Sleep Disruption In Patients Research Articles

Sleep disruption in patients with active and treated endogenous Cushing’s syndrome

ContextThe hypothalamic-pituitary-adrenal axis is a critical regulator of circadian rhythm in humans. Impaired sleep adversely affects metabolic, emotional, and cognitive health.ObjectiveTo characterize sleep disturbances in patients with active and treated Cushing’s syndrome (CS), and identify factors associated with impaired sleep in treated patients.DesignSingle-center cross-sectional study.MethodsPatients with pituitary or adrenal CS enrolled in an observational study completed Nottingham Health Profile (NHP), CushingQoL, and Hospital Anxiety and Depression assessments. Cross-sectional analysis was conducted including patients with active and treated disease.Results113 (94 female) patients with CS were included, 104 pituitary and 9 adrenal, with mean age at diagnosis of 43.9 ± 13.4 years. Mean and maximum duration of follow up was 5.1 and 23 years. Mean NHP sleep score was lower (i.e., improved) in patients with treated vs. active disease (29.6 ± 30.2 vs. 51.9 ± 30.9, p = 0.0005), as was CushingQoL sleep score (p = 0.015), but 41.5% of patients with treated disease stated they often or always had trouble sleeping. The proportion of treated vs. active patients taking medication for sleep, mood, or pain was not different. Neither NHP nor CushingQoL pain scores were lower in treated vs. active patients (p = 0.39 and 0.53). In patients with treated CS, anxiety and depression correlated with worse sleep scores.ConclusionsPatients with treated CS report improved sleep quality compared to those with active disease, but almost half of treated patients still report sleep challenges. The need for sleep medications, reported by one third of patients, was not different after CS treatment. Ongoing mood disturbances may play a role in persistent sleep disruption. Further work should focus on determinants of sleep impairments in treated CS patients.

The impact of sleep disruption in patients with chronic rhinosinusitis with nasal polyps using immunological therapy: a systemic review

The impact of sleep disruption in patients with chronic rhinosinusitis with nasal polyps using immunological therapy: a systemic review

Sleep and cognition in South African patients with non-functioning pituitary adenomas.

Strong lines of evidence in the neuroscience literature indicate that (a) healthy sleep facilitates cognitive processing, and (b) sleep disruption is associated with cognitive dysfunction. Despite the fact that patients with pituitary disease often display both disrupted sleep and cognitive dysfunction, few previous studies investigate whether these clinical characteristics in these patients might be related. Hence, we explored whether sleep disruption in patients with pituitary disease mediates their cognitive dysfunction. We recruited 18 patients with non-functioning pituitary adenomas (NFPA) and 19 sociodemographically matched healthy controls. They completed the Global Sleep Assessment Questionnaire (thus providing self-report data regarding sleep disruption) and were administered the Brief Test of Adult Cognition by Telephone, which assesses cognitive functioning in the domains of processing speed, working memory, episodic memory, inhibition, and reasoning. We found no significant differences in cognition between patients and controls. Furthermore, spectra of sleep disturbance did not differ significantly between patients and controls. Our data suggest that NFPA patients' cognition and sleep quality is relatively intact, and that sleep disruption does not mediate cognitive dysfunction. Larger studies should characterize sleep and cognition in patients with NFPA (and other pituitary diseases) to confirm whether disruption of the former mediates impairment in the latter.

Difelikefalin improves itch-related sleep disruption in patients undergoing haemodialysis.

