Self-reported Daytime Sleepiness Research Articles

Analgesic Use and Daytime Sleepiness in Residents With and Without Dementia in Residential Aged Care Facilities.

Managing pain in residents of residential aged care facilities (RACFs) is challenging, especially for people with dementia. Clinicians must weigh the benefits of analgesic use against the potential for adverse events, particularly daytime sleepiness. The aim was to investigate the association between analgesic use and daytime sleepiness in residents with and without dementia in RACFs. This was a cross-sectional study of 383 permanent residents from six low-level and high-level RACFs in South Australia. Main measures included analgesic use in the previous 24 h, analgesic load and self-reported daytime sleepiness. Covariates included relevant comorbidities (insomnia, depression, painful conditions), Charlson's Comorbidity Index, sedative load, self-reported and clinician-observed pain and dementia severity. Logistic regression was used to compute odds ratios (ORs) and confidence intervals (CIs) for the association between analgesic use and daytime sleepiness. Analgesics were used by 288 residents (75.2%) in the previous 24 h. These included paracetamol (n = 264, 68.9%), opioids (n = 110, 28.7%) and oral NSAIDs (n = 14, 3.7%). Overall, 116 (30.3%) residents were categorized as having daytime sleepiness. Of those with dementia, 77 (45.6%) were categorized as having daytime sleepiness. Opioid use in the previous 24 h was not associated with daytime sleepiness in unadjusted or adjusted analyses. Paracetamol use was positively associated with daytime sleepiness (OR 2.31; 95% CI 1.20-4.42). Although daytime sleepiness occurred in a large number of residents, especially those with dementia, this sleepiness was not necessarily associated with use of opioids. The risk of opioid-induced sedation may have been managed by strategies including preferential prescribing of paracetamol to residents at risk of sleepiness, opioid discontinuation in residents who experienced sleepiness, and use of low doses of opioids.

The relationship between self-reported sleep disturbance and polysomnography in individuals with traumatic brain injury

Primary objective: To characterize sleep architecture and self-reported sleep quality, fatigue and daytime sleepiness in individuals with TBI. Possible relationships between sleep architecture and self-reported sleep quality, fatigue and daytime sleepiness were examined.Methods: Forty-four community-dwelling adults with TBI completed the Pittsburgh Sleep Quality Index (PSQI), Multidimensional Assessment of Fatigue (MAF) and Epworth Sleepiness Scale (ESS). They underwent two nights of in-laboratory nocturnal polysomnography (NPSG). Pearson product-moment correlation coefficients and hierarchical linear regression was used to analyse the data.Results: Based on the PSQI cut-off score of ≥ 10, 22 participants were characterized as poor sleepers. Twenty-seven participants met criteria for clinically significant fatigue as measured by the GFI of the MAF. Fourteen participants met criteria for excessive daytime sleepiness as measured by the ESS. Poor sleep quality was associated with poor sleep efficiency, short duration of stage 2 sleep and long duration of rapid eye movement sleep. There was little-to-no association between high levels of fatigue or daytime sleepiness with NPSG sleep parameters.Conclusions: A high proportion of the sample endorsed poor sleep quality, fatigue and daytime sleepiness. Those who reported poorer sleep quality evidenced a shorter proportion of time spent in stage 2 sleep. These findings suggest that disruptions in stage 2 sleep might underlie the symptoms of sleep disturbance experienced following TBI.

Adjunctive lisdexamfetamine in bipolar depression: a preliminary randomized, placebo-controlled trial.

This study evaluated the efficacy and tolerability of lisdexamfetamine (LDX) in the treatment of bipolar depression. Twenty-five outpatients with bipolar I or II disorder and syndromal depression despite at least 4 weeks of stable mood stabilizer and/or antipsychotic therapy were randomized to receive LDX (N=11) or placebo (N=14) in an 8-week, prospective, parallel-group, double-blind study. In the primary longitudinal analysis, LDX and placebo produced similar rates of improvement in depressive symptoms as assessed by the Montgomery-Asberg Depression Scale. However, LDX was associated with a statistically significantly greater rate of improvement in self-reported depressive symptoms and daytime sleepiness, and with greater reductions in fasting levels of low-density lipoprotein and total cholesterol. In the secondary baseline-to-endpoint analysis, LDX was associated with statistically significant improvements in self-reported measures of depression, daytime sleepiness, fatigue, and binge eating, as well as with improvements in fasting levels of triglycerides and low-density lipoprotein and total cholesterol. LDX was well tolerated and was not associated with any serious adverse events, but there was one case of suspected misuse. The small sample size (because of premature study termination by the funding sponsor) may have limited the detection of important drug-placebo differences. Larger studies on the use of psychostimulants for treatment of bipolar depression seem warranted.

