Pittsburgh Sleep Quality Index Component Research Articles

A survey of sleep quality of employed nurses in military hospitals

Objective: To investigate the sleep quality of the employed nurses in three grade A tertiary military hospitals in Beijing, China and its influential factors and to provide a reference for improving the sleep quality of employed nurses. Methods: From January 2014 to January 2017, a questionnaire survey was carried out to investigate the sleep quality of 253 employed nurses in three grade A tertiary military hospitals in Beijing, China using the Pittsburgh Sleep Quality Index (PSQI) and a general status questionnaire. The results were compared with the adult norms to analyze the influential factors for sleep quality of the employed nurses. Results: The global PSQI score of the 253 employed nurses was 7.76 ± 3.53. Their global PSQI score and PSQI component scores were significantly higher than the adults norms (P<0.05) . And 54.94% of the employed nurses had poor sleep quality; they had high scores of daytime dysfunction (1.39±0.83) , sleep latency (1.67±0.94) , sleep quality (1.33±0.88) , and sleep time (1.23±0.78) . The one-way analysis of variance showed that the sleep quality of the employed nurses was associated with nursing age, educational background, professional title, whether to have children, frequency of night shifts, and department (P<0.05) . The multivariate logistic regression analysis showed that the risk factors for sleep quality of the employed nurses were technical secondary school education (OR=4.292) and emergency department and intensive care unit (OR=2.582) ; the protective factors for sleep quality of the employed nurses were outpatient department and assistant department (OR=0.312) , no children (OR=0.318) , and no night shift (OR=0.332) . Conclusion: The employed nurses in military hospitals have poorer sleep quality than the normal adults. The influential factors for sleep quality of employed nurses are educational background, department, whether to have children, and frequency of night shifts.

Associations between sleep quality and domains of quality of life in a non-clinical sample: results from higher education students

ObjectiveThe association between sleep quality and quality of life (QoL) in clinical samples diagnosed with sleep disorders, mental disorders, or other medical conditions has been widely investigated. However, few studies focused on this relationship in samples of mostly young and healthy adults. This study analyzed the associations between sleep quality and several dimensions of QoL in higher education students and examined whether or not sleep quality would significantly predict QoL after statistically controlling for psychopathological symptoms. DesignObservational and transversal. SettingNon-clinical; higher education. ParticipantsA sample of 324 college students, aged 17 to 47 years (M=20.89±2.85) were enrolled. MeasurementsEuropean Portuguese versions of the Pittsburgh Sleep Quality Index (PSQI), the WHOQOL-Bref to measure QoL, and the Brief Symptom Inventory (BSI) to measure psychopathological symptoms. ResultsAll PSQI components were significantly associated with general QoL and the psychological and physical QoL domains. The subjective sleep quality and daytime dysfunction PSQI components were consistently associated with all WHOQOL-Bref domains and general QoL. Hierarchical regression analyses further showed that the PSQI components as a whole, and in particular subjective sleep quality, added significant contributions to the general QoL facet and to the psychological, physical, and environmental QoL domains, after controlling for psychopathological symptoms. ConclusionsSeveral components of sleep quality and different facets/domains of QoL are associated in higher education students, particularly subjective sleep quality, which remains a significant predictor of most aspects of QoL, regardless of the presence of psychopathological symptoms.

The relationship between serum vitamin D levels and sleep quality in fixed day indoor field workers in the electronics manufacturing industry in Korea

