Changes In Sleep Patterns Research Articles

Napping in Older Adults: A Review of Current Literature.

Daytime napping-frequently reported among older populations-has attracted increasing attention in geriatric research due to its association with multiple health conditions. This review aims to integrate the latest knowledge about napping in older adults to provide implications for future research. The prevalence of napping in older adults ranges from 20% to 60% in different studies, but has been consistently reported to be higher than in other age groups. Age-related changes in circadian rhythm and sleep patterns, cultural beliefs, chronic conditions, medications, and lifestyle changes contribute to the high prevalence of napping in older adults. Daytime napping has been associated with multiple health conditions in older adults. Naps of short duration (e.g., 30 minutes) are reported in adults with better health; naps with longer durations (e.g., >90 minutes) have been linked to adverse cardiovascular and diabetes outcomes, declining cognitive function, and increased mortality. Current evidence in the literature, however, is not enough for us to determine the exact role of napping in the health of older adults. Longitudinal and interventional studies are needed to investigate the influence of napping and the critical parameters such as duration, timing, and frequency on health in older adults and the underlying mechanisms. A combination of objective and self-reported measurements of napping are recommended instead of self-reported data only.

Sleep Pattern Changes in Nursing Students during the COVID-19 Lockdown

The prevalence of poor sleep quality among students is very high and, in nursing students, has been associated with reduced performance, behavioral changes, dietary changes, and even aggressive behavior due to changes in sleep patterns. The lockdown in response to COVID-19 may have resulted in lifestyle changes that affected sleep quality. For this reason, the objective of this study is to determine the difference in nursing students’ sleep quality before and during the lockdown, put in place in response to the coronavirus (COVID-19) pandemic. To meet this objective, we conducted a longitudinal observational study on 207 nursing students, with two cut-off points (February and April). The main dependent variable was sleep quality, measured using the Pittsburgh sleep quality index (PSQI) and its seven components. Parametric and nonparametric tests were used for paired and unpaired data, as well as group-stratified analysis. The mean time students spent in bed was 7.6 h (standard deviation (SD) = 1.1 h) before lockdown and 8.5 h (SD = 1.2 h) during lockdown. The PSQI score got 0.91 points worse during lockdown (95% CI, −0.51, −1.31). Of the five components, five were statistically significantly affected (p ≤ 0.05), and of these, the most changed were sleep latency, sleep duration, and sleep efficiency. When stratified by group, we observed differences in women, first-year students, second-year students, alcohol consumers, those of normal weight, and those that live with family. The main conclusion is that although students spent more time in bed, overall sleep quality was worse during lockdown, as well as being worse in five of the seven components.

Depression and Anxiety among Iranian Medical Students during COVID-19 Pandemic.

Objective: COVID-19 has spread throughout the world and has become a global pandemic. This situation can cause psychological distress among people, especially health care workers.This study aimed to determine depression and anxiety levels among Iranian medical students during the COVID-19 pandemic. Method : In this cross sectional study, we designed an online survey of Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) questionnaires. The survey link was sent to 500 medical clerks and interns studying at Tehran University of Medical Sciences (TUMS). Results: A total of 64.6% of the students completed the survey. The prevalence of mild to severe anxiety and depression among them was 38.1% and 27.6%, respectively. Anxiety and changes in sleep patterns were the most common symptoms. Higher levels of anxiety were related to female gender, lower grade point average (GPA), and experience of COVID-19 symptoms. Students with lower GPA and prior experience of COVID-19 symptoms were more likely to feel depressed. Conclusion: Depression and anxiety did not significantly differ among Iranian medical students before and after the COVID-19 outbreak. Somatic symptoms of depression are more common during this pandemic and need particular attention in future similar situations. A higher GPA is related to lower anxiety and depression among medical students.

