Predictors Of Poor Sleep Quality Research Articles

Predictors of poor sleep quality and excessive daytime sleepiness in Turkish adults with type 2 diabetes

Predictors of poor sleep quality and excessive daytime sleepiness in Turkish adults with type 2 diabetes

Quality of Sleep in Patients With Bipolar I Disorder During Remission

Sleep disturbances have been noted not only during affective episodes in bipolar disorder, but also between affective episodes. The goal of this study was to assess and identify determinants of sleep quality in patients with bipolar I disorder. This cross-sectional study enrolled patients with bipolar disorder who were currently in remission. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Mood symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (Ham-D). Adherence was assessed using the Medication Adherence Rating Scale. The mean age in the sample (N=103) was 37.4 years; 44.7% of the sample were men. On the basis of PSQI scores, 41 patients (39.8%) were poor sleepers. Poor sleepers had significantly higher Ham-D scores (mean score of 1.8 vs. 0.9, P=0.012) and higher rates of medication nonadherence (36.6% vs. 11.3%, P=0.002). The relationship between Ham-D scores and sleep quality did not remain significant when the sleep-related items on the Ham-D were removed. Logistic regression analysis suggested that medication nonadherence was the only independent predictor of poor sleep quality in this study. A significant proportion of patients with bipolar disorder who are in remission have sleep problems that seem to be independent of core symptoms of depression.

Disturbed sleep in type 2 diabetes mellitus independent of chronic complications, pain, and nocturia

This study was to compare the sleep quality in people with type 2 diabetes with healthy controls and to investigate the association of diabetes and sleep quality in people with type 2 diabetes without chronic complications. We also explored the effect of pain, nocturia, and obstructive sleep apnea (OSA) on sleep quality. Four hundred and five people were recruited in this case-control study. Sleep quality was assessed in 202 people with type 2 diabetes and was compared with 203 healthy individuals. All diabetic people were free from chronic complications. The Persian version of Pittsburgh Sleep Quality Index (PSQI) was used for the assessment of sleep quality. Poor sleep quality was defined as PSQI score >5. Poor sleep quality was more prevalent in people with type 2 diabetes. The odds ratio for poor sleep quality was 2.63 in people with long-standing diabetes (diabetes duration ≥10 years). Although the PSQI score was slightly better in diabetic people without pain/nocturia (P = 0.03), the prevalence of disturbed sleep showed no significant change after excluding these people from analysis. Diabetes was associated with 1.77-fold increase in risk of OSA, and poor sleep quality was more frequent in diabetic people at high risk for OSA (P = 0.005) independent of body weight. Long-standing diabetes was a significant predictor of poor sleep quality. Furthermore, the effect of diabetes on sleep quality was independent of its complications and other intervening risk factors such as pain/nocturia. Diabetes was also associated with OSA, stronger than the observed association between obesity and OSA.

The Relationships Among Sleep Quality and Chronotype, Emotional Disturbance, and Insomnia Vulnerability in Shift Nurses.

Shift work is a prominent feature of most nursing jobs. Although chronotype, emotional disturbance, and insomnia vulnerability are important factors for patients with insomnia in general, their effects on shift nurses are unknown. This study explores the relationships between the sleep quality of shift nurses and the variables of chronotype, emotional disturbance, and insomnia vulnerability. A survey was conducted with 398 shift nurses in a medical center. Chronotype, emotional disturbance, insomnia vulnerability, and sleep quality were evaluated using the Smith Morningness-Eveningness Questionnaire, the Brief Symptom Rating Scale, the Ford Insomnia Response to Stress Test, and the Pittsburgh Sleep Quality Index, respectively. On the Pittsburgh Sleep Quality Index, 70.1% of the participants scored higher than 5. Multiple regression analysis revealed that, together with night shift work (b [SE] = 1.05 [0.35], p = .003), higher levels of emotional disturbance (b [SE] = 0.30 [0.05], p < .001) and higher insomnia vulnerability (b [SE] = 0.18 [0.03], p < .001) were predictors of poor sleep quality and that chronotype was not a predictor of poor sleep quality. The multiple mediator model indicated that emotional disturbance significantly mediated an indirect effect of evening chronotype preference on poor subjective sleep quality (one subscale of the Pittsburgh Sleep Quality Index). In addition to shift patterns, emotional disturbance and high insomnia vulnerability are factors that may be used to identify shift nurses who face a higher risk of sleep disturbance. Because evening chronotype may indirectly influence subjective sleep quality through the pathway of emotional disturbance, further research into the mechanism that underlies this pathway is warranted.

