Moderate Sleep Disturbance Research Articles

Parkinson's disease sleep scale—validation of the revised version PDSS‐2

The previous Parkinson's disease sleep scale (PDSS) is a 15-item visual analogue scale that assesses the profile of nocturnal disturbances in Parkinson's disease (PD) patients. To extend the scale so that it becomes a frequency measure scale with five categories and encompasses unmet needs such as restless legs syndrome, akinesia, pain, and sleep apnea. For validation of the PDSS-2, PD patients' ratings and investigators' interviews were compared to ratings from a semistructured interview with a caregiver/partner, and to related scales. PDSS-2 was repeated for test-retest-reliability after 1-3 days. A total of 113 PD patients showed a mean (SD) total score of 16.5 (±8.9) (range: 2-40) indicating mild to moderate sleep disturbances. PDSS-2 item-total correlation for proving internal consistency was satisfactory (correlations >0.30). From a factor analysis, three subscales were derived: (1) "motor problems at night," (2) "PD symptoms at night" and (3) "disturbed sleep." The alpha coefficient for the total score was 0.73, for subscales 0.47 to 0.66. The test-retest-reliability intra-class-coefficient for the total score was 0.80, with 0.69 and 0.77 within the subscales. For discriminative validity, significant differences were found in the PDSS-2 total score depending on CGI and Hoehn and Yahr severity levels. A comparison between caregivers' and patients' ratings was carried out. The PDSS-2, with an extended spectrum of nocturnal disabilities and easier use for patients, is a reliable, valid, precise, and potentially treatment-responsive tool for measuring sleep disorders in PD.

Varenicline for tobacco dependence treatment in recovering alcohol-dependent smokers: An open-label pilot study

The purpose of this study was to obtain preliminary evidence of the efficacy of a 12-week course of varenicline for 7-day point prevalence smoking abstinence among recovering alcohol-dependent smokers. We enrolled 32 smokers with 6 months or more of recovery from alcohol dependence in an open-label clinical trial. Participants received varenicline 1 mg twice daily and 12 weeks of behavioral counseling. Participants were 69% men, 94% Caucasian, and smoking an average of 20.3 ± 5.0 cigarettes per day. After 12 weeks of treatment, 31% were biochemically confirmed 7-day point prevalence abstinent from smoking and 28% had prolonged smoking abstinence (2 weeks after target quit date onward). The most common adverse effects were mild to moderate nausea (28%) and sleep disturbance (19%). No serious adverse events were reported. Varenicline may be a useful aid for treating tobacco dependence among smokers who are in stable recovery from alcohol dependence. Further study of this treatment is warranted.

Restless Legs Syndrome Risk Factors, Behaviors, and Diagnoses in Persons With Early to Moderate Dementia and Sleep Disturbance

In this study, restless legs syndrome (RLS) risk factors, RLS-associated behaviors, and the ability to understand and answer an RLS diagnostic interview were investigated. In 23 older adults with early to moderate dementia and nighttime sleep disturbance, the most common risk factors for RLS were a periodic leg movement sleep index > 15 (54.55%), based on polysomnography, and use of selective serotonin reuptake inhibitors (SSRIs) (34.78%). The most common RLS-associated behaviors were repetitious mannerisms (56.52%) and general restlessness (34.78%), according to direct observation from research assistants. Finally, older adults with early to moderate dementia were unable to understand and reliably answer the RLS diagnostic interview. Older persons with mild to moderate dementia and sleep disturbance may require objective diagnostics to identify RLS.

Chronic Sleep Disturbance Impairs Glucose Homeostasis in Rats

Epidemiological studies have shown an association between short or disrupted sleep and an increased risk for metabolic disorders. To assess a possible causal relationship, we examined the effects of experimental sleep disturbance on glucose regulation in Wistar rats under controlled laboratory conditions. Three groups of animals were used: a sleep restriction group (RS), a group subjected to moderate sleep disturbance without restriction of sleep time (DS), and a home cage control group. To establish changes in glucose regulation, animals were subjected to intravenous glucose tolerance tests (IVGTTs) before and after 1 or 8 days of sleep restriction or disturbance. Data show that both RS and DS reduce body weight without affecting food intake and also lead to hyperglycemia and decreased insulin levels during an IVGTT. Acute sleep disturbance also caused hyperglycemia during an IVGTT, yet, without affecting the insulin response. In conclusion, both moderate and severe disturbances of sleep markedly affect glucose homeostasis and body weight control.

