Number Of Nocturnal Awakenings Research Articles

Effect of Third Molar Surgery on Sleep Health Parameters of Young Adults: An Observational Study.

Background and Objectives: The role of surgical extraction of the third molar in patients' sleep quality remains unclear, although it is one of the most common oral surgical procedures. The aim of this study is to assess the changes in patient-reported sleep health outcomes after third molar surgery and to investigate any associations between sleep parameters and post-extraction pain. Materials and Methods: Young adults without known comorbidities who were in need of mandibular third molar surgical extraction were included. All participants completed a sleep diary, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) questionnaires, which were used to assess sleep habits, daytime sleepiness, sleep quality and insomnia severity one week before and after extraction. In addition, a visual analog scale was completed postoperatively to assess the perception of pain. Results: Out of 75 patients who completed the study protocol, 32 (42.7%) were males and 43 (57.3%) were females, with a mean age of 24.01 (±3.43) years. Postoperatively, statistically significant higher scores were observed for PSQI [4.85 (±2.32) before vs. 5.39 (±2.75) after, p = 0.041], AIS [5.56 (±3.23) before vs. 6.91 (±4.06) after, p < 0.001] and average weekly number of nocturnal awakenings [2.01 (±3.72) before vs. 4.19 (±5.20) after, p < 0.001] but not for ESS, average weekly sleep duration and average weekly sleep onset latency. Pain perception was increased in patients who slept worse on almost all seven postoperative days, although this did not reach statistical significance. Conclusions: Third molar surgery impacts sleep quality and insomnia severity in the first week after extraction, while there is no effect on daytime sleepiness. The worsening of subjective sleep symptoms after extraction may be associated with an increased perception of pain.

The efficacy of a transdiagnostic sleep intervention for outpatients with sleep problems and depression, bipolar disorder, or attention deficit disorder: study protocol for a randomized controlled trial

BackgroundPatients with mental disorders have a higher prevalence of sleep problems than the general population. Sleep problems may include insomnia, circadian rhythm disorders, or hypersomnia. A transdiagnostic approach combining cognitive behavioral therapy for insomnia (CBT-I) with chronotherapy addressing a broad range of sleep problems has shown promising results in a limited number of studies. The aim of the study is to investigate the efficacy of a transdiagnostic sleep intervention for patients with sleep problems comorbid to bipolar disorder, unipolar depression, or attention deficit disorders. The primary hypothesis is that the intervention improves sleep quality compared with a control group. The secondary hypotheses are that the intervention increases subjective and objective sleep efficiency, reduces sleep onset latency, wake after sleep onset, number of awakenings, and severity of insomnia; and that it improves well-being, personal recovery, work ability, and consumption of sleep medication compared with a control group.MethodsThe study is a randomized controlled trial enrolling 88 outpatients with bipolar disorder, major depression, or attention deficit disorder with symptoms of various sleep problems (insomnia, circadian rhythm disorders, or hypersomnia). Patients are allocated to either an intervention group receiving six sessions of transdiagnostic sleep treatment or to a control group receiving a single session of sleep hygiene education. Assessments are made at baseline, at week two, and after 6 weeks in both groups. Actigraphy is performed continuously throughout the 6-week study period for all patients. The primary outcome is changes in the subjective appraisal of sleep quality (Pittsburgh Sleep Quality Index). The secondary outcomes are changes in sleep efficiency, sleep onset latency, wake after sleep onset, number of nocturnal awakenings (based on actigraph and sleep diary data), changes in insomnia severity (Insomnia Severity Index), well-being (WHO-5 Well-Being Index), personal recovery (INSPIRE-O), work ability (Work Ability Index), and consumption of sleep medication (sleep-diaries).DiscussionThe study was initiated in 2022 and the inclusion period will continue until mid-2024. The results may have implications for the development and implementation of additional treatment options for patients with mental disorders and comorbid sleep problems.Trial registrationClinicalTrials.gov. NCT05406414. Registered on June 6, 2022.