BackgroundAlthough recent studies have investigated the influence of vitamin D on sleep patterns, there is a lack of research on the relationship between vitamin D and sleep patterns in Korean workers. This study focused on the relationship between serum vitamin D levels and sleep in fixed day indoor field workers in the electronics manufacturing industry in Korea.MethodsThe 1472 subjects who were included in this study were selected from fixed day workers in the electronics manufacturing industry who had received a worker’s special health examination at a hospital in Changwon, South Gyeongsang Province between January 2015 and December 2015. Nighttime workers and those who showed symptoms of depression were excluded from this study. The sociodemographic and lifestyle variables of the participants were investigated, including age, sex, marital status, level of education, body mass index, smoking habits, alcohol consumption habits, and regular exercise. Work-related factors were evaluated, such as employee tenure and occupational stress. Serum 25-hydroxyvitamin D was measured as an indicator of vitamin D levels, and quality of sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI) translated into Korean.ResultsThe subjects had a mean serum vitamin D level of 13.70 ± 5.93 ng/mL. Vitamin D deficiency, defined as a serum vitamin D level of <10 ng/mL, was found in 24.8% of males and significantly more frequently in females (47.6%). Poor sleep quality was reported by 19.8% of participants with serum vitamin D levels ≥10 ng/mL and by 21.7% of those with serum vitamin D levels <10 ng/mL, which was a significant difference (P = .007). Multiple logistic regression analysis adjusting for significant variables found that poor sleep quality was more likely in those with vitamin D deficiency than those with higher serum vitamin D levels (odds ratio = 1.36; 95% CI, 1.01–1.82). A comparison of serum vitamin D levels and PSQI components showed that the mean scores for subjective sleep quality, sleep latency, and sleep duration were significantly higher in the vitamin D-deficient participants, indicating that the vitamin D-deficient participants had poorer sleep quality.ConclusionsThis study investigated serum vitamin D levels in fixed day indoor field workers in the manufacturing industry in Korea and analyzed the relationship of vitamin D deficiency with sleep quality. A significant correlation was found between serum vitamin D deficiency and poor sleep quality. Based on the results of this study, sleep disorder management for workers can be improved by providing regular examinations checking their serum vitamin D levels and supplying vitamin D to workers with serum vitamin D deficiency to enhance their quality of sleep.

A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial.

To test the effectiveness of a 4-week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4-week information-only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double-blind, randomized, clinical trial. Forty-two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in-person sleep and health assessments at baseline, post-treatment and 4-months follow-up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post-treatment and 4-months follow-up, with baseline values as covariates. SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post-treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4-month follow-up (all p's < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4-month follow-up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post-treatment or 4-month follow-up. A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.

Good and poor sleepers among OSA patients: sleep quality and overnight polysomnography findings

Previous studies aimed to determine if Pittsburgh sleep quality index (PSQI) is a valid screening instrument for obstructive sleep apnea, indicating its disadvantages. However, the rationale of PSQI use in sleep clinics is not the screening, but the assessment of sleep quality itself. Therefore, the aims of this study were to investigate the sleep quality in obstructive sleep apnea patients and to identify the cutoff point for differentiation of "good" and "poor" sleepers among them. We constructed the Croatian version of PSQI and assessed its psychometric properties. The protocol of the study included the assessment of sleep quality in 130 obstructive sleep apnea patients and 75 healthy control subjects. All subjects completed the Croatian version of the PSQI, and the patients underwent overnight polysomnography screening. Obstructive sleep apnea patients had higher values of the global PSQI component score, indicating lower sleep quality, compared to a healthy control group (p<0.001). The psychometric properties of PSQI scores in the prediction of normal sleep efficiency indicate that the cutoff score of 9.5 differentiates patients in total sleep time (p< 0.001), REM duration (p=0.014), sleep efficiency (p=0.001), time spent awake during sleep (p=0.006), after sleep (p=0.024), and after sleep onset (p=0.001). In OSA patients, a PSQI cutoff score of 9.5 differentiated good and poor sleepers significantly in total sleep time, REM duration, time spent awake during sleep, and WASO time. Current findings enhance the interpretability of PSQI results in a population of OSA patients.

