Pittsburgh Sleep Quality Index Subscales Research Articles

When sleep disorders in patients with bipolar disorder indicate a risk of suicidal behavior

IntroductionSleep disturbances and suicidal behaviors are common among patients with type II bipolar disorder ( BDII), but the relationship between the two is unclear. Investigating this connection is important to identify interventions that can improve the quality of life and reduce the risk of suicide in this population.ObjectivesOur study’s objective is to examine the association between sleep disorders and suicidal behavior in patients with type II bipolar disorder (BDII).MethodsIn order to comprehensively investigate the association between sleep disturbances and suicidal behaviors among individuals diagnosed with type II bipolar disorder (TBII), we conducted a cross-sectional, descriptive, and analytical study over a duration of one month, specifically from the 1st to the 31st of October 2022. Our research was conducted within the follow-up unit of the mental health department at Nabeul Hospital, Tunisia, with the aim of capturing a diverse range of participants representative of the population of interest.To ensure the integrity and accuracy of our findings, we meticulously selected participants who met specific eligibility criteria. This included individuals aged between 18 and 60 years, who had a confirmed diagnosis of type II bipolar disorder according to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM V). Furthermore, we sought to include participants who were psychiatrically stable, meaning they had not required hospitalization in the six months preceding the study.The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the participants’ sleep quality over a one-month period, while the Suicidal Behavior Questionnaire-Revised (SBQ-R) was used to assess suicidal behavior.The data was gathered through a questionnaire that prioritized ethical concerns, including obtaining informed consent from participants and maintaining confidentiality and anonymity throughout the study.ResultsIn this study, we enrolled 40 male patients with a mean age of 36 ± 13.2 years and evaluated their sleep quality and suicidal behaviors. The results showed that the participants had a mean PSQI score of 7.28 ± 3.35, indicating that the overall sleep quality was not optimal. Specifically, 65% of the participants had poor sleep quality (> 5), and 45% reported poor sleep(PSQI ≥ 8) . The mean SBQ-R score was 10.3 ± 3.6, indicating a moderate level of suicidal behavior. Interestingly, we found a statistically significant correlation between PSQI and SBQ-R subscales, particularly with regard to suicidal thoughts (p=0.003) and suicide attempts (p=0.002).ConclusionsOur study found a strong link between sleep problems and suicidal behavior in people with type II bipolar disorder. This highlights the need to address sleep issues to reduce suicide risk in these patients.Disclosure of InterestNone Declared

Is There a Correlation Between Internet Use and Sleep and Cognitive Function Among Medical Students?

Background: Currently, the Internet is widely used by students for academic purposes; however, excessive Internet use might have negative consequences on students’ academic performance, sleep quality, and cognitive abilities. Objectives: This study aimed to investigate the relationship between Internet usage, sleep quality, and cognitive function among medical students. Methods: This analytical cross-sectional study was conducted on 525 pre-internship medical students, including 304 first- and second-year students, 113 third-year students, and 108 externs, within 2019 and 2021 at Mashhad University of Medical Sciences, Mashhad, Iran. The participants were selected using a stratified sampling method. All participants completed the Cognitive Ability Questionnaire (CAQ), Internet Addiction Questionnaire (IAQ), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS software (version 22). Results: According to the IAQ, 430 participants (81.9%) were categorized as average Internet users, 94 participants (17.9%) had occasional or frequent problems, and 1 participant had significant problems with Internet use. Mean PSQI and CAQ scores were significantly higher among participants with occasional or frequent problems/significant problems than the average Internet users (P < 0.001 each). The total IAQ score showed a positive correlation with total CAQ (r = 0.439, P < 0.001) and total PSQI (r = 0.264, P < 0.001) scores. Among the PSQI subscales, sleep latency (P = 0.032), daytime dysfunction due to sleepiness (P < 0.001), sleep efficiency (P = 0.001), and overall sleep quality (P < 0.001) were worse in participants with occasional or frequent problems/significant problems than in average Internet users. Conclusions: Excessive Internet use negatively affects the sleep quality and cognitive performance of medical students.

Patient-reported outcomes on sleep quality and circadian rhythm during treatment with intravenous ketamine for treatment-resistant depression.

