Sleep Medication Usage Research Articles

Faktor-faktor yang Berhubungan dengan Kualitas Tidur Pasien dengan Lupus Eritematosus Sistemik

Introduction. Sleep disturbances are often found among Systemic Lupus Erythematosus (SLE) patients. Poor sleep may cause low quality of life. Study about sleep quality among SLE patients and related factors in Indonesia is scarce. This study aimed to know factors related to poor sleep quality among SLE patients. Methods. This cross-sectional study was conducted among SLE patients at Cipto Mangunkusumo Hospital Jakarta Indonesia. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), with global PSQI score >5 indicates poor sleep quality. Factors evaluated were symptoms of depression and anxiety by Hospital Anxiety Depression Scale (HADS), pain by Visual Analogue Scale (VAS), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), autonomic dysfunction by Low Frequency/High Frequency (LF/HF) ratio from Heart Rate Variability (HRV), and high sensitivity C-Reactive Protein (hs-CRP) level. Bivariate analysis was done by Chi Square or Fisher’s test. Multivariate analysis was done by logistic regression, p value <0.05 was considered statistically significant. Results. Total of 166 SLE patients were included. Mean age was 32.7 years old with the majority in age group of 21-30 years old and female. Poor sleep quality in SLE patients was found in 82.5% of subjects. Symptoms of depression were significantly associated with poor sleep quality in SLE patients, especially sleep efficiency. Anxiety was associated with subjective month- and week-long sleep quality, sleep disturbances, and sleep medication usage. Musculoskeletal component of the SLEDAI-2K was associated with month- and week-long sleep quality, sleep latency, and daytime dysfunction. Hematologic involvement was associated with daytime dysfunction, whereas mucocutaneous involvement was associated with sleep disturbances. Conclusions. Symptoms of depression were significantly associated with poor sleep quality in SLE patients, especially sleep efficiency. Anxiety was associated with subjective month- and week-long sleep quality, sleep disturbances, and sleep medication usage.

Progressive muscle relaxation alleviates anxiety and improves sleep quality among healthcare practitioners in a mobile cabin hospital: a pre-post comparative study in China.

To investigate the anxiety levels, sleep quality and potential risk factors of healthcare practitioners involved in the management of COVID-19 patients in a mobile cabin hospital, and further to assess the impact of progressive muscle relaxation (PMR) on their anxiety levels and sleep quality. We conducted a pre-post self-controlled trial. Healthcare practitioners meeting the inclusion criteria underwent daily 30-min PMR sessions for seven consecutive days. The Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Scale (HAMA) were used to assess the anxiety and sleep quality of subjects pre- and post-intervention. Statistical analysis was performed using the Wilcoxon test, Mann-Whitney U test, Kruskal-Wallis H test, and Spearman rank correlation. A total of 94 participants completed the study. No statistically significant differences in HAMA or PSQI total scores were observed between groups categorized based on demographic variables such as age, sex, and years of education (p > 0.05). The PSQI total score and its components (excluding sleep medication usage) exhibited a positive correlation with the HAMA total score and its psychological anxiety component (p < 0.05), and a correlation was observed between somatic anxiety manifestations and several components of the PSQI. The PSQI total scores before and after intervention were 10.0 (8.0, 13.0) and 8.0 (6.0, 9.0) respectively (p < 0.001); the HAMA total scores were 8.0 (5.0, 13.0) and 6.0 (4.0, 9.5) respectively (p < 0.001). The detection rates of poor sleep and anxiety states, along with their severity, significantly decreased post-intervention (p < 0.001). Healthcare practitioners experience prominent anxiety and sleep issues in the mobile cabin hospital. PMR can be an effective intervention for improving the anxiety and sleep quality of healthcare professionals during support periods in the mobile cabin hospital. However, trials with larger samples are necessitated to further affirm these preliminary findings.

Subjective-Objective Sleep Discrepancy in a Predominately White and Educated Older Adult Population: Examining the Associations With Cognition and Insomnia.