Neuropathic pain after breast cancer treatment and its impact on sleep quality one year after cancer diagnosis

ObjectivesData regarding the impact of breast cancer treatment-related neuropathic pain (NP) on sleep quality are scarce. Therefore, we aimed to assess the impact of breast cancer treatment-related NP on patients' sleep quality, during the first year after cancer diagnosis. Materials and methodsA total of 501 breast cancer patients were followed prospectively. Incident NP was identified through systematic evaluations after treatments and one year after enrolment. NP severity was quantified using the Brief Pain Inventory severity subscale and sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI), at baseline and after one year. Adjusted regression coefficients (β) and 95% confidence intervals (95%CI) were used to quantify the relation between NP and the variation in the PSQI z-scores. ResultsThe occurrence of NP was associated with a deterioration in sleep quality during the first year of follow-up, more pronounced among those with good sleep quality (PSQI≤5) than those with poor sleep quality at baseline (PSQI>5) (β = 0.44, 95%CI: 0.11 to 0.77 versus β = 0.33, 95%CI: 0.08 to 0.59). These differences were accentuated when only the cases of NP with greater severity were considered (β = 0.86, 95%CI: 0.37 to 1.35 versus β = 0.31, 95%CI: −0.08 to 0.64). Within the PSQI components, daytime dysfunction and sleep duration were the most impaired by NP. ConclusionOur findings highlight the importance of the promotion of sleep hygiene among breast cancer patients diagnosed with NP, especially among those with good sleep quality before treatments.

Association of sleep quality in Behcet disease with disease activity, depression, and quality of life in Korean population.

Background/AimsSleep disturbance is prime concern in patients with Behcet disease. The purpose of this study was to find out the effects of sleep quality, in Korean patients suffering from Behcet disease. We further investigated the relationship between depression, quality of life and the clinical findings of Behcet disease.MethodsThe study was performed by the cross-sectional design. Sleep quality was assessed by the Korean version of Pittsburgh sleep quality index (PSQI). Disease activity of Behcet disease was evaluated by Behcet disease current activity form (BDCAF). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2). Quality of life was assessed by the Korean version of the Leeds Behcet disease quality of life measure (BDQoL).ResultsAmong the 100 patients studied, 42% reported poor sleep quality (PSQI ≥ 9). These patients have a higher BDI-2, total BDCAF and pain visual analogue scale (VAS) score (p < 0.001, p = 0.022, and p = 0.005). Considering BDCAF, the frequency of genital ulcer was significantly higher (p = 0.01). Behcet was higher in females. The BDQoL was lower in poor sleeper group (p = 0.004 and p < 0.001). Among 7 PSQI components, daytime dysfunction was higher in patients with high disease activity (p = 0.03). Total PSQI score were strongly correlated with BDCAF, BDI-2, BDQoL, and pain VAS score (p = 0.02, p < 0.001, p < 0.001, and p < 0.001, respectively).ConclusionsLow sleep quality is directly associated with disease activity, depression, and quality of life in Korean patients with Behcet disease.

Comparison of subjective sleep and fatigue in breast- and bottle-feeding mothers

ObjectivesArtificial milk supplementation remains a popular practice in spite of the well documented and indisputable advantages of breast feeding for both mother and child. However, the association between maternal sleep, fatigue and feeding method is understudied and remains unclear. The aim of this study is to investigate whether perceived sleep and fatigue differ between breast- and bottle feeding post partum women. In addition, the relationship between subjective sleep characteristics and fatigue is examined. MethodsPost partum women (four to 16 weeks) filled out a socio-demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS). FindingsSixty-one within the past week exclusively breast- and 44 exclusively bottle-feeding mothers were included. The first group showed better subjective sleep quality, but lower habitual sleep efficiency as measured by the PSQI. Global PSQI, as well as subjective fatigue and global CIS, did not differ between the two groups. Significant positive correlations were found between global CIS and the number of night feeds and global PSQI. However, only global PSQI significantly predicted global CIS in relation to the number of night feeds. ConclusionsWithin a general pattern of deteriorated sleep quality, breast-feeding women showed better subjective sleep quality, but lower habitual sleep efficiency, between four and fourteen weeks after childbirth. However, the PSQI component scores compensated for each other, resulting in absence of any difference in global PSQI sleep quality between the two groups. Global PSQI significantly predicted global CIS, resulting in an absence of any difference in post partum fatigue according to feeding method. Implications for practiceMidwives and nurses should, together with the parents, continue to focus on exploring ways to improve maternal sleep quality and to reduce postnatal fatigue.