Intravenous (IV) ketamine is a rapid acting antidepressant used primarily for treatment-resistant depression (TRD). It has been suggested that IV ketamine's rapid antidepressant effects may be partially mediated via improved sleep and changes to the circadian rhythm. This study explores IV ketamine's association with changes in patient-reported sleep quality and circadian rhythm in an adult population with TRD. Adult patients (18-64 years) with TRD scheduled for IV ketamine treatment were recruited to complete patient rated outcomes measures on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and circadian rhythm using the Morningness-Eveningness Questionnaire (MEQ). Over a 4-week course of eight ketamine infusions, reports were obtained at baseline (T0), prior to second treatment (T1), prior to fifth treatment (T2), and 1 week after eighth treatment (T3). Forty participants with TRD (mean age = 42.8, 45% male) were enrolled. Twenty-nine (72.5%) had complete follow-up data. Paired t tests revealed statistically significant improvements at the end of treatment in sleep quality (PSQI) (p = 0.003) and depressive symptoms (Clinically Useful Depression Outcome Scale-Depression, p < 0.001) while circadian rhythm (MEQ) shifted earlier (p = 0.007). The PSQI subscale components of sleep duration (p = 0.008) and daytime dysfunction (p = 0.001) also improved. In an exploratory post hoc analysis, ketamine's impact on sleep quality was more prominent in patients with mixed features, while its chronobiotic effect was prominent in those without mixed features. IV ketamine may improve sleep quality and advance circadian rhythm in individuals with TRD. Effects may differ in individuals with mixed features of depression as compared to those without. Since this was a small uncontrolled study, future research is warranted.

Evaluating the effect of sleep quality and chronotype differences on erectile dysfunction.

Erectile dysfunction (ED) refers to an inability to achieve or maintain a firm penile erection sufficient for satisfactory sexual intercourse. Insufficient, irregular sleep and sleep disorders adversely affect human health, including sexual function. Significant differences between biological rhythms (chronotypes) have been reported. In the present study we examine the effect of sleep quality and chronotype differences on ED patients and a control group. The study included 69 patients who presented with ED and 64 healthy controls. The respondents completed a sociodemographic data form, and disease severity in the ED group was measured using the International Index of Erectile Function (IIEF). The participants were further administered the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ), and the scale scores were compared statistically between the patient and control groups. There was no difference in the age, body mass index (BMI), alcohol use and smoking of the ED and healthy control groups, while the IIEF score was significantly lower in the ED group than in the control group. The PSQI subscale scores other than for sleep duration subscale, the PSQI global score and the HADS score were higher in the ED group than in the control group, while there was no difference between the groups in the MEQ and ISI scores. The IIEF score was correlated with the PSQI and HADS scores, and the PSQI score with the ISI and HADS scores. It would be useful to evaluate sleep quality in addition to anxiety and depression while evaluating patients with ED. Our study found no relationship between chronotype differences and ED.

Effects of progressive muscle relaxation exercises on patients with epilepsy on level of depression, quality of sleep, and quality of life: A randomized controlled trial

ObjectiveThis study aims to evaluate the effects of progressive relaxation exercises applied to patients with epilepsy on patients’ depressive symptom severity, quality of sleep, and quality of life. MethodsThe study was designed as a randomized controlled interventional study with a control group and pre-and post-test intervention. It was conducted with 70 patients with epilepsy, 35 in the intervention group and 35 in the control group, between November 1, 2021, and April 15, 2022. The patients in the intervention group were required to perform 12 progressive muscle relaxation exercise sessions 3 days a week for a total of 4 weeks. No interventions were made in the control group during the study. The data were collected with a “Personal Information Form,” “Pittsburgh Sleep Quality Index (PSQI),” “Beck Depression Inventory (BDI),” and “Quality of Life in Epilepsy Inventory (QUOLIE -31).” ResultsThe mean PSQI total score, subscale scores, and mean BDI total scores of the patients in the intervention group decreased significantly compared to those in the control group after the intervention (p<0.05). Additionally, a significant difference was found between the mean QUOLIE-31 total scores and subscale scores of the patients in the intervention and control group after the intervention (p<0.05), the mean scores of the intervention group were significantly higher than those of the control group (p<0.05). ConclusionProgressive muscle relaxation exercises decreased depressive symptoms severity and improved sleep and life quality in patients with epilepsy. Progressive relaxation exercises may be recommended as a complementary nursing intervention in treating epilepsy.