This study examined associations between various cognitive domains and sleep discrepancy (self-reported vs objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia vs insomnia). Older adults (N = 65, Mage = 68.72, SD = 5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7 days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep Profiler during the 7-day period), and completed cognitive tasks (National Institutes of Health Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to the same one night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time (TST), sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Working memory interacted with insomnia status in associations with sleep discrepancy related to TST and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported TST (p = .008) and lower sleep efficiency (p = .04) than PSG measured. In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline.

Comparison of sleep improvement in patients undergoing lumbar spine decompression.

Degenerative spine conditions affect many people each year. These conditions have been shown to negatively impact pain, function, and patient quality of life (QOL), which often require surgical intervention. It is understood that sleep plays an important role in all of these factors. However, the relationship between sleep disruption and lumbar surgery is not well understood. The objective of this study was to use a large database to understand the relationship between sleep quality and lumbar spine surgery outcomes. The surgical database of the authors' institute was used to identify all patients undergoing lumbar spine surgery for degenerative spine disease from January 1, 2012, through December 31, 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were collected, and only patients with both pre- and postoperative scores were included. Additional measures related to disability, pain, and depression were also obtained. Chart review was performed to collect patient demographics, health risk factors, and information related to sleep disturbances such as sleep medication usage and prior sleep condition diagnosis. The study had 674 patients who met the criteria. At 3, 6, and 12 months postoperatively, there was a significant decrease in sleep disruption scores (i.e., sleep improvement), although these decreases were not greater than the minimal clinically important difference (MCID). When stratified based on preoperative sleep quality, patients with poor preoperative scores (PROMIS sleep disruption > 63.04) showed a significant decrease in sleep disruption by 8.17 at 3 months, 7.99 at 6 months, and 7.21 at 12 months. All of these decreases were greater than the sleep disruption MCID of 6.5. Multivariate analysis showed high preoperative sleep disruption and improvement in PROMIS physical health were most associated with decreased postoperative sleep disruption at all postoperative time points. In patients with degenerative spine conditions, lumbar spine surgery offers improvement in sleep disruption for all patients. Those with poor preoperative sleep quality are more likely to see clinical improvement in their sleep disruption.

An examination of the impact of age and sleep quality on neurocognition within a multi‐ethnic sample

AbstractBackgroundOlder adults and ethnoracially diverse groups (e.g., non‐Latinx Black (NLB), Latinx) are at higher risk of poor sleep quality. Poor sleep is linked to neurocognitive (NC) decline in middle/older adults, but much of the sleep literature has relied on global NC screening measures. This study examined the effects of age and sleep quality on NC functioning within a multi‐ethnic sample of middle/older adults utilizing a multi‐domain NC battery.MethodThis cross‐sectional study included 119 middle/older adults (M age = 65.3, SD age = 6.9; 46% NLB, 31% Latinx, and 23% non‐Latinx White (NLW); 63% female) who completed demographic questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and a comprehensive NC battery. PSQI global and component scores (e.g., Daytime Dysfunction; PSQI‐DD) measured subjective reporting of sleep quality. Demographically‐adjusted NC T‐scores were used to compute 8 NC‐domain and global average T‐scores. Pearson’s correlations, ANOVA, and multiple regressions were used to test hypotheses.ResultGlobal NC was not related to any PSQI components, and the PSQI components did not differ across ethnoracial groups (all p’s&lt;.05). However, within‐group correlations revealed that the relationship between PSQI components and NC domains significantly differed across ethnoracial groups. For example, frequency of sleep medication usage was significantly negatively correlated with executive functioning in the NLB group (r = ‐.39, p = .02), but not NLW or Latinx groups. Multiple regressions, including age and the interactions between race/ethnicity and PSQI component scores, significantly predicted 21‐39% of the variance in all NC domains (p’s&lt;.05), except attention/working memory (p = .60). The interaction between PSQI‐DD and ethnoracial status significantly predicted memory (p’s&lt;.05); this relationship was positive in the NLW group (B = 20.20), yet negative in the NLB (B = ‐1.16) and Latinx (B = ‐0.56) groups (ps&lt;.05).ConclusionDisordered sleep may have a greater impact on NC functioning, namely memory, among middle/older adults from diverse ethnoracial groups, who are already at heightened risk for NC decline. Importantly, global cognitive screening may be insufficient in examining the effects of sleep quality on NC in middle/older adults. Given the ethnoracial differences in sleep quality, future research should consider culturally‐tailored sleep interventions. Using objective sleep quality measures (e.g., actigraphy) may better quantify sleep components.