Sleep Behaviors and Sleep Quality in Children with Autism Spectrum Disorders

(1) Compare sleep behaviors of children with autism spectrum disorders (ASD) with sleep behaviors of typically developing (TD) children using the Children's Sleep Habits Questionnaire (CSHQ); (2) compare sleep quality—defined as mean activity, sleep latency, number of awakenings, sleep efficiency and total sleep time—of the cohort of children with ASD and TD, as measured by 10 nights of actigraphy; and (3) estimate the prevalence of sleep disturbances in the ASD and TD cohorts. Descriptive cross-sectional study. The Children's Hospital of Philadelphia. Randomly selected children from the Regional Autism Center. The ASD cohort of 59 children, aged 4 to 10 years, (26 with autism, 21 with pervasive developmental disorder-not otherwise specified [PDD-NOS], and 12 with Asperger disorder) were compared with 40 TD control subjects. The CSHQ, sleep diaries, and 10 nights of actigraphy using the Sadeh algorithm of children with ASD and TD control subjects were compared. CSHQ showed 66.1% of parents of children with ASD (62.5% autism, 76.2% PDD-NOS, 58.3% Asperger disorder) and 45% of parents of the control subjects reported that their children had sleep problems. Actigraphic data showed that 66.7% of children with ASD (75% autism, 52.4% PDD-NOS, 75% Asperger disorder) and 45.9% of the control subjects had disturbed sleep. The prevalence estimate of 45% for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern. The prevalence estimate of 66% for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face. The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD.

Sleep Behaviors and Sleep Quality in Children with Autism Spectrum Disorders

(1) Compare sleep behaviors of children with autism spectrum disorders (ASD) with sleep behaviors of typically developing (TD) children using the Children's Sleep Habits Questionnaire (CSHQ); (2) compare sleep quality--defined as mean activity, sleep latency, number of awakenings, sleep efficiency and total sleep time--of the cohort of children with ASD and TD, as measured by 10 nights of actigraphy; and (3) estimate the prevalence of sleep disturbances in the ASD and TD cohorts. Descriptive cross-sectional study. The Children's Hospital of Philadelphia. Randomly selected children from the Regional Autism Center. The ASD cohort of 59 children, aged 4 to 10 years, (26 with autism, 21 with pervasive developmental disorder-not otherwise specified [PDD-NOS], and 12 with Asperger disorder) were compared with 40 TD control subjects. The CSHQ, sleep diaries, and 10 nights of actigraphy using the Sadeh algorithm of children with ASD and TD control subjects were compared. CSHQ showed 66.1% of parents of children with ASD (62.5% autism, 76.2% PDD-NOS, 58.3% Asperger disorder) and 45% of parents of the control subjects reported that their children had sleep problems. Actigraphic data showed that 66.7% of children with ASD (75% autism, 52.4% PDD-NOS, 75% Asperger disorder) and 45.9% of the control subjects had disturbed sleep. The prevalence estimate of 45% for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern. The prevalence estimate of 66% for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face. The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD.

Sleep Quality Varies as a Function of 5-HTTLPR Genotype and Stress

To test the hypothesis that allelic variation in 5HTT gene-linked polymorphic region (5-HTTLPR) genotype was associated with sleep quality (Pittsburgh Sleep Quality Index, PSQI) as a main effect and as moderated by the chronic stress of caregiving. Serotonin (5HT) is involved in sleep regulation and the 5HT transporter (5HTT) regulates 5HT function. A common 44-base pair deletion (s allele) polymorphism in the 5-HTTLPR is associated with reduced 5HTT transcription efficiency and 5HT uptake in vitro. Subjects were 142 adult primary caregivers for a spouse or parent with dementia and 146 noncaregiver controls. Subjects underwent genotyping and completed the PSQI. Variation in 5-HTTLPR genotype was not related to sleep quality as a main effect (p > .36). However, there was a caregiver X 5-HTTLPR interaction (p < .009), such that the s allele was associated with poorer sleep quality in caregivers as compared with controls. Findings suggest that the s allele may moderate sleep disturbance in response to chronic stress.

Sleep Disturbances Among Young Patients with IBD in Israel

Objective: This prospective survey was conducted to examine the prevalence of sleep disturbances among young patients with inflammatory bowel disease (IBD), and to investigate the influence of disease characteristics and activity on sleep patterns in these patients. Methods: From January through June 2006, 41 consecutive IBD patients, from the Pediatric Gastroentnrology division at Safra Children's Hospital in Israel, were investigated using Mini- Sleep Questionnaire to detect insomnia, excessive daytime sleepiness and other sleep characteristics. Demographic and clinical data of the patients were recorded at the time of the survey. Statistical analysis included Analysis of Variance, Kruskal-Wallis Analysis of Variance, and Pearson's Chi- Square Test. Results: Out of 41 patients (50.2% females, age 16.9± 4.0 years), 22 (54%) had sleep disturbances; Ten patients (24%) had moderate sleep disturbance score, and 12 patients (29%) had severe sleep disturbance score. The most frequent sleep disturbances were morning fatigue on awakening (75.6%), waking up during sleep (53.6%) and chronic unexplained fatigue (39%). Only one patient used sleep medication. No correlation was found between sleep disturbances and disease type, disease activity, medical treatment, anthropometric measures, age and gender of the patients. Conclusions: This study is the first to evaluate sleep patterns and disturbances in IBD patients. Moderate and severe sleep disturbances are frequent among IBD patients, however, in this small study, no correlation to disease characteristics and medical therapy was demonstrated. Larger scale controlled studies, and evaluation of sleep patterns in IBD patients by polysomnography, are needed.

