Poor Subjective Quality Research Articles

Sleep Disturbances in Generalized Anxiety Disorder: The Role of Calcium Homeostasis Imbalance

Patients with a generalized anxiety disorder (GAD) often report preeminent sleep disturbances. Recently, calcium homeostasis gained interest because of its role in the regulation of sleep-wake rhythms and anxiety symptoms. This cross-sectional study aimed at investigating the association between calcium homeostasis imbalance, anxiety, and quality of sleep in patients with GAD. A total of 211 patients were assessed using the Hamilton Rating Scale for Anxiety (HAM-A), Pittsburgh Sleep Quality Index questionnaire (PSQI) and Insomnia Severity Index (ISI) scales. Calcium, vitamin D, and parathyroid hormone (PTH) levels were evaluated in blood samples. A correlation and linear regression analysis were run to evaluate the association of HAM-A, PSQI, and ISI scores with peripheral markers of calcium homeostasis imbalance. Significant correlations emerged between HAM-A, PSQI, ISI, PTH, and vitamin D. The regression models showed that patients with GAD displaying low levels of vitamin D and higher levels of PTH exhibit a poor subjective quality of sleep and higher levels of anxiety, underpinning higher psychopathological burden. A strong relationship between peripheral biomarkers of calcium homeostasis imbalance, insomnia, poor sleep quality, and anxiety symptomatology was underlined. Future studies could shed light on the causal and temporal relationship between calcium metabolism imbalance, anxiety, and sleep.

P 28. The postoperative sleep quality in patients with gynecological cancer

Background . Sleep disturbances appear to be more common in cancer patients than in the general population. Methods. The aim of this study was to evaluate the prevalence of sleep disorders and the factors associated with an alteration in sleep quality in Moroccan women with gynecological cancer postoperatively. A cross-sectional study was carried out in the oncology department of the Ibn Rochd University Hospital, Casablanca, on Moroccan women who had undergone radical surgery for gynecological cancer ( n = 100). A questionnaire translated and adapted to the Moroccan context and composed of socio-demographic and clinical factors as well as the Pittsburgh Sleep Quality Index (PSQI) was used. Results. The majority of patients (78%) were considered to be poor sleepers. Most patients had very poor subjective quality, low sleep latency, a short period of sleep, and a low rate of usual sleep efficiency. The vast majority of these patients were in poor shape during the day and did not use sleeping pills. Conclusion. Sleep disorders affect the quality of life of patients with gynecological cancer. Their screening and management are essential in oncology services. Keywords : gynecological cancer, sleep disorders, sleep quality.

Body image dissatisfaction and lower self-esteem as major predictors of poor sleep quality in gynecological cancer patients after surgery: cross-sectional study

BackgroundSleep quality is among the indicators associated with the quality of life of patients with cancer. A multitude of factors may affect patient sleep quality and are considered as associated predictive factors. The aim of this study was to examine the predictors of poor sleep quality in Moroccan women with gynecological cancer after radical surgery.MethodsA cross-sectional study was carried out at the Oncology Department of the Ibn Rochd University Hospital, Casablanca (Morocco), on women who had undergone radical surgery for gynecological cancer (n = 100; mean age: 50.94 years). To assess sleep quality, symptoms of depression and anxiety, self-esteem and body image, the following translated and validated Arabic versions of the tools were used: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Rosenberg’s Self-Esteem Scale and Body Image Scale. To determine predictors of sleep quality, multiple linear and hierarchical regressions were used.Results78% of participants were considered poor sleepers, most of them exhibited very poor subjective quality (53%), longer sleep onset latency (55%), short period of sleep (42%) and low rate of usual sleep efficiency (47%). 79% of these patients did not use sleep medication and 28% were in poor shape during the day. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. Higher PSQI scores were positively correlated with higher scores of anxiety, depression, body image dissatisfaction and with lower self-esteem (p < 0.001). The medical coverage system, body image dissatisfaction and low self-esteem predicted poor sleep quality. After controlling for the socio-demographic variables (age and medical coverage system), higher body image dissatisfaction and lower self-esteem significantly predicted lower sleep quality.ConclusionBody image dissatisfaction and lower self-esteem were positively linked to sleep disturbance in women with gynecological cancer after undergone radical surgery. These two predictors require systematic evaluation and adequate management to prevent sleep disorders and mental distress as well as improving the quality of life of these patients.