Sleep disturbances among cancer survivors

PurposeWe investigated sleep disturbances among cancer survivors compared to similarly aged women without cancer history. MethodsWe identified 2067 women with a history of cancer other than breast or non-melanoma skin cancer at enrollment in the Sister Study, a US-wide cohort of women with a family history of breast cancer. Cancer survivors were matched with up to 5 cancer-free women (N = 9717) on age at enrollment. An index age (for covariate classification) was defined as the age at cancer diagnosis for survivors and the same age for their matched comparators. Sleep disturbances included duration, sleep medication usage, insomnia symptoms, long sleep-latency onset (≥30 min to fall asleep), frequent night awakenings (waking ≥3/night, ≥ 3 times/week), frequent napping (≥ 3 times/week), and a composite outcome of ≥ 1sleep disturbance. Multivariable linear regression (effect estimate, 95% confidence interval (CI)) and logistic regression (odds ratio, OR, 95% CI) were used for continuous and dichotomous outcomes, respectively. ResultsAt enrollment, cancer survivors were on average 13.8 years (range=0, 62) from diagnosis. After adjustment for age at enrollment and depression, diabetes, hypertension, and menopausal status prior to the index age, sleep disturbances were generally not more common among cancer survivors compared to those without cancer. However, among cancer survivors, those > 2 years from diagnosis were more likely to report ≥ 1 sleep disturbance (OR=1.44; 1.07, 1.93) compared to survivors 0–2 years from diagnosis. ConclusionAddressing sleep disturbances may improve well-being for cancer survivors.

RAMAZAN VE UYKU: ÜNİVERSİTE ÖĞRENCİLERİNİN UYKU DÜZENLERİNİN İNCELENMESİ

Fasting during Ramadan, one of the Muslim societies' religious practices, affects individuals' daily lives in various ways. The aim of this study was to examine the sleep habits of university students during the online education process during Ramadan. Seventy-four university students from two universities in Turkey were evaluated using the Pittsburgh Sleep Quality Index (PSQI) before and after Ramadan. The results indicated a significant deterioration in subjective sleep quality, sleep latency, sleep disturbances, daytime dysfunction, and overall sleep quality (global PSQI score) during Ramadan. However, no significant changes were observed in sleep duration, habitual sleep efficiency, and sleep medication usage. The findings underline the need for tailored strategies to support university students' sleep hygiene during Ramadan.

0079 Subjective-Objective Sleep Discrepancy in Older Adults: Does Cognitive Functioning Matter?

Abstract Introduction Differences between subjective and objective sleep [subjective-objective sleep discrepancy (SOSD)] is prevalent in insomnia and older adults. Despite associations between cognition and sleep parameters, the impact of cognitive functioning on SOSD is unclear. We examined associations between various cognitive domains and SOSD in older adults and whether insomnia status moderates these associations. Methods Older adults with (N=47, Mage=68.85, 66% women) and without (N=32, Mage=67.41, 78% women) insomnia [met DSM-5 criteria plus reported &amp;gt;30 mins sleep onset latency (SOL) and/or wake time after sleep onset (WASO) on 3+nights/7] completed measures of subjective sleep (7-days of sleep diaries), objective sleep (one-night polysomnography, PSG), and objective cognitive tasks: Dimensional Change Card Sort (executive functioning, EF), List Sorting (working memory, WM), Auditory Verbal Learning Test (episodic memory), Flanker (inhibitory control), Pattern Comparison (processing speed). SOSD direction (average sleep diary variable – PSG variable) was computed. Moderated regressions determined independent and interactive (with insomnia status) associations between cognitive performance and SOSD for SOL, WASO, total sleep time (TST) and sleep efficiency, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Results For insomnia, longer self-reported than PSG TST was associated with better WM (b=27.90, SE=9.05, p=.003, episodic memory (b=12.83, SE=2.77, p=.01), processing speed (b=9.50, SE=2.00, p&amp;lt;.01), and inhibitory control (b=118.40, SE=54.09, p=.03). Similarly for insomnia, better self-reported than PSG sleep efficiency was associated with better WM (b=5.58, SE=2.12, p=.01), episodic memory (b=2.66, SE=1.08, p=.02), and processing speed (b=2.11, SE=0.47, p&amp;lt;.01). For non-insomnia, reports of SOSD were not associated with cognitive functioning (ps&amp;gt;.05). Conclusion Better diffuse cognitive functioning may be a contributing SOSD mechanism in older adults with insomnia. We speculate that better cognitive functioning may suppress cognitive arousal symptoms that are prevalent in insomnia patients, leading to better self-reported sleep relative to what is objectively measured. Prospective studies examining independent and interactive associations between cognition functioning and arousal, and insomnia on SOSD may inform underlying mechanisms of poor sleep health and the temporal impact on cognition. Support (if any) This research project was made possible by awards (PI: Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.