Strategies for controlling sleep-related intrusive thoughts, and subjective and objective sleep quality: how self-reported poor and good sleepers differ

Objectives Along with changes in subjective and objective sleep patterns, metacognitive control of intrusive and unwanted thoughts at bedtime has been shown to significantly influence sleep quality. The present study examined individual differences between self-reported poor and good sleepers’ thought control strategies, as well as their subjective and objective sleep quality, considering adults in a broad range of ages. Method The study involved 147 individuals aged 18-79 years, divided into self-reported poor and good sleepers using the Pittsburgh Sleep Quality Index (PSQI). Participants’ thought control strategies were assessed using the Thought Control Questionnaire for Insomnia - Revised (TCQI-r). Subjective sleep parameters were recorded in a sleep diary, and objective sleep parameters were measured over 7 days using actigraphy. Results Self-reported poor sleepers employed aggressive suppression, reappraisal and worry strategies more than self-reported good sleepers. On logistic regression, the use of reappraisal and worry strategies distinguished between poor and good sleepers, while age did not. Self-reported poor sleepers objectively had a much longer sleep onset latency, a shorter total sleeping time, and a lower sleep efficiency, as well as subjectively longer times awake again after sleep onset, and a lower sleep efficiency than self-reported good sleepers. Conclusion Together with some subjective and objective sleep parameters, the use of certain thought control strategies (reappraisal and worry, in particular) seems to be one of the crucial aspects accounting for individual differences between self-reported poor and good sleepers.

Factors associated with sleep quality during chemotherapy: An integrative review.

AimTo identify the most important factors associated with sleep pattern changes in patients with cancer during chemotherapy treatment.DesignAn integrative review of the literature was performed between December 2017–August 2018.MethodsTwo independent reviewers searching the National Library of Medicine (PubMed/MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Latin American and Caribbean Literature in Health Sciences (LILACS), Scopus and Scielo. The process followed the recommendations of the PRISMA tool. A total of 16 articles were selected for the final study sample, including 11 cohort studies and 5 cross‐sectional studies.ResultsThe predisposing factors for the most prevalent sleep disturbances were precipitants related to the disease and the treatment, such as fatigue, pain, depression, anxiety and distress. Predisposing factors related to lifestyle and demographic characteristics have a significant correlation with sleep disturbances.

Evaluating the quality and duration of sleep using actigraphy in petroleum industry shift workers

IntroductionIncreased use of shift work has led to more and more people working outside a traditional daytime schedule. Currently, approximately 20% of the labor force in developed countries is shift workers. Shift work can have devastating effects on employees’ quality of life and sleep, leading to negative consequences for individuals and their families. This study evaluates the effect of different shift schedules (seven days/seven nights, fixed-day or fixed-night, and stand-by shift) on the sleep of oil rig shift workers. Participants and methodsIn this cross-sectional study, 43 offshore workers from the National Iranian Drilling Company were enrolled. Subjects were asked to complete a questionnaire package consisting of the Epworth Sleepiness scale and Pittsburgh Sleep Quality Index (PSQI). Changes in sleep patterns were measured using actigraphy for different shift schedules. ResultsThe mean age of the participants was 35.9 ± 7.9 years and the mean tenure with the drilling company was 10 ± 6.8 years. The mean total sleep time was 353 ± 58 min. The seven day/seven night shift workers had less total sleep time than the other three groups of shift workers. The mean PSQI and Epworth Sleepiness scale scores were 6.77 ± 3.1 and 7.49 ± 4.3, respectively. Twelve shift workers (27%) were diagnosed with shift work disorder in the current study and 31 participants had poor sleep quality according to PSQI score (≥5). ConclusionPoor sleep quality is common in oil rig shift workers. Further research is needed to evaluate sleep problems in oil rig shift workers.

WAS POSTPONING THE TOKYO 2020 OLYMPIC AND PARALYMPIC GAMES A CORRECT DECISION?