Impact of sleep on osteoporosis: sleep quality is associated with bone stiffness index

ObjectiveThe aim of the present study was to investigate the impact of sleep on osteoporosis. MethodsThe study used a baseline examination of the Hiroshima Sleep and Healthcare study, which was a cross-sectional and cohort study that addressed the association of sleep habits with lifestyle-related diseases. A total of 1032 participants (25–85 years of age) who underwent health examinations were included. Sleep habits, including its timing (bed time), quantity (time in bed [TIB]), and quality, were assessed using the Pittsburgh Sleep Quality Index (PSQI). The bone stiffness index (SI), a marker of osteoporosis, was measured using quantitative ultrasound systems. ResultsBed time (r = 0.065, p < 0.05), TIB (r = −0.064, p < 0.05), and global PSQI score (r = −0.126, p < 0.0001) significantly correlated with SI. Multiple regression analyses revealed that after adjusting for age, sex, body mass index, smoking, and alcohol intake, the global PSQI score (β = −0.053, p < 0.05) was significantly associated with SI, whereas bed time or TIB was not. Among each component of PSQI, sleep disturbances (β = −0.084, p < 0.005) were significantly associated with SI. ConclusionPoor sleep quality may be associated with osteoporosis. In particular, increased sleep disturbances may be a key factor in the association between poor sleep quality and osteoporosis.

Sleep quality in patients with chronic low back pain

Abstract Introduction : Sleep performs a restorative function for the body. Medical conditions such as Chronic Low Back Pain (CLBP) may cause sleep changes and impair sleep quality. Objectives : To identify the prevalence of sleep disorders among individuals with CLBP, and investigate whether there is an association between these disorders and perceived functional disability. Materials and methods : This observational, descriptive study was conducted with 51 patients seen at the Clinic of the School of Physical Therapy of Santa Catarina State University. Data were collected through interviews addressing socio-demographic and clinical data, and administration of the Roland-Morris Disability Questionnaire (RMDQ) and Pittsburgh Sleep Quality Index (PSQI). Results : Participants had high levels of functional disability (mean, 16.71 ± 4.16 score points). 82.35% of patients had poor sleep quality (mean, 10.22 ± 4.84 score points). The PSQI components with the highest mean scores were: sleep latency and sleep disturbances. There was also a weak association between functional disability and sleep quality (Spearman = 0.31; p = 0.025), i.e., the higher the disability, the worse the quality of sleep. Conclusion : We found a high prevalence of sleep disorders among patients with CLBP, and a weak association with the level of perceived disability. It is important to conduct further studies on the relationship between these factors and sleep quality. Moreover, there is a need for a multidisciplinary approach in the treatment of CLBP, in order to treat sleep disorders and improve patients' quality of life.

Association between sleep quality and inflammatory complement components in collegiate males.

An accumulating amount of evidence has linked humoral mediators of inflammation with sleep measures. Nevertheless, important details of this association, in particular the role of the complement components in the context of chronic sleep attributes, have remained largely uncharacterized. Fifty university students (age, 23.3 ± 3.8years; BMI, 23.7 ± 2.9kg/m(2)) completed the study. Four dichotomized sleep measures assessed by the Pittsburgh Sleep Quality Index (PSQI) were used in association analysis using binary logistic regression with complement component 3, 4, and complement factor I (CFI). The sleep measures were defined as sleep quality (good sleep/poor sleep; PSQI ≤5/PSQI >5), bedtime (early/late; before 00:00h/after 0:00h), sleep duration (short/normal ≤6h/>6h), and sleep onset latency (normal/disturbed; 0-1 score/2-3 score on the PSQI component of sleep latency). The complement component 4 was associated with sleep quality (unadjusted, OR = 1.025, p < 0.05; adjusted for age, OR = 1.025, p < 0.05; adjusted for BMI, OR = 1.027, p < 0.05) and sleep duration (unadjusted, OR = 1.041, p < 0.01; adjusted for age, OR = 1.041, p < 0.01; adjusted for BMI, OR = 1.046, p < 0.01). CFI was associated with bedtime (unadjusted, OR = 0.737, p < 0.01; adjusted for age, OR = 0.717, p < 0.01; adjusted for BMI, OR = 0.677, p < 0.01) and with sleep duration (unadjusted, OR = 0.796, p < 0.05; adjusted for age, OR = 0.796, p < 0.05). The findings indicate the importance of the role of complement components in the dynamics of sleep. Therefore, sleep should be assessed in conditions where complement components are affected.