The Relationship between Sleep Architecture and Symptoms of Sleep Disturbance in Individuals with Traumatic Brain Injury

Objective: To measure sleep architecture in individuals with TBI and determine its relationship with self-reported sleep quality, fatigue, and daytime sleepiness. Design: Participants: completed self-report measures and underwent two nights of in-laboratory nocturnal polysomnography. Setting: General community. Participants: 46 individuals with mild to severe TBI. Inclusion criteria included age between 18 years to 65 years and a documented TBI as a result of a blow to the head with a loss of consciousness or period of being dazed and confused (e.g., EMS report, hospital record, physician record, or a positive screen on the Brain Injury Screening Questionnaire). Participants: were required to be at least one year post injury (SD Z 13.33 years, range 1.17 years e 56.33 years), English-speaking, and have at least a sixth-grade reading level. No use of Modafinil, amphetamines or soporific medications (e.g., zolpidem, zolpidem MR, eszopiclone, zaleplon, sedating antidepressants, melatonin, valerian root, Benedryl, Ramelteon or chloral hydrate) was allowed 72 hours prior to polysomnography. Use of medications known to cause hypersomnolence (e.g. barbiturates, benzodiazepines, opiates) was not allowed for seven days prior to study. Exclusion criteria included active hepatic or renal failure (which may lead to hypersomnia), active substance abuse disorder, prior or current psychotic disorder, pre-existing neurological disorder or a brain injury with an etiology other than trauma, untreated hypothyroidism and any medical condition or reason that, in the investigator’s opinion, might make the participant unsuitable to participate. All participants were recruited through flyer postings in the Mount Sinai Medical Center and through healthcare provider referrals. The study was approved by the institutional review board of Icahn School of Medicine at Mount Sinai. Informed consent was obtained prior to screening to determine whether or not they met inclusion/exclusion criteria. Interventions: Not applicable. Main Outcome Measure(s): The measures included self-report measures of sleep quality (Pittsburgh Sleep Quality Index; PSQI), fatigue (Multidimensional Assessment of Fatigue; MAF), daytime sleepiness (Epworth Sleepiness Scale; ESS), and nocturnal polysomnography (NPSG) from which sleep efficiency, sleep onset latency, REM latency, wake time after sleep onset, and percentage of stage 1, 2, 3, and REM 4 sleep were extracted. Results: Pearson product-moment correlation coefficients were used to analyze the association between responses on self-report questionnaires. Hierarchical linear regression was used to analyze the association between NPSG sleep parameters and self-report questionnaires, adjusting for age, sex, body mass index, sleep apnea, and TBI severity. Poor sleep quality as measured by the PSQI was associated with fatigue as measured by the MAF. Poor sleep quality was associated with poor sleep efficiency, short duration of stage 2 sleep, and long duration of rapid eye movement sleep. There was a weak association between high levels of fatigue and poor sleep efficiency. Daytime sleepiness as assessed was not associated with any NPSG sleep parameters. Conclusions: In this sample of TBI survivors, those who reported poor sleep quality evidenced shorter time spent in stage 2 sleep compared to those who reported better sleep quality. These findings suggest that disruptions in stage 2 sleep might underlie the symptoms of sleep disturbance experienced following TBI.

Daytime sleepiness in Parkinson's disease: a reappraisal.