ABSTRACT In December 2019, Wuhan, in China, attracted international attention due to a pneumonia outbreak caused by the new coronavirus (2019-nCoV). Infection by 2019-nCoV is more likely in elderly people with comorbidities or with associated chronic diseases. Due to the high transmission rate among humans, this disease is rapidly disseminated, which led to several events being canceled, including the Tokyo 2020 Olympic and Paralympic Games. The aim of this article is to discuss the risk factors for Olympic and Paralympic athletes, as well as for spectators, that justify the decision to postpone the Tokyo Games 2020. Regular physical exercise is associated with health and the prevention of chronic diseases. Although athletes generally appear to be healthy and physically fit, this may not be true. The immune system, which protects the organism from invasive microorganisms, can be affected by the duration and quality of sleep, as well as by physical exercise which influences the quality of the immune response. High volumes of high-intensity physical exercise, as well as changes in sleep patterns during the pre-competition period and the impacts of jet lag on athletes traveling for the Tokyo Games in 2020 may lead to immune system suppression, making these groups more vulnerable to infection by 2019-nCoV. Moreover, during the period planned for the games in 2020 the pandemic may be subsiding in some countries and increasing in others, and this was also taken into consideration as a risk factor. Hence, the decision taken to postpone the Tokyo 2020 Olympic and Paralympic Games until 2021 due to the 2019-nCoV was the correct one, and was extremely important to protect the health of Olympic and Paralympic athletes, as well as spectators. Level of evidence V; expert opinion .

Sleep Patterns in Pregnant Women with Obesity Differentially Affect Energy Intake and Metabolic Health

Abstract Objectives During pregnancy, altered glucose kinetics coupled with disrupted sleep increase the risk for adverse metabolic health outcomes. The aim of this prospective, observational study in pregnant women with obesity was to 1) examine sleep patterns in early and late pregnancy; and 2) identify how changes in sleep patterns impact gestational weight gain, energy intake and metabolic health. Methods In 52 healthy pregnant women with obesity (27.4 ± 0.6 y; BMI: 36.3 ± 0.7 kg/m,2), energy intake (intake-balance method), and changes in weight, fasting glucose, insulin, lipids and habitual sleep (5 consecutive nights via wrist worn accelerometer) were assessed from early (13,0–15,6 weeks) to late (35,0–36,6) pregnancy. A change to habitual sleep parameters (increase or decrease) was defined as ± one-half of the standard deviation of the 5-day measurement in early pregnancy. Results Results In early pregnancy, time spent in bed (TIB) was 9.40 ± 0.13 h and varied 1.61 ± 0.11 h across the 5 nights. Total sleep time (TST) and sleep efficiency (SE) significantly declined from early to late pregnancy 7.05 ± 0.13 h to 6.46 ± 0.15 h (P < 0.001) and 76 ± 0.1% to 71 ± 0.2% (P < 0.001), respectively. Women who increased TIB (11 of 52) had a significant decrease in plasma glucose −11.6 ± 4.3% (P < 0.01) and a trend towards lower insulin (−57.8 ± 33.5%; P = 0.09) and HOMA-IR (−72.4 ± 37.3%; P = 0.058) across pregnancy compared to women who decreased their TIB (13 of 52). Women who increased TIB had a significantly lower daily energy intake (−540 ± 163 kcal; P < 0.01) and tended to have less gestational weight gain (−146.7 ± 87.6 g/wk; P = 0.10). There was no difference in weight gain, energy intake or plasma markers between women who increased or decreased TST or SE. Conclusions Although sleep time and sleep quality decline throughout pregnancy, TIB had the greatest impact on metabolic health in pregnant women with obesity. Women spending more TIB consumed fewer calories. Our data suggest that the relationship between glucose metabolism and sleep during pregnancy is at least in part explained by lower energy intakes, possibly due to shorter eating windows. Studies that manipulate the eating window, independent of sleep timing are needed to understand the benefits to metabolic health for women during pregnancy. Funding Sources National Institutes of Health [R01DK099175].