Patterns and predictors of trajectories for subjective quality of life in patients with early psychosis: Three-year follow-up of the randomized controlled trial on extended early intervention.

Subjective quality of life is an important outcome of psychotic disorders. However, longitudinal course of subjective quality of life in the early illness stage is under-studied. We aimed to investigate the patterns and baseline predictors of subjective quality of life trajectories over 3 years in early psychosis patients, utilizing growth mixing modeling analysis, in the context of a 3-year follow-up of a randomized controlled trial comparing 1-year extension of early intervention with step-down psychiatric care for first-episode psychosis. One hundred sixty Chinese patients were recruited from specialized early intervention program for first-episode psychosis in Hong Kong after they had completed this 2-year early intervention service, and underwent 1-year randomized controlled trial as well as 2-year post-randomized controlled trial follow-up (i.e. 3-year follow-up). Assessments on premorbid adjustment, onset profile, psychopathology, functioning and treatment characteristics were conducted. Individual class membership of subjective quality of life trajectory derived from growth mixing modeling was based on the 36-Item Short Form Health Survey mental component summary scores measured at four different time-points (baseline, 1, 2 and 3 years) among 142 participants across 3-year follow-up. Three distinct subjective quality of life trajectories were identified including higher-improving (68.3%, n = 97), lower-stable (24.6%, n = 35) and deteriorating (7%, n = 10) trajectories. Age of onset; duration of untreated psychosis; depressive, positive and negative symptoms; and intervention condition were significantly different between good (higher-improving trajectory) and poor (combined lower-stable and deteriorating trajectories) trajectory groups. Multiple regression analysis revealed that younger age of onset, more severe depression and receipt of step-down care independently predicted poor subjective quality of life trajectory. Approximately one-third of patients displayed poor subjective quality of life trajectory in the early phase of psychotic illness. Our results affirm depression as a critical determinant of prospective subjective quality of life and underscores positive effect of extended early intervention on sustained subjective quality of life improvement. Further longitudinal research is warranted to facilitate better characterization of subjective quality of life course patterns and development of targeted intervention to optimize subjective quality of life in patients with early psychosis.

Relationship between sleep disturbances, lipid profile and insulin sensitivity in type 1 diabetic patients: a cross-sectional study.

Objective The consequences of sleep deprivation in type 1 diabetes (T1D) patients are poorly understood. Our aim was to determine how sleep disorders influence lipid profile and insulin sensitivity in T1D patients. Materials and methods This was a cross-sectional study at a public university hospital. Demographic information and medical histories were obtained during regular scheduled visit of T1D patients to the outpatient clinic. Insulin sensitivity was obtained using the estimated glucose disposal rate (eGDR) formula. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Berlin Questionnaire. Results The adult participants (n = 66, 62% women) had a median age of 28.0 years (interquartile range 21.8-33.0). Six patients (9%) had metabolic syndrome according to the International Diabetes Federation criteria. Thirty patients (46%) were considered poor sleepers according to the Pittsburgh Sleep Quality Index. The LDL-c and total cholesterol levels of poor sleepers were higher than those of good sleepers (103 v. 81; p = 0.003 and 178.0 v. 159.5 mg/dL; p = 0.009, respectively). Three patients (4%) were at high risk of obstructive sleep apnea syndrome (OSAS) according to the Berlin Questionnaire. The eGDR was lower in the group of patients with high probability of having OSAS (6.0 v. 9.1 mg.kg-1.min-1;p = .03). Conclusions Poor subjective quality of sleep and higher risk of OSAS were correlated with a worsened lipid profile and decreased insulin sensitivity, respectively. Therefore, T1D patients with sleep disturbances might have an increased cardiovascular risk in the future.

Predictor of sleep difficulty among community dwelling older populations in 2 African settings.