Exogenous melatonin for sleep disorders in neurodegenerative diseases: a meta-analysis of randomized clinical trials.

The purpose of this work is to investigate the efficacy of exogenous melatonin in the treatment of sleep disorders in patients with neurodegenerative disease. We searched Pubmed, the Cochrane Library, and ClinicalTrials.gov, from inception to July 2015. We included randomized clinical trials (RCTs) that compared melatonin with placebo and that had the primary aim of improving sleep in people with neurodegenerative diseases, particularly Alzheimer's disease (AD) and Parkinson's disease (PD). We pooled data with the weighted mean difference in sleep outcomes. To assess heterogeneity in results of individual studies, we used Cochran's Q statistic and the I (2) statistic. 9 RCTs were included in this research. We found that the treatment with exogenous melatonin has positive effects on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in PD patients (MD: 4.20, 95 % CI: 0.92-7.48; P = 0.01), and by changes in PSQI component 4 in AD patients (MD: 0.67, 95 % CI: 0.04-1.30; P = 0.04), but not on objective sleep outcomes in both AD and PD patients. Treatment with melatonin effectively improved the clinical and neurophysiological aspects of rapid eye movement (REM) sleep behavior disorder (RBD), especially elderly individuals with underlying neurodegenerative disorders. This meta-analysis provided some evidence that melatonin improves sleep quality in patients with AD and PD, and melatonin can be considered as a possible sole or add-on therapy in neurodegenerative disorders patients with RBD.

Associations between poor sleep quality and different measures of obesity

ObjectivePoor sleep may be a risk factor for obesity. Previous studies have mainly investigated the effects of sleep duration on body mass index, but research considering overall sleep quality and other anthropometric measures is scarce. The aim of this study was to examine the association between sleep quality and different measures of obesity (general obesity, abdominal obesity, body composition) in a population-based sample of adults. MethodsThe study included 753 participants aged 35–65 years from the BiDirect Study, conducted in Münster, Germany. Participants completed the Pittsburgh Sleep Quality Index (PSQI) on sleep characteristics. Weight, height, and waist circumference were measured by trained study nurses. Body composition (fat mass and fat-free mass) was assessed using bioelectrical impedance analysis. The cross-sectional relationship between sleep quality and measures of obesity was investigated using logistic regression analysis. ResultsAmong the participants, 65.3% reported good (PSQI ≤ 5) and 34.7% poor (PSQI > 5) sleep quality. We observed a significant association of poorer sleep quality assessed by the continuous PSQI score with general obesity and high body fat (for both, odds ratio = 1.07, 95% confidence interval = 1.01–1.13), adjusted for socio-demographic and lifestyle factors. Further adjustment for depressive symptoms and somatic comorbidities attenuated the relationship. The observed association was mainly driven by the PSQI components sleep latency, sleep disturbances, and daytime dysfunction. ConclusionsThe present study suggests that poor sleep quality may predict obesity and high body fat mass among adults. However, a causal relationship still has to be confirmed by prospective studies with objective measurements of sleep and obesity.

Being mindful of later-life sleep quality and its potential role in prevention.

