Poor Sleep Group Research Articles

The relationship between sleep quality and diabetic autonomic neuropathy in elder patients with type 2 diabetes mellitus

To explore the relationship between the sleep quality and diabetic autonomic neuropathy of elder patients with type 2 diabetes mellitus. A total of 90 elder patients with diabetes in Beijing Hospital was enrolled in this study. Questionnaires of Pittsburgh Sleep Quality Index(PSQI) were completed to evaluate the quality of sleep and Holter was applied to evaluate heart rate variability (HRV). Other related clinical data such as, catecholamine[epinephrine(E); norepinephrine(NE); dopamine(DA)]and diabetes complications were also collected after admission to the hospital. Patients were divided into three groups: the poor-sleeper group, the common-sleeper group and the good-sleeper group according to PSQI score. HRV and the level of catecholamine were compared among three groups. The level of HRV including meanNN [(743 ± 58) ms vs(824 ± 99)ms and (837 ± 104)ms], ASDNN [(30 ± 10)ms vs (39 ± 14)ms and (41 ± 14)ms], very low frequency(VLF)[(15.33 ± 6.10)ms(2) vs(22.11 ± 7.94)ms(2) and (22.66 ± 7.87)ms(2)], low frequency (LF)[(8.30 ± 3.95) ms(2) vs(12.58 ± 6.11)ms(2) and(12.81 ± 6.96)ms(2)] and LF/high frequency(HF)[(1.23 ± 0.32) vs (1.56 ± 0.46) and (1.47 ± 0.42)] in the poor-sleeper group were lower than in both the common-sleeper group and good-sleeper group (all P<0.05). The level of catecholamine in poor-sleeper group [E: (108.91 ± 4.19)ng/L; NE: (1458.0 ± 50.35)ng/L] were lower than both the common-sleeper group [E: (120.23 ± 4.37) ng/L; NE: (1901.09 ± 131.36)ng/L] and the good-sleeper group [E: (118.23 ± 19.9)ng/L; NE: (1771.87 ± 116.73)ng/L] (all P<0.05), suggesting a dysfunction in autonomic nervous system in subject in the poor-sleeper group. Sleep quality is associated with the severity of diabetic autonomic neuropathy and might be one of clinical features for diabetic autonomic neuropathy.

Salivary melatonin levels and sleep-wake rhythms in pregnant women with hypertensive and glucose metabolic disorders: A prospective analysis.

In preeclampsia and gestational diabetes, the sympathetic nerves are activated, leading to disrupted sleep. Melatonin, which transmits information to regulate the sleep-wake rhythm and other such biorhythms, has been implicated in insulin resistance, antioxidant behaviors, and metabolic syndrome. In addition, its reduced secretion increases the risk of hypertension and diabetes. The aim of this study was to elucidate the features of melatonin secretion, sleep quality, and sleep-wake rhythms in pregnant women with complications. Fifty-eight pregnant women with pregnancy complications (hypertensive or glucose metabolic disorders) and 40 healthy pregnant women completed questionnaires, including sleep logs and the Pittsburgh Sleep Quality Index (PSQI), during the second to third trimesters. Their salivary melatonin levels were also measured. Pregnant women with complications had significantly lower morning (p < 0.001), daytime (p < 0.01), evening (p < 0.001), night (p < 0.01), daily mean (p < 0.001), peak (p < 0.001), and bottom (p < 0.01) melatonin values than healthy pregnant women. Pregnant women with complications also had significantly smaller melatonin amplitudes than healthy pregnant women (p < 0.001). Among pregnant women with complications, the duration (p < 0.05) and frequency (p < 0.01) of wake after sleep-onset were significantly greater in the poor sleep group than in the favorable sleep group which was divided by PSQI cutoff value. Pregnant women with hypertensive or glucose metabolic disorder complications had smaller circadian variation in salivary melatonin secretion, and their values were lower throughout the day than healthy pregnant women.