Sleep deprivation is a common phenomenon among older population and is commonly linked to behavioral, physiological, and psychosocial factors. Not much is known about sleep deprivation among older population in Africa. Therefore, in this study we aimed to investigate the basic sociodemographic and psychosocial predictors of self-reported sleep deprivation among older population.In this study we analyzed cross-sectional data on 1495 community dwelling men and women aged 50 years and above. Data were collected from the SAGE Well-Being of Older People Study conducted in South Africa and Uganda. Outcome variable was self-reported sleep difficulty last 30 days. Multivariable logistic regression models were used to identify the variables significantly associated with sleep difficulty.The prevalence of mild-moderate sleep difficulty was 32.6% (27.9, 37.6) and severe/extreme 23.0% (20.3, 26.0) respectively. Multivariable analysis revealed that sleep difficulty was associated with several behavioral, environment, and illness conditions. In South Africa, those who reported dissatisfaction with living condition had 1.592 [1.087, 2.787] times higher odds of reporting mild/moderate sleep difficulty. Poor subjective quality of life (QoL) was associated with higher odds of severe/extreme sleep difficulties (odds ratios [OR] = 4.590, 95% confidence interval [CI] = 2.641, 7.977 for South Africa, and OR = 4.461, 95% CI = 2.048 and 9.716 for Uganda). In Uganda, perceived depression was associated with higher odds of severe/extreme (OR = 2.452, 95% CI = 1.073, 5.602) sleep difficulties among men, and both mild/moderate (OR = 1.717; 95% CI = 1.011, 2.914) and severe/extreme sleep difficulties among women (OR = 2.504, 95% CI = 1.408, 4.453).More than half of the participants had sleep difficulty of certain degrees, emphasising an urgent need for intervention for sleep deprivation in the population. Interventions targeting to promote subjective health, quality of life, and living environment may prove beneficial for improving sleep health in this regard.

Sleep-related Cognitions Mediate the Impact of Neuroticism on Insomnia.

Our study aimed to explore how neuroticism and neuroticism-related traits as well as sleep-related cognitions (dysfunctional beliefs and subjective quality of sleep) influence the emergence of insomnia using a mediational model. A cross-sectional study was conducted in which 159 insomniac patients paired with 159 normal sleepers in sex and age (N = 318) completed an online questionnaire. At the global level, dysfunctional beliefs and poor subjective quality of sleep mediated the neuroticism-insomnia path; at the trait-specific level, these variables mediated the anxiety-insomnia path and partially mediated the effects of vulnerability and self-consciousness on insomnia; some other relations were essentially indirect effects (between depression and insomnia). These findings extend our understanding of how neuroticism is a predisposing factor of insomnia. This knowledge could be helpful to shape prevention and intervention programs to treat insomnia.

Depression and sleep problems in a Nigerian family practice setting

Depressive symptoms in family practice clinics are often undetected, despite the fact they are associated with sleep disorders. There is paucity of data on the association between depression and sleep disorders in a Nigerian family practice setting, hence the need for this study. This was a hospital based study. Systematic sampling method was used in recruiting the patients. The PHQ-9 was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the quality and patterns of sleep in the respondents. One hundred and seventy eight (44.5%) out of the four hundred respondents were found to have one form of depression or other, out of which one hundred and seventy two (96.6%) had sleep disturbance, 39 (21.9%) stayed more than 60 minutes before falling asleep, 85 (47.7%) had poor subjective sleep quality, forty eight (36.9%) had taken medication (prescribed or over the counter) to assist in sleeping. These were statistically significant (p-values = 0.001, 0.000, 0.000 and 0.000) respectively. One hundred and fifty three (85.9%) were poor sleepers. One hundred and sixty one (90.4%) had habitual sleep efficiency greater than 85%, while 60 (33.7%) had trouble staying awake while driving, eating meals or engaging in social activities. Depression is common in primary care patients and is associated with sleep disturbance, sleep latency, poor subjective quality and medication before sleep. Sleep evaluation should be part of routine assessment of the new patients presenting at a family practice setting

Subjective quality of life in At‐Risk Mental State for psychosis patients: relationship with symptom severity and functional impairment

The understanding of factors related to poor subjective quality of life (sQoL) in early psychosis patients is important for both research and treatment efforts. This study examined how sQoL is associated with age at onset of prodromal symptoms, duration of untreated illness (DUI), symptom severity, premorbid functioning and current functional impairment in At-Risk Mental State (ARMS) for psychosis patients. Forty ARMS patients were assessed for sQoL, symptom severity, premorbid functioning, and social and role functioning. As expected, a large number of significant and negative correlations between sQoL domains and several symptom dimensions emerged, especially for negative symptoms, behavioural change and depression. Poor premorbid functioning in late adolescence was associated with impairments in the psychological health and social relationship domains of sQoL. Current functional impairment was associated with all sQoL domains. Neither age at onset of prodromal symptoms nor DUI was related with sQoL. Findings indicate that different domains of sQoL are differentially and meaningfully associated with symptom severity and functional impairment, suggesting that greater symptom severity and poor functioning are already related with decreased sQoL in the ARMS for psychosis stage. Furthermore, findings highlight the importance of examining functional impairment and affective-motivational symptoms in future research on sQoL in ARMS populations due to their strong relationship with poor sQoL. Finally, findings underscore the importance of addressing the social and occupational dysfunctions already present in early psychosis with psychosocial interventions.