Poor sleep quality is associated with higher mortality and lower quality of life in patients with chronic kidney disease-associated pruritus (CKD-aP). Difelikefalin reduces itch in patients with CKD-aP undergoing haemodialysis (HD). This post hoc analysis of the Phase 3 difelikefalin studies (Study 3105 and the pooled dataset from KALM-1 and KALM-2) evaluated whether itch reduction in individuals with CKD-aP improved sleep quality. Itch intensity was assessed in patients undergoing HD who had moderate-to-severe CKD-aP treated with intravenous difelikefalin (0.5µg/kg, three times weekly) (N=222, Study 3105; N=426, KALM-1 and -2) or placebo (N=425, KALM-1 and -2) for 12weeks, using the Worst Itch Intensity Numerical Rating Scale (WI-NRS). Sleep quality was assessed using the sleep disability question of the 5-D Itch Scale (5-D SDQ) in all studies and, in Study 3105, with the Sleep Quality Numeric Rating Scale (SQ-NRS). Greater improvements in sleep quality were observed in patients with ≥3-point versus <3-point WI-NRS improvement using SQ-NRS in Study 3105 [mean (95% confidence interval) -5.2 (-5.6, -4.8) vs -1.5 (-2.0, -1.0)] and 5-D SDQ in KALM-1 and -2 [-1.8 (-2.1, -1.6) vs -0.8 (-1.1, -0.4)]. SQ-NRS and WI-NRS scores were highly correlated at both baseline and Week 12 in Study 3105 (Spearman correlation coefficient: 0.77 and 0.84, respectively). Correlations were also observed between 5-D SDQ and WI-NRS scores in Study 3105 and KALM-1 and -2. In patients undergoing HD with moderate-to-severe CKD-aP, itch reduction with intravenous difelikefalin was associated with improved sleep quality. As disturbed sleep may contribute to mortality and morbidity in CKD-aP, difelikefalin may help to address a major clinical burden by improving sleep quality, secondary to itch relief. KALM-1 (NCT03422653), KALM-2 (NCT03636269), Study 3105 (NCT03998163).

0897 Sleep Architecture and Epileptiform Discharges in Rett Syndrome

Abstract Introduction Rett syndrome (RTT) is an X-linked dominant neurodevelopmental disorder affecting females and is linked to mutations in the methyl-CpG-binding protein 2 (MeCP2) gene. Sleep issues and frequent epileptiform discharges are common in RTT. Typical comorbidities in RTT include poor growth, feeding difficulties, hyperventilation and breath-holding, seizures, scoliosis, and disrupted sleep. Although polysomnographic studies indicate sleep disruption in patients with RTT, few evaluate if the epileptiform activity is associated with significantly greater changes in sleep. We analyzed if epileptiform discharges were associated with greater sleep changes than those seen without epileptiform discharges. Methods This retrospective case control of 10 RTT subjects (mean age, 11.19 years; ranged from 1 to 33 years) underwent standard in-lab polysomnography (PSG) recording. Subjects were compared to 10 age and gender matched controls with an AHI &amp;lt; 5 and no chronic medical problems. Rett children were divided into those with epileptiform discharges and those without. The two groups were compared using binomial cutoffs for each sleep parameter, and significance was determined by Fisher’s Exact Test. All studies were scored using the AASM criteria. Results Comparing our cohort of RTT patients to control subjects, the RTT patients have higher N3% of sleep, decreased N2%, and shorter sleep onset latency. 4 of the 10 PSGs are notable for frequent interictal epileptiform discharges. However, comparing those RTT patients with epileptiform discharges to those without, only REM latency trending shorter in those with epileptiform discharges (p= 0.057). No other significant differences were seen sleep staging, latency, total sleep time, efficiency, periodic limb movements nor respiratory parameters. Conclusion Our cohort did not find major differences in sleep features between those RTT patients with epileptiform discharges compared to those without. This may be related to a lack of influence of epileptiform discharges on these parameters or related to our small sample size. Although our cohort did not show major significant differences between those with epileptiform discharges, further study is required to delineate a more subtle relationship of these discharges to sleep. Support (if any)

Opposing inflammatory biomarker responses to sleep disruption in cancer patients before and during oncological therapy.