Comorbidity of poor sleep and primary headaches among nursing staff in north China

BackgroundSleep disorders and primary headaches are both more prevalent among nursing staff than in the general population. However, there have been no reports about the comorbidity of poor sleep and primary headaches among nursing staff.MethodsStratified random cluster sampling was used to select 1102 nurses from various departments in three hospitals in north China. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The diagnosis of primary headaches including migraine, tension-type headache (TTH), and chronic daily headache (CDH) was based on the International Classification of Headache Disorders, 3rd edition (beta version) (ICHD-3-beta).ResultsThe response rate was 93 %. Among 1023 nurses, the prevalence of poor sleep was 56.7 %. Of these, 315 nurses (34.13 %) had poor sleep comorbid with primary headaches. The prevalence of poor sleep in the groups with CDH (82.1 %), migraine (78.9 %), and TTH (59.0 %) was significantly higher than that in the group without headaches (47.3 %) (all P < 0.05). Multivariate logistic regression revealed that rotating shifts and suffering headache were independent risk factors for poor sleep. Also, the 1-year prevalence of the three types of primary headache was significantly increased in the poor sleep group (migraine: 21.2 % vs. 7.2 %; TTH: 27.9 % vs. 24.9 %; CDH: 4.1 % vs. 1.1 %; P < 0.05). Compared with normal sleepers, nurses with poor sleep were 1.72 times more likely to have severe headache (OR: 1.72, 95 % CI: 1.14–2.57).ConclusionComorbidity of poor sleep and primary headaches among nursing staff is common. Therefore, sleep quality should be carefully evaluated in nurses with primary headaches.

The Characteristics of Sleep in Headache Patients

Purpose: To investigate the relationship between headache and sleep by evaluating sleep quality, daytime sleepiness, and specific features related to sleep-disordered breathing (SDB). Methods: One hundred one subjects with headache and 118 healthy controls were enrolled. To collect various information on headache attacks, headache group completed self-reported questionnaire about the characteristics of headache attacks and the migraine disability assessment (MIDAS) questionnaire. The subjective quality of sleep was evaluated in all of the subjects using the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). In addition, the following specific features of sleep were evaluated in 28 subjects selected randomly from each group: apnea-hypopnea index (AHI), prevalence of SDB, nocturnal oxygen saturation (SaO₂), and oxygen desaturation index (ODI) as measured using a portable monitoring device. Results: The global PSQI and the prevalence of poor sleeping (global PSQI ＞5), ESS scores and the prevalence of daytime sleepiness (ESS score ＞10) were significantly higher in the headache group (both p＜0.0001, respectively). The mean scores on the numerical rating scale and the MIDAS were significantly higher in the poor-sleeper group than in the good-sleeper group (p=0.0347 and p=0.0016, respectively). The global PQSI and prevalence of daytime sleepiness were significantly higher in the chronic-headache group than in the acute-headache group (p=0.0003 and p=0.0312, respectively). Conclusions: There is a significant association between headache and sleep. Especially, severity and chronicity of headache were significantly associated with sleep quality and daytime sleepiness.

Impact of inflammatory markers on the relationship between sleep quality and incident cardiovascular events in type 2 diabetes

AimsTo analyze relevance of sleep quality with CVD in T2D patients and determine whether inflammation prompted by poor sleep has impact on the CVD. Methods332 T2D patients were recruited and their sleep qualities were evaluated by PSQI. The patients with PSQI score >7 were in the poor sleep group, and the others were in the good sleep group. Plasma samples of the patients were obtained to measure inflammatory markers. Correlation analyses and regression analyses were performed to examine the cross-sectional relationships among the poor sleep, inflammatory markers and CVD. ResultsThe morbidity of CVD was significantly higher in the poor sleep patients compared to the good sleep patients (P=0.000). PSQI score ORs were both >1 for CVD in model 1 and model 2 (P<0.05). PSQI score were positively related to IL-6 and ICAM-1(P<0.05), negatively to FBI (P<0.05), but not related to CRP in linear regression models. Multiple logistic regression analysis showed IL-6 and ICAM-1, but not FBI and CRP, were related to CVD (P<0.05). ConclusionsPoor sleep is regarded as a plausible risk factor for CVD in T2D patients, and may be mediated by certain inflammatory markers.

The relationship between sleep quality and functional exercise capacity in COPD.