0355 Neurobiological Correlates of Sleepiness in Middle Aged and Older Adults: A FDG-PET Study

Abstract Introduction Sleepiness has been associated with functional and cognitive decline, and may present with excessive daytime sleepiness (EDS) and/or increased sleep duration. We investigated whether sleepiness and changes in sleep patterns are associated with FDG-PET levels in wake-promoting regions. Methods From the Mayo Clinic Study of Aging cohort, we identified 373 cognitively-unimpaired middle-aged and older adults (mean +/- s.d. 66.1 +/- 13.2 yo) who underwent FDG-PET. EDS was defined as ESS score >=10. Changes in sleep patterns (sleeping more, less, or no change) were assessed using question #16 of the Beck Depression Inventory-2. We used probabilistic maps to create regions of interest (ROIs): the locus coeruleus (LC), posterior lateral hypothalamus (PLH), and the basal forebrain divided in 1) medial septum/diagonal band of Broca (MS/DB) and 2) nucleus basalis of Meynert (nbM). FDG-PET levels were referenced to the pons (SUVR). In this cross-sectional analysis, we fit linear models to assess the association between EDS and changes in sleeping patterns with FDG SUVR in in each ROI, while controlling for age, sex, education, BMI, witnessed apneas, and cardiovascular risk factors. Results 10.5% had EDS, 15% reported sleeping more and 21% reported sleeping less than usual. 30.7% of participants with EDS reported sleeping more, 25.6% less, and 43.5% the same. EDS was associated with an elevation in FDG-PET SUVR in the MS/DB region (.035 [95% CI .008; .063], p=.012), while sleeping more was associated with a decrease in FDG-PET SUVR in the same region (-.027 [95%CI -.052; -.002], p=.036). Sleeping less was associated with an increase in FDG-PET SUVR in the PLH (.021 [95% CI .005; .03], p=.019). No associations were found in other ROIs. Conclusion Our results suggest that sleepiness and changes in sleep patterns in cognitively-unimpaired middle-aged and older adults were associated with measurable metabolic changes in areas of the brain involved in sleep and wakefulness. Further research should clarify whether these findings could represent different phenotypes of sleepiness with potential diagnostic and prognostic implications. Support NIA/NIH

0260 Association Between Free-Living Physical Activity and Sleep in Icelandic Adolescents

Abstract Introduction Sleep and physical activity are both important to health, but the demands of our modern schedule often require individuals to choose one over the other. In adolescents, the association between objectively measured sleep and physical activity is not well established in the literature. The aim of current study was to assess associations between free-living and physical activity and sleep among 15-year-old adolescents. Methods Free-living physical activity and sleep were assessed with wrist-worn accelerometers, sleep diary, and questionnaires during a 7-day period including school days and non-school days in 270 (161 girls) adolescents (mean age 15.8±0.3y) in Reykjavik, Iceland. Linear regression analysis was used to explore the associations between objectively measured physical activity and sleep. T-test was used to determine if there is a significant difference in objectively measured sleep between those who reported sports or exercising <6 versus ≥6 h/week. Results Weekly mean physical activity (2040±466 counts/min of wear/day) was negatively associated with total sleep time (6.6±0.64 h/night) (β±SE=-3.5±0.7, p<0.001). However, physical activity was also negatively associated with minutes of wake after sleep onset on non-school days (p=0.047) and standard deviation (i.e. night-to-night variability) of total sleep time over the week (p=0.028). Subjects who reported exercising ≥6 h/week (n=116) had lower night-to-night variability in bedtime (41.2±27.9 min) than those who did not (49.8±37.5 min), p=0.033. Conclusion The negative association between physical activity and sleep duration suggests that in more active individuals’ physical activity may be displacing sleep. However, greater physical activity is also associated with fewer minutes of awakening and a less variable sleep schedule, indicating better sleep quality. These findings suggest that physical activity is important for good sleep quality, but students should more closely consider sleep guidelines when designing an exercise schedule. Future studies should test how change in sleep patterns might influence physical activity. Support Icelandic Centre for Research, National Institute of Diabetes and Digestive and Kidney Diseases.

Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy.

Italy is one of the major COVID‐19 hotspots. To reduce the spread of the infections and the pressure on Italian healthcare systems, since March 10, 2020, Italy has been under a total lockdown, forcing people into home confinement. Here we present data from 1,310 people living in the Italian territory (M age = 23.91 ± 3.60 years, 880 females, 501 workers, 809 university students), who completed an online survey from March 24 to March 28, 2020. In the survey, we asked participants to think about their use of digital media before going to bed, their sleep pattern and their subjective experience of time in the previous week (March 17–23, which was the second week of the lockdown) and up to the first week of February (February 3–10, before any restriction in any Italian area). During the lockdown, people increased the usage of digital media near bedtime, but this change did not affect sleep habits. Nevertheless, during home confinement, sleep timing markedly changed, with people going to bed and waking up later, and spending more time in bed, but, paradoxically, also reporting a lower sleep quality. The increase in sleep difficulties was stronger for people with a higher level of depression, anxiety and stress symptomatology, and associated with the feeling of elongation of time. Considering that the lockdown is likely to continue for weeks, research data are urgently needed to support decision making, to build public awareness and to provide timely and supportive psychosocial interventions.

Insomnia and psychological reactions during the COVID-19 outbreak in China.

Citation:Li Y, Qin Q, Sun Q, Sanford LD, Vgontzas AN, Tang X. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020;16(8):1417–1418.

Quality of sleep and quality of life measured monthly in pregnant women in South Korea.

The change in sleep patterns across the duration of pregnancy is an item of interest. The aim of this study is to provide data on pregnant women's quality of sleep (QoS) and quality of life (QoL) to determine appropriate times to screen for potential problems. This is a multicenter, prospective, longitudinal observational study. Primigravidae, with no previous illness, completed questionnaires once a month. Strict exclusion criteria were applied in order to evaluate QoS and QoL in "normal" pregnant women. A total of 83 normal primigravidae completed this study. The mean age was 33.1 ± 4.0. During pregnancy, body mass index gradually increased, and QoS worsened to a significant degree between the fifth and ninth months (Pittsburgh Sleep Quality Index 6.8 ± 2.8 vs. 8.9 ± 3.6, p < 0.001). There was a statistically significant difference in QoL between the fifth and seventh months (Short Form-36 70.8 ± 18.3 vs. 67.3 ± 15.1, p = 0.009). There was no evidence of significant depression or suspicion of sleep-disordered breathing. Pregnant women in South Korea have gradual worsening of QoS which becomes clinically significant by full term. QoL changes significantly between the fifth and seventh months. The results of this observational study suggest that it would be fruitful to evaluate QoS and QoL in pregnant women between the second and third trimesters.

A common neuronal mechanism of hypertension and sleep disturbances in spontaneously hypertensive rats: Role of orexinergic neurons

Epidemiologic studies have shown that sleep disorders are associated with the development of hypertension. The present study investigated dynamic changes in sleep patterns during the development of hypertension across the lifespan in spontaneously hypertensive rats (SHRs) and the neural mechanism that underlies these comorbidities, with a focus on the orexinergic system. Blood pressure in rats was measured using a noninvasive blood pressure tail cuff. Sleep was monitored by electroencephalographic and electromyographic recordings. Immunohistochemistry was used to detect the density and activity of orexinergic neurons in the perifornical nucleus. Hcrt2-SAP (400 or 800 ng) was microinjected in the lateral hypothalamus to lesion orexinergic neurons. Compared with Wistar-Kyoto rats, SHRs exhibited various patterns of sleep disturbances. In SHRs, dynamic changes in hypersomnia in the rats' active phase was not synchronized with the development of hypertension, but hyperarousal in the inactive phase and difficulties in falling asleep were observed concurrently with the development of hypertension. Furthermore, the density and activity of orexinergic neurons in the perifornical nucleus were significantly higher in SHRs than in age-matched Wistar-Kyoto rats. The reduction of orexinergic neurons in the lateral hypothalamus partially ameliorated the development of hypertension and prevented difficulties in falling asleep in SHRs. These results indicate that although the correlation between sleep disturbances and hypertension is very complex, common mechanisms may underlie these comorbidities in SHRs. Overactivity of the orexin system may be one such common mechanism.