BackgroundSleep disruption is known to be highly prevalent in cancer patients, aggravated during oncological treatment and closely associated with reduced quality of life, therapeutic outcome and survival. Inflammatory factors are associated with sleep disruption in healthy individuals and cancer patients, but heterogeneity and robustness of inflammatory factors associated with sleep disruption and how these are affected by oncological therapy remain poorly understood. Furthermore, due to the complex crosstalk between sleep-, and therapy-associated factors, including inflammatory factors, there are currently no established biomarkers for predicting sleep disruption in patients undergoing oncological therapy.MethodsWe performed a broad screen of circulating biomarkers with immune-modulating or endocrine functions and coupled these to self-reported sleep quality using the Medical Outcomes Study (MOS) sleep scale. Ninety cancer patients with gastrointestinal, urothelial, breast, brain and tonsillar cancers, aged between 32 and 86 years, and scheduled for adjuvant or palliative oncological therapy were included. Of these, 71 patients were evaluable. Data was collected immediately before and again 3 months after onset of oncological therapy.ResultsSeventeen among a total of 45 investigated plasma proteins were found to be suppressed in cancer patients exhibiting sleep disruption prior to treatment onset, but this association was lost following the first treatment cycle. Patients whose sleep quality was reduced during the treatment period exhibited significantly increased plasma levels of six pro-inflammatory biomarkers (IL-2, IL-6, IL-12, TNF-a, IFN-g, and GM-CSF) 3 months after the start of treatment, whereas biomarkers with anti-inflammatory, growth factor, immune-modulatory, or chemokine functions were unchanged.ConclusionOur work suggests that biomarkers of sleep quality are not valid for cancer patients undergoing oncological therapy if analyzed only at a single timepoint. On the other hand, therapy-associated increases in circulating inflammatory biomarkers are closely coupled to reduced sleep quality in cancer patients. These findings indicate a need for testing of inflammatory and other biomarkers as well as sleep quality at multiple times during the patient treatment and care process.

0519 Sleep Dysfunction in Rett Syndrome

Abstract Introduction Rett syndrome (RTT) is an X-linked neurodevelopmental disorder affecting females and is linked to mutations in the methyl-CpG-binding protein 2 (MeCP2) gene. Typical comorbidities in RTT include poor growth, feeding difficulties, hyperventilation and breath-holding, seizures, scoliosis, and disrupted sleep. A few studies indicate sleep disruption in patients with RTT yet there is minimal data on polysomnographic findings in this population. We reviewed our cohort of Rett syndrome patients who underwent polysomnography. Methods This retrospective case control of 10 RTT subjects (mean age, 11.19 years; ranged from 1 to 33 years) underwent standard polysomnography (PSG) recording. Subjects were compared to 10 age and gender matched controls with an AHI &amp;lt;5 and no chronic medical problems using a student paired t test. All studies were scored using the AASM criteria. Results We found our cohort to have increased N3% sleep, decreased N2%, and shorter sleep onset latency (p&amp;lt; 0.05). Trends of lower BMI, lower oxygen saturation, and shorter REM latency (p &amp;lt; 0.10 but &amp;gt; 0.05). Review of PSGs shows the slow wave have morphological of typical slow waves and not that of the slowing seen on wake EEG nor the epileptiform activity. 4 of the 10 PSGs are notable for frequent interictal epileptiform discharges. 2 of the 10 subjects had a central apnea index &amp;gt;5, 2 had an AHI &amp;gt;5 and 1 demonstrated hypoventilation. There were central apneas associated with hyperventilation during awake and sleep-awake transition. Conclusion Our cohort of RTT patients demonstrates differences in sleep architecture, manifested most notably by a high percentage of SWS. This population has high amplitude rhythmic slow (theta) activity on wake EEG, primarily in the frontal-central regions. This slowing was distinct from the epileptiform activity seen in 40% of our cohort. Central apnea also appeared in older patients and the very young. Larger population studies are needed for future research. Support (If Any)