Repercussion of sleep quality and daytime sleepiness on postural steadiness in menopausal women

Introduction Changes on perceived sleep quality are recognized to impact severely on functionality. They have been reported to be increased in women menopause period. This study investigates whether poor sleep quality and daytime sleepiness in a midlife women sample are associated with postural steadiness. Materials and methods The sample comprises 112 women aged 51–69 characterized for being in the menopause period. Data were obtained from the participants during two laboratory assessment separated by no more than one week. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and the daytime sleepiness with the Epworth Sleepiness Scale. Postural steadiness was measured according to different test scores: one leg stance test, Minibest test battery and dual task Timed up & Go Test (TUG) combined with manual and cognitive tasks. The relationship between sleep quality, sleepiness and postural steadiness were assessed by lineal correlations between these variables. Results Global PSQI score was linked significantly with TUG results (r: 0.488, p 0.001). Sleep disturbances score (0.365, 0.425, p 0.001), sleep duration (0.290, 0.267, p 0.001 ) and sleep efficiency (0.263, 0.327, p 0.001) were linked to lower values in cognitive and manual tasks added to TUG, respectively. Results in Minibest test showed no relationship with global PSQI score (0.269, p = 193). Conclusion There is a relationship between poor subjective quality of sleep and postural steadiness disturbances in menopausal women. Sleep quality disorders should be taken into account in this population because they are very prevalent and they play an important role in functionality.

Factors associated with subjective quality of life in Korean patients with depressive disorders: the CRESCEND study

A number of studies suggest that depression is associated with the significant disability and the poorer subjective quality of life (QOL). We aimed to assess subjective QOL in Korean patients with depression and explore the factors (sociodemographic characteristics and clinical features) associated with subjective QOL. We obtained the data from 808 depressive patients who entered the Clinical Research Center for Depression (CRESCEND) study and evaluated the relationship between subjective QOL and personal sociodemographics, and various clinical features, including depressive severity, and subjective QOL. We assessed subjective QOL using the 26-item abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) instrument. Decrements in patients' physical health, psychological health, social relationships, and environment domains of subjective QOL were all strongly associated with the greater depressive symptom severity. After controlling for age and depressive symptom severity, the lower subjective QOL was independently related to being divorced or separated, the less monthly household income, and having no religious practices. Our results suggest the importance of sociodemographic characteristics in addition to symptoms for the understanding of subjective QOL in depressed patients. The prospective studies to compare the different treatments' effects on various subjective QOL domains are needed.

Insight and quality of life in schizophrenia: recent findings and treatment implications

Several studies have reported that patients with schizophrenia lack awareness of having a mental disorder or symptoms of a mental disorder. The concept of insight has long been considered important for engagement in treatment, psychotherapeutic progress and good prognosis. Contradictory results were found regarding the relationship between insight into illness and quality of life in patients with schizophrenia. Although previous studies found an inverse or no significant association, recent studies reported that greater insight into illness is significantly associated with an increase in depression and poor subjective quality of life. Patients with good insight might realize their restrictions more clearly. The stigma of being mentally ill and the need for treatment or hospitalization are serious psychological strains. The increase of depression and suicidal ideation and decrease in subjective quality of life in patients with better insight underline the importance of insight for the clinical course in schizophrenia. The inclusion of modules focussing on depressive symptoms and quality of life-related aspects to psychoeducational programmes, as well as a greater awareness of the physician for these questions and a strengthening of the therapeutic alliance, might help improve insight without the risk of deteriorating mood and quality of life.

Sleep disturbances in depression and the effects of antidepressants

Depressed patients often report sleep problems, which usually include difficulties with initiation and maintenance of sleep, as well as poor subjective quality of sleep. Such reports are confirmed by objective analysis of depressed patients’ sleep through polysomnography, although there is no exact correspondence between subjective and objective measurements. In the present paper, we discuss some methodological problems related to the subjective estimates of sleep. Further, we review the differential effects of the various classes of antidepressants on subjective sleep parameters, as well as on sleep onset latency, continuity of sleep, sleep efficiency and rapid eye movement (REM) sleep verified with sleep recordings. Finally, we discuss the attempts to use these and other indices, such as delta sleep ratio (DSR), as signposts of the course of the illness, and predictors of response to treatment.