Abstract 038: Comparative Effects Of Aerobic, Resistance, And Combined Exercise On Sleep

Introduction: Poor sleep quality is associated with high blood pressure and elevated cholesterol, and regular short sleep (&lt;7 hours) has been found to increase the risk of cardiovascular events. The American Heart Association recommends aerobic physical activity to improve sleep, although there are limited data on the effects of other popular types of physical activity, such as resistance exercise, on sleep. Hypothesis: We hypothesized that 1 year of aerobic, resistance, and combined aerobic and resistance exercise would significantly improve sleep compared to a no-exercise control group. Methods: Participants were 406 inactive adults (53% women, 35-70 years) with overweight/obesity and elevated/stage 1 hypertension at high risk of cardiovascular disease. They were randomly assigned to 1 of 4 groups: aerobic exercise (AE) only (n=101), resistance exercise (RE) only (n=102), combined AE and RE (CE) (n=101), and no-exercise control group (CON) (n=102) for 1 year. All exercise participants performed time-matched supervised exercise 3 times/week, 60 min/session (CE performed 30 min of each AE and RE), at 50-80% of their maximum intensity. Participants completed the Pittsburgh Sleep Quality Index (PSQI) at baseline and 12 months, and only participants with complete baseline data on all PSQI subscales were included (n=386). Primary outcomes were the PSQI total sleep quality score (lower scores = better sleep), sleep duration (hours), sleep efficiency (time asleep/time in bed), sleep latency (time to fall asleep), and sleep disturbances (a combination of the number and frequency of disturbances). Linear mixed effects models following the intention-to-treat principle were used to determine the effects of exercise groups on 12-month changes in sleep outcomes while adjusting for age, sex, and the baseline values of each outcome. Results: Overall, 94% of participants completed the intervention with an 83% exercise adherence rate. The PSQI total score and sleep disturbances decreased significantly in all groups, including the control group. Within groups, sleep duration increased significantly by 17 minutes in RE (p=0.005), but not in AE (p=0.73; -2 min), CE (p=0.77; -2 min), or CON (p=0.13; -11 min), among participants getting less than 7 hours of sleep at baseline (p=0.02 for between-within groups interaction). Within groups, sleep efficiency increased in RE (p=0.0005) and CE (0.03), but not in AE (p=0.97) or CON (p=0.86; p=0.04 for between-within groups interaction). Sleep latency also decreased by 3 minutes in RE (p=0.003), although the overall between-within groups interaction effect was not significant (p=0.14). Conclusions: These results indicate that resistance exercise may have superior benefits on sleep compared to aerobic exercise, which could provide a novel pathway for the role of resistance exercise in promoting cardiovascular health.

Prevalence and Associated Factors with Poor Sleep Quality in Non-Professional Caregivers.

This study aimed to determine the prevalence and associated factors of poor sleep quality in non-professional caregivers. With this purpose, cross-sectional data were collected from 201 dependent people’s family caregivers using the Pittsburgh Sleep Quality Index (PSQI), the Caregiver Burden Inventory (CBI), the General Health Questionnaire (GHQ-12), and an ad hoc questionnaire to obtain sociodemographic data. A total of 153 family caregivers were categorized as poor sleepers (PSQI > 5), resulting in a prevalence of poor sleep quality of 76.1% (95% CI = 70.5–82.5). Poor sleepers were more likely to care for persons with mental disorders (χ2 = 7.31; p < 0.01) and scored significantly higher on perceived burden (z = −4.44; p < 0.001), psychological distress (z = −6.24; p < 0.001), and in all the PSQI subscales (p < 0.001), compared with good sleepers (PSQI ≤ 5). By contrast, no differences were found between poor and good sleepers in age, gender, years providing care, and daily hours of care. Multiple linear regression analysis showed that the factors of caregiver burden (β = 0.15; p < 0.05) and psychological distress (β = 0.53; p < 0.001) were significantly associated with sleep quality in dependent people’s family caregivers. Cognitive-behavioral strategies to improve sleep quality in the primary health care of family caregivers are suggested.