BackgroundExcessive daytime sleepiness is a frequent complaint in Parkinson’s disease (PD); however the frequency and risk factors for objective sleepiness remain mostly unknown. We investigated both the frequency and determinants of self-reported and objective daytime sleepiness in patients with Parkinson’s disease (PD) using a wide range of potential predictors.MethodsOne hundred and thirty four consecutive patients with PD, without selection bias for sleep complaint, underwent a semi-structured clinical interview and a one night polysomnography followed by a multiple sleep latency test (MSLT). Demographic characteristics, medical history, PD course and severity, daytime sleepiness, depressive and insomnia symptoms, treatment intake, pain, restless legs syndrome, REM sleep behaviour disorder, and nighttime sleep measures were collected. Self-reported daytime sleepiness was defined by an Epworth Sleepiness Scale (ESS) score above 10. A mean sleep latency on MSLT below 8 minutes defined objective daytime sleepiness.ResultsOf 134 patients with PD, 46.3% had subjective and only 13.4% had objective sleepiness with a weak negative correlation between ESS and MSLT latency. A high body mass index (BMI) was associated with both ESS and MSLT, a pain complaint with ESS, and a higher apnea/hypopnea index with MSLT. However, no associations were found between both objective and subjective sleepiness, and measures of motor disability, disease onset, medication (type and dose), depression, insomnia, restless legs syndrome, REM sleep behaviour disorder and nighttime sleep evaluation.ConclusionWe found a high frequency of self-reported EDS in PD, a finding which is however not confirmed by the gold standard neurophysiological evaluation. Current treatment options for EDS in PD are very limited; it thus remains to be determined whether decreasing pain and BMI in association with the treatment of sleep apnea syndrome would decrease significantly daytime sleepiness in PD.

The Efficacy of a Brief Motivational Enhancement Education Program on CPAP Adherence in OSA: A Randomized Controlled Trial

Poor adherence to CPAP treatment in OSA adversely affects the effectiveness of this therapy. This randomized controlled trial (RCT) examined the efficacy of a brief motivational enhancement education program in improving adherence to CPAP treatment in subjects with OSA. Subjects with newly diagnosed OSA were recruited into this RCT. The control group received usual advice on the importance of CPAP therapy and its care. The intervention group received usual care plus a brief motivational enhancement education program directed at enhancing the subjects' knowledge, motivation, and self-efficacy to use CPAP through the use of a 25-min video, a 20-min patient-centered interview, and a 10-min telephone follow-up. Self-reported daytime sleepiness adherence-related cognitions and quality of life were assessed at 1 month and 3 months. CPAP usage data were downloaded at the completion of this 3-month study. One hundred subjects with OSA (mean ± SD, age 52 ± 10 years; Epworth Sleepiness Scales [ESS], 9 ± 5; median [interquartile range] apnea-hypopnea index, 29 [20, 53] events/h) prescribed CPAP treatment were recruited. The intervention group had better CPAP use (higher daily CPAP usage by 2 h/d [Cohen d = 1.33, P < .001], a fourfold increase in the number using CPAP for ≥ 70% of days with ≥ 4 h/d [P < .001]), and greater improvements in daytime sleepiness (ESS) by 2.2 units (P = .001) and treatment self-efficacy by 0.2 units (P = .012) compared with the control group. Subjects with OSA who received motivational enhancement education in addition to usual care were more likely to show better adherence to CPAP treatment, with greater improvements in treatment self-efficacy and daytime sleepiness. ClinicalTrials.gov; No.: NCT01173406; URL: www.clinicaltrials.gov.

B-61 * Impact of Sleep Quality, Depression, Daytime Sleepiness, and Fatigue on Cognition in Multiple Sclerosis

Objective: To assess the association between measures of self-reported sleep quality, depression, daytime sleepiness, fatigue, and objective cognitive performance in individuals with Multiple Sclerosis (MS). Method: Twenty-eight highly educated (M = 15.39, SD = 2.11) MS participants (Mage = 49.25, SD = 10.79) reported hours of sleep the previous night and completed the Pittsburgh Sleep Quality Index (PSQI), Quick Inventory of Depressive Symptomology (QIDS), Epworth Sleepiness Scale (ESS), Modified Fatigue Impact Scale (MFIS) and a neuropsychological battery as part of a longitudinal study examining cognitive functioning in MS. Pearson r correlations were obtained between self-report measures and cognitive variables, including verbal fluency, Texas Card Sorting Test (TCST), Oral Symbol Digit Modalities Test, Stroop Color and Word, California Verbal Learning Test-II (CVLT-II), and Brief Visuospatial Memory Test-Revised. Results: Neither hours of sleep nor PSQI global scores correlated with any neuropsychological test scores. However, daytime sleepiness (ESS) was significantly associated with verbal memory (CVLT-II r's = .52 to .60, p ≤ .01) and executive function (TCST r = .55, p = .003). QIDS was marginally associated with memory (CVLT-II total T score; r = −.39, p = .04), and MFIS only correlated with Stroop Interference T scores (r = −.39, p = .04). There was no relationship between ESS and PSQI or MFIS scores. Conclusion(s): Despite the prevalence of sleep problems in MS, data suggests subjective sleep architecture may not be related to cognition in this population. However, associations were found between daytime sleepiness and cognitive variables. Additional research is needed to better understand the mechanisms behind daytime sleepiness, as this symptom affected cognition independent of fatigue and sleep quality/quantity.

