Sleep Problems In Patients Research Articles

Combined mindfulness-based stress reduction and physical activity improved psychological factors and sleep quality in patients with MDD: A randomized controlled trial study

Non-pharmacological interventions are available to improve sleep quality including mindfulness-based stress reduction (MBSR) and physical activity (PA). The present study aimed to evaluate the effectiveness of the combination of MBSR and PA interventions as an augmentation to treatment as usual with sertraline to improve sleep and psychological factors among patients with MDD. Sixty-seven patients in outpatient care diagnosed with MDD for a minimum of 2 months (mean age: 35.32 ± 7.8; 65 % female) and currently on sertraline treatments were randomized into four groups including: 1) Physical activity, 2) MBSR, 3) Combination MBSR and physical activity (MBSRPA), and 4) Control. All participants completed self-reported questionnaires on sleep quality, depression, anxiety, and perceived stress from baseline to 8 weeks later at post-test and four weeks later at follow-up. Over time, sleep disturbance and psychological problems were reduced in all conditions when compared to the control. Moreover, MBSRPA had a more positive impacts on perceived stress, anxiety, depressive symptoms and sleep quality. The results of the present study confirmed the effectiveness of MBSRPA as an augmentation to standard therapy to help reduce symptoms of depression, anxiety, perceived stress, and sleep problems in patients with MDD.

Sleep disorders in patients with heart diseases - present knowledge

Abstract Introduction The problem of sleep disorders plays a significant role in the functioning of people in the contemporary world, particularly affecting cardiac patients. It entails a series of consequences that impact health. The study analyzed the occurrence of sleep disorders among cardiac patients. Purpose The project aimed to assess the available literature regarding described sleep disorders in patients with cardiovascular diseases and to analyze the impact of sleep disorders on the functioning of cardiac patients. Methods Materials available in PubMed and Google Scholar were analyzed using keywords such as "sleep disorders," "insomnia," "cardiovascular disease," "heart attack," "heart failure," "hypertension," "coronary artery disease" in various configurations. A comprehensive analysis of publications was conducted to identify studies on sleep disorders in cardiac patients, focusing on risk factors and management strategies for sleep problems in this patient group. Results Sleep disorders occur in cardiac patients and significantly affect their health. Sleep disorders also increase cardiovascular risk in healthy individuals. Sleep disorder management methods include problem recognition, lifestyle modifications, pharmacotherapy, and behavioral interventions. A crucial aspect of care appears to be the need for diagnosing sleep problems in cardiac patients and implementing integrated multidisciplinary care. Conclusions Sleep disorders pose a significant risk for cardiac patients, requiring an interdisciplinary therapeutic approach. Future research should assess the scale of sleep disorders in cardiac patients in Poland, as well as identify factors influencing sleep disorders in this patient group. Subsequently, treatment strategies and integrated care should be developed.

Antipsychotic medications and sleep problems in patients with schizophrenia

BackgroundSleep problems are common and related to a worse quality of life in patients with schizophrenia. Almost all patients with schizophrenia use antipsychotic medications, which usually increase sleep. Still, the differences in subjective sleep outcomes between different antipsychotic medications are not entirely clear. MethodsThis study assessed 5466 patients with schizophrenia and is part of the nationwide Finnish SUPER study. We examined how the five most common antipsychotic medications (clozapine, olanzapine, quetiapine, aripiprazole, and risperidone) associate with questionnaire-based sleep problems in logistic regression analyses, including head-to-head analyses between different antipsychotic medications. The sleep problems were difficulties initiating sleep, early morning awakenings, fatigue, poor sleep quality, short (≤6 h) and long sleep duration (≥10 h). ResultsThe average number of antipsychotic medications was 1.59 per patient. Clozapine was associated with long sleep duration (49.0 % of clozapine users vs 30.2 % of other patients, OR = 2.05, 95 % CI 1.83–2.30, p < .001). Olanzapine and risperidone were in head-to-head analyses associated with less sleep problems than patients using aripiprazole, quetiapine, or no antipsychotic medication. Aripiprazole and quetiapine were associated with more insomnia symptoms and poorer sleep quality. Patients without antipsychotic medications (N = 159) had poorer sleep quality than patients with antipsychotic use, and short sleep duration was common (21.5 % of patients not using antipsychotics vs 7.8 % of patients using antipsychotics, OR = 2.97, 95 % CI 1.98–4.44, p < .001). ConclusionsPrevalence of sleep problems is markedly related to the antipsychotic medication the patient uses. These findings underline the importance of considering and assessing sleep problems when treating schizophrenia patients with antipsychotics.

Short and Long-term Effects of Cognitive Behavioral Therapy on Sleep Problems and Psychotic Symptoms in Patients with Psychotic Disorders: A Meta-Analysis Study.

Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, this method has some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia. In recent years, there has been an increasing interest in its use in patients with psychotic disorders. This meta-analysis aims to evaluate the effectiveness of CBT-I on sleep problems in patients with psychotic disorders. A systematic search was conducted using PubMed, Scopus, and EBSCO (MEDLINE) databases to identify relevant studies. The study included RCTs and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had sleep problems for at least one month, and who were receiving treatment. The initial search yielded 246 studies, and eight studies were selected for the meta-analysis after screening and applying inclusion and exclusion criteria.The statistical analysis was conducted using the R software. CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders during short and long-term periods. In addition to this, CBT-I leads to a significant improvement in psychotic symptoms in the short-term period and contributes significantly to the improvement in mental well-being in both short and long-term periods. CBT-I is an effective and valuable method for sleep problems in patients with psychotic disorders and its use is recommended to be widespread.

P059 Sleep and Fibromyalgia: Identifying and Managing Sleep Disorders.

Abstract Introduction Little is known about the presentation and management of sleep problems in patients with fibromyalgia [FMS]. This pilot study aims to 1) characterise sleep/wake patterns and sleep disorders in participants with FMS, and 2) assess changes in sleep and FMS symptoms with individualised sleep disorder treatment. Methods Women with FMS were recruited from the Rheumatology Unit at The Queen Elizabeth Hospital, South Australia. Participants recorded their sleep and activity for two-weeks using an under-mattress sleep sensor (Withings), sleep diaries and a wrist accelerometer. Questionnaires included Berlin Sleep Questionnaire (OSA); Epworth Sleepiness Scale; Flinders Fatigue Scale; Restless Legs Syndrome (RLS) Screener, Sleep Condition Indicator, and Fibromyalgia Impact Questionnaire. Results Preliminary data from 7 women (aged 49.3±12.8years, BMI 30.9±7.8kg/m2, average pain duration 14.1±9.4 years) were investigated. Sleep efficiency was low (65.9%±11.9). Five women were ‘high-risk’ for a sleep disorder (3 RLS, 3 OSA, 3 insomnia, 3 circadian rhythm disorders). Two were ‘high-risk’ for &amp;gt;2 sleep disorders. Two women had delayed, and one had advanced, circadian rhythms. Average self-reported sleep time in ‘high-risk’ women was shorter than the two women not at risk (6.2±1.1 vs 7.8±0.4hours). (6.2±1.1 vs 7.8±0.4hours). Fatigue Scores exceeded those commonly observed for respondents living with a medical condition (25.2±2.4 vs. 20.4 + 6.2). Participants are currently undergoing sleep disorder treatments and preliminary results will be reported. Conclusion Identifying and managing sleep disorders, using cognitive behavioural therapy for insomnia and chronotherapeutic approaches may be an important therapeutic target for FMS patients to improve sleep quality, daytime functioning, and FMS symptoms.

Sleep Problems in Patients With Psoriatic Arthritis: A Systematic Literature Review and Metaanalysis.

The aim of this systematic review and metaanalysis is to summarize evidence regarding the relationship between psoriatic arthritis (PsA) and sleep problems. We identified 36 eligible studies-26 cross-sectional, 7 cohort, and 3 interventional studies-in PubMed and Embase. The prevalence of self-reported sleep problems in patients with PsA ranged from 30% to 85%. A metaanalysis of 6 studies that used the Pittsburgh Sleep Quality Index revealed a prevalence of poor sleep quality for patients with PsA of 72.9% (95% CI 63-81.8; I2 = 78%), which was statistically higher than in healthy controls (26.9%, 95% CI 11.7-45.4; I2 = 81%) but not significantly different than in patients with psoriasis (59.8%, 95% CI 46.9-72.1; I2 = 51%). Sleep disturbance was ranked in the top 4 health-related quality of life domains affected by PsA. One study suggested a bidirectional relationship between PsA and obstructive sleep apnea. Predictors of sleep problems included anxiety, pain, erythrocyte sedimentation rate, depression, fatigue, physical function, and tender or swollen joint count. Tumor necrosis factor inhibitors, guselkumab, and filgotinib (a Janus kinase inhibitor) were associated with improved sleep outcomes. Poor sleep quality is prevalent in patients with PsA. Objective sleep measures (ie, actigraphy and polysomnography) have not been used in PsA studies, and evidence on the validity of patient-reported sleep measures in PsA is lacking. Future studies should validate self-reported sleep measures in PsA, explore how sleep quality relates to PsA disease activity and symptoms using both objective and subjective sleep measures, assess the efficacy of strategies to manage sleep problems, and assess the effects of such management on symptoms and disease signs in patients with PsA.

Common but neglected problem in chronic spontaneous urticaria: Sleep disturbance

Background: Association of chronic spontaneous urticaria (CSU) with sleep disturbance has not been evaluated in studies that involve a large number of patients. Objective: In this study, we aimed to evaluate the sleep attitude and circadian rhythm in patients with CSU. Methods: As the patient group, recently diagnosed 100 patients with CSU, 100 patients with allergic rhinitis (AR) as the patient control group, and 100 healthy