Cross-sectional research on sleep hygiene and health complaints among Pakistani college students.

With recent technological advancement, a major shift in the lifestyle of individuals has been observed. This change is more evident in youth in terms of sleep pattern changes and socialization. It is therefore important to assess the quality of life in this productive group of society. The protocol consisted of the Urdu version of the demographic questionnaires, the Pittsburgh Sleep Quality Index (PSQI), the Cohen-Hoberman Inventory of Physical symptoms (CHIPS) and the World Health Organization Quality of Life (WHOQOL-BREF). A total of 150 young adults (boys = 62, girls = 88) were included through convenience sampling. A significant positive association was found between poor sleep quality and health complaints (r = 0.53**). However, a significant negative association was found between poor sleep and quality of life in terms of physical health, psychological health, social relationships and the environment (r = -0.57**, -0.35**, -0.39**, -0.33**), respectively, which indicates the importance of sleep in determining quality of life. Furthermore, the majority of the participants (57%) reported good sleep quality and low health complaints [M = 15.08, standard deviation (SD) = 13.29] whereas 43% of participants reported poor sleep quality, more health complaints (M = 32.94, SD = 22.59) and poor quality of life. It shows that most of the participants are healthy and able to manage their daily routine, work commitment and provide services for country's development.

Is Sleep Disruption a Cause or Consequence of Alzheimer's Disease? Reviewing Its Possible Role as a Biomarker.

In recent years, the idea that sleep is critical for cognitive processing has gained strength. Alzheimer’s disease (AD) is the most common form of dementia worldwide and presents a high prevalence of sleep disturbances. However, it is difficult to establish causal relations, since a vicious circle emerges between different aspects of the disease. Nowadays, we know that sleep is crucial to consolidate memory and to remove the excess of beta-amyloid and hyperphosphorilated tau accumulated in AD patients’ brains. In this review, we discuss how sleep disturbances often precede in years some pathological traits, as well as cognitive decline, in AD. We describe the relevance of sleep to memory consolidation, focusing on changes in sleep patterns in AD in contrast to normal aging. We also analyze whether sleep alterations could be useful biomarkers to predict the risk of developing AD and we compile some sleep-related proposed biomarkers. The relevance of the analysis of the sleep microstructure is highlighted to detect specific oscillatory patterns that could be useful as AD biomarkers.

Diagnóstico de Enfermería: dolor crónico. Análisis crítico de sus características definitorias

Objective: a critical analysis of the defining characteristics described in the Nursing Diagnosis [00133] Chronic Pain, according to the NANDA taxonomy. Method: a narrative review of the defining characteristics of the diagnosis and their relationship with it. A bibliographic search was conducted in different databases: Cinahl, Pubmed, Cuiden, Scopus, Dialnet and Scielo.The following keywords were used: “chronic pain”, “diagnosis” and “nursing”. The search was limited to publications within the past five years, in Spanish and English. Results: chronic pain is a global public health problem which persists during a period over three months. Chronic pain is not only considered a symptom but a disease, associated with alterations in the physical, psychological, emotional, occupational, social and sexual settings. In terms of the psychological and emotional aspect, there is a prevalence of depression, anxiety and fear, which can lead to disability. The defining characteristics found in the Chronic Pain Nursing Diagnosis were: “Altered ability to continue previous activities”, “Changes in Sleep Pattern”, “Self-focused”, “Anorexia”, “Reports, self-reports and check-lists as defining characteristics of diagnosis”. Conclusions: it is necessary to review the characteristics defining “Altered ability to continue previous activities” and “Anorexia”, because no evidence was found that these were really characteristics identifying this diagnosis. The inclusion of “Fear of Pain” must be assessed, with the aim to help to identify this diagnosis more easily.