How Well Do Train Driver's Sleep in Relay Vans?

Relay working operations typically require two crews of train drivers to work a rotating 8-h schedule for two or more days. While one crew is driving, the other has the opportunity to sleep onboard the train. The current study investigated the impact of relay work on drivers sleep quantity and quality. Fourteen drivers wore wrist activity monitors and completed sleep/wake diaries for 3 d prior to and during short (<48 h) relay trips. Drivers obtained an average of 7.8 h sleep per night while at home, and an average of 4 h sleep per opportunity during the relay trip. Sleep obtained in the relay van was associated with longer sleep onset latencies, lower efficiency and poorer subjective quality than sleep at home. During the relay trip, drivers obtained significantly more sleep during opportunities that occurred in the evening, than those that occurred early morning or during the day. These findings suggest that while drivers are able to obtain sleep during short relay operations, it is of poorer quality than sleep obtained at home. Further, the timing of the sleep opportunities during the relay trip impacts on the quantity and quality of sleep obtained.

Nutritional status and its relationship to quality of life in a sample of chronic hemodialysis patients

Objective: To assess the relationship between nutritional status and quality of life in a sample of chronic hemodialysis patients. Design: Cross-sectional study. Setting: Haemodialysis Units of St Vincent's and St George Hospitals, Sydney, Australia. Patients: Sixty-four patients participated in the nutritional assessment, of which 53 completed the quality of life questionnaire. Intervention: Nutritional status was assessed using subjective global assessment in addition to a number of anthropometric and biochemical parameters. Quality of life was assessed by means of a patient questionnaire and assessment of physical functioning. Main outcome measures: Nutrition status, 6 quality of life subscales related to general well-being, health and functioning, social and economic, psychological/spiritual well-being, and family life, employment status, income, participation in recreational/sports activities, the number of hospital admissions, days of hospitalization, and lengths of hospital stay. Results: Sixty-four percent of patients were well nourished, 23% were moderately malnourished, and 13% were severely malnourished. Malnutrition was associated with poorer subjective quality after controlling for the affects of sociodemographic and medical variables. Severe malnutrition was also independently associated with poorer physical function, and resulted in significantly more hospital admissions, more days of hospitalization, and longer average lengths of hospital stay. Conclusion: Malnutrition is common in chronic hemodialysis patients and is associated with poorer quality of life when the degree of malnutrition becomes severe. Prospective studies are required to determine whether improving the nutritional status of these patients will result in meaningful improvements in quality of life and other medical outcomes.

Sleep and Breathing at High Altitude.

Sleep at high altitude is characterized by poor subjective quality, increased awakenings, frequent brief arousals, marked nocturnal hypoxemia, and periodic breathing. A change in sleep architecture with an increase in light sleep and decreasing slow-wave and REM sleep have been demonstrated. Periodic breathing with central apnea is almost universally seen amongst sojourners to high altitude, although it is far less common in long-standing high altitude dwellers. Hypobaric hypoxia in concert with periodic breathing appears to be the principal cause of sleep disruption at altitude. Increased sleep fragmentation accounts for the poor sleep quality and may account for some of the worsened daytime performance at high altitude. Hypoxic sleep disruption contributes to the symptoms of acute mountain sickness. Hypoxemia at high altitude is most severe during sleep. Acetazolamide improves sleep, AMS symptoms, and hypoxemia at high altitude. Low doses of a short acting benzodiazepine (temazepam) may also be useful in improving sleep in high altitude.

Effects of repeated ritanserin on middle-aged poor sleepers

Nine subjects who believed themselves to be poor sleepers, of mean age 58 years, took a placebo for 7 days, then ritanserin 5 mg for 20 days, followed by 3 days on placebo. Sleep was recorded electrophysiologically on 2 nights during baseline, 2 early drug nights, 2 late drug nights and the 2nd and 3rd withdrawal nights. Ratings of sleep quality were collected each morning. Ritanserin, a 5HT2 antagonist, caused a persistent doubling of the amount of EEG slow wave sleep, without altering the total duration of sleep. Ritanserin decreased the frequencies of awakening and after about a week it appeared to improve the subjective quality of sleep. Sleep was then impaired during withdrawal, as indicated by decreased duration and poorer subjective quality, being worst on the 3rd withdrawal night.