Sleep Latency Periods Research Articles

Are you asleep? Comparing sleep metrics in pediatric cardiac patients with objective and subjective indicators

BackgroundExamination of sleep in pediatric cardiology patients has typically relied on self-reports with unknown reliability to objective assessments. Wearable technologies provide an objective data source to evaluate sleep. Improved understanding and treatment of sleep in pediatric heart patients may be an untapped aspect that could improve health-related quality of life. ObjectivesThe purpose of this study was to identify patterns of duration and quality of sleep in pediatric cardiology patients using both subjective and objective assessment. MethodsPatients were recruited in a pediatric cardiology clinic and completed a set of sleep and quality of life questionnaires including the Pittsburg Sleep Quality Index (PSQI), the Pediatric Cardiac Quality of Life Inventory (PCQLI), and the Cardiac Anxiety Questionnaire (CAQ). Patients also agreed to wear an actigraphy watch for 7 days, and caregivers were also recruited as proxy raters. ResultsThe sample included 31 patients with a mean age of 15.58 (SD = 1.89). Patients self-reported an average sleep duration of 7.61 h (SD = 1.67, range = 3–11). In contrast, objective sleep data indicated that patients obtained an average of 5.98 h of sleep nightly (SD = 1.01, range = 3.23–7.46) with a sleep efficiency score of 73.2 (SD = 6.23) and a sleep latency period of 21.04 min (SD = 19.16, range = 1–63). Parent-reported sleep duration on the PSQI had a mean of 8.10 h (SD = 1.34, range = 6–11). Thirty four percent of patients met PSQI cut off score for poor sleep based on self-report and 30 % based on parental-report. ConclusionsPediatric cardiac patients report better sleep duration than objective assessments. These data suggest that sleep complaints from pediatric cardiac patients may benefit from objective assessment and may need enhanced clinical attention since complaints may over-estimate the duration of sleep.

Interaction effects between sleep-related disorders and depression on hypertension among adults: a cross-sectional study

BackgroundHypertension, sleep disorders, and depression represent notable public health issues, and their interconnected nature has long been acknowledged. The objective of this study is to explore the interplay between sleep disorders and depression in the context of hypertension.MethodsThis cross-sectional study involved 42,143 participants aged 18 and above from the NHANES database across seven survey cycles between 2005 and 2018. After excluding those with missing data on depression, sleep disorders, and hypertension, as well as incomplete main variables, 33,383 participants remained. We used weighted logistic regression to examine the relationship between sleep disorders, depression, and hypertension. Additionally, we assessed the interaction between sleep disorders and depression on hypertension using both multiplicative and additive approaches to quantify their combined effect.ResultsCompared to individuals without sleep disorders, those with sleep disorders have an increased risk of hypertension (OR = 1.51, 95% CI: 1.37–1.67). Furthermore, individuals with depression experience a significantly higher risk of hypertension compared to those with sleep disorders alone (OR = 2.34, 95% CI: 1.95–2.80). Our study reveals a positive interaction between sleep disorders and depression in relation to hypertension risk (OR = 1.07, 95% CI: 1.02–1.13). In addition, we observed the quantitative additive interaction indicators (RERI = 0.73, 95% CI: 0.56 ~ 0.92; API = 0.31, 95% CI: 0.11 ~ 0.46; SI = 2.19, 95% CI: 1.08–3.46) influencing hypertension risk. Furthermore, our research also identified that individuals with less than 7 h of sleep, a sleep latency period between 5 and 30 min, or a latency period exceeding 30 min experience a significantly increased risk of hypertension.ConclusionsOur research uncovered separate links between sleep disorders, depression, and hypertension prevalence. Moreover, we identified an interaction between depression and sleep disorders in hypertension prevalence. Enhancing mental well-being and tackling sleep disorders could help prevent and manage hypertension. Yet, more investigation is required to establish causation and clarify mechanisms.