Excessive daytime sleepiness and central sleep apnea in patients with stable heart failure

including total sleep time sleep efficiency, and indices of oxygen desaturations also failed to show a significant association to EDS (Table 2). The only clinical variable associated with EDS was NYHA class III with a relative risk of 2.78 (95% CI: 1.30–5.91, p = 0.01) compared to NYHA class I or II (Fig. 2). Our study resulted in 3 clinically important observations: first, only 13% of patients with stable HF report EDS using the Epworth Sleepiness Scale with a cut-point ≥11. Second, EDS in HF patients is not associated with CSA, AHI and any other sleep study parameters. Finally, NYHA functional HF class is the only clinical variable with a significant association to EDS suggesting an important link between self-reported daytime sleepiness and functional HF severity. The median ESS score in our study was 6.0, which is consistent with the results of Riegel et al. [8], whoalso founda median ESS of 6.0in 280HFpatients withouta significant association between EDS and sleep-disordered breathing during diagnostic sleep studies. The variables associated with EDS in the

Associations between physical activity, sedentary time, sleep duration and daytime sleepiness in US adults

ObjectiveTo examine the associations between objectively measured physical activity (PA) or sedentary behavior and self-reported sleep duration or daytime sleepiness in a nationally representative sample of healthy US adults (N=2128). MethodsWe report analyses of four aspects of sedentary behavior and PA derived from accelerometry data (minutes of sedentary time, activity counts/minute, Minutes of Moderate and Vigorous PA [MVPA], and MVPA in 10-minute bouts) versus self-report of sleep duration and frequency of daytime sleepiness from the 2005–2006 National Health and Nutrition Examination Survey. ResultsAge and sex dependence of associations between PA and sleep were observed. Aspects of PA were significantly lower in adults reporting more frequent daytime sleepiness in younger (20–39) and older (≥60) age groups, but not in middle-aged (40–59), respondents. In younger respondents, PA increased with sleep duration, but in middle aged and older respondents PA was either unrelated to sleep duration or lower in those reporting ≥8h of sleep. Objectively measured sedentary time showed limited evidence of associations with sleep duration. ConclusionsFurther research delineating the relationships between sleep and PA is important because both activities have been implicated in diverse health outcomes as well as in the etiology of obesity.

The relationship between sleep and drug use characteristics in participants with cocaine or methamphetamine use disorders

The goal of this project was to evaluate the relationship between self-reported sleep habits, daytime sleepiness, and drug use variables in individuals with cocaine and methamphetamine (METH) use disorders. Participants with a cocaine or meth use disorder completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and a demographic/drug use form. Participants with a cocaine (N=51) or meth use disorder (N=85) were separated into those with either high or low sleep deficits. In participants with a cocaine use disorder, ANOVA revealed significantly higher ESS scores among those defined as “poor sleepers” (with a PSQI score >5) when compared to those defined as “good sleepers” (with a PSQI score ≤5). In addition, poor sleepers reported using cocaine for more days out of the past 30 when compared to good sleepers. Interestingly, good sleepers reported using more grams of cocaine/day compared to poor sleepers. In participants with a METH use disorder, ANOVA revealed significantly higher ESS scores among poor sleepers when compared to good sleepers. Finally, individuals with a METH use disorder that endorsed elevated daytime sleepiness also had significantly higher PSQI scores when compared to those with normal daytime sleepiness. The results indicate that drug use variables, such as recent and daily use, may affect sleep quality and daytime sleepiness in individuals with stimulant use disorders; however, further investigations (i.e. in cocaine and METH users that do not meet criteria for a cocaine or METH use disorder) must be conducted in order to provide more conclusive evidence of the impact these usage variables may have on these sleep characteristics.