NOVEMA® NIGHT (diphenhydramine + naproxen) in patients with pain and insomnia: results of a multicenter non-interventional observational study

Pain and sleep disorders are interrelated problems that significantly affect patients’ quality of life (QoL) and daily functioning.Objective: to evaluate the efficacy and safety of the use of the combination of diphenhydramine + naproxen (NOVEMA® NIGHT) in patients with acute pain syndrome or exacerbation of chronic pain syndrome and sleep disorders.Material and methods. The study included 4365 outpatients with acute pain (musculoskeletal pain, post-traumatic pain, headache) and sleep disorders who took naproxen 275 mg, 1 tablet in the morning and diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) for 5 days before bedtime. Pain intensity, using a visual analogue scale (VAS), and sleep disorders were assessed before and after treatment; QoL was assessed after treatment using a five-point scale.Results. During treatment, a reduction or complete regression of pain was observed in 92% of cases (60 [50; 61] points on the VAS before treatment versus 10 [0; 20] after treatment; p&lt;0.0001) and normalisation of sleep in most patients: faster falling asleep – in 81% (χ2=9650.2; p&lt;0.0001), an increase in total sleep duration – in 75.5% (χ2=7351.2; p&lt;0.0001), a decrease in the number of nocturnal awakenings – in 84% of patients (χ2=10,568; p&lt;0.0001). At the end of treatment course, the majority of patients rated their quality of life as 4 out of 5 possible points (4 [4; 5]): 41% of patients – “high quality of life”; 48% – “above average”; 11% – “average”; 0.09% – “below average”). None of the patients had a low QoL. The therapy was well tolerated and no patient discontinued treatment due to adverse events (AEs).Conclusion. Short-term treatment (5 days) with naproxen 275 mg and a combination of diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) at bedtime effectively reduces the pain syndrome associated with insomnia. This therapy significantly improves patients’ QoL and has a low risk of AEs, so that we can recommend NOVEMA® NIGHT as an additional analgesic for patients with concomitant sleep disorders.

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.

Non-pharmacological interventions for sleep disturbances in people with dementia.

Non-pharmacological interventions for sleep disturbances in people with dementia.

604 The Relationship between Birth Order and Sleep Patterns in 6-Month-Olds

Abstract Introduction The influence of birth order has been investigated in many areas of child development, but few studies have examined its relationship with infant sleep; those that have yield contradictory findings. Moreover, nocturnal parental practices may differ depending on the number of children, but these characteristics are rarely studied. This study aimed to compare nocturnal parental practices and sleep patterns of first-born to non-first-born 6-month-olds. Methods The mothers of fifty-two 6-month-olds completed a 14-day sleep diary to record their infant’s sleep. The following variables were averaged: total nocturnal sleep duration (in minutes), longest consecutive sleep duration (without interruption; in minutes) and number of nocturnal awakenings. Independent t-tests were used to compare each sleep variable between first-borns (n = 21) and non-first-borns (2nd, 3rd or 4th born, n = 31). Chi-square tests were used to compare parental sleep practices (breastfeeding frequency and infant sleep location) between first-borns and non-first-borns. Results First-borns had a longer consecutive nocturnal sleep duration (417.83 ± 142.42 vs. 310.08 ± 118.23; p &amp;lt; .01) and fewer nocturnal awakenings (1.69 ± 1.07 vs. 2.57 ± 1.09; p &amp;lt; .01) than non-first-borns. However, first-born and non-first-born infants did not differ in terms of total nocturnal sleep duration (p &amp;gt; .05). Breastfeeding frequency and sleep location differed as a function of birth order: 57.9% of first-born infants were exclusively breastfed, compared to 89.7% of non-firstborn infants (χ2 (1, N = 52) = 6.56; p &amp;lt; .05). Furthermore, 20.0% of first-borns slept in the parents’ room, compared to 56.7% of non-first-borns (χ2 (1, N = 50) = 6.62; p &amp;lt; .05). Conclusion First-born infants had longer periods of consecutive sleep and fewer nocturnal awakenings than non-first-borns; however, birth order was not associated with maternal reports of total nocturnal sleep duration. These results suggest that non-first-borns have more fragmented sleep. Moreover, sleep-related practices also differed between mothers of first-born and non-first-born infants. A study conducted in a larger sample and using objective sleep measures could clarify whether these different sleep patterns reflect specific nocturnal parental sleep-related practices, or if the presence of other children in the home play a role in infant sleep consolidation. Support (if any) SSHRC, FRQS