0054 Does the Early Bird Get the Worm? Associations of Waketime Variability and Metacognition in College Students

Abstract Introduction Deviation in sleep patterns have been associated with cognitive functioning in college students, but little research has examined how deviation in bed and waketime impact next-day metacognition. Given college students have high daily variability with their bedtime and waketime, these are understudied parameter of interest in this population. Considering metacognition has been associated with academic outcomes (e.g., GPA), it is important to understand how daily bedtime and waketime patterns might impact metacognition. The present study examined how daily deviation from bedtime and waketime are associated with metacognitive ratings in college students. Methods College students (N=81, Mage=18.8, SD = 1.1, 64 females) completed seven days of sleep diaries reporting bedtime, sleep duration, and waketime. Students also provided morning metacognitive ratings regarding the perceived quality of mental functioning from very poor (0) to very good (100). Multilevel modeling analyses tested whether intraindividual patterns of associations between daily bedtime and daily waketime and daily morning metacognitive ratings, after controlling for intraindividual daily anxiety severity, interindividual levels of bed/wake time variability and sleep duration, as well as age, sex, and daily sleep medication usage. Results Daily waketime was associated with same morning metacognitive ratings (B=.02, p=0.03), in that those who woke up earlier than their typical average reported worse cognitive function. Findings did not reveal an association between bedtime variability and metacognition. Conclusion Findings suggest that regardless of how long one has slept, waking up earlier than typical may negatively impact perceptions of cognitive functioning in college students. Similar patterns are not observed at the average/interindividual level. Given younger adults typically have a delayed circadian preference, findings may reflect acute circadian disruption and associated “brain fog” in college students when waking up earlier than typical. Future studies should examine associations between daily waketime and objective cognition to better understand how regularity impacts daytime functioning. Similar to findings in adolescent populations, such evaluations could inform recommendations regarding college class start times. Support (if any)

Sleep Disturbances and Dementia Risk in Older Adults: Findings From 10 Years of National U.S. Prospective Data

Previous research has identified a link between sleep disturbances and cognitive impairment; however, no study has examined this relationship using a national United States sample. This study examines how multiple longitudinal measures of sleep disturbances (sleep-initiation insomnia, sleep-maintenance insomnia, sleep-medication usage) are associated with dementia risk. Ten annual waves (2011-2020) of prospective cohort data from a nationally representative U.S. sample of adults aged ≥65 years were analyzed from the National Health and Aging Trends Study. Sleep disturbances were converted into a longitudinal score and measured as sleep-initiation insomnia (trouble falling asleep in 30 minutes), sleep-maintenance insomnia (trouble falling asleep after waking up early), and sleep-medication usage (taking medication to help sleep). Cox regression models analyzed time to dementia diagnosis for a sample of 6,284 respondents. In the unadjusted model, sleep-initiation insomnia was significantly associated with a 51% increased dementia risk (hazard ratio=1.51, 95% CI=1.19, 1.90). Adjusted for sociodemographics, sleep-medication usage was significantly associated with a 30% increased dementia risk (adjusted hazard ratio=1.30, 95% CI=1.08-1.56). Adjusted for sociodemographics and health, sleep-maintenance insomnia was significantly associated with a 40% decreased dementia risk (adjusted hazard ratio=0.60, 95% CI=0.46, 0.77). These findings suggest that sleep-initiation insomnia and sleep-medication usage may elevate dementia risk. On the basis of the current evidence, sleep disturbances should be considered when assessing the risk profile for dementia. Future research is needed to examine other sleep disturbance measures and to explore the mechanisms for decreased dementia risk among older adults with sleep-maintenance insomnia.