(640) - Predictors and Outcomes of Sleep Quality the First Year After Lung Transplantation

Sleep quality affects recovery and ability to perform self-management among individuals living with chronic illness. The aims of this study were to identify the prevalence and predictors of poor sleep quality and the associations between sleep quality and self-management behaviors and health outcomes 12 months after transplantation.

Predictors of poor sleep quality and excessive daytime sleepiness in Turkish adults with type 2 diabetes.

Journal of Clinical NursingVolume 24, Issue 9-10 p. 1436-1439 Research in Brief Predictors of poor sleep quality and excessive daytime sleepiness in Turkish adults with type 2 diabetes Belgüzar Kara RN, Corresponding Author Belgüzar Kara RN Associate Professor, Instructor Department of Internal Medicine Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey Correspondence: Belgüzar Kara, Associate Professor, Instructor, Gülhane Askeri Tıp Akademisi, Hemşirelik Yüksekokulu, 06013 Ankara, Turkey. Telephone: +90 312 3041565. E-mail: sb.kara@mynet.comSearch for more papers by this authorÖzge Kılıç RN, Özge Kılıç RN Nurse Department of Endocrinology and Metabolism Diseases, Gulhane Military Medical Academy, Ankara, TurkeySearch for more papers by this author Belgüzar Kara RN, Corresponding Author Belgüzar Kara RN Associate Professor, Instructor Department of Internal Medicine Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey Correspondence: Belgüzar Kara, Associate Professor, Instructor, Gülhane Askeri Tıp Akademisi, Hemşirelik Yüksekokulu, 06013 Ankara, Turkey. Telephone: +90 312 3041565. E-mail: sb.kara@mynet.comSearch for more papers by this authorÖzge Kılıç RN, Özge Kılıç RN Nurse Department of Endocrinology and Metabolism Diseases, Gulhane Military Medical Academy, Ankara, TurkeySearch for more papers by this author First published: 25 November 2014 https://doi.org/10.1111/jocn.12710Citations: 6 This manuscript was presented as a poster presentation at the 50th National Diabetes Congress, Antalya, Turkey, April 23–27, 2014. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume24, Issue9-10May 2015Pages 1436-1439 RelatedInformation

Sleep status of cervical cancer patients and predictors of poor sleep quality during adjuvant therapy.

This study was designed to detect the prevalence of poor sleep quality in cervical cancer patients before and after adjuvant therapy, determine whether the prevalence of poor sleep quality in cervical cancer patients is higher than that in the general population, and analyze the factors associated with poor sleep quality. A total of 76 stages I and II cervical cancer patients and 116 female residents completed the Pittsburgh Sleep Quality Index (PSQI). Patient Neurotoxicity Questionnaire (PNQ), Distress Thermometer (DT), Multidimensional Fatigue Inventory, and Hospital Anxiety and Depression Scale were used to measure the patients' chemotherapy-induced peripheral neurotoxicity (CIPN), psychological distress, fatigue, anxiety, and depression. Data on social support and exercise were collected by the questionnaire. Logistic regression was used to identify the factors associated with poor sleep quality. Prevalence rates of poor sleep quality were 27.59 % for female residents, 52.63 % for patients before adjuvant therapy, and 64.50 % for patients after adjuvant therapy. The distributions of the PSQI scores of the patients before (Z = 3.814, P < 0.001) and after (Z = 5.957, P < 0.001) adjuvant therapy were different from those of the residents. The difference in the PSQI scores before and after adjuvant therapy among cervical cancer patients was significant (P = 0.007). The factors associated with poor sleep quality were high DT score (P = 0.045), depression (P = 0.028), anxiety (P = 0.027), high PNQ grade (P = 0.016), and chemotherapy + radiotherapy treatment (P = 0.017). Exercise was a protective factor for poor sleep quality (P =0.019). The prevalence of poor sleep quality in stages I and II cervical cancer patients was approximately twice than that of women in the communities. Cancer treatment considerably affected sleep quality. Psychological distress, depression, anxiety, and high grade of CIPN during adjuvant therapy were factors associated with poor sleep quality. Exercise during adjuvant therapy could reduce the risk of poor sleep quality.