Relationship Between Waiting Time, Anxiety and Sleep Disturbances Among Saudi Parents of Children Admitted to Pediatric Intensive Care Unit

Parents of children admitted to PICU experience extreme level of anxiety. It is an extremely difficult process for parents to make a transition from parents of well-child to parents of acutely ill child. Aim: To identify the relationship between waiting time, anxiety and sleep disturbances among saudi parents of children admitted to pediatric intensive care unit. Methods: A cross sectional descriptive correlational study design was employed to conduct this study on a convienience sample of 115 adult parents of children admitted to the PICU. Participants were asked to complete three questionnaire survey including participant’s demographic background, Spielberger State-Trait Anxiety Inventory, and a parental sleep disturbance questionnaire. An explanation about the purpose and the nature of the study was offered for each individual potential participant. Subjects were assured about the confidentiality of the collected data and that it will be only used by the researcher for the purpose of the current study. Data were analyzed using SPSS version 22. Results: More than half of the participants (62.6%) scored 12 and above reflecting considerable levels of anxiety. A very significant precentage (92.7%) of the parents reported sleep problems. Three quarters of the participants (73.2%) mentioned that sleep problems affected them negatively. There was a highly statistically significant difference between groups with different educational background in relation to anxiety, as well Unemployed participants experienced significantly higher anxiety. Conclusion: The findings of this exploratory study indicate considerable levels of anxiety and changes in sleep pattern of parents of children admitted to paediatric intensive care unit. During this period, identifying the parental needs and the causes of anxiety might contribute to parents' mental health. Keywords: PICU, Parental Anxiety, waiting time, sleep disturbances DOI: 10.7176/JHMN/71-11 Publication date: February 29 th 2020

Sedation selection to reduce delirium risk: Why dexmedetomidine may be a better choice.

In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk. Propofol, like benzodiazepines, causes changes in sleep patterns by suppressing the rapid eye movement sleep stage not seen with dexmedetomidine, worsening the ICU patient's already poor sleep quality. This reduction in sleep quality increases the risk of delirium. As patient advocates, advanced practice nurses play a vital role in minimizing risk of patient harm. Sedative use and management are areas of opportunity for nurses to minimize this risk. When sedatives are needed, daily sedation vacations should be conducted to re-evaluate the minimum required dose. These practices can reduce sedation risks for delirium and allow for bedside screening and early detection.

Effectiveness of an mHealth Intervention for Infant Sleep Disturbances

Bedtime problems and night wakings are highly prevalent in infants. This study assessed the real-world effectiveness of an mHealth behavioral sleep intervention (Customized Sleep Profile; CSP). Caregivers (83.9% mothers) of 404 infants (age 6 to 11.9 m, M = 8.32 m, 51.2% male) used the CSP (free and publicly available behavioral sleep intervention delivered via smartphone application, Johnson’s® Bedtime® Baby Sleep App). Caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R) at baseline and again 4 to 28 days later. Changes in sleep patterns were analyzed, based on sleep problem status (problem versus no problem sleepers; PS; NPS). Sleep onset latency improved in both groups. Earlier bedtimes, longer continuous stretches of sleep, as well as decreased number and duration of night wakings, were evident in the PS group only. The BISQ-R Total score, total nighttime sleep, and total 24-hour sleep time improved for both groups, with a greater change for the PS group. Further, caregivers of infants in the PS group decreased feeding (bedtime and overnight) and picking up overnight, and perceived better sleep. Bedtime routine regularity, bedtime difficulty, sleep onset difficulty, and caregiver confidence improved for both groups, with the PS group showing a greater magnitude of change. Thus, a real-world, publicly available, mHealth behavioral sleep intervention was associated with improved outcomes for older infants. Intervention recommendations resulted in changes in caregivers’ behavior and improvements in caregiver-reported sleep outcomes in infants, in as few as 4 days.