Sleep medication use and falls risk among African Americans with dementia

AbstractBackgroundSleep disturbances and falls are frequent in older adults and risk increases with increasing age (M. Ohayon, 2002; World Health Organization, 2007), especially for those people living with dementia (PLWD). While existing research sheds light on the difference between high‐ and low‐ frequency sleep medication use in people with and without dementia (L. Anderson, 2021), little evidence exists in the nature of racial differences. This study seeks to determine the differential effect of high versus low frequency sleep medication use in non‐Hispanic Blacks with dementia.MethodWe used data from the 2011 National Health and Aging Trends Study (n = 8,245) to create logistic regression models examining the association high‐ versus low‐ frequency sleep medication use with falls in community‐dwelling non‐Hispanic Blacks living with dementia. High‐frequency sleep medication use was defined as 5 or more nights per week, while low‐frequency sleep medication use was defined as 4 or fewer nights per week.ResultIn our fully adjusted model, non‐Hispanic Blacks living with dementia (n = 121) who were high‐frequency sleep medication users were much more likely to fall compared to non‐Hispanic Blacks living with dementia who were low‐frequency sleep medication users (OR = 7.59, 95% CI: 2.86, 20.13). Fully adjusted model controlled for sociodemographic characteristics, anxiety, depression, arthritis, diabetes, and hypertension.ConclusionAfter controlling for potential confounders, non‐Hispanic Blacks living with dementia and having high‐frequency sleep medication usage are over 7 times more likely to fall compared with non‐Hispanic Blacks with dementia who have low‐frequency sleep medication usage. Reducing sleep medication use in this population may help reduce the risk of falls and fall‐related outcomes.

0113 Daily Patterns of Sleep and Metacognition in College Students

Abstract Introduction Sleep problems have been associated with subjective cognitive complaints (a type of metacognition) in older adults, but little research has examined if this same relationship exists in younger adults. Additionally, college students have high intra-individual variability with their sleep, making day-to-day sleep an understudied parameter of interest in this population. Considering that metacognition has been associated with academic outcomes (e.g., GPA) in college students, it is important to understand how daily sleep patterns might impact metacognition. The present study examined how intra-individual variability in sleep is associated with metacognitive ratings in college students. Methods College students (N=81, Mage=18.8, SD = 1.1, 64 females) completed seven days of sleep diaries reporting total sleep time (TST), sleep onset latency (SOL), number of nighttime awakenings, and wake after sleep onset (WASO). Students also provided morning metacognitive ratings regarding the perceived quality of mental functioning from very poor (0) to very good (100). Multilevel modeling analyses tested whether intraindividual variability in daily sleep variables was associated with daily metacognitive ratings, after controlling for interindividual sleep patterns, age, sex, sleep medication usage, and anxiety symptoms (via the Hospital Anxiety and Depression Scale). Results Daily TST was associated with metacognitive ratings (B=2.35, p=0.003), in that those who slept less than their typical average reported worse metacognitive ratings. Similarly, daily number of nighttime awakenings (B=-1.92, p=0.02) and WASO (B=-0.13, p=0.009) were also associated with metacognitive ratings, in that those with more awakenings and greater WASO than their typical average reported worse metacognitive ratings. Conclusion Findings suggest that deviation in typical daily sleep patterns (shorter TST, a greater number of nighttime awakenings, greater WASO) may impact daily metacognitive ratings in college students. Similar patterns are not observed at the average/interindividual level, prompting the need for future studies to examine daily sleep in college students. These findings point to the need for research examining whether sleep interventions (e.g., Cognitive Behavioral Therapy for Insomnia) for college students who experience sleep variability, could improve metacognition, which in turn could improve academic outcomes. Support (If Any)

The effect of COVID-19 pandemic stay-at-home orders on sleep deprivation in medical students: a retrospective study.