The relationship between white coat hypertension and sleep quality

Impaired sleep quality is frequently associated with hypertension.The present study aims to examine self-reported sleep quality of patients with white coat hypertension. A total of 74 subjects who were evaluated in a cardiology outpatient clinic, including 39 normotensive subjects and 35 patients with white coat hypertension between the ages of 20 and 65 were included in this study. Patients with elevated office blood pressure (≥140/90 mm Hg) and normal 24-h and daytime ambulatory blood pressure (<125/80 mm Hg and <130/85 mm Hg, respectively) were defined as white coat hypertension. Patient’s sleep quality was evaluated using the Pittsburgh sleep quality index. Global Pittsburgh sleep quality index score was significantly higher in patients with white coat hypertension than normotensive subjects (7.2 ± 3.7 vs. 5.1 ± 3.8, P =0.01). Poor sleep quality was present in 65% of patients with white coat hypertension, and in 30% of the normotensive group (P = 0.003). A multiple logistic regression analysis showed that white coat hypertension (odds: 6.7 (95% confidence interval [CI] 1.22–36.64), P = 0.03) and female gender (odds: 10.1(95% CI 1.35–76.32), P = 0.02) were independent predictors of poor sleep quality. In conclusion, white coat hypertension seems to be associated with impaired sleep quality.

Prevalence and Predictors of Poor Sleep Quality in Mild Cognitive Impairment

To investigate the prevalence of and contributors to poor sleep quality in patients with mild cognitive impairment (MCI). Data were collected for 158 patients meeting the criteria for MCI. Measures included the Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Mini-Mental State Examination. Demographic, lifestyle, medication, and substance use data were also collected. A total of 63% of patients with MCI demonstrated sleep disturbance, a significantly higher rate than that of the controls (44%; chi-square = 8.77; P = .003). Depressive symptoms, cognition, antidepressant usage, alcohol consumption, age, and education were identified as significant predictors of self-reported sleep quality in patients with MCI (R(2) = .327, F 6,145 = 11.729, P < .0001). Sleep disturbance occurs in around two-thirds of patients with MCI. Interventions addressing depression, cognition, and substance and medication use may improve sleep quality in MCI.

Predictors of poor sleep quality among Lebanese university students: association between evening typology, lifestyle behaviors, and sleep habits

Adequate, good night sleep is fundamental to well-being and is known to be influenced by myriad biological and environmental factors. Given the unavailability of sleep data about Lebanon, the cultural shifts and socioeconomic pressures that have affected many aspects of society, particularly for students and working adults, as well as our understanding of sleep in university students in other countries, we conducted a national study to assess sleep quality and factors contributing to sleep and general health in a culture-specific context. A self-filled questionnaire, inquiring about sociodemographics, health-risk behaviors, personal health, and evaluating sleep quality and chronotype using standard scales was completed by 540 students at private and public universities in Lebanon. Overall, they reported sleeping 7.95±1.34 hours per night, although 12.3% reported sleeping <6.5 hours and more than half scored in the poor-sleeper category on the Pittsburgh Sleep Quality Index (PSQI). Sleep timing differed markedly between weekdays and weekends, with bedtimes and wake-up times delayed by 1.51 and 2.43 hours, respectively, on weekends. While most scored in the “neither type” category on the Morningness–Eveningness Questionnaire (MEQ), 24.5% were evening types and 7.3% were morning types. MEQ score was significantly correlated with smoking behavior and daily study onset, as well as with PSQI score, with eveningness associated with greater number of cigarettes, later study times, and poor sleep. We conclude that the prevalence of poor sleep quality among Lebanese university students is associated with reduced sleep duration and shifts in sleep timing between weekdays and weekends, especially among evening types. While chronotype and certain behavioral choices interact to affect sleep dimensions and quality, raising awareness about the importance of obtaining adequate nighttime sleep on daily performance and avoiding risky behaviors may help Lebanese students make better choices in school and work schedules.