0796 The sleep instability in chronic rhinosinusitis patients with nasal polyps using CAP analyses during NREM sleep

Abstract Introduction The sleep instability can increase the impact of several sleep disorders. The chronic rhinosinusitis leads to sleep fragmentation, and changes in systemic inflammatory biomarkers followed by upper airway flow limitation or nasal mucosa inflammation near the skull base. To evaluate the effect of sleep dysruption in chronic rhinosinusitis patients with nasal polyps using CAP analyses, this study aimed to analyse these patients before and after the anti-inflammatory effect of intranasal corticosteroids on nasal obstruction. Methods After two months of washout, thirty individuals with nasal polyps and sleep-disordered breathing used intranasal budesonide 400 mcg every day for one month. Before and after the treatment, they underwent the same exams: nasal endoscopy, subjective nasal resistance scores, fatigue severity scale, and Epworth sleepiness scale. Besides, T helper-two inflammation was measured by serum levels of eosinophils, interleukin-four and five. Intermittent hypoxia impact was documented using serum levels of IL-6 and tumor necrosis factor-alpha. Type 1 polysomnography was performed. It was scored according to the last manual of AASM and Terzano’s rules. The nonparametric Wilcoxon test was used to assess within-group differences before and after exposure to corticosteroids. Correlation between quantitative variables was analyzed by using the Spearman correlation coeficient, and p&amp;lt; 0.05 was statistically significant. Results All the participants had sleep' fragmentation in non-REM sleep. The treatment decreased the subjective nasal obstruction (p&amp;lt;0.005) and IL-5 levels (p&amp;lt;0.05), without significant impact on other biomarkers, nasal endoscopy results, fatigue or somnolence scales, and sleep architecture. Interestingly, the subtypes of phase A of CAP weren′t statistically significant (p&amp;gt;0.05) decreased compared two groups (before and after treatment). Conclusion The anti-inflammatory effects of intranasal corticosteroid decreased the nasal resistance and Th2 systemic inflammation without any changes in sleep fragmentation, highlighting. Terzano’s manual quantifies the sleep fragmentation using the cyclic alternating pattern, and it can be a sensitive electroencephalogram analysis of the non-NREM sleep described as a marker of sleep instability, however the analyse of phase A subtypes CAP did not show changes sleep disruption in patients with nasal polyps after their treatment of nasal mucosa inflammation. More studies are need to clarify the sleep complaints in these patients. Support (If Any)

Decrease in sleep depth is associated with higher cerebrospinal fluid neurofilament light levels in patients with Alzheimer's disease.

The majority of studies investigating the association between sleep and Alzheimer's disease (AD) biomarkers have been performed in healthy participants. Our objective was to investigate the association between sleep and several biomarkers that reflect distinct aspects of AD physiopathology. The cohort included 104 individuals with mild-moderate AD. The participants were submitted to one-night polysomnography, and cerebrospinal fluid was collected in the following morning to measure the selected biomarkers associated with amyloid deposition, tau pathology, neurodegeneration, axonal damage, synaptic integrity, neuroinflammation, and oxidative damage. There was a positive correlation between neurofilament light (NF-L) and the time spent in stage 1 of non-rapid eyes movement (NREM) (N1) sleep and a negative correlation between this marker and the time spent in stage 3 of NREM (N3) sleep. Accordingly, we observed that deep sleep was associated with lower levels of NF-L, whereas light sleep increased the probability of having higher levels of this marker. Furthermore, chitinase-3-like-1 (YKL-40) was negatively correlated with sleep efficiency, the time spent in stage 2 of NREM (N2) sleep, and the time spent in N3 sleep. Conversely, there was a positive correlation between N3 sleep and the oxidative protein damage markers N-ε-(carboxyethyl)lysine and N-ε-(malondialdehyde)lysine. There were significant correlations between sleep parameters and AD biomarkers related to axonal damage and neuroinflammation, such as NF-L and YKL-40. A lack of deep sleep was associated with higher levels of NF-L. This highlights a potential role for NF-L as a biomarker of sleep disruption in patients with mild-moderate AD in addition to its role in predicting neurodegeneration and cognitive decline.