0949 Should Parents and Children Share the Same Bed? A Systematic Review of the Consequences of Bedsharing on Sleep and Child Development

Abstract Introduction Bedsharing is a common practice worldwide except in Western societies where it is more controversial. The advantages and disadvantages of bedsharing on child health, safety, and development have been widely debated. This study examines the potential consequences of bedsharing on sleep and child development. Methods The systematic review was conducted in accordance with PRISMA guidelines and the University librarian advisor. Height electronic data base were searched with no limit on date. To be selected, studies must include only regular practice of bedsharing, have been conducted with children sharing the bed with their parents before the age of three, use an observational design, and present results on sleep quality or duration. The effect of bedsharing was assessed with six outcome measures: sleep quality, sleep duration, attachment quality, autonomy and independence, cognitive skills, as well as emotional and behavioural problems. Due to high heterogeneity in the measures used between studies, a narrative synthesis was done. Studies’ quality was assessed using the Scottish Intercollegiate Guidelines Network framework. Results A total of 28 publications were included, 17 of which were cross-sectional and 11 prospective studies. The studies were carried out between 1989 and 2017 in 25 countries. Sample sizes range from 41 to 55,831 participants aged from 6-week to 18-year old. Samples presented an equivalent amount of boys and girls. 16 studies reported data only on sleep, 7 only on child development, and 5 on both. The quality of the studies was considered low and moderate. For sleep, studies have shown a significant increase in the number of nocturnal awakenings among children who share the parental bed. Evidence of an association between bedsharing and other sleep parameters (difficulty falling asleep, resistance to bedtime, and sleep duration) is inconclusive. Regarding child development, only three studies found a positive impact on autonomy, cognitive skills, and anxiety. The absence of significant results in the remaining studies suggests that bedsharing is not a determining factor in child development. Conclusion The heterogeneity between studies and the quality of available data prevents definitive conclusions about the effects of regular bedsharing on sleep and child development. Support No financial support

Association of β-Amyloid Burden With Sleep Dysfunction and Cognitive Impairment in Elderly Individuals With Cognitive Disorders

Evidence shows that sleep dysfunction and β-amyloid (Aβ) deposition work synergistically to impair brain function in individuals with normal cognition, increasing the risk of developing dementia later in life. However, whether Aβ continues to play an integral role in sleep dysfunction after the onset of cognitive decline in individuals with dementia is unclear. To determine whether Aβ deposition in the brain is associated with subjective measures of sleep quality and cognition in elderly individuals with cognitive disorders. A nested survey study was conducted at the Cognitive Disorders and Comprehensive Alzheimer Disease Center of Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Participants included patients aged 65 years and older with cognitive disorders verified by neuropsychological testing. Eligible participants were identified from a referral center-based sample of patients who underwent fluorine 18-labeled florbetaben positron emission tomography imaging at Thomas Jefferson University Hospital as part of the multicenter Imaging Dementia-Evidence for Amyloid Scanning study. Data collection and analysis occurred between November 2018 and March 2019. Sleep quality was measured via responses to sleep questionnaires, Aβ deposition was measured via fluorine 18-labeled florbetaben positron emission tomography, and cognition was measured via Mini-Mental State Examination (MMSE) performance. Of the 67 eligible participants, 52 (77.6%) gave informed consent to participate in the study. Of the 52 enrolled participants (mean [SD] age, 76.6 [7.4] years), 27 (51.9%) were women. Daytime sleepiness was associated with Aβ deposition in the brainstem (B = 0.0063; 95% CI, 0.001 to 0.012; P = .02), but not MMSE performance (B = -0.01; 95% CI, -0.39 to 0.37; P = .96). The number of nocturnal awakenings was associated with Aβ deposition in the precuneus (B = 0.11; 95% CI, 0.06 to 0.17; P < .001) and poor MMSE performance (B = -2.13; 95% CI, -3.13 to -1.13; P < .001). Mediation analysis demonstrated an indirect association between Aβ deposition and poor MMSE performance that relied on nocturnal awakenings as an intermediary (B = -3.99; 95% CI, -7.88 to -0.83; P = .01). Nighttime sleep disruption may mediate the association between Aβ and cognitive impairment, suggesting that there is an underlying sleep-dependent mechanism that links Aβ burden in the brain to cognitive decline. Further elucidation of this mechanism may improve understanding of disease processes associated with Aβ accumulation.