Sleep quality in college students: a study about the contribution of lifestyle, academic performance and general well-being

Sleep assumes a major role in human functioning. The aim of this study was to describe features concerning sleep quality, lifestyle, general well-being and academic satisfaction/ performance in college students; characterize the relationship between sleep quality and several aspects related to lifestyle, levels of personal/social well-being and academic performance/satisfaction and to identify predictive factors of poor sleep quality in this population. The sample of this descriptive, cross-sectional, analytic study was collected during six days, in November 2009. 574 students from Minho University completed an online survey about sleep habits. The questionnaire included the Pittsburgh Sleep Quality Index and an author-designed group of questions about lifestyle, academic performance and general wellbeing. All statistic analysis was performed using Statistic Package for the Social Sciences version 17. From the assessed students, 64.8% presented poor sleep quality. An association was found between those subjects and lower levels of academic success and satisfaction, worse adaptation to scholastic demands, worse opinion about conditions of the place where sleep occurs, more physical and psychological symptoms, learning problems, daily and academic organization problems and poorer relationships with peers and intimate relationships. Logistic regression analyses identified smoking habits and caffeine intake, a higher punctuation on “Symptoms/difficulties/problems” index and less satisfaction with life and support received from social relationships as predictors of poor sleep quality. Still, 53.3% of students considered the quality of their sleep as fairly good, and the vast majority (88.7%) denied use, in the previous month, of psychotropic medication with effects on sleep. Nonetheless, about 10.1% of the subjects admitted having resorted to any kind of expert help for problems related to sleep. In Portugal, there is still a lack of information regarding this subject. Results showed that poor sleep quality is present at alarming levels in this college student population. The recognition of the factors involved in the deterioration of sleep quality in this group, namely trough prospective design studies, would contribute to outline prevention and intervention health programs, improving global assistance to these subjects. The authors thank to all participants and institutions involved in this study.

Sleep quality among primary care attendees in Kaduna, Northern Nigeria: a case-control study.

To assess sleep quality and its determinants among primary care patients in a Northern Nigerian setting. We administered the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale to 217 consecutive patients attending the General Outpatient Clinic of Barau Dikko Specialist Hospital, Kaduna, and PSQI to 223 age-matched controls to evaluate their sleep quality and levels of anxiety and depression. A data collection sheet was used to record the sociodemographic characteristics of patients and controls, and the clinical characteristics of the patients. The mean ages of all the subjects, patients, and controls were 33.7 (SD 10.6), 33.5 (SD 10.6), and 34.0 (SD 10.5) years respectively; 54.4% of the patients were females, 54.8% were Muslims, 56.2% admitted they had pain, 60.8% and 46.5% had anxiety and depressive symptoms respectively, while 68.7% had poor sleep quality. The mean global score of sleep quality for patients was 9.2 (SD 3.6) while that of the control was 3.8 (SD 1.4). The difference was statistically significant (t = 20.834, P value < 0.001, 95% CI 4.891-5.910). Islamic religious faith, presence of pain, anxiety symptoms, and depressive symptoms were significantly associated with poor quality of sleep (P value < 0.05). Multiple regression analysis identified being a Muslim (OR 6.422, P value 0.027, 95% CI 0.196-0.907), pain (OR 8.038, P value < 0.001, 95% CI 0.016-0.091), and anxiety symptoms (OR 5.253, P value < 0.001, 95% CI 0.136-0.473) as predictors of poor sleep quality among the patients. Poor quality of sleep is common in primary care patients. Efforts should be made to improve its recognition, identify associated factors, and consider a holistic approach to patients' care.