A cross-sectional study of the relationship between quality of life and sleep quality in Japanese patients with type 1 diabetes mellitus.

This study aimed to reveal the relationship between quality of life (QOL) and sleep quality in patients with type 1 diabetes mellitus (T1DM). Overall, 202 patients with T1DM were registered in our study, and 192 were eligible for analysis. Baseline characteristics and laboratory values were determined. Patients completed the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Therapy-Related QOL (DTR-QOL) questionnaires. We investigated the relationship between the global PSQI and DTR-QOL total scores by using linear regression analysis. In univariate regression analysis, DTR-QOL total scores were associated with body mass index, alcohol consumption, hypertension, hemoglobin A1c (HbA1c), and global PSQI score (all p-value <0.05) but not with sleep duration. When the association between PSQI subscales and DTR-QOL total scores was examined, DTR-QOL total scores were significantly related to subjective sleep quality and daytime dysfunction. In a multivariate regression analysis, the global PSQI score was negatively related to DTR-QOL total scores. Patients with an HbA1c concentration ≥8.0% had significantly lower DTR-QOL total scores. We revealed a relationship between QOL and sleep quality in T1DM patients and showed that the relationship between QOL and PSQI subscales in T1DM patients may be different from that in patients with type 2 diabetes mellitus. Assessing and managing sleep quality may be necessary for patients with diabetes to improve QOL.

Sleep Disturbances Are Associated With Depressive Symptoms in a Chinese Population: The Rugao Longevity and Aging Cohort.

Objective: To investigate the cross-sectional and longitudinal relationships between sleep disturbances and depressive symptoms in older Chinese adults.Methods: This study included baseline and 3.5-year follow-up data of 1,631 Chinese men and women aged 70 years or older from the aging arm of the Rugao Longevity and Aging Study. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS). Sleep disturbances were assessed by using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression models were used to estimate the odds ratios (ORs) of the associations.Results: In the cross-sectional analysis, individuals with greater total PSQI scores exhibited significantly higher risk of “depressive symptoms” (OR: 1.31, 95% CI: 1.21–1.41) and “some depressive symptoms” (OR: 1.22, 95% CI: 1.17–1.28). Specifically, higher scores on the sleep efficiency PSQI subscale were associated with greater odds for “depressive symptoms” (OR: 1.54, 95% CI: 1.30–1.84) and “some depressive symptoms” (OR: 1.42, 95% CI: 1.29–1.57). Our longitudinal analyses indicated an association between greater PSQI total scores at baseline and greater odds of having “some depressive symptoms” at follow-up (OR: 1.07, 95% CI: 1.00–1.14). Additionally, higher scores on the sleep efficiency PSQI subscale had an association with higher odds for “some depressive symptoms” (OR: 1.21, 95% CI: 1.04–1.41).Conclusions: Poor self-reported global sleep quality and sleep efficiency PSQI subscale scores were associated with levels of depressive symptoms in an older Chinese population, indicating that global sleep quality and sleep efficiency may be risk factors for depression and can possibly predict the levels of depressive symptoms.

The association between self‐reported sleep and hippocampus volume in mid‐life to older cognitively unimpaired individuals