CHANGES IN CIRCADIAN CHARACTERISTICS OF PATIENTS WITH PARKINSON DISEASE AFTER CORRECTION OF POOR SLEEP QUALITY USING MELATONIN: AN OPEN-LABEL CONTROLLED RANDOMISED TRIAL

Introduction. Recent studies are increasing the amount of evidence suggesting that the circadian system is disrupted in Parkinson's disease that can lead to poor sleep. Currently, international guidelines for managing non-motor symptoms of Parkinson's disease do not have recommendations with proven efficacy, but only methods with potential benefit. Two of the most widely available methods for correcting poor sleep quality in patients with Parkinson's disease in Ukraine are sleep hygiene training, also known as somnoeducation, and melatonin administration. The aim of the study is to compare the state of circadian characteristics before and after the correction of poor sleep quality in patients with Parkinson's disease in the context of sleep hygiene and an integrated approach with the implementation of chronotherapy using melatonin. Materials and methods. We conducted a clinical trial at the Centre for Patients with Parkinson's Disease and Other Neurodegenerative Diseases, which included 34 patients with poor sleep quality who were randomised into 2 groups: group 1a (n = 17) consisted of patients with Parkinson's disease who followed sleep hygiene rules and received chronotherapy; group 1b (n = 17) involved patients with Parkinson's disease who followed sleep hygiene rules but did not take any medications to improve sleep. Circadian characteristics were analysed using the Munich Chronotype Questionnaire. Results. Our study has found that the correction of poor sleep quality by introducing sleep hygiene into the treatment process of patients with Parkinson's disease demonstrates a shift in the time of sleep onset and mid-sleep to earlier, accompanied by a shift in chronotypes towards earlier, as well as an increase in sleep duration against a decrease in the time spent in bed, which led to an increase in the average actual sleep efficiency. At the same time, melatonin supplementation helps to reduce sleep latency in Parkinson's disease. Conclusions. Adherence to sleep hygiene recommendations contributes to changes in circadian characteristics and improves sleep efficiency in patients with Parkinson's disease, regardless of melatonin administration. Additional use of melatonin to correct the quality of sleep for 1 month is accompanied by a reduction in the sleep latency period.

Assessment of Sleep Quality among Nursing Students on Clinical Posting in a Tertiary Health Facility in North-Western Nigeria

Abstract Context: The sleep quality of nursing students needs to be assessed in the context of their living conditions in order to know the best way to improve any abnormality noted. Aim: To assess the quality of sleep of nursing students and determine its relationship with their conditions of living among other factors. Methods and Material: A cross-sectional descriptive study involving nursing students on postings in a tertiary health facility. The socio-demographic data were collected with the aid of a structured questionnaire. The sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. Statistical Analysis Used: Data were analyzed using the Statistical Product for Service Solution (SPSS) for Windows version 22. Chi-square (χ2) or Fisher’s exact tests were used to determine the association between sleep quality and various parameters. Results: The total participants were 255 with a mean age of 21.5 ± 3.4 yrs and a male to female ratio of 0.4:1. The mean sleep latency period and mean sleep duration were 21.5 ± 14.0 minutes and 6.4 ± 1.4 hours respectively. The mean ESS was 9.8 ± 3.5 indicating an increased tendency for daytime sleepiness. The mean PSQI was 6.2 ± 3.0. Seventy-three percent of the participants were poor sleepers (had scores of ≥5); 7.1% of them had a level of severity needing medical help. The quality of sleep and daytime sleepiness were significantly associated with the number of roommates and source of funding respectively. Conclusion: Most of the participants have poor sleep quality which is significantly associated with the number of roommates and source of funding.

Sedative and hypnotic effects of the roots of Asparagus africanus (Asparagaceae) decoction on white mice (Mus musculus Swiss)