Psychosocial work characteristics and sleep quality: a systematic review of longitudinal and intervention research

The objective of this study was to review longitudinal and intervention studies examining the association between psychosocial work characteristics (eg, job demands, job control, and social support) and sleep quality. Our main research aims were to examine whether (i) psychosocial work characteristics are a predictor of sleep quality, and (ii) sleep quality, in turn, is a predictor of psychosocial work characteristics. A systematic literature search resulted in 20 relevant papers, of which 16 were longitudinal studies and 3 were intervention studies (1 study was discussed in separate papers). To quantify results, we assessed the strength of evidence of all examined associations and subsequently evaluated the studies' research quality based on predefined quality criteria. One intervention and three longitudinal studies studies were categorized as being of high-quality. In longitudinal studies, we found consistent and strong evidence for a negative relation between job demands and sleep quality as well as evidence for a positive relation between job control and sleep quality. Other psychosocial work characteristics were examined in an insufficient number of (high-quality) studies. Moreover, both intervention studies as well as studies investigating reversed and reciprocal relations are rare, which further limits the possibility of drawing conclusions on causality. Based on the current literature, it can be concluded that high job demands and low job control are predictors of poor sleep quality. More high-quality research is needed to examine the possible causal relationship between these and other psychosocial work characteristics with sleep quality, in addition to research focusing on reversed and reciprocal relations.

Prevalence and predictors of poor sleep quality in Korean older adults

The purposes of this study were to evaluate the levels of sleep quality and to examine its related factors in the elderly Korean adults. A cross-sectional research design was used, and 157 adults, aged from 65 to 89, were recruited from five community health centres in Gyeonggi province and Seoul, Korea. All participants were informed about the purpose of the study and were asked to provide demographic characteristics, chronic conditions, self-rated health, pain, depression, life satisfaction and sleep quality. More than 60% of the participants reported having poor sleep quality. Hierarchical multiple regression analysis showed that age, self-rated health, pain and depression were related to poor sleep quality. The findings suggest that it is important to screen regularly for sleep quality, and attention to depression, poor self-rated health and perceived pain were needed to improve sleep quality of older adults.

Self‐Reported Sleep Quality of Patients with Atrial Fibrillation and the Effects of Cardioversion on Sleep Quality

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance encountered in clinical practice and is associated with impaired quality of life. Data from the previous studies have shown that sleep quality (SQ), as a component of life quality, may also deteriorate in patients with AF. However, it remains unclear; we do not know whether SQ improves after sinus rhythm is maintained. Therefore, we aimed to examine the relationship between SQ and AF, as well as the effects of sinus rhythm restoration with direct current cardioversion (DCC) on SQ among patients with persistent AF. One hundred fifty-three patients with a diagnosis of nonvalvular AF and 150 age-matched control subjects with sinus rhythm were recruited. SQ was assessed using the Pittsburgh Sleep Quality Index (PSQI). The study was designed with two stages. First, the difference in SQ between AF patients and age-matched controls was examined. Patients with global PSQI scores greater than 5 were defined as "poor sleepers." Thus, a higher global PSQI score indicated worsened SQ. Predictors of poor SQ were also analyzed using a regression model. Second, the effect of rhythm control on SQ was studied in patients with AF who were eligible for DCC. Of the 65 patients with persistent AF, 54 patients with successful cardioversion were followed for 6 months. The remaining 11 patients, whose cardioversion was unsuccessful, were not followed. After 6 months of follow-up, the PSQI scores of patients with sinus rhythm maintenance (n = 39) and patients with AF recurrence (n = 15) were reassessed. Changes in global PSQI scores (baseline vs after 6 months) were analyzed. The PSQI scores were significantly higher in the AF group compared to the control group (9.4 ± 4.6 vs 5.8 ± 4.1, P = 0.001, respectively). The prevalence of poor sleepers was significantly higher in the AF group (76%) than in the control group (45%) (P < 0.001 by the χ(2) test). Multivariate logistic regression analysis showed that AF (odds ratio [OR]: 3.36, 95% confidence interval [CI]: 2.00-5.55), age (OR: 1.02, 95% CI: 1.00-1.04), and diabetes mellitus (OR:1.79, 95% CI: 1.03-3.14) were independent predictors of poor SQ. In the second stage, the effect of rhythm control on the SQ of the 54 patients with successful DCC was analyzed. PSQI scores improved significantly between baseline and the 6 months in sinus rhythm maintenance group (8.7 ± 4.1 vs 7.2 ± 3.8, P < 0.001, respectively). However, in the AF recurrence group, the change in global PSQI scores between baseline and the sixth month was not statistically significant (9.8 ± 4.5 vs 9.2 ± 4.2, P = 0.56, respectively). Patients with AF have shorter sleep duration and poor SQ. Maintenance of sinus rhythm after DCC may have a favorable effect on the SQ of patients with AF. Nevertheless, AF is an independent predictor of poor SQ.