AbstractBackgroundSleep disturbances and hippocampal atrophy both increases with normal ageing. However, there are mixed findings in the literature regarding the association of sleep and Hippocampus Volume (HV) in humans, from an inverse to no relationship between HV and poor sleep, or even a direct association in one study. We aim to first investigate the effect of age and the apolipoprotein E (APOE) on self‐reported sleep measures in mid‐life to older (43–77‐year‐old) cognitively unimpaired (CU) individuals, and then explore any relationship between their hippocampus volume and sleep across age.Method170 middle to old age (43 to 77 years of age) CU adults (age 60.8.2±6.4, 129 Females, and 96 APOE ε4 carriers) underwent 3T MRI scan and completed the Pittsburgh sleep quality index (PSQI) as part of the PISA study. Generalized Additive Models (GAM) were used to study the effect of age and APOE on different sleep variables and also examine the relationship between sleep and hippocampus volume. HV was normalised using total intracranial volume. Gender and APOE were used as independent covariates.ResultNo significant difference found on sleep between ε4 carriers and ε4 non‐carriers. There was a significant association between age and some of the self‐reported sleep measures (i.e., PSQI subscales). With ageing, sleep efficiency decreased (p‐value=0.01), sleep latency increased (p‐value=0.05), and sleep became poorer (p‐value=0.05), as the PSQI global score increased (). Also, male subjects reported a better sleep quality (p‐value=0.02), and less usage of sleep medications (p‐value=0.04) compared to females. There was no association between sleep and HV.ConclusionAgeing has a significant effect on some aspects of sleep, including sleep efficiency and sleep latency. Among cognitively unimpaired mid‐life to older adults, females are more prone to poor sleep than men. However, no sleep‐HV association was observed.

Effect of a Multilayer, Extended-Release Methylphenidate Formulation (PRC-063) on Sleep in Adolescents with Attention-Deficit/Hyperactivity Disorder: A Randomized, Double-Blind, Fixed-Dose, Placebo-Controlled Trial Followed by a 6-Month Open-Label Follow-Up.

Objectives: We analyzed patient-reported sleep parameters for an extended-release methylphenidate formulation (PRC-063) in adolescents with attention-deficit/hyperactivity disorder. Methods: Clinical efficacy and long-term safety/tolerability data from a 4-week, double-blind, placebo-controlled, fixed-dose study (NCT02139111) and a subsequent 6-month, optimized-dose, open-label extension (OLE) study (NCT02168127) were used. In the double-blind study, participants were randomly assigned 1:1:1:1:1 to one of four doses of PRC-063 (25, 45, 70, or 85 mg/day) or placebo. In both the double-blind and OLE studies, sleep outcomes were assessed using the Pittsburgh Sleep Quality Index (PSQI). Results: During double-blind treatment, no statistically significant least-squares mean difference in change from baseline between PRC-063 (all doses combined; N = 293) and placebo (N = 74) was found for either global PSQI score (-0.3 vs. -0.5; p = 0.6110) or scores for any of the seven PSQI subscales. Compared with the placebo group, a marginally higher proportion of patients in the PRC-063 group (all doses combined) went from being poor to good sleepers (global PSQI score ≤5; 14.4% vs. 11.3%). In a logistic regression analysis, study treatment was not a predictor of poor sleep (p = 0.5368) at the end of the double-blind study. In the OLE study, there was a trend of improvement in sleep after 1 month of individualized dosing that was maintained through 6 months. Sleep efficiency (time asleep as a proportion of time in bed) showed improvement at the end of the OLE study. Conclusion: While individual patients may experience changes in sleep as an adverse event, group data evaluating sleep as an outcome found there were no differences between PRC-063 and placebo in self-reported sleep outcomes on the PSQI.

367 A sleep hygiene and relaxation training program after the Great East Japan Earthquake: What aspects of sleep could be improved?

Abstract Introduction After a natural disaster, the incidence of sleep difficulties tends to increase. Specifically, the prevalence of suspected insomnia was reported to have increased among disaster victims after the Great East Japan Earthquake of March 11, 2011. In a previous study, we have reported that education on sleep hygiene and relaxation training was effective in improving nighttime sleep in students of universities in Sendai city after the earthquake of March 2011. According to analyses of subscale scores of the Pittsburgh Sleep Quality Index (PSQI), the present study aimed to determine what aspects of sleep difficulties were successfully improved. Methods University undergraduates and graduates who reported having sleep difficulties were asked to respond to a questionnaire including the PSQI thrice, before attending a 90-min lecture on sleep hygiene and relaxation training, and a month and three months after attending the program. All participants who reported the total PSQI score of the cutoff point (6) or more were divided into two groups based on their PSQI scores before the program, that attending the course and that not attending it, that is, the “waiting list” group. Results The “attending” group exhibited a decrease in the total PSQI score in the first month after attending the program, and the score in this group reduced further three months later; Nine of twenty (45.0%) attending participants reported the score of less than 6 after a month, while only three of seventeen (17.6%) wait-list participants did. The PSQI subscale scores reported by the nine successful attending participants indicated a significant decrease in the subscale scores on subjective sleep quality, sleep latency, sleep duration, and sleep disturbance from before the program to one month later. Conclusion These results suggest that the short course on sleep hygiene and relaxation training intended for university students was effective, and about a half of the attended participants reported the PSQI score of less than the PSQI cutoff score one month later. This substantial effect would be mainly based on the improvement of their subjective sleep quality, latency, duration, and disturbance. Support (if any) This study was supported by a research grant from the Japanese Psychological Association, Tokyo, Japan.