Asparagus africanus Lam. (Asparagaceae) is a plant widely used in traditional medicine as an anti-inflammatory, for the treatment of nervous disorders and insomnia. The aim of this work was to study the sedative and hypnotic effects of the roots of A. africanus decoction on white mice (Mus musculus Swiss). Sleep potentiation tests induced by diazepam and sodium pentobarbital were used. The sleep latency period onset and the sleep duration were recorded. The concentrations of GABA a[nd GABA-T in the brains of mice were also estimated. A. africanus significantly decreased the sleep latency period onset and increased the sleep duration induced by diazepam and sodium pentobarbital. Bicuculline, a competitive photosensitive antagonist of the GABAA receptor complex, did not prevent this potentiation. The effect of A. africanus on the sleep time was not blocked by flumazenil, a specific antagonist to the benzodiazepine site in the GABAA receptor complex. GABA increased and GABA-T decreased in the animals brain A. africanus treated significantly. Therefore the sedative properties of A. africanus might be possibly mediated by the activation of GABAergic neurotransmission on inhibitory receptors and by the decrease in the recapture of GABA by inhibiting GABA-T. These properties justified its use against insomnia in traditional medicine.

Sleep differences among children with autism spectrum disorders and typically developing peers: a meta-analysis.

Sleep problems such as difficulties in sleep initiation, nighttime awakening, and shortened sleep time are often subjectively reported in children with autism spectrum disorder (ASD). However, results of objective studies have been mixed. Our goal was to evaluate the existing data from objective measures using a systematic approach to identify and describe the differences in sleep parameters by comparing total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) in children with ASD with those of typically developing (TD) peers. Studies that used objective measures such as actigraphy or polysomnography (PSG) to describe the sleep parameters of TST, SL, and SE in children with ASD compared with children with TD were identified. A meta-analysis was performed for the 10 studies that met inclusion criteria with evaluation of differences in means using random effects models. A total of 343 children with ASD and 221 children with TD were included. Assessments for sources of heterogeneity and publication bias were undertaken. TST for children with ASD was on average 32.8 minutes less per day (95% confidence interval [CI]: 16.6-49.0 minutes) than their TD peers. Average SL was 10.9 minutes longer (95% CI: 6.7-15.0 minutes), and average SE was 1.9% less (95% CI: 0.7%-3.1%) than their TD peers. Notable heterogeneity was found within studies for TST, and mild heterogeneity was found for SE. Concurrent intellectual disability was a moderator of TST. Children with ASD and normal intelligence had a small and nonsignificant decrease in TST as compared with TD peers, whereas those with ASD and intellectual disability (ID) had a significant decrease in TST as compared with TD peers. The magnitude of the difference in mean SL and SE increased as compared with TD peers as age increased. Studies that used PSG and those that did not include children on medications were more likely to report mean decreases in SE. Children with ASD have small but measurable objective differences in their sleep parameters that are consistent with subjective reporting. Children with ASD have shorter TST, longer SL periods, and decreased SE as compared with TD peers. Concurrent ID, medication use, method of data collection, and age of subjects significantly moderated these results. The decrease in TST in children with ASD and normal intelligence was not significant as compared with TD peers, suggesting that ID may help explain the shortened TST in children with ASD.

Sleep-wake time perception varies by direct or indirect query.

The diagnosis of insomnia rests on self-report of difficulty initiating or maintaining sleep. However, subjective reports may be unreliable, and possibly may vary by the method of inquiry. We investigated this possibility by comparing within-individual response to direct versus indirect time queries after overnight polysomnography. We obtained self-reported sleep-wake times via morning questionnaires in 879 consecutive adult diagnostic polysomnograms. Responses were compared within subjects (direct versus indirect query) and across groups defined by apnea-hypopnea index and by self-reported insomnia symptoms in pre-sleep questionnaires. Direct queries required a time duration response, while indirect queries required clock times from which we calculated time durations. Direct and indirect queries of sleep latency were the same in only 41% of cases, and total sleep time queries matched in only 5.4%. For both latency and total sleep, the most common discrepancy involved the indirect value being larger than the direct response. The discrepancy between direct and indirect queries was not related to objective sleep metrics. The degree of discrepancy was not related to the presence of insomnia symptoms, although patients reporting insomnia symptoms showed underestimation of total sleep duration by direct response. Self-reported sleep latency and total sleep time are often internally inconsistent when comparing direct and indirect survey queries of each measure. These discrepancies represent substantive challenges to effective clinical practice, particularly when diagnosis and management depends on self-reported sleep patterns, as with insomnia. Although self-reported sleep-wake times remains fundamental to clinical practice, objective measures provide clinically relevant adjunctive information.