Older adults commonly report disturbed sleep, and an expanding literature suggests that poor sleep increases the risk of adverse health outcomes.1 In this issue of JAMA Internal Medicine, Black et al2 present a randomized clinical trial (RCT) among adults 55 years and older with moderately disturbed sleep, comparing a sleep hygiene intervention with a community-based mindfulness meditation intervention. They assess the outcomes of global sleepquality, insomnia symptoms, fatigue, and depressive symptoms. As the authorsexplain, effectivenonpharmacological interventions that are both “scalable” and “community accessible” are needed to improve disturbed sleep and prevent clinical levels of insomnia. This is imperative given links between insomnia and poor health outcomes, risks of sleepmedication use, and the limited availability of health care professionals trained in effectivenondrug treatments suchasbehavior therapyandcognitivebehavioral therapy for insomnia.This contextmakes the positive results of this RCT compelling. Behavior therapy and cognitive behavioral therapy for insomnia arenonpharmacological interventions for clinical levels of insomnia, with known efficacy across age groups, including inolder adults.However, awarenessof these therapies is lowamongphysicians and the general public, and the availability of trainedhealth careprofessionals to administer these treatments is below what is required to address the clinical need.Fortunately, initiatives tomorewidelydisseminate these interventions have begun. The Department of Veterans Affairs has been training non–sleep specialist physicians, psychologists, nurses, and socialworkers to deliver cognitive behavioral therapy for insomniawithin its primary care,mental health, and other clinics.3 Outside of the Department of Veterans Affairs, a nurse-administered brief behavioral treatment for insomniahasbeendevelopedforuse inprimarycare.4 Althoughthesearepositivedevelopments, suchtreatmentsare notyetwidely available inprimary care settings, rendering the outside-of-the-clinic approachofBlacket al2 to treatment (and perhaps prevention) of disturbed sleep all themore relevant. There are some important methodological aspects of the study by Black et al2 thatwarrant discussion. The authors did not require participants in their RCT tomeet criteria for a particular common sleep disorder such as insomnia, sleepdisorderedbreathing, or restless legs syndrome. Instead, they excluded individuals reporting sleep-disordered breathing or restless legs syndrome and recruited individuals with a selfreported Pittsburgh Sleep Quality Index (PSQI) exceeding 5, whichsuggestspoor sleepquality.5 Sleepquality is abroadconstruct that has been defined in various ways. It encompasses and is affectedbyseveral aspectsof sleep, including sleep fragmentation, extended latency to sleep onset, perceived restfulness of sleep, and (according to some definitions) sleep duration.5 The cutoff value of greater than 5 on the PSQI was originally selected for its ability to differentiate poor sleepers (definedas individualswithproblems fallingor stayingasleep, excessivedaytime sleepiness, or depression) fromgood sleepers with no sleep complaints.5 Some may question the decision to recruit study participants on the basis of a PSQI score rather than, for example, an insomniadiagnosis.However, the selection of the PSQI makes sense given the epidemiological evidence that among older adults a PSQI exceeding 5 is associated with adverse health outcomes, including frailty and lowercognitive function.6,7Therefore, thePSQIcutoffofgreater than 5 should identify individuals at risk for poor sleeprelated health outcomes and would likely capture a greater number of them than would be identified by more stringent diagnostic criteria for insomnia. These are important qualities for a community-based intervention inwhich prevention of clinical insomnia and its outcomes may eventually be the goal. In line with this, while Black et al2 describe their study participants as having moderate sleep problems, a PSQI exceeding5 canalso reflect severedisturbances. Therefore, their sample likely included older adults with subclinical insomnia and others with clinical levels of insomnia. In addition, there may well have been cases of sleep-disordered breathingand restless legs syndrome in the samplegiven that thehistory of these disturbances was screened for only via selfreport. The likelihood that their sample contained individuals with sleep disturbances other than insomnia and that their sleepmay have beenmore thanmoderately disturbedmakes the authors’ positive findings all the more impressive. This excellent study raises somequestions that need tobe answered in future research.Forexample,whichaspectsof the broad construct of sleep quality does the mindfulness meditation intervention improve?While the global PSQI scorewas the primary outcome of this trial, how does the intervention affect the different PSQI components,5 including sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, sleepmedications, anddaytimedysfunction? Inaddition, the mechanisms by which mindfulness meditation affects sleep remain unclear. Indeed, depression and fatigue were classifiedbyBlack et al2 as secondary “sleep-relateddaytime impairment” outcomes andwere improvedby themindfulness intervention. However, rather than being consequences of improvements in insomnia, it is possible that improvements in depression and fatigue mediated the effect of mindfulness on sleep quality. Future studies with repeatedassessmentof theseputativemediators throughout the intervention would help determine whether this is the case. Finally, theauthors indicated that theirRCTwas the first study Related article page 494 Research Original Investigation Mindfulness Meditation in Sleep-Disturbed Adults