EFFECTS OF RESTLESS LEG SYNDROME ON THE QUALİTY OF LİFE AND SLEEP DURİNG PREGNANCY: A CASE-CONTROL STUDY

The study was conducted to examine the effect of restless legs syndrome (RLS) on sleep and quality of life during pregnancy. The study was conducted as a cross-sectional and case-control study with a total of 76 pregnant women, 38 with RLS during pregnancy and 38 without RLS during pregnancy. Research data were collected using; the Restless Leg Syndrome Diagnostic Criteria Questionnaire, Individual Description Form, Pittsburgh Sleep Quality Index and Quality of Life Scale. Obtained data were evaluated using chi-square and t test. Groups were found to be similar in terms of socio-demographic and obstetric characteristics. Statistically significant difference was found between the case and control groups in terms of Pittsburgh Sleep Quality Index subscale and total scale (case group: 10.15 ± 3.51, control group: 5.12 ± 3.21); the case group was determined to have worse sleep quality than the control group. In addition, the mean scores of the quality of life scale sub-dimensions of the pregnant women in the case group were found to be statistically significantly lower than the control group. In this study, it was concluded that both the sleep and the quality of life levels of pregnant women with RLS were lower than those without RLS.

Effects of physical activity on sleep problems in breast cancer survivors: a meta-analysis.

To investigate the possible role of physical activity (PA) on sleep disturbance in breast cancer patients. Literature in PubMed, Embase, and the Cochrane Library was systematically searched until January 30, 2020. Randomized controlled trials that focused on the role of PA interventions on sleep disturbance were selected. The main outcome measures included the global Pittsburgh Sleep Quality Index (PSQI) score and PSQI subscales. Subgroup analysis was performed based on the study area and intervention time. The stability and authenticity of the results were measured by sensitivity analysis and publication bias analysis, respectively. Six articles were included in this meta-analysis. There were no significant differences in global PSQI scores between the PA intervention group and the usual care group (P = 0.057). As for PSQI subscales, PA intervention could improve sleep quality (weighted mean difference = 0.22; 95% confidence interval 0.04-0.40; P = 0.018). There were no significant differences in sleep duration, sleep medication, sleep latency, habitual sleep efficiency, and daytime dysfunction between the two groups (all P > 0.05). PA serves as an effective intervention to improve sleep quality.

Assessment of the Effect of Subthalamic Deep Brain Stimulation on Sleep Quality of Parkinson's Disease Patients.

To investigate the effects of subthalamic deep brain stimulation (STN DBS) therapy on sleep quality of Parkinson?s Disease (PD) patients and the relationship between sleep, motor symptoms, depression, and adverse effects of dopamine replacement therapies. A total of 26 PD patients have been included and assessed using various tools both 1 week before and 8 months after the STN DBS therapy. The data collection tools were the Unified Parkinson?s Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Parkinson?s Disease Questionnaire (PDQ-39), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and Polysomnography. PSQI, ISI, and ESS scores were found to have significantly improved after the STN DBS therapy (p=0.002, p=0.006, p < 0.001, respectively), as were the scores obtained from several PSQI sub-scales, that is, sleep duration, sleep disturbance and daytime dysfunction (p=0.023, p=0.005, p=0.032, respectively). Additionally, Wake Times After Sleep Onset (WASO) (p=0.047) and Rapid Eye Movement (REM) sleep latency values (p=0.005) were found to have decreased after the STN DBS treatment, whereas REM sleep durations (p=0,028) and REM sleep percentages (p=0.007) were found to have increased, after the STN DBS therapy. No correlation was found between the ESS scores and Levodopa Equivalent Dosage (LED) or between the scores obtained from the sleep scales and the scores obtained from the UPDRS and BDI. There was also no correlation between sleep scores and other PD-related factors. The findings of this study indicated that STN DBS therapy positively affected the PD patients? sleep. This result was attributed to the neuromodulatory effects of the STN DBS independent of the motor symptoms, depression levels, and LED decrease.