The impact of daytime sleepiness on the school performance of college students with attention deficit hyperactivity disorder (ADHD): a prospective longitudinal study

This prospective longitudinal study evaluated the impact of daytime sleepiness on the school performance of 62 college students diagnosed comprehensively with attention deficit hyperactivity disorder. The primary goal of the study was to determine if self-reported daytime sleepiness rated at the beginning of the academic year could predict academic and overall functioning at the end of the academic year while also considering potentially important covariates, including symptoms of inattention, hyperactivity and impulsivity, medication status and whether or not students lived at home or on-campus. Self-reported daytime sleepiness predicted longitudinally school maladjustment, overall functional impairment and the number of D and F grades (i.e. poor and failing) students received in courses above and beyond both self- and parent-report of symptoms, but did not predict overall grade point average. Living at home served as a protective factor and was associated with less school maladjustment and overall impairment. Gender was the only significant predictor in the overall grade point average model, with female gender associated with higher overall grades. The implications of these findings for monitoring and treatment of sleep disturbances in college students with attention deficit hyperactivity disorder are discussed.

Excessive daytime sleepiness and the risk for obstructive sleep apnea in Georgian population

Excessive daytime sleepiness (EDS) is a common complaint in obstructive sleep apnea (OSA) patients. OSA, the most prevalent sleep breathing disturbance, is a risk-factor for various adverse health conditions. Epidemiological data on this subject in the Georgian population are scarce. The present study is aimed at investigating self-reported daytime sleepiness and the severity of sleep apnea risk in the population of the two largest cities of Georgia – Tbilisi and Kutaisi. 304 subjects from Tbilisi (mean age 37.07 + 10.73, 67.4% female) and 91 subjects from Kutaisi (39.4 + 10.8, 67.1% female) were surveyed. Participants completed Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Beck depression inventory, short form (BDI SF). The risk of sleep apnea was screened using STOP BANG questionnaire (low risk – 0–2 positive answers; intermediate risk – 3–4 positive answers; high risk – 5 or more positive answers). Socio-demographic data and self evaluation of the overall health status were also obtained. EDS was defined as an ESS score ⩾11. Pearson chi-square tests were used to examine associations between OSA risk and sleep, health and socio-demographic variables. Group comparisons were conducted with unpaired t-test. Mean ESS score in the Tbilisi sample was 6.9 ± 3.8, and 19.7% had an EDS. These parameters were lower in the Kutaisi sample – 5.64 ± 3.54, and 7.7%. The between group differences in ESS score was statistically significant (t393 = 2.8, p = 0.005). Poor sleep quality was observed in 46.1% of Tbilisi sample (mean score 5.56 ± 3.13), and 33% of Kutaisi sample (4.52 ± 2.7). The significant correlation between sleep quality and BDI score was found in both groups. 7.9% of the Tbilisi and 4.4% of the Kutaisi sample had a high risk for OSA. 26% of the Tbilisi and 25.3% of the Kutaisi sample had an intermediate risk for OSA. In the Tbilisi population EDS and OSA severity were significantly associated with health status, sleep quality, BMI, age, gender and with EDS for OSA. In the Kutaisi sample, EDS was associated with health status, sleep quality and gender, and OSA severity was associated with EDS, age and gender. However, when the number of positive answers were checked the significant association was detected also with BMI ( p = 0.14). The findings point to poor sleep quality and a high prevalence of OSA risk in the Georgian population. Further studies are needed to determine the target subpopulation for OSA treatment. Study supported by Swiss National Science Foundation, SCOPES, grant IZ74Z0_137415

Prevalence and Symptoms of Occult Sleep Disordered Breathing among Older Veterans with Insomnia