Sleep Quality among Hispanics of Mexican Descent and Non-Hispanic Whites: Results from the Sleep Health and Knowledge in US Hispanics Study

Objectives: To investigate differences in sleep quality between Hispanics of Mexican descent (HMD) and Non-Hispanic Whites (NHW) and evaluate the effect of acculturation to the US lifestyle in sleep health. We hypothesize that the detrimental effect of acculturation on health outcomes will impact sleep quality among HMD. Design: We performed a population-based random digit dialing telephone survey to determine sleep quality in HMD and NHW. We collected from 3667 subjects, demographics, previous diagnosis of depression or anxiety, past treatment for sleep disorders, the Pittsburgh Sleep Quality Index (PSQI) and the Short Acculturation Scale for Hispanics. Results: The prevalence of poor sleep quality (PSQI > 5) was 64.4% for HMD and 64.3% for NHW (p = 0.93). A prior diagnosis of depression or anxiety was an independent predictor of poor sleep quality in both groups (OR 3.4 and 2.7 for HMD and NHW. Ethnicity was not a predictor of poor sleep quality in HMD or NHW. Acculturation was not a predictor of poor sleep quality in HMD. However, highly acculturated young HMD males had significantly more prevalence of poor sleep quality compared to NHW (64.8% vs. 49.8%, p Conclusion: The absence of sleep quality differences in a large sample of HMD and NHW living in San Diego County is contrary to current data of having poorer sleep quality among Latinos. We found that neither ethnicity nor acculturation were predictors of poor sleep quality in HMD. However, we demonstrated a highly prevalent poor sleep quality among the two ethnic groups. The finding of significantly lower sleep quality in young highly acculturated HMD men may represent the heterogeneity of ethnicity related to sleep. Programs to improve sleep quality in subjects with depression and/or anxiety, and in young highly-acculturated HMD seems warranted.

Sleep-Related Disorders and Quality of Life among Post-menopausal Egyptian Women in Ismailia

Aim: To determine the prevalence of poor sleep quality among postmenopausal women and its impact on their quality of life. Subjects and Method: After approval of our ethics committee, a total 315 postmenopausal women aged 45–60 were recruited and investigated using an interview questionnaire. The questionnaire contains three main items: Socidemographic data, assessment of sleep quality using an Arabic translated version of the Pittsburgh Sleep Quality Index (PSQI), and Arabic version of the Medical Outcomes Study Short Form-36 Survey (SF-36). Results: 69.5% of the participants had poor sleep quality. Poor sleepers have higher prevalence of sedentary lifestyle, poor sleep quality of spouse, and increased caffeine intake. Bivariate analysis did not show any significant difference between poor and good sleepers regarding age, BMI, residence, occupational status, educational level and socioeconomic status. Sedentary lifestyle was found to be a significant predictor of poor sleep quality. All SF-36 domain scores were significantly lower among poor sleepers. Conclusion: Poor sleep quality is a high prevalent problem among postmenopausal women and it affects health-related quality of life of these women. A lot of modifiable risk factors were previously found to affect sleep quality, but we have found that only sedentary lifestyle is the only modifiable risk factor that significantly affects sleep quality.

Sleep quality in chronic obstructive pulmonary disease

Previous reports have shown that patients with chronic obstructive pulmonary disease (COPD) sleep poorly, but the underlying basis remains speculative. The aim of this retrospective study was to determine potential predictors of poor sleep quality in COPD patients. This is a secondary analysis of two previously published trials investigating the impact of long-acting bronchodilators on nocturnal oxygen saturation in moderate to severe COPD patients. One hundred and six patients with established COPD were studied. Each patient underwent overnight polysomnography studies in a dedicated university-affiliated sleep laboratory. Epworth Sleepiness Scores, spirometry and daytime arterial oxygen tension (PaO(2)) were also recorded. Univariate and multivariate analysis sought independent predictors of sleep quality from baseline demographic, spirometry and oximetry values. Patients' age was 66.4 ± 7.3 years (mean ± standard deviation), forced expiratory volume in 1 s (FEV(1)) 33.4 ± 12.9% predicted and daytime PaO(2) 64 ± 7.5 mm Hg. In comparison with historical normative populations, the cohort demonstrated impaired sleep quality. Sleep efficiency was 66 ± 17% and sleep stage analysis revealed altered architecture with diminished periods of rapid eye movement sleep (12.7 ± 8.3%). In multivariate analysis, daytime PaO(2) correlated independently with sleep efficiency (P = 0.041), whereas FEV(1) positively correlated with arousal index, and age correlated negatively with rapid eye movement sleep duration. Sleep quality is poor in patients with severe COPD compared with normative populations of similar age, and daytime hypoxaemia is independently associated with impaired sleep efficiency.