Iron Deficiency and Its Role in Sleep Disruption in Patients With Angelman Syndrome.

To determine if Angelman syndrome patients with sleep complaints have an increased risk of iron deficiency, and if iron therapy improves their sleep difficulties. About two-thirds of Angelman syndrome patients experience sleep difficulties, which are likely multifactorial. Because iron deficiency can contribute toward restlessness in sleep, we investigated whether it might be a contributing factor in this special population. This retrospective study involved medical record review of Angelman syndrome patients <18 years old who had attended our multidisciplinary Angelman syndrome clinic and had sleep complaints. Serum ferritin levels were compared to age- and sex-matched controls. Sleep history and nocturnal polysomnogram findings of the Angelman syndrome patients were also characterized. Nineteen Angelman syndrome patients (9 female, mean age 6.2±4.4 years) were identified. All 19 reported sleep difficulties. The mean serum ferritin level was 19.9±8.5 μg/L, while that in controls was 27.8±17.8 μg/L (P value .13). The odds ratio of iron deficiency in Angelman syndrome compared to controls was 4.17 (95% confidence interval 1.23-14.10), using normal serum ferritin level of 24 μg/L based on literature. Fifteen Angelman syndrome patients underwent nocturnal polysomnogram with 9/15 showing an elevated periodic limb movement index (overall mean 9.8±10.4). Seventeen of 19 received iron therapy. Twelve had follow-up after iron therapy, with parents reporting improved sleep quality. Eight had serum ferritin levels rechecked after iron therapy, showing a mean increase of 24±5.1 μg/L. Sleep difficulties in Angelman syndrome, though multifactorial, may in part be related to iron deficiency. Treatment with iron improved sleep to a modest degree in this population.

Significant Cognitive Function Impairment in Association with Sleep Disruption in Patients with Chronic Rhinosinusitis (CRS)

Significant Cognitive Function Impairment in Association with Sleep Disruption in Patients with Chronic Rhinosinusitis (CRS)

Poor quality of life, depressed mood, and memory impairment may be mediated by sleep disruption in patients with Addison's disease

Standard replacement therapy for Addison's disease (AD) does not restore a normal circadian rhythm. In fact, hydrocortisone replacement in AD patients likely induces disrupted sleep. Given that healthy sleep plays an important role in improving quality of life, optimizing cognition, and ensuring affect regulation, the aim of this study was to investigate whether poor quality of life, mood alterations, and memory complaints reported by AD patients are associated with their disrupted sleep patterns. Sixty patients with AD and 60 matched healthy controls completed a battery of self-report questionnaires assessing perceived physical and mental health (Short-Form 36), mood (Beck Depression Inventory—II), sleep quality (Pittsburgh Sleep Quality Index), and cognition (Cognitive Failures Questionnaire). A latent variable model revealed that although AD had a significant direct effect on quality of life, the indirect effect of sleep was significantly greater. Furthermore, although AD had no direct effect on cognitive functioning, the indirect effect of sleep was significant. The overall model showed a good fit (comparative fit index=0.91, root mean square of approximation=0.09, and standardized root mean square residual=0.05). Our findings suggest that disrupted sleep, and not the disease per se, may induce poor quality of life, memory impairment, and affect dysregulation in patients with AD. We think that improving sleep architecture may improve cognitive, affective, and physical functioning.