Effect of ramelteon coadministered with antidepressant in patients with insomnia and major depressive disorder: an exploratory study

The purpose is to evaluate the effect and safety of ramelteon 8 mg/day for 8 weeks in the treatment of insomnia in patients with concurrent depression in an exploratory manner. This phase 4, open-label, exploratory study included outpatients aged 20 to < 65 years with sleep-onset insomnia and major depressive disorder taking stable antidepressant medication. Following a 1-week run-in, 26 eligible patients received ramelteon 8 mg/day plus their usual antidepressants for 8 weeks. Outcomes included sleep parameters measured by actigraphy and sleep diary, 3-Dimensional Sleep Scale (3DSS), 17-item Hamilton Rating Scale for Depression (HAM-D17), Patient Global Impression (PGI), adverse events, and body weight. Actigraphy- and diary-measured sleep latency improved at the end of ramelteon treatment (mean decrease − 6.8 and − 11.5 min, respectively), but neither change reached statistical significance in this exploratory study. Other subjective measures indicated improved sleep, including diary-measured total sleep time (mean change + 41.2 min; p = .0220) and number of nocturnal awakenings (− .4; p = .0420), and 3DSS total scores for sleep quality and quantity (p < .01). Most patients (88.5%) reported improvement in PGI. HAM-D17 total scores improved at end of treatment (mean change − 4.0; p < .0001). One patient discontinued ramelteon due to moderate somnolence. Ramelteon coadministered with antidepressants was well tolerated. Results from this exploratory study suggest that ramelteon may be effective and well tolerated in the treatment of sleep-onset insomnia in patients with concurrent depression.

The Relationships Between Dream Recall, Motivation to Remember Dreams, and Waking Memory Ability

Dream recall ability can vary between and within individuals, dependent on a number of influencing factors, including personality dimensions, number of nocturnal awakenings, and attitudes towards dreaming. Only a few studies, however, consider the possible connection of dream recall ability to general waking memory ability, or the influence of being motivated to actively remember dreams. The present survey-based study had two major aims: 1) To search for correlates and relationships between memory for dreams and memory for waking experience; 2) To address the effect of motivation on dream recall ability, split for both dream recall frequency (DRF) and dream recall detail (DRD). These questions were assessed in 57 participants who completed an online survey, consisting of questions from the Mannheim Dream Questionnaire (MADRE) and a memory exercise for an original short story. DRF and DRD were positively related, but showed different patterns of relation with the other measures. Of most interest, participants who reported high DRD also remembered the most details from the story, suggestive of an overlap between waking and dream recall ability. However, this relationship was non-linear, as the lowest memory score came from the intermediate DRD group, not the low DRD group, hence a non-significant correlation between DRD and score. DRF was unrelated to memory score, with no significant differences between high and low DRF groups, and no significant correlation between measures. This is likely due to the nature of the task being more compatible with memory for details. Correlations showed a consistent relationship between motivation and attitude measures, particularly the motivation to understand dreams. The most important points to be taken away from this study are: 1) there is apparent partial overlap between dream recall and waking memory for details; 2) being actively motivated to remember or understand dreams is an important variable to consider in future experiments; 3) and dream recall should be studied as its constituent parts of frequency and detail.

Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children

Although sleep disturbances in infants and toddlers are common, there is no suitable validated tool in Spanish to evaluate sleep disorders. The Brief Infant Sleep Questionnaire (BISQ) is a well-established multidimensional questionnaire widely used internationally. To adapt the BISQ questionnaire to Spanish and analyse its reliability and validity. To explore its feasibility, both in the clinical context, and in epidemiological research. Participants were parents of children between 3 and 30 months of age. The adaptation to Spanish (BISQ-E) was achieved by using both back translation and consensus, following the international guidelines.Reliability was determined by means of test-retest and measurement of agreement (Kappa value) between 2forms of administration of the questionnaire (self-administration and clinical interview). Construct validity was established by analysing its correlation with a sleep diary. A total of 87 families/children participated. The test-retest reliability undertaken in 60 subjects was excellent; r=0.848 (P<0.001). The kappa value was 0.939 (95% CI: 0.858-1.00, P<0.001).The agreement between BISQ-E and the sleep diary was analysed in 27 families/children, with statistically significant values being obtained for the following variables: bedtime (r=0.731), hours of night sleep (r=0.726), hours of daytime sleep (r = 0.867), and number of nocturnal awakenings (r=0.888) (P<0.001). The Spanish adaptation of the BISQ shows overall adequate validity and reliability for the evaluation of sleep in infants and pre-school children. Its use as a clinical tool, or for clinical-epidemiological research studies, is feasible.