To determine the prevalence of occult sleep disordered breathing (SDB) and describe the relationship between classic SDB symptoms (e.g., loud snoring) and occult SDB in older veterans with insomnia. We analyzed baseline survey and in-home sleep study data for 435 veterans (mean age = 72.0 years [SD 8.0]) who had no known history of SDB, met International Classification of Sleep Disorders 2(nd) Edition criteria for insomnia, and were enrolled in a behavioral intervention trial for insomnia. Variables of interest included apnea-hypopnea index (AHI) ≥ 15, age, race/ethnicity, marital status, body mass index (BMI), insomnia subtype (i.e., onset, maintenance, or terminal), self-reported excessive daytime sleepiness, snoring, and witnessed breathing pause items from the Berlin Questionnaire. We computed the frequency of AHI ≥ 15 and assessed whether each classic SDB symptom was associated with an AHI ≥ 15 in 4 separate multivariate logistic regression models. Prevalence of AHI ≥ 15 was 46.7%. Excessive daytime sleepiness (adjusted odds ratio 1.63, 95% CI 1.02, 2.60, p = 0.04), but not snoring loudness, snoring frequency, or witnessed breathing pauses was associated with occult SDB (AHI ≥ 15). Insomnia subtypes were not significantly associated with occult SDB (p > 0.38). In our sample of older veterans with insomnia, nearly half had occult SDB, which was characterized by reported excessive daytime sleepiness, but not loud or frequent snoring or witnessed breathing pauses. Insomnia subtype was unrelated to the presence of occult SDB.

Randomized Controlled Trial of Light Therapy for Fatigue Following Traumatic Brain Injury

Background. Fatigue is a common, persistent complaint following traumatic brain injury (TBI). Effective treatment is not well established. Objective. The current study aimed to investigate the efficacy of 4 weeks of light therapy for fatigue in patients with TBI. Methods. We undertook a randomized, placebo-controlled study of 4-week, 45 min/morning, home-based treatment with short wavelength (blue) light therapy (λmax = 465 nm, 84.8 µW/cm2, 39.5 lux, 1.74 × 1014 photons/cm2/s) compared with yellow light therapy (λmax = 574 nm, 18.5 µW/cm2, 68 lux, 1.21 × 1012 photons/cm2/s) containing less photons in the short wavelength range and a no treatment control group (n = 10 per group) in patients with TBI who self-reported fatigue and/or sleep disturbance. Assessments of fatigue and secondary outcomes (self-reported daytime sleepiness, depression, sleep quality, and sustained attention) were conducted over 10 weeks at baseline (week −2), midway through and at the end of light therapy (weeks 2 and 4), and 4 weeks following cessation of light therapy (week 8). Results. After controlling age, gender, and baseline depression, treatment with high-intensity blue light therapy resulted in reduced fatigue and daytime sleepiness during the treatment phase, with evidence of a trend toward baseline levels 4 weeks after treatment cessation. These changes were not observed with lower-intensity yellow light therapy or no treatment control conditions. There was also no significant treatment effect observed for self-reported depression or psychomotor vigilance performance. Conclusions. Blue light therapy appears to be effective in alleviating fatigue and daytime sleepiness following TBI and may offer a noninvasive, safe, and nonpharmacological alternative to current treatments.

Snoring, Daytime Sleepiness, and Incident Cardiovascular Disease in The Health, Aging, and Body Composition Study

To examine the association between snoring and incident cardiovascular disease (CVD). This is a prospective study in which community dwelling older adults were evaluated at baseline, and followed up for an average of 9.9 years. Data on snoring, daytime sleepiness, as well as demographic and clinical characteristics of study participants was collected at baseline, and participants were followed up every six months for an average of 9.9 years. Based on snoring and sleepiness status, 4 groups of participants were created: (1) No Snoring, No Sleepiness; (2) No Snoring, Sleepiness; (3) Snoring, No Sleepiness; (4) Snoring, Sleepiness. Incident CVD was defined as a diagnosis of myocardial infarction, angina pectoris, or congestive heart failure that resulted in overnight hospitalization during the follow-up period. Cox proportional hazard was used to estimate the risk of incident cardiovascular disease during follow-up by baseline snoring and sleepiness status. A total of 2,320 participants with a mean age of 73.6 (2.9) years at baseline were included in the analysis. Fifty-two percent were women, and 58% were white. A total of 543 participants developed CVD events during the follow-up period. Participants who reported snoring associated with daytime sleepiness had significantly increased hazard ratio for CVD events (HR = 1.46 [1.03-2.08], P = 0.035) after adjusting for demographic and clinical confounding factors. The results suggest that self-reported snoring and daytime sleepiness status are associated with an increased risk of future cardiovascular disease among older adults.