Poor sleep is often associated with a series of health problems in patients with chronic obstructive pulmonary disease (COPD), but the relationship between sleep quality and functional exercise capacity has not been previously investigated. To evaluate the relationship between quality of sleep and functional exercise capacity in clinically stable COPD. One hundred three consecutive subjects with stable COPD were recruited. The subjects were assessed with the Pittsburgh Sleep Quality Index (PSQI) and divided into poor sleep group (PSQI >5) and good sleep group (PSQI ≤5). Subjects were also assessed with spirometry, 6-min walk distance (6MWD), oxygen saturation (SP O2 ), the Epworth Sleepiness Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, COPD Assessment Test (CAT), Modified Medical Research Council dyspnea scale and quadriceps muscle function. Poor sleep was present in 43.69% of the patients with COPD. Subjects with poor sleep had shorter 6MWD (t = -3.588, P < 0.001), greater age (t = 2.519, P = 0.013), worse quality of life (t = 5.487, P < 0.001) and more depression (t = 6.576, P < 0.001) or anxiety (t = 4.245, P < 0.001) symptoms. 6MWD showed significant negative correlations with the PSQI global score (r = -0.373, P < 0.001). Multiple stepwise regresion analysis showed that PSQI global score was an independent psychological predictor of 6MWD, and 6MWD was the only physical predictor of PSQI total score in patients with COPD. There is a close relationship between sleep quality and functional exercise capacity in patients with COPD.

Patterns and predictors of sleep quality before, during, and after hospitalization in older adults.

The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.

Sleep Disturbances and Quality of Life in Patients After Living Donor Liver Transplantation

BackgroundFollowing improvements in patient and graft survival after liver transplantation (LT), the recipients' quality of life has become an important focus of patient care. Sleep is closely related to physical and mental health; however, sleep disturbances in LT patients have not yet been evaluated. MethodsWe assessed 59 LT patients (aged ≥18 years) between September 2011 and September 2012. The patients completed the restless legs syndrome (RLS), 36-item short-form health survey (SF-36), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) questionnaires. In addition, laboratory data were obtained and neuropsychological tests (NPT) were performed during study entry. ResultsThirty-eight patients (64%) were included in the poor sleep group (PSQI ≥6 or ESS ≥10). The SF-36 scores were lower in the poor sleep group than in the good sleep group. Eleven patients (18%) had RLS. An NPT score ≥3 indicated minimal hepatic encephalopathy (MHE3). The MHE3 group consisted of 22 patients (43%). The time after LT was shorter; serum albumin, branched chain amino acid/tyrosine molar ratio (BTR), and role limitations due to poor physical health were lower; and serum ammonia levels were higher in the MHE3 group than in the MHE0-2 group. When the poor sleep group was divided into subgroups (control, MHE, RLS, and unknown), MHE patients had high model for end-stage liver disease scores, high ammonia levels, and low BTR, whereas RLS patients showed a short time after LT. ConclusionSixty-four percent of recipients were classified as poor sleepers. SF-36 scores were lower for poor sleepers than good sleepers. RLS and MHE are major diseases that cause sleep disturbances in patients after LT.

Sleep Disturbances in Korean Patients with Ankylosing Spondylitis are Associated with Increased Disease Activity

Objective. To evaluate the prevalence of sleep disturbance in Korean patients with ankylosing spondylitis (AS), and its association with disease activity and depression. Methods. Forty patients with AS and eighty healthy controls were included in this study. Sleep quality was assessed using the Korean version of Pittsburgh sleep quality index (PSQI). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2). Ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP) was used to evaluate disease activity. Patients were dichotomized into a good sleeper group (PSQI≤5) and a poor sleeper group (PSQI>5). Results. The mean total PSQI score of patients with AS was 7.23±3.84. It was higher than that of the control subjects. AS patients had higher scores in all of the PSQI components, except for the use of sleep medication. Sixty percent of the AS patients were classified as poor sleepers. The mean BASDAI, ASDAS-CRP, and BDI-2 scores of the poor sleeper group were higher than that of the good sleeper group. Significantly, higher disease activity according to ASDAS-CRP was associated with poor sleep quality and depression. Multiple regression analysis revealed that the duration of morning stiffness and depression were independent risk factors that influenced poor sleep quality. Conclusion. Sleep disturbances are prevalent amongst Korean patients with AS. Lower quality of sleep is significantly associated with higher disease activity and depression. Therefore, optimal management to improve sleep quality in patients with AS is important.