Evaluation of tolerance to ambulatory blood pressure monitoring: Analysis of dipping profile in a large cohort of hypertensive patients.

Ambulatory blood pressure monitoring (ABPM) is a helpful tool to comprehensively identify and diagnose arterial hypertension. Moreover, it allows to better identify alterations in the circadian BP profile, as the nocturnal “nondipping” status, characterized by a lack of the physiological 10% night BP reduction and associated with a greater risk of target organ damage. However, ABPM has some limitations such as restricted availability, discomfort, particularly at night, cost implications, and reproducibility.Aim of the study was evaluate if the “nondipping” phenomenon may be related to low degree of tolerance to ABPM. Additionally, to determine whether self-reported events of sleep disorders and nighttime urinations may affect the “nondipping” status.From January 2013 to December 2015, we consecutively evaluated 1046 patients with arterial hypertension, performing ABPM, considering a tolerance index calculated on the basis of the patients’ responses to a questionnaire.Thirty-eight out of 1046 patients showed complete lack of tolerance to the instrument during the day, whilst 126 during the night. There were no statistically significant differences in daytime and nighttime values of tolerance to the instrument between “dippers” and “nondippers,” between “extreme-dippers” and the remaining patients or between “reverse-dippers” and the remaining patients. There were no statistically significant differences in the number of nocturnal awakenings between the groups. However, we found that the number of awakenings followed by urination was higher in “nondipping” patients and in “reverse-dipping” patients compared to the other groups.We found that the poor tolerance to the instrument does not seem to influence the BP “dipping” phenomenon among hypertensive individuals. Moreover, we think that in the evaluation of the ABPM data, factors, such as nocturnal urination and sleep disorders, need to be carefully taken into account, since may lead to a higher incidence of “nondipping” pattern.

Perfectionism and Polysomnography-Determined Markers of Poor Sleep.

Perfectionism has been suggested to represent a predisposing factor for poor sleep. However, previous studies have relied on self-reported measures. The association between perfectionism and poor sleep measured by polysomnography (PSG) warrants further investigation. The current retrospective exploratory study used the Frost Multidimensional Perfectionism Scale and PSG in an unselected sample of 334 consecutive sleep laboratory patients (140 males, 194 females, 44.6 ± 15.9 years). Data were analyzed using linear regression analyses. High levels of perfectionism were associated with PSG-determined markers of poor sleep in the first sleep laboratory night. The total Frost Multidimensional Perfectionism Scale score was significantly associated with the number of nocturnal awakenings in the first sleep laboratory night. The subscales "concern over mistakes" and "personal standards" of perfectionism were significantly associated with markers of poor sleep. In contrast, there were only a few associations between perfectionism and PSG variables of the second sleep laboratory night. This pattern of results suggests that high levels of perfectionism may predispose individuals to sleep disturbances in the context of acute stressors. Thus, the influence of perfectionism on poor sleep should be further investigated to improve treatment.

A randomized controlled trial comparing a xyloglucan-based nasal spray with saline in adults with symptoms of rhinosinusitis