The Efficacy of Combined Electroacupuncture and Auricular Pressure on Sleep Quality in Patients Receiving Methadone Maintenance Treatment.

Previous studies have revealed that the electroacupuncture or auricular-point pressure as a single treatment approach is beneficial for relieving insomniac symptoms among patients under methadone maintenance treatment (MMT). This study is designed to evaluate the clinical efficacy of combining two treatments. This study was a randomized, controlled, crossover trial. A total of 50 participants were recruited from the Linsen Chinese Medicine and Kunming Branches of Taipei City Hospital and randomly assigned to Groups A (25 participants) and B (25 participants). In Group A (electroacupuncture at the Hegu point (LI4) and Zusanli point (ST36) and auricular-point pressure on the Shenmen point) and Group B (only auricular-point), the interventions were implemented biweekly for 4 weeks. After a 1-week washout period, a crossover of the groups was performed. Sleep quality, according to the Pittsburgh Sleep Quality Index (PSQI), and daily attendance rate of MMT were evaluated. Combined therapy significantly improved sleep quality, especially in the PSQI subscales of subjective sleep quality (60.91% vs 20.93%, P < 0.05) and sleep latency (42.59% vs 11.28%, P < 0.05). A significantly higher daily attendance rate was noted in combined therapy than single therapy (87% ± 2% vs 82% ± 2%, P < 0.001). The combination of the electroacupuncture with auricular-point pressure demonstrated high efficacy for improving sleep quality and increasing MMT adherence compared with single therapy of auricular-point pressure. Combined therapy of the electroacupuncture and auricular-point pressing should be introduced as a routine, facilitating treatment for patients under methadone maintenance. (Am J Addict 2020;00:00-00).

Positive Aspects of Caregiving Among Family Caregivers of Individuals With Dementia

Traditionally, caregiving for individuals with dementia has been viewed as a negative experience. Understanding positive aspect of caregiving and related factors is important to improve health among family caregivers. We analyzed baseline data from an ongoing dyadic sleep education trial for individuals with dementia and their caregivers (N=21 dyads; mean age 70.8± 11.1 for caregivers, 80.5± 8.3 for care-recipients). The Positive Aspects of Caregiving (PAC 9-item) was used to assess subjective satisfaction with caregiving. Other measures included Zarit Burden Interview (ZBI), SF-12 Health Survey (SF-12v2), Revised Memory and Behavior Problems Checklist (RMBPC), and Pittsburgh Sleep Quality Index (PSQI). Pearson correlations and t-tests were calculated for analyses. Caregivers most frequently endorsed that caregiving enabled them to appreciate life more (n=16 agreed a lot). Caregivers who began providing care within the first few months of the care-recipient needing care (n=16) had greater positive aspects of caregiving than those who started providing care sometime later (n=5) (36.37±7.33 versus 25.8±8.29, p=0.01). Caregivers with higher PAC scores had lower ZBI score (r=-0.49, p=0.02), better mental health on the SF-12v2 (r=0.53, p=0.01), less distress related to care-recipient behaviors on the RMBPC (r=-0.50, p=0.02), and lower PSQI subscale (perceived sleep quality) score (r= -0.46, p=0.04). Findings suggest that higher positive caregiving experience was associated with better mental health and sleep quality, and less burden and distress from the care-recipients behaviors. More research is needed to better understand this relationship and to determine possible interventions to increase positive aspects of caregiving.

Sleep quality among adults with attention deficit hyperactivity disorder or autism spectrum disorder: which is the role of gender and chronotype?