Sleep Disturbances and Risk of Depression in Older Men

Self-reported sleep disturbances are associated with an increased risk of depression in younger and older adults, but associations between objective assessments of sleep/wake disturbances via wrist actigraphy and risk of depression are unknown. Depressive symptoms (Geriatric Depression Scale [GDS]), self-reported (questionnaires), and objective (actigraphy) sleep parameters were measured at baseline in 2,510 nondepressed men 67 y or older. Depressive symptoms were reassessed an average of 3.4 ± 0.5 y later. Of the 2,510 men without evidence of depression at baseline, 116 (4.6%) were depressed (GDS ≥ 6) at the follow-up examination. After adjusting for multiple potential confounders, including baseline depressive symptoms (GDS 0-5), there was evidence of an association between poor self-reported sleep quality and higher odds of being depressed at follow-up (multivariable odds ratio [MOR] = 1.53, 95% confidence interval (CI) 1.00-2.33). In age- and site-adjusted models, objectively measured reduced sleep efficiency (odds ratio [OR] = 1.88, 95% CI 1.13-3.13), prolonged sleep latency (OR = 1.77, 95% CI 1.04-3.00), greater nighttime wakefulness (OR = 1.48, 95% CI 1.01-2.18) and multiple long-wake episodes (OR = 1.69, 95% CI 1.15-2.47) were associated with increased odds of depression at follow-up, but these associations were attenuated and no longer significant after further adjustment for number of depressive symptoms at baseline. Self-reported excessive daytime sleepiness and objectively measured total sleep time were not associated with depression status at follow-up. Excluding baseline antidepressant users from the analyses did not alter the results. Among nondepressed older men, poor self-reported sleep quality was associated with increased odds of depression several years later. Associations between objectively measured sleep disturbances (e.g., reduced sleep efficiency, prolonged sleep latency, greater nighttime wakefulness, and greater long-wake episodes) and depression several years later were largely explained by a greater burden of depressive symptoms at baseline. Paudel M; Taylor BC; Ancoli-Israel S; Blackwell T; Maglione JE; Stone K; Redline S; Ensrud KE; for the Osteoporotic Fractures in Men Study Group. Sleep disturbances and risk of depression in older men. SLEEP 2013;36(7):1033-1040.

Serotonin transporter polymorphism is associated with increased apnea-hypopnea index in older adults.

A functional polymorphism of the serotonin transporter gene (5-HTTLPR) has previously been related to upper airway pathology, but its contribution to obstructive sleep apnea (OSA), a highly prevalent sleep disorder in older adults, remains unclear. We aimed to investigate the relationship between apnea-hypopnea index (AHI) and genetic variations in the promoter region of the 5-HTTLPR in older adults. DNA samples from 94 community-dwelling older adults (57% female, mean age 72 ± 8) were genotyped for the 5-HTTLPR polymorphism. All participants were assessed in their homes with full ambulatory polysomnography in order to determine AHI and related parameters such as hypoxia, sleep fragmentation, and self-reported daytime sleepiness. The 5-HTT l allele was significantly associated with AHI (p = 0.019), with l allele carriers displaying a higher AHI than s allele homozygotes. A single allele change in 5-HTTLPR genotype from s to l resulted in an increase of AHI by 4.46 per hour of sleep (95% CI, 0.75-8.17). The l allele was also associated with increased time during sleep spent at oxygen saturation levels below 90% (p = 0.014). The observed significant association between the 5-HTTLPR l allele and severity of OSA in older adults suggests that the l allele may be important to consider when assessing for OSA in this age group. This association may also explain some of the observed variability among serotonergic pharmacological treatment studies for OSA, and 5-HTT genotype status may have to be taken into account in future therapeutic trials involving serotonergic agents.