Assessment of Physical and Mental Health in Male University Students with Varying Sleep Habits

Healthy sleep habits entail not only sleeping for a sufficient period (quantity) but also regularity of the sleep cycle and getting sound sleep (quality). University students often have erratic schedules that cause irregular sleep patterns even though sleep durations remain relatively constant. This study compared the physical and mental health of 90 male university students with different sleep habits. We created sleep habit scales using the Tokyo Metropolitan Institute for Neuroscience life habits inventory (TMIN-LHI; Miyashita, 1994) by performing a factor analysis and classifying sleeping habits based on regularity, quality, and quantity. Four types of sleep habits were identified by cluster analysis; good sleep was characterized by regular and high quality sleep but of relatively short sleep duration; long sleep was regular and relatively long but of low quality; short sleep was of high quality but short and irregular, while poor sleep was irregular, of low quality, and relatively long. The good sleep group had a significantly lower average waist circumference, and lower systolic and diastolic blood pressure. The long and poor sleep groups, which both had low quality sleep, scored lower than the national standard on the mental component summary (MCS) calculated from the Social Functioning-36 (SF-36) short-form health survey. Furthermore, the average MCS score of the poor sleep group was significantly lower than that of any other sleep habit group. Subjects with poor sleep also scored lowest on the Self-rating Depression Scale (SDS). In addition, the short and poor sleep groups were prone to glucose or lipid metabolism disorders. Maintaining good physical and mental health without sound sleep and a regular sleep cycle is difficult, even if sleeping hours are kept constant. Therefore, we included the assessment of regularity and quality in addition to hours of sleep in order to develop appropriate sleep guidelines for improved physical and mental health.

Do sleep difficulties exacerbate deficits in sustained attention following traumatic brain injury?

Sustained attention has been shown to be vulnerable following traumatic brain injury (TBI). Sleep restriction and disturbances have been shown to negatively affect sustained attention. Sleep disorders are common but under-diagnosed after TBI. Thus, it seems possible that sleep disturbances may exacerbate neuropsychological deficits for a proportion of individuals who have sustained a TBI. The aim of this prospective study was to examine whether poor sleepers post-TBI had poorer sustained and general attentional functioning than good sleepers post-TBI. Retrospective subjective, prospective subjective, and objective measures were used to assess participants' sleep. The results showed that the poor sleep group had significantly poorer sustained attention ability than the good sleep group. The differences on other measures of attention were not significant. This study supports the use of measures that capture specific components of attention rather than global measures of attention, and highlights the importance of assessing and treating sleep problems in brain injury rehabilitation.

Relationship between Sleep Quality and Metabolic Syndrome and Infl ammatory Markers in Middle-aged Men in Korea

Background: As many studies revealed that sleep restriction is associated with obesity and insulin resistance and blood pressure elevation, the relationship between sleep and metabolic syndrome has been concerned. But little information exists on correlation between sleep quality and metabolic syndrome. In this study, we investigated the relationship between sleep quality measured by Pittsburgh Sleep Quality Index (PSQI) and metabolic syndrome. Methods: A total of 100 middle-aged male adults were included in this study from March to May 2008 at a health promotion center. The subjects were divided into two groups of poor sleeper group (N = 47) vs. good sleeper group (N=53) by PSQI global score. The components of metabolic syndrome and infl ammatory markers were measured. The metabolic syndrome criterion of the AHA/NHLBI 2005 was adopted. Results: There was no significant differences in baseline characteristics between the two groups. HDL-cholesterol was signifi cantly lower in the poor sleeper group compared to the good sleeper group (P < 0.05). The negative correlation was noted between subjective sleep quality score with HDL-cholesterol (P < 0.05). There was a positive correlation between sleep latency and triglyceride and a negative correlation with HDL-cholesterol (P < 0.05). The longer sleep latency, the higher level of white blood cell count was observed (P = 0.001). Conclusion: The above data suggest that a possible causal interaction between poor sleep quality and lower HDLcholesterol of metabolic syndrome components and higher level of white blood cell counts. Further prospective studies regarding the change in the components of metabolic syndrome and the risk factors of cardiovascular diseases after relieving sleep disturbance seem to be warranted.