The COVID-19 pandemic required medical schools to transition to online learning due to mandated stay-at-home orders. This created a drastic change in the learning environment and behavior of medical students, as well as increased stress about school and the pandemic, which may have impacted sleep. This study assessed medical student sleep timing, duration and quality retrospectively using the Pittsburgh Sleep Quality Index (PSQI) and a sleep questionnaire to determine changes prior to and following the stay-at-home orders. In addition, perceptions of stress related to COVID-19 and to school, as well as age and gender, were examined using a survey to determine relationships to sleep variables. Repeated-measures MANOVAs showed that medical student sleep timing changed significantly, shifting sleep and wake times later on both weekdays and weekends (p < 0.001). In addition, sleep quality significantly worsened post-COVID as compared to pre-COVID, with most subscales of the PSQI worsening after the stay-at-home order, especially in males. Older students had significantly longer sleep duration than younger students post-COVID. Sleep duration did not change significantly, and stress was not significantly related to sleep quality. Interestingly, sleep medication usage significantly increased post-COVID, with more students using sleep medications more frequently after the stay-at-home order (p < 0.05). This study represents the first research to assess how medical student sleep timing, quality and medication use was affected by the stay-at-home order due to the COVID-19 pandemic.Graphical abstract

Sleep quality, anxiety and depression in advanced lung cancer: patients and caregivers

ObjectiveTo investigate the clinical implications of sleep quality, anxiety and depression in patients with advanced lung cancer (LC) and their family caregivers (FCs).MethodsA total of 98 patients with advanced LC...

Effect of cognitive behavioural therapy on sleep and opioid medication use in adults with fibromyalgia and insomnia

Sleep and opioid medications used to treat insomnia and chronic pain are associated with adverse side effects (falls and cognitive disturbance). Although behavioural treatments such as cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) improve sleep and clinical pain, their effects on sleep and opioid medication use are unclear. In this secondary analysis of published trial data, we investigated whether CBT-I and CBT-P reduced reliance on sleep/opioid medication in patients with fibromyalgia and insomnia (FMI). Patients with FMI (n=113, Mage =53.0, SD=10.9) completed 8 weeks of CBT-I (n=39), CBT-P (n=37) or waitlist control (WLC; n=37). Participants completed 14 daily diaries at baseline, post-treatment and 6-month follow-up, assessing sleep and opioid medication usage. Multilevel modelling examined group by time effects on days of medication use. A significant interaction revealed CBT-P reduced the number of days of sleep medication use at post-treatment, but usage returned to baseline levels at follow-up. There were no other significant within- or between-group effects. CBT-P led to immediate reductions in sleep medication usage, despite lack of explicit content regarding sleep medication. CBT-I and CBT-P may be ineffective as stand-alone treatments for altering opioid use in FMI. Future work should explore CBT as an adjunct to other behavioural techniques for opioid reduction.

Insomnia, hypnotic use, and road collisions: a population-based, 5-year cohort study.

The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age. A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions. There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00-1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01-1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17-1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16-2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness. Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.

Determinants of Sleep Medication Use among Participants in the National Alzheimer's Coordinating Center Uniform Data Set.

Sufficient sleep is critical for health in older adults, but prescription sleep aids are associated with numerous health risks (e.g., cognitive impairment and falls). We examine usage prevalence of two medication categories-sedative hypnotics (SH) and medications commonly used for insomnia (MCUFI)-among adults aged 45+ in the National Alzheimer's Coordinating Center data set. Analyzing the visits conducted between September 2005 and June 2018, we determine the factors associated with SH and MCUFI use, including sociodemographic, health, independence, and cognitive statuses. Usage rates were 9% for MCUFI (N = 3,279) and 4% for SH (N = 1,382). Multivariable logistic regression identified White race, higher education, younger age, depression, and sedative polypharmacy as factors associated with prescription sleep aid use. We conclude that sleep medication usage rates among older adults, higher likelihood of sedative medication polypharmacy, and higher likelihood of MCUFI use among adults with cognitive impairment are findings of concern and may warrant clinical intervention.

Poor Postpartum Sleep Quality Predicts Subsequent Postpartum Depressive Symptoms in a High-Risk Sample.