Mindfulness-Based Stress Reduction for Chronic Insomnia in Adults Older than 75 Years: A Randomized, Controlled, Single-Blind Clinical Trial

To assess the effectiveness of mindfulness-based stress reduction (MBSR) for chronic insomnia and combined depressive or anxiety symptoms of older adults aged 75 years and over. A randomized, controlled, single-blind clinical trial. Participants included 60 adults aged 75 years and over with chronic insomnia. Participants were randomly assigned to the eight-week MBSR group or the wait-list control group. Assessments using the Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Sale (SAS), and Geriatric Depression Scale (GDS) were taken at baseline and post-treatment. For each outcome measure, a repeated measures analysis of variance was used to detect changes across assessments. There was a significant time × group interaction for the PSQI global score (P = .006); the MBSR group had a decrease in the PSQI global score (Cohen׳s d = 1.12), while the control group did not (Cohen׳s d = -0.06). Among the PSQI components, there was a significant time × group interaction for daytime dysfunction (P = .048); Cohen׳s d of the MBSR group was 0.76, while Cohen׳s d of control group was -0.04. There was no significant time × group interaction for the SAS score (P = .116), while for the GDS there was a significant time × group interaction (P = .039); the Cohen׳s d value for the MBSR group was 1.20, and it was 0.12 for the control group. This study demonstrated that the MBSR program could be a beneficial treatment for chronic insomnia in adults aged 75 years and older.

Cigarette Smoking Habit and Subjective Quality of Sleep

Background: Cigarette smoking habit is a physical addiction to nicotine that has long been regarded as one of the most important risk factors of several diseases, especially heart and lung diseases, and particularly lung cancers. Objectives: This study was conducted to assess the effect of cigarette smoking on subjective sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its components. Patients and Methods: This is a cross-sectional study conducted on 2923 individuals aged between 18 and 98 years in Tehran province, Iran, to evaluate the effect of cigarette smoking on sleep quality. Night-shift workers were not included in the study. Participants were divided into two groups according to the current or noncurrent cigarette smoking habit. Sleep quality was compared between groups using 7 components of Pittsburgh Sleep Quality Index (PSQI) and its global score. Results: Data of 2923 individuals comprised of 1638 (56%) females and 1285 (44%) males with a mean age of 43.68 ± 17.74 years (aged 18-98 years) were analyzed. Out of 2923 participants, 308 cases (10.5%) were current cigarette smokers and 2615 (89.5%) were not current smokers. Three out of seven PSQI components comprising sleep quality, duration, and sedative medication use, in addition to global PSQI score were significantly poorer in the current smokers compared to nonsmokers (P = 0.013, 0.036, 0.001, and 0.010, respectively). Among current smokers, PQSI increased significantly with the number of cigarettes smoked per day (Pearson’s correlation coefficient r = 0.122, P = 0.036). Conclusions: PQSI global score reflecting sleep quality was poorer in the individuals with a history of one-month cigarette smoking. It means that even one month of cigarette smoking could significantly decrease the quality of sleep and still could be worsen with increasing the number of cigarettes smoked per day.

Association between self-reported global sleep status and prevalence of hypertension in Chinese adults: data from the Kailuan community.