Sleep quality and its correlates in patients on continuous ambulatory peritoneal dialysis

The aim of this study was to investigate demographic, clinical and psychosocial factors associated with sleep quality in patients on continuous ambulatory peritoneal dialysis (CAPD). Demographic data, clinical and biochemical parameters of 112 CAPD patients (convenience sample of 52 women and 60 men, mean age 51 ± 15 years) were measured. In the same patients, the Pittsburgh Sleep Quality Index (PSQI) was used for assessing sleep quality, the Beck Depression Inventory (BDI) for severity of depressive symptoms, the International Restless Legs Syndrome Study Group criteria for the diagnosis of restless legs syndrome (RLS), and the Short Form-36 (SF-36) of Medical Outcomes Study questionnaire for quality of life (QoL). Patients with PSQI scores of > 5 ("bad sleepers") had lower serum albumin (p = 0.008), total cholesterol (p = 0.034), normalized protein equivalent of nitrogen appearance (p = 0.046) and residual renal function (p = 0.012), but higher serum ferritin (p = 0.016) and BDI scores (p < 0.001). No significant correlation could be demonstrated between sleep quality and other demographic and clinical parameters. Although the prevalence of RLS was higher in poor sleepers, the difference did not reach statistical significance (p = 0.067). In multivariate analysis, only elevated BDI was an independent predictor of poor sleep quality (p = 0.031). Compared with good sleepers, poor sleepers had significantly lower QoL scores in all subscales of the SF-36. Although poor sleepers had lower nutritional indices, an elevated BDI was the only independent predictor of poor sleep quality. Poor sleep quality was also associated with lower QoL in patients on CAPD.

Sleep Quality and Sleepiness in Persons with Implantable Cardioverter Defibrillators: Outcome from a Clinical Randomized Longitudinal Trial

Patients receiving an implantable cardioverter defibrillator (ICD) report various types and degree of sleep disruptions, but little is known regarding their characteristics, duration, and associated factors. The purposes of this study were: (1) to describe the effect of a psychoeducational intervention on sleep quality and daytime sleepiness, (2) to describe patterns of sleep over time, and (3) to identify predictors of poor sleep in an ICD population. A randomized longitudinal intervention trial was designed to test the effects of a psychoeducational intervention, which included a sleep education and counseling session in patients receiving their initial ICD. Patients (n=236; 75% men; mean age 58.4 [±11.2] from the PsychoEducationAl Intervention for ICD PatiEnts (PEACE) trial comprised the study population. Variables related to sleep were measured by the Pittsburgh Sleep Quality Inventory (PSQI) and Epworth Sleepiness Scale (ESS). No psychoeducational intervention effects on sleep outcomes were observed. However, 67.2% of the patients reported poor sleep quality at baseline, and 56.8% had low sleep quality at 6 months based on PSQI scores>5; one-third (32.6%) were excessively sleepy based on ESS scores≥10 at 6 months. Anxiety, depression, physical function, pain intensity, and pain severity were all highly correlated to each other across time. Female gender was a significant covariate for the PSQI. New York Heart Association (NYHA) class was a significant covariate for sleepiness (Epworth). Low sleep quality and daytime sleepiness are found at time of insertion and over time in patients with ICD. Female gender, higher NYHA class, as well as two latent factors encompassing increased anxiety, depressive symptoms, and decreased physical function and increased pain, were significant predictors of poor sleep quality and sleepiness over time. These data help identify those at higher risk for sleep problems after ICD.