Outcome of new benzodiazepine prescriptions to older adults in primary care

Objective The objective of this study was to examine the indications for benzodiazepine use, and the baseline characteristics, duration of use and clinical outcomes of older primary care patients prescribed benzodiazepines. Methods Computerized records were used to identify outpatients ( n=129) aged ≥60 years who received new benzodiazepine prescriptions from primary care physicians of a group model managed care organization. A baseline telephone survey assessed indications for prescription, sleep quality (Pittsburgh Sleep Quality Index), depression (Symptom Checklist depression scale and Structured Clinical Interview for DSM-IV), alcohol use (CAGE) and functional status (SF-36). A 2-month follow-up survey assessed benzodiazepine use, sleep quality and depression. Results The most common indications for prescription were insomnia (42%) and anxiety (36%). At baseline, participants reported moderate sleep disturbance (mean Pittsburgh Sleep Quality Index=9.3, S.D.=4.0), only 15% met criteria for current depressive episode and only 3% reported at-risk alcohol use. After 2 months, 30% of participants used benzodiazepines at least daily. Both those continuing daily use and those not continuing daily use reported significant improvements in sleep quality and depression, with no difference between groups in rates of improvement. Conclusions Initial benzodiazepine prescriptions to older adults are typically intended for the treatment of anxiety or insomnia, with little evidence for occult depression or alcohol abuse. A significant minority develops a pattern of long-term use, raising concerns about tolerance and dependence.

After effects of noise-induced sleep disturbances on inhibitory functions

The study focuses on possible after effects of noise-induced sleep disturbances on inhibitory brain processes reflecting in performance changes and alternations of inhibition-related components of event-related potentials (ERPs). Following a quiet night and three nights, in which railway noise was presented with different levels, twelve women and ten men (19–28 years) performed a visual Go/Nogo task that contained stimuli either compatible or incompatible with a response. Noise-induced sleep disturbances are highly evident in worsening of subjective sleep quality but did not show up in significant changes of reaction time and error rate. A smaller N2 amplitude and longer latency to incompatible than to compatible stimuli as well as an unspecific attenuation of N2 amplitude under Noise were found. The amplitude of the fronto-central P3 was reduced under Noise compared to baseline only in Nogo trials. The amplitude of the parietal P3 in Go trials was smaller to incompatible than to compatible stimuli but was not affected by Noise. Disturbed sleep was associated with a decreased blink rate during task performance. The results suggest that physiological costs to maintain performance are increased after noisy nights. Decisional processes underlying overt responses (Go-P3) are less vulnerable to noise-disturbed sleep than those related to inhibition (Nogo-N2, NoGo-P3). The deficits may have been compensated by increased on-task concentration and thereby did not become apparent in the performance data. Inhibition-related ERPs may be more sensitive indicators of moderate sleep disturbances caused by noise than performance measures.

CSF hypocretin-1 levels in schizophrenics and controls: relationship to sleep architecture

Hypocretins/orexins are newly identified peptides of hypothalamic origin. Hypocretin deficiency is involved in the sleep disorder narcolepsy, suggesting the importance of hypocretin neurotransmission for the regulation of sleep. Hypocretin is known to excite midbrain dopaminergic neurons and to induce hyperactivity and stereotypy in animals. Altered hypocretin neurotransmission might therefore be involved in schizophrenia, since an involvement of dopaminergic mechanisms and an association with sleep disturbance are well demonstrated in patients with schizophrenia. Hypocretin is also known to affect the hypothalamic–pituitary–adrenal axis by stimulating the release of corticotropin releasing hormone (CRH). In the current study, we measured CSF hypocretin levels in 12 controls and 13 patients with chronic schizophrenia associated with moderate sleep disturbance, such as longer sleep onset latency, decreased total sleep time and decreased sleep efficacy. No difference in CSF hypocretin levels between schizophrenia and control subjects was found. CSF hypocretin levels were positively correlated with CSF CRH levels in the patient, control and combined subject populations, but the correlation did not reach statistical significance in any population. The hypocretin levels in schizophrenic patients were, however, positively and significantly correlated with sleep latency, one of the most consistent sleep abnormalities seen in schizophrenia. This correlation was not significant in controls, and no other significant correlation between CSF hypocretin levels and any measure of sleep architecture in either patients or controls was observed. Further studies of whether CNS hypocretin neurotransmission is involved in sleep and neuroendocrine abnormalities seen in patients with schizophrenia and other psychiatric conditions are warranted.

The effect of sleep fragmentation on sleep and performance in younger and older subjects

Groups of 12 normal 55-70-year-old and young adult subjects had their sleep experimentally disturbed at a rate of approximately 14 times per hour to determine the residual effects of moderate sleep disturbance and to determine any differential impact as a function of age. Normal age-related changes in sleep were seen on baseline and recovery nights. In the second night of sleep disturbance, the older subjects had a smaller increase in total awakenings than young adults. Older subjects had a slower increase in auditory arousal threshold as sleep disturbance progressed. The older subjects also tended to have less performance deterioration on morning testing than did young adults, and this difference was significant for numbers of correctly completed addition problems. These evidences led to the conclusion that, while both age groups were sensitive to moderate sleep disturbance, the older individuals appeared somewhat less sensitive than the young adults.