Background: Assessment of sleep only by sleep duration is not sufficient. This cross-sectional study aimed to investigate the potential association of self-reported global sleep status, which contained both qualitative and quantitative aspects, with hypertension prevalence in Chinese adults. Methods: A total of 5461 subjects (4076 of them were male) were enrolled in the current study and were divided into two groups with the age of 45 years as the cut-off value. Sleep status of all subjects was assessed using the standard Pittsburgh Sleep Quality Index (PSQI). Hypertension was defined as blood pressure ≥140/90 mmHg in the current study. Results: After adjusting for basic cardiovascular characteristics, the results of multivariate logistic regression indicated that sleep status, which was defined as the additive measurement of sleep duration and sleep quality, was associated with hypertension prevalence in males of both age groups (odds ratio (OR) = 1.11, 95% confidence interval (CI), 1.07–1.15, p < 0.05; OR = 1.12, 95% CI, 1.08–1.15, p < 0.05) and in females aged ≤45years (OR = 1.10, 95% CI, 1.02–1.18, p < 0.05). As one component of PSQI, short sleep duration was associated with hypertension prevalence only in Chinese male subjects, but this association disappeared after the further adjustment of the other components of PSQI that measured the qualitative aspect of sleep. Conclusion: Association between sleep status and hypertension prevalence in Chinese adults varied by age and sex. Sleep should be measured qualitatively and quantitatively when investigating its association with hypertension.

Mongolian Medical Acupuncture Improves Sleep Quality in Patients with Primary Insomnia

The aim of this study was to evaluate the therapeutic effects of the Mongolian medical warm needle acupuncture (MMA) in treating patients with primary insomnia. 40 patients with primary insomnia were randomly divided into 2 groups as (1) Control Group, who received automatic neural balance regulation (ANBR), and (2) MMA Group, who received ANBR plus MMA treatment. The MMA treatment was administered to 5 acupuncture points according to traditional Mongolian medicine. Pittsburgh Sleep Quality Index (PSQI) was used to quantitatively measure patients’ outcome at time 0 (prior to study involvement), time 1 (after 8-week treatment), and time 2 (follow-up examination 4-week post-treatment). Multivariate analyses were conducted using treatment, gender, time, and age as factors and covariates. Cronbach’s alpha coefficient was used to evaluate internal homogeneity. MMA significantly reduced PSQI in insomniac patients compared with control (t = 9.59, p < 0.001). Six component scores of the PSQI were internally consistent (Cronbach’s alpha coefficient = 0.89). Out of the 6 components of PSQI, MMA significantly improved subjective sleep quality, sleep latency, and daytime dysfunction. The Mongolian medical warm needle acupuncture combined with automatic neural balance regulation has significant therapeutic effects in treating primary insomnia.

Sleep quality in patients with dental anxiety

BackgroundPsychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. ObjectivesTo measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. Methods67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. Results49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. ConclusionsDA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.

Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study.

Guidelines discourage chronic benzodiazepines and related Z drugs (BZD/Zs) for sleep problems. However, prevalence among nursing home residents remains high. Discontinuing these drugs is widely recommended but seems difficult to implement. The aim of our study was to evaluate the overall feasibility in the nursing home, in terms of willingness towards discontinuation and success rate at 8 months, together with the impact on withdrawal symptoms, change in sleep quality, quality of life and medication use. In a convenience sample of five nursing homes (823 residents), we included cognitively competent residents with chronic BZD/Z use for insomnia. We investigated sleep quality [with Pittsburgh Sleep Quality Index (PSQI)], quality of life (EQ-5D) and withdrawal symptoms [Benzodiazepine Withdrawal Symptom Questionnaire (BWSQ)]. Success rate was analysed with survival analysis. Of the 135 eligible residents, both general physician (GP) and resident were willing to initiate discontinuation in 38 residents. Reasons for refusing to initiate discontinuation among GPs was the unmotivated patient and among residents the reluctance towards change. At 8 months, 66.0% were successful discontinuers, with the subjective PSQI component evolving favourably (p = 0.013) and a decreasing number of midnight awakenings (p = 0.041). In the relapse group (n = 13), the quality of life decreased (p = 0.012), with mainly an increase of problems with activities and pain/discomfort. In both groups, the withdrawal symptoms, functionality and medication use did not change. Discontinuation of chronic BZD/Z use is feasible in the nursing home setting without noticeable withdrawal symptoms, without a switch in medication use, without detrimental effect on quality of life and with a positive effect on the self-perceived sleep quality.