Postpartum depression (PPD) occurs in 15% to 20% of mothers worldwide and is associated with adverse outcomes for mother and child. Prior research has established a relationship between concurrent sleep quality and PPD. We conducted a secondary analysis in 45 women with mood disorders to study overall sleep quality (and individual components of sleep), measured in the early postpartum period, as a predictor of subsequent PPD. We measured sleep quality using the Pittsburgh Sleep Quality Index (PSQI; subscale and total scores) at 1 month postpartum (and during the third trimester). We measured depressive symptoms using the Inventory of Depressive Symptoms, Self-Report (IDS-SR) at 3 months postpartum. We used bivariate and multivariate linear regression models to study the association between PSQI and IDS scores. We found that higher global PSQI scores as well as higher component scores for self-reported sleep quality, sleep latency, sleep efficiency, sleep medication usage, and daytime dysfunction, measured 1 month postpartum, were associated with increased IDS scores (at 3 months postpartum (P = .01, .01, .01, .003, < .001, respectively). We did not find an association between poor sleep quality in the third trimester and PPD. Poor sleep quality in the early postpartum period independently predicts development of later PPD. This is clinically significant and highlights the importance of sleep interventions as an immediate postpartum therapeutic tool. McEvoy KM, Rayapati D, Washington Cole KO, Erdly C, Payne JL, Osborne LM. Poor postpartum sleep quality predicts subsequent postpartum depressive symptoms in a high-risk sample. J Clin Sleep Med. 2019;15(9):1303-1310.

Use of Sleep Evaluations and Treatments in Children with Down Syndrome.

To characterize practice patterns regarding sleep evaluation and intervention among children with Down syndrome (DS). Data were obtained from electronic health records from 2009 to 2013 for a retrospective cohort of 954 children with DS, aged 5 to 21 years during the time sampled. International Classification of Diseases, Ninth Revision, diagnoses were used to identify children with obstructive sleep apnea and/or behavioral sleep disturbances. Primary outcomes were confirmed by participation in an overnight diagnostic polysomnography (PSG) and/or documented provision of specified sleep interventions including positive airway pressure, otolaryngology (ENT) surgery, sleep medication, and behavioral sleep therapy. Overall, 47.7% of children with DS had undergone PSG, 39.1% had diagnosed sleep problems, and of those diagnosed with sleep problems, 81.2% had received sleep intervention. Consistent with best practice clinical care, sleep treatments matched the diagnosed sleep problems. Age, gender, and race, but not body mass index (BMI), were associated with PSG completion rate and occurrence rates for ENT surgery and sleep medication usage. BMI was associated with obstructive sleep apnea. Despite high rates of reported sleep problems in children with DS, less than half underwent PSG. Children diagnosed with sleep problems received treatment consistent with their sleep diagnosis. However, age and gender were associated with differential rates of treatment delivery that was incongruous with prevalence rates for diagnosed sleep problems. These findings underscore the importance of screening for sleep problems in children with DS, and referring for and providing appropriate targeted sleep interventions.

Improving the sleep of children’s hospital employees through an email-based sleep wellness program.

Health care worker sleepiness and fatigue increases the risk of adverse events, compromises patient safety, and increases risk to personal safety and well-being. Addressing sleep problems in large health care institutions through traditional face-to-face interventions can be expensive and difficult to implement to a large employee pool. Little is known about the use of more cost-effective and time-efficient sleep health programs with health care professionals, such as online or email-based sleep interventions. The purpose of this article was to describe the development, implementation, and outcomes of Sleep Smart, an email-based employee sleep wellness program. Sleep Smart was created by a clinical psychologist board certified in behavioral sleep medicine, with consultation and review by an experienced employee wellness coordinator. It consisted of 8 weekly e-mailed modules highlighting different aspects of sleep, paired with online surveys. Participants (employees of a large midwestern tertiary children’s hospital and some spouses [n = 1,333]) completed measures including the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline and after completing the program. Results indicate a significant improvement in sleep quality, reduction in insomnia symptoms, decreases in daytime fatigue and reported sleepiness while driving, and a reduction in sleep medication usage. Outcomes from this study support additional exploration of cost-effective technology-based sleep health initiatives aimed at health care professionals. Improving hospital employee sleep could positively affect the delivery of care and patient safety. Challenges specific to employee wellness program evaluation and data collection and information for psychologists interested in this work is discussed.