The Effect of Sleep on Quality of Life in Cognitively Impaired Elder

Backgraound: The prevalence of sleep disturbance in patients with Alzheimer’s disease (AD) is common. The purpose of this study is whether quality of sleep (QoS) has effect on quality of life (QoL) in Alzheimer’s disease (AD) patients and amnestic mild cognitive impairment (aMCI) patients or not. Method: The participants were included 44 AD patients and 54 aMCI patients in this study. AD patients met NINCDS-ADRDA criteria for “probable” or “possible” AD and K-MMSE score was more than 16, single or multi domain aMCI patients met Peterson’s Criteria. The QoS was assessed by Pittsburgh Sleep Quality Index (PSQI) and the QoL by Medical Outcome Study Short From-36 (SF-36). Result: Poor sleep was defined by PSQI score more than 6. Therefore, in AD group 23 patients were good sleepers and 21 patients were poor sleepers and in aMCI group 28 patents were good sleepers and 26 patents were poor sleepers. There was no significant difference in the demographic variables demographic factor and global cognitive function which was assessed by K-MMSE and CDR between good sleeper group and poorer sleep group. The poor sleeper group in AD and aMCI had significantly higher depression score and poorer QoL than good sleeper group. The depression played a role as a mediator between QoS and QoL. Conclusion: QoS was also associated QoL in AD and aMCI and depression seemed to play a role as a mediating variable between QoS and QoL. Therefore, QoS had an effect on QoL indirectly rather than directly. In conclusion, sleep has a great effect on cognitively impaired elder, even in very early stage.

Performance on the continuous performance test in children with ADHD is associated with sleep efficiency.

To examine whether the level of sleep efficiency of children diagnosed with ADHD moderates their performance on the Continuous Performance Test (CPT) while receiving a placebo and while receiving methylphenidate (MPH). Nightly sleep actigraphic assessment during a double-blind, placebo-controlled, crossover clinical study (1 week of 0.5 mg/kg MPH; 1 week of placebo) were obtained on 37 children between 6 and 12 years of age with a DSM-IV diagnosis of ADHD. Subjects were divided into 2 groups based on the mean sleep efficiency score during the placebo condition, with subjects above and below the mean placed in the Poor Sleep Group (PSG) and Good Sleep Group (GSG), respectively. Vigilance testing was conducted in the laboratory; sleep was assessed in the home. Sleep was monitored using actigraphy for 2 weeks. In addition, parents were asked to complete nightly sleep logs and a sleep questionnaire. The Conners' Continuous Performance Test (CPT) was used to assess vigilance. Significant interaction of Sleep Group with Medication was found on 1 CPT factor. The findings of the present study support the hypothesis that sleep moderates performance on CPT in children with ADHD while receiving placebo or MPH.

Classification of the sleeping pattern of normal adults.

A questionnaire concerning their sleep-related lifestyle and mental health was mailed to people aged in their twenties to fifties living in the Fukushima (North East), Tokyo (Central, Metropolitan) and Okayama (West) areas of Japan. We classified the sleeping pattern of 3642 people (1702 men, 1940 women; mean age 41.3+/-10.67) by multivariational analyses (factor analysis and cluster analysis). They were classified into six groups and defined as 'poor sleeper group' (30.0%), 'good sleeper group' (28.3%), 'long sleeper group' (8.2%), 'short sleeper group' (18.5%), 'irregular sleeper group' (11.3%), and 'Delayed Sleep Phase Syndrome group' (3.7%) based on their characteristics of the factor pattern.

Melatonin and hormonal changes in disturbed sleep during late pregnancy

Although sleep disturbance is commonly reported in pregnancy, there have been surprisingly few studies on the etiology of this condition. Since most hormones show circadian rhythmicity and maintain specific phase relationships with that of the sleep-wake cycle, it was of interest to establish whether sleep disturbances covaried with endocrine changes. This overnight study of pregnant women compared melatonin, cortisol, and prolactin secretion rhythms in six good sleepers and six poor sleepers. The groups were compared by ratios of the areas under the various hormonal curves. Significant differences in the cortisol/melatonin ratio were found between the poor sleeper group (lower values) and the good sleeper group (higher values). Nonsignificant trends, which might be expected to become significant with larger sample sizes, were found for decreased amplitude in the cortisol rhythm and increased amplitude in the melatonin rhythm in poor sleepers. The decreased amplitude of the cortisol rhythm in poor sleepers appeared to be due to a suppression of the early morning (0500-0800) rise. Prolactin levels were high and showed no rhythmicity in both groups. These differences may reflect changes in the circadian pacemaker system of poor sleepers, with increases in melatonin release being a response to counteract poor sleep.