Prevalence and predictive factors for poor sleep quality among migraineurs in a tertiary hospital headache clinic

The aim of this study was to investigate the prevalence and predictive factors for poor sleep quality among migraineurs in a tertiary hospital headache clinic in southwest China. In this study, we used a visual analog scale (VAS), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS) to assess headache intensity, sleep quality as well as anxiety and depression symptoms. In 211 subjects who were assessed continuously, we found that the average PSQI score was 8.03 ± 4.71, and 130 (61.61 %) migraineurs exhibited poor sleep quality (PSQI >5). Poor sleep quality was largely expressed as experiencing an extended sleep latency period, daytime dysfunction, poor subjective sleep quality, and short sleep duration. The primary factors that predicted poor sleep quality included the migraine history and comorbidity with anxiety and/or depression. Moreover, we found that most migraineurs did not adopt treatment for their poor sleep quality. Only 17 (8.06 %) patients used sleeping medication to improve their poor sleep quality; however, this medication was not effective in 16 (94.12 %) patients. Therefore, it is highly important to resolve poor sleep quality in migraineurs.

Brain targeted transcranial administration of diazepam and shortening of sleep latency in healthy human volunteers.

Application of medicated oils on scalp had been practiced for centuries in the Ayurvedic system of medicine in diseases associated with the central nervous system. It is possible that the effectiveness of the therapy may be a result of targeted delivery of active compounds to the brain transcranially. Evidence also comes from two previous studies with positive results on brain targeted transcranial delivery of methadone base and diazepam on rat models. Possibility of transcranial drug delivery was investigated in healthy human volunteers using electroencephalography techniques by assessing the ability of transcranially administered diazepam in bringing about β activity in the electroencephalographic wave patterns and shortening of the sleep latency period. Non polar drug molecules dissolved in a non-aqueous sesame oil based vehicle is a significant feature in the transcranial dosage design. The study was under taken in two phases. In the Phase-I study scalp application of a single dose of 2 mg/3 ml of the oil was employed and in the Phase-II study repeat application of three doses 24 h apart were employed. Sleep latency changes were monitored with Multiple Sleep Latency Tests with 5 naps employing the standard electroencephalography, electroocculography and electromyography electrodes. Sleep onset was identified with the first epoch of any sleep stage non rapid eye movement 1, 2, 3, 4 or rapid eye movement using electroencephalography, electroocculography and electromyography criteria. In both phases of the study there was significant reduction in the sleep latencies. It was much more pronounced in the Phase-II study. None of the subjects however displayed beta activity in the electroencephalography. Sleep latency reduction following scalp application in both the phases are suggestive of transcranial migration of diazepam molecules to the receptor sites of the nerve tissue of the brain eliciting its pharmacological effect of sedation. Transcranial brain targeted dosage design is therefore feasible.

Factors associated with poor sleep and health-related quality of life

The aim of the study was to establish factors associated with poor sleep and to assess the relationship between self-evaluated sleep quality and health-related quality of life. Sleep complaints were evaluated using Basic Nordic Sleep Questionnaire, and health-related quality of life was assessed by SF-36. Subjective data about sleep quality were obtained from 1602 randomly selected persons: 600 males and 1002 females, aged 35-74 years. SF-36 was filled in by 1016 persons: 379 males and 637 females. Health status was evaluated by Perceived Health Questionnaire. The odds ratios of poor sleep were calculated using binary logistic regression analysis. Among males poor self-evaluated health, frequent stress events, regular nighttime awakenings, and sleep latency period longer than 15 min in workdays were significant predictors of poor sleep. Among females, duration of sleep shorter than 7 h, frequent stress events, poor self-evaluated health, sleep latency period longer than 15 min in workdays, and regular nighttime awakenings predicted poor sleep. Poor sleepers, as compared with good ones, had poorer health-related quality of life. Poor perceived health, frequent stress events, regular nighttime awakenings, and sleep latency period longer than 15 min were indicated as significant predictors of poor sleep. Poor sleep worsened health-related quality of life in all domains of SF-36.