Background: This study assessed the efficacy, safety and tolerability of a xyloglucan-based nasal spray in the treatment of symptoms of rhinosinusitis.Methodology: In this randomized, double-blind study, 40 patients with itching, nasal congestion or continuous sneezing and a Total Nasal Symptom Score (TNSS) of ≥8 were randomized to 2 weeks’ treatment with a xyloglucan-based nasal spray (“xyloglucan”) or a physiological saline nasal spray (“saline”). Assessments included the TNSS, rhinosinusitis severity index, nocturnal awakenings, use of rescue medication, safety and tolerability.Results: Baseline symptom scores were similar between groups. At treatment end, improvements from baseline were observed in both groups for TNSS (xyloglucan 58%; saline 35%, both p < .05) and number of nocturnal awakenings (p < .05). A significant improvement in the rhinosinusitis severity index was observed only with xyloglucan (p < .05). At treatment end, mean [SD] scores were significantly lower in the xyloglucan group versus the saline group for TNSS (3.60 [2.16] vs. 5.40 [2.64], p < .05), rhinosinusitis severity index (7.55 [1.19] vs. 6.45 [1.40], p < .05), and rhinorrhea and itching (both p < .05). No rescue medication was used. Both treatments were well tolerated.Conclusions: A xyloglucan-based nasal spray provided greater relief of rhinosinusitis symptoms than a physiological saline spray and was well tolerated.Trial registration number (EUDRACT): 2014-000143-32.

Predictors of sleep disturbances in the first year of life: a longitudinal study

ObjectiveThe aim of this study was to identify early predictors of nocturnal awakenings and short sleep duration during the first year of life, in terms of sleep habits and patterns. We also analyzed the trend of nocturnal awakenings and total sleep duration from 3 to 12 months of age. MethodsThe parents of 704 infants (49.3% female) were interviewed during their first year of life. The interview included questions on infant sleep (eg, sleep habits, sleep duration, number of nocturnal awakenings) and maternal perception of infant sleep difficulties. ResultsThe study results indicate that most of the infants at risk, with three or more nocturnal awakenings or ≤10 h of total sleep duration in the early months of life, tend to display a similar pattern of sleep problems at 12 months. The main early predictors of sleep problems at 12 months were sleep duration, sleep initiation method, and nocturnal awakenings. More specifically, infants with three or more nocturnal awakenings or ≤10 h of total sleep duration at 12 months were those with a higher number of awakenings during the night and a shorter sleep duration, at both three and six months. In addition, infants at risk for sleep problems at 12 months had an independent sleep initiation method at three months, whereas these same infants had a nonindependent sleep initiation method at six months. ConclusionsOur study identified the early predictors of sleep problems at 12 months. Caregivers should identify these early symptoms in infants to prevent possible sleep difficulties in later years.

0659 FREQUENT CRAVING FOR SWEETS AT WAKE UP IS ASSOCIATED WITH SUBJECTIVE NOCTURNAL AWAKENING AND SLEEP STAGE TRANSITION INDEX IN PATIENTS WITH NARCOLEPSY TYPE 1

Body mass index independent metabolic abnormalities are reportedly associated with narcolepsy. We found that abnormal fatty acid metabolism is involved in the pathophysiology of narcolepsy and other hypersomnia, and appeared to be associated with the symptom of frequent nocturnal awakenings. We hypothesized that craving for sweets at wake up, often observed in narcolepsy patients, reflected the dysfunction of energy metabolism, and studied the possible association of this symptom with subjective and objective nocturnal sleep instability. Subjects were a series of consecutive patients who visited Seiwa hospital for unexplained excessive daytime sleepiness and underwent PSG-MSLT for diagnosis purpose from October 2014 to November 2016. All subjects gave written informed consent. Those comorbid with other sleep disorders and with severe first night effect on PSG were excluded. Finally data from 139 subjects (Narcolepsy type1 19, type2 28, idiopathic hypersomnia 65, non hypersomnia control 27) were used for analyses. Age(25.8 ± 8.8) and BMI(21.6 ± 2.7) did not differ among 4 groups. Demographic data and information related to sleep habits, including frequency of craving for sweets at wake up and frequency and duration of subjective nocturnal awakening were obtained by questionnaire. Nocturnal sleep instability was also evaluated objectively by calculating sleep stage transition index in addition to conventional sleep variables. Frequency of craving for sweets at wake up tended to be high in narcolepsy group but the disese specificity did not reach statistical significance. This symptom was associated with the number of nocturnal awakenings and total duration of nocturnal awakenings. It is also associated with sleep transition index such that sleep transition index is higher among those with frequent sweets craving group, especially in narcolepsy type1. Association of the frequency of craving for sweets and subjective/objective sleep instability suggests that this symptom could reflect the dysfunction in energy metabolism and contribute to the sleep instability. Further studies with larger sample size and with objective evaluation of energy status is required and ongoing. None.