Both Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) present increased prevalence rates of sleep difficulties, which persist into adulthood. However, it is still unclear whether in adults these disorders show specific sleep patterns and which role is played by comorbidities, circadian preferences and gender. This study aimed to describe and compare subjective measures of sleep in adults with ADHD and high-functioning ASD, in relation to the levels of anxiety and depression, chronotype and gender. In a sample of 136 adults (43 ADHD, 43 high-functioning ASD, 50 controls) subjective sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), and clinical scales were used to assess chronotype and the levels of anxiety and depression. The three groups showed a significant difference in the distribution of chronotypes, with greater prevalence of an Evening chronotype among ASD compared to controls. The MANCOVA using PSQI subscale scores as dependent variables and MEQ-SA score and depression range as covariates showed that the three groups significantly differ in quality, latency, efficiency, and dysfunction scores with a significant differences between ASD and ADHD in efficiency and dysfunction. Compared to men, women showed higher scores on PSQI total and quality subscale across the three groups and higher duration scores only within ASD group. Our results indicate that both ADHD and ASD adults show unique sleep disturbances and suggest that ASD patients, especially women, may display more pronounced disordered sleep.

Analysis of the Change in Sleep Quality in Lung Transplant Recipients

We previously reported that sleep quality is impaired in waitlisted patients for lung transplantation in Japan, and that respiratory symptoms and psychological status were main contributive factors to sleep quality. However, it is unknown whether sleep quality would improve after lung transplantation or not. Then we aim to assess changes in sleep quality and other patient reported measures including health related quality of life (HRQL) after lung transplantation. In this multicentric study, we prospectively collected patient-reported data of 56 lung transplant recipients. We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), HRQL using the St. George's Respiratory Questionnaire (SGRQ), psychological status using Hospital Anxiety and Depression Scale (HADS) and dyspnea using modified Medical Research Council Dyspnea Scale (mMRC). We then examined the changes in sleep quality, HRQL, psychological status and dyspnea within about one year after lung transplantation. We also assessed PSQI subscale scores to examine the details of changes in sleep quality. Interstitial pneumonia (n=24), pulmonary complication after post hematopoietic stem cell transplantation (n=8), chronic obstructive pulmonary disease (n=7) and lymphangioleiomyomatosis (n=7) were the four most frequent indications. HRQL, psychological status and dyspnea significantly improved after lung transplantation (p< 0.0001). The PSQI score neither significantly change from 6.7 ± 3.6 to 7.1 ± 3.8 (p = 0.38), nor the percentage of the patients with poor sleep quality (PSQI > 5) changed significantly from 51.7% (at baseline) to 62.5% (after lung transplantation) (p = 0.25). In PSQI subscales, sleep medication worsened significantly (p= 0.04) after lung transplantation. While lung transplantation had positive impacts on HRQL, psychological status and dyspnea, sleep quality remained unchanged. Sleep quality should be followed separately from those patient-reported measures not to miss its worsening.

Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial.

This randomized, placebo-controlled, crossover, and double-blind trial aimed to examine the possible effects of four weeks L-theanine administration on stress-related symptoms and cognitive functions in healthy adults. Participants were 30 individuals (nine men and 21 women; age: 48.3 ± 11.9 years) who had no major psychiatric illness. L-theanine (200 mg/day) or placebo tablets were randomly and blindly assigned for four-week administration. For stress-related symptoms, Self-rating Depression Scale, State-Trait Anxiety Inventory-trait, and Pittsburgh Sleep Quality Index (PSQI) scores decreased after L-theanine administration (p = 0.019, 0.006, and 0.013, respectively). The PSQI subscale scores for sleep latency, sleep disturbance, and use of sleep medication reduced after L-theanine administration, compared to the placebo administration (all p < 0.05). For cognitive functions, verbal fluency and executive function scores improved after L-theanine administration (p = 0.001 and 0.031, respectively). Stratified analyses revealed that scores for verbal fluency (p = 0.002), especially letter fluency (p = 0.002), increased after L-theanine administration, compared to the placebo administration, in individuals who were sub-grouped into the lower half by the median split based on the mean pretreatment scores. Our findings suggest that L-theanine has the potential to promote mental health in the general population with stress-related ailments and cognitive impairments.