Abstract MP90: Association of Sleep Duration and Quality with Incident Diabetes: Coronary Artery Risk Development in Young Adults Sleep Study

Background: Most prior longitudinal studies investigating the association of sleep characteristics with incident diabetes are based on self-reported sleep duration and quality. However, self-reported sleep is prone to differential error that is based on the amount of actual sleep that a person gets. Objective: To test whether objectively-measured sleep duration and quality or self-reported sleepiness were associated with the development of diabetes in a population sample. Methods: Participants from the Chicago, IL center of the CARDIA study who wore wrist actigraphs (Actiwatch TM ) twice between 2003-2005 and who were free from diabetes in 2000-2001 were included in the analysis (n=594). The following sleep parameters were averaged over 6 days: sleep duration, sleep maintenance (percentage of sleep period actually sleeping) and minutes of wake after sleep onset (WASO). The Epworth Sleepiness Scale (ESS) assessed daytime sleepiness; higher scores reflect more sleepiness. Diabetes was determined based on fasting glucose &gt;126 mg/dL, medication use, post-load glucose &gt;200 mg/dL or Hemoglobin A1c &gt;6.5% during examinations in 2005-2006 and 2010-2011. Results: Participants were 40.1 years old (SD=3.6), average sleep duration was 365.8 min (SD=64.3), sleep maintenance was 88.9% (SD=5.4), WASO was 46.0 min (SD=24.0) and the ESS was 7.5 (SD=4.3). Over ~10 years, 68 participants (11.4%) developed diabetes. Each sleep measure was associated with diabetes incidence in unadjusted models; however, only the association with daytime sleepiness remained significant following adjustment for demographic characteristics and diabetes risk factors. Conclusions: Self-reported daytime sleepiness is a straightforward measurement of sleep quality that can identify adults at risk for diabetes. Although objective measures of sleep duration and quality are associated with incident diabetes, the association is entirely explained by demographic characteristics.

Clinical implications of daytime sleepiness for the academic performance of middle school-aged adolescents with attention deficit hyperactivity disorder.

This study investigated the relative impact of total time slept per night and daytime sleepiness on the academic functioning of 100 middle school-aged youth (mean age=11.9) with attention deficit hyperactivity disorder (ADHD). The primary goal of the study was to determine if total time slept per night and/or daytime sleepiness, as measured by youth self-report on the Pediatric Daytime Sleepiness Scale (PDSS), predicted academic functioning above and beyond symptoms of ADHD and relevant covariates, such as intelligence, achievement scores and parent education level. Self-reported daytime sleepiness but not self-reported total time slept per night was associated significantly with all academic outcomes. When examined in a hierarchical regression model, self-reported daytime sleepiness significantly predicted parent-rated homework problems and academic impairment and teacher-rated academic competence above and beyond symptoms of ADHD and relevant covariates, but did not predict grade point average or teacher-rated academic impairment. The implications of these findings for understanding more clearly the association between ADHD and sleep and the functional implications of this relationship are discussed.

The relationship between self-reported nocturnal sleep duration, daytime sleepiness and 24-h urinary albumin and protein excretion in patients with newly diagnosed type 2 diabetes

AimIn the current study the relationship between self-reported nocturnal sleep duration (NSD) and daytime sleepiness with 24-h urinary protein excretion (UPE) and 24-h urinary albumin excretion (UAE) were investigated in patients with newly diagnosed type 2 diabetes mellitus. MethodsAll patients underwent history taking, physical examination, blood pressure (BP) measurement, 12 lead electrocardiographic evaluation, routine urine analysis, biochemical analysis, 24-h urine collection to measure UAE, UPE and creatinine clearance. Self reported NSD and daytime sleepiness (using Epworth Sleepiness Scale (ESS)) were recorded for all patients. ResultsIn total 110 patients (56 male and 54 female) were included. Self reported NSD was 7.17±1.07h. Mean ESS score was 5.59±2.48. Stepwise linear regression of independent factors revealed that logarithmically converted 24-h UAE (as a dependent parameter) was related with clinical systolic BP (b: 0.01, p: 0.003), HbA1c (b: 0.082, p: 0.033), self reported NSD (b: −0.152, p: 0.004) and ESS score (b: 0.044, p: 0.043). Additionally, on the other hand, 24-h UPE was related with clinical systolic BP (b: 0.011, p: 0.001) and self reported NSD (b: −0.179, p<0.0001) in regression analysis. ConclusionIn conclusion, 24-h UAE were independently related with self reported NSD and daytime sleepiness where as 24-h UPE was related with only NSD in patients with newly diagnosed type 2 diabetic patients.