0817 ADHERENCE TO CPAP TREATMENT IN WOMEN WITH OBSTRUCTIVE SLEEP APNEA

Family physicians are under-referring patients with obstructive sleep apnea (OSA) to sleep medicine specialists for diagnosis and treatment, a phenomenon particularly acute in women. Because recruited women have been found to have a surprisingly high OSA diagnosis rate of substantial severity, the present study examines predictors of continuous positive airway treatment (CPAP) adherence in an exclusively female sample - a group rarely selected for evaluation. The objectives were to describe the factors associated with CPAP non-adherence and to examine predictors of treatment adherence. Participants were 29 women (mean age = 56.5, sd = 9.8), recruited from two hospital based family medicine clinics. OSA was diagnosed by polysomnography; insomnia-related variables, quality of life and psychological adjustment were assessed by self-report measures. There were no significant differences between adherent and non-adherent women with respect to severity of OSA. The adherent group had worse nocturnal and daytime functioning than the non-adherent group; this difference reached statistical significance for feeling unrefreshed in the morning, perceived poor sleep quality, feeling sleepy during the day and having difficulty concentrating.. The two most important adherence predictors were: feeling refreshed in the morning and number of nocturnal awakenings. Our findings suggest that women with moderate to severe OSA may be identified first by complaints related to feeling unrefreshed in the morning, followed by perceived poor sleep quality, sleepiness during the day and difficulty concentrating. These, also, are the women are most likely to accept and adhere to CPAP treatment. Since adherence predictors were basically sleep quality variables, one might speculate that identified CPAP adherent women in family practice settings may be at risk for having their sleep apnea misdiagnosed as insomnia and subsequently be offered inappropriate treatment (e.g. sedatives or hypnotics). Notably, the non adherent women had equally severe OSA, and these are the women, at elevated risk of having their OSA overlooked by their physician. CIHR.

Sleep quality during pregnancy: associations with depressive and anxiety symptoms.

Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms. A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory. Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too-early morning awakenings increased in late pregnancy compared with mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow up. In late pregnancy, depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy. We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectionally associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy.

Correlation analysis between subjective and objective indexes of sleep quality in patients with liver cancer before surgery

Objective To investigate the correlation between subjective and objective indexes of sleep quality in the patients with liver cancer before surgery. Methods Totally 78 patients with liver cancer in the First Affiliated Hospital of Xi′an Jiaotong University from October 2014 to March 2016 were selected as the research object by convenience sample method. The Pittsburgh sleep quality index (PSQI) and actigraphy were used to evaluate the subjective and objective indexes of sleep quality. Pearson correlation analysis was used to analyze the subjective and objective indexes of sleep quality. Results The PSQI total score of participants before surgery was (9.4±4.1) and 49 cases (62.8%) were subjectively poor sleepers. 29 cases were good sleepers, which accounted for 37.2%. The objective sleep time of patients was (401.0±113.4) min, the sleep efficiency was 81.0%, and the number of nocturnal awakenings was (3.5±2.1). Objective sleep onset latency was correlated with PSQI global score, subjective sleep quality, sleep latency, sleep efficiency, and daytime dysfunction (r=0.23, 0.26, 0.22, 0.20, 0.24; P 0.05). Conclusions PSQI and the subjective and objective indexes of sleep quality all showed that, patients with liver cancer have poor sleep before surgery, but the correlation between subjective index and objective index is low, and the dimensions to evaluate the subjective and objective indexes are not in accordance. It is important to evaluate the sleep of patients with liver cancer by combining the subjective and objective indexes together. Key words: Hepatoma; Sleep initiation and maintenance disorders; Pittsburgh sleep quality index; Actigraphy; Correlation analysis

Internet-based cognitive–behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials

ObjectiveTo evaluate the effectiveness of internet-based cognitive–behavioural therapy for insomnia (ICBT-i) in adults.DesignA meta-analysis of ICBT-i.Data sourcesSystematic searches of randomised controlled trials of ICBT-i were performed in the PubMed, EMBASE,...