Sleep disruption in patients with chronic leg ulcers

To investigate the incidence of sleep disruption in people with chronic leg ulcers and to explore which factors may contribute to sleep problems. A questionnaire survey was completed by a convenience sample of 52 leg ulcer patients attending community-based Leg Clubs in England and Wales. The questionnaire assessed wound pain, quality of sleep, factors contributing to sleep disruption and general health. Sixty-nine per cent (n=36) of leg ulcer patients reported sleep disruption, with 88% stating that they wake at least once during the night. General wound pain was the most frequently-cited cause (58%), while pain associated with treatment affected the sleep of 38% of respondents. Additionally, nearly a third (n=14) expressed that worrying about their wound impacted on their sleep. A significant correlation was found between wound pain and sleep disruption. The findings suggest that the majority of leg ulcer patients suffer sleep disruption, either as a direct consequence of wound pain or due to treatment-related or psychological issues associated with the wound. This has important implications for patient quality of life and also for the healing process; therefore, assessment and management of sleep problems in leg ulcer patients is essential. This study was supported by a financial grant from Mölnlycke Health Care. The authors have no commercial or social conflicts of interest with respect to the article or its content.

Lavender essential oil improves sleep in residents of a memory care assisted living facility

People with dementia often have problems with sleep including difficulties falling and staying asleep. Aromatherapy is a form of complementary medicine that uses fragrant oils extracted and distilled from plant material, known as essential oils, for altering mood or behavioral health. There is limited evidence that the use of lavender oil can improve sleep and behavioral symptoms in people with memory loss. The purpose of this study was to determine if lavender can be an effective tool to manage sleep disruption in patients residing in a memory care assisted living facility. Twenty-two residents from memory care units in the Deer Crest assisted living facility (Red Wing, MN) were enrolled in this blinded, randomized-controlled cross-over trial of lavender oil versus placebo oil. Participants were monitored with actigraphs for 3 weeks and acclimated to study procedures in the first week. Participants were randomized to receive either lavender or placebo (almond) oil in week 2 and switched to the other oil during week 3. While dressing for participant's bedtime, resident assistants applied lotion (for acclimation week) or essential oil to the participant's neck, upper back, and spine over a period of one minute. A diffuser containing the corresponding treatment was also turned on for 20 minutes. Total minutes of sleep were calculated after sleep periods were manually defined using data from sleep logs. A linear-mixed effects model was conducted on data from four, 24 hr weekday epochs adjusting for patient-level clustering, patient-specific time trend, sequence of oil application, and overall time trend across all subjects. The average participant was 85.7 yr, 29% male, with a Montreal Cognitive Assessment score of 7.0. As expected, there was considerable variation in sleeping patterns across subjects. The total minutes of sleep per night with placebo oil was 408 minutes (sd=86). This significantly increased (p=.01) by 41 minutes (95% CI: 44.7, 38.35) during the week they received lavender. There was not a significant effect of time or the order in which oils were applied. The use of lavender shows promise as a non-pharmacologic alternative for management of sleep disturbance in people with memory loss.

Efficacy, safety and tolerability of a higher-dose 13.3 mg/24 h rivastigmine patch in people with severe Alzheimer's disease with and without concomitant memantine use

symptoms in peoplewithmemory loss. The purpose of this studywas to determine if lavender can be an effective tool tomanage sleep disruption in patients residing in a memory care assisted living facility.Methods: Twenty-two residents from memory care units in the Deer Crest assisted living facility (Red Wing, MN) were enrolled in this blinded, randomized-controlled cross-over trial of lavender oil versus placebo oil. Participants were monitored with actigraphs for 3 weeks and acclimated to study procedures in the first week. Participants were randomized to receive either lavender or placebo (almond) oil in week 2 and switched to the other oil during week 3.While dressing for participant’s bedtime, resident assistants applied lotion (for acclimation week) or essential oil to the participant’s neck, upper back, and spine over a period of one minute. A diffuser containing the corresponding treatment was also turned on for 20 minutes. Total minutes of sleep were calculated after sleep periods were manually defined using data from sleep logs. A linear-mixed effects model was conducted on data from four, 24 hr weekday epochs adjusting for patient-level clustering, patient-specific time trend, sequence of oil application, and overall time trend across all subjects.Results: The average participant was 85.7 yr, 29% male, with a Montreal Cognitive Assessment score of 7.0. As expected, there was considerable variation in sleeping patterns across subjects. The total minutes of sleep per night with placebo oil was 408 minutes (sd1⁄486). This significantly increased (p1⁄4.01) by 41 minutes (95% CI: 44.7, 38.35) during the week they received lavender. There was not a significant effect of time or the order in which oils were applied. Conclusions: The use of lavender shows promise as a non-pharmacologic alternative for management of sleep disturbance in people with memory loss.

Sleep apnea risk and clinical correlates in patients with bipolar disorder

Despite the high prevalence of risk factors for obstructive sleep apnea (OSA) among individuals with bipolar disorder, the presence of sleep-disordered breathing has not been systematically assessed in this population. In this study, we sought to determine the level of risk for OSA in a population of remitted individuals with a diagnosis of bipolar I disorder. A total of 72 individuals with a diagnosis of bipolar I disorder, all of whom were overweight by the World Health Organization criteria, completed the Berlin Questionnaire, a self-assessment tool to establish risk for OSA. Over half of this study population (54.1%) was found to be in the high-risk category for OSA. Participants at high risk for OSA scored significantly higher on measures of both depression and mania, even when sleep items were not counted in the total scores. Sleep apnea may be prevalent in patients with bipolar I disorder. Considering the substantial overlap of symptoms between OSA and depression and the potentially harmful effects of sleep disruption in patients with mood disorders, a systematic screening to assess prevalence and associated features of OSA in patients with bipolar disorder is warranted.

Sleep and allergic disease: A summary of the literature and future directions for research

Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. Asummary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research.

Sleep and Epilepsy: Common Bedfellows

Sleep is an essential part of the everyday life. Epilepsy and sleep disorders are considered by many to be common bedfellows. Sleep can affect seizure occurrence, threshold, and spread, while epilepsy can have a profound effect on the sleep/wake cycle and sleep architecture. The etiology of sleep disruption in patients with epilepsy is multifactorial and includes factors such as inadequate sleep hygiene, coexisting sleep disorders, circadian rhythm disturbances, epilepsy per se, seizure frequency, and the effect of antiepileptic medications. A series of manuscripts in this issue further attempt to define the complex relationship between epilepsy and sleep.

The effect of nocturia on sleep

Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.

Prevalence, Demographics, and Psychological Associations of Sleep Disruption in Patients With Cancer: University of Rochester Cancer Center–Community Clinical Oncology Program

Sleep disruption is prevalent in patients with cancer and survivors, but the prevalence of insomnia, a distressing sleep disorder, in these populations has yet to be determined in large-scale studies. A total of 823 patients with cancer receiving chemotherapy (mean age, 58 years; 597 female patients) reported on sleep difficulties in a prospective study. During day 7 of cycle 1 of chemotherapy, 36.6% (n = 301) of the patients with cancer reported insomnia symptoms, and 43% (n = 362) met the diagnostic criteria for insomnia syndrome. Patients with cancer younger than 58 years were significantly more likely to experience either symptoms of insomnia or insomnia syndrome (chi(2) = 13.6; P = .0002). Patients with breast cancer had the highest number of overall insomnia complaints. A significant positive association was found between symptoms of insomnia during cycles 1 and 2 of chemotherapy (phi = .62, P < .0001), showing persistence of insomnia during the first two cycles of chemotherapy. Sixty percent of the patient sample reported that their insomnia symptoms remained unchanged from cycle 1 to cycle 2. Those with insomnia complaints had significantly more depression and fatigue than good sleepers (all P < .0001). The proportions of patients with cancer in this sample reporting symptoms of insomnia and meeting diagnostic criteria for insomnia syndrome during chemotherapy are approximately three times higher than the proportions reported in the general population. Insomnia complaints persist throughout the second chemotherapy cycle for the majority of patients with cancer in this study. Insomnia is prevalent, underrecognized, undermanaged, and understudied among patients with cancer receiving chemotherapy.