with a 95% confidence interval. A total of 136 people, including women with FMS (n=30), spouses of FMS women (n=30), non-FMS control women (n=38), and spouses of the control women (n=38), were included in the study. The patient and control groups were similar in age and gender. However, participants in the study group had higher mean Body Mass Indexes compared to the controls. Quality of life and its sub-scales (except SF-36/Social function parameter), depression, anxiety status, and sleep quality were significantly different between the patients and controls. Additionally, quality of life and its sub-scales (except SF-36/Social function parameter), depression, and anxiety status were significantly different between the spouses of the patients and controls. There were no significant differences between the groups regarding the mean SF-36/SF (p=0.995 for both). Additionally, there was no significant difference between the spouse of the patient and control regarding the mean PSQI values (p=0126). We believe that new and more comprehensive studies are necessary regarding the spouses of women with FMS in depression, anxiety, sleep quality disorders that we frequently see in women with FMS, and other psychosocial conditions that we have not mentioned here. In conclusion, women with FMS and their spouses.

The Impact of Quarantine on Sleep Quality and Psychological Distress During the COVID-19 Pandemic.

PurposeWe investigated the impact of isolation on sleep quality and psychological distress during the COVID-19 pandemic in Saudi Arabia.MethodsAn online survey was conducted on 353 (88 isolated and 265 not isolated) individuals from May to June 2020. Subjective sleep quality was determined using the Pittsburgh sleep quality index (PSQI), and psychological distress measured using the Kessler psychological distress scale (K10).ResultsThe mean age of the isolated group was 28.6 years versus 27.5 years for the non-isolated group, with male participants accounting for 37% in both groups. The mean PSQI score was 8.5±3.6 and 8.4±3.5 for the isolated and non-isolated groups, respectively (P= 0.92). The mean K-10 score was 27.6± 9.4 and 25.3± 9.5 for the isolated and non-isolated groups, respectively (P= 0.04). Poor sleep (PSQI ≥6) was reported in 235 (66.6%) and psychological distress (K-10 ≥20) in 244 (69.1%) participants. Isolation was not associated with poor sleep (OR: 0.73 (95% CI: 0.41–1.3), P=0.29), but was statistically significant with psychological distress (OR: 2.12 (95% CI: 1.10–4.08), P=0.03).ConclusionPoor sleep and psychological distress symptoms were highly prevalent in our study population. Isolation may influence psychological distress but not sleep quality during the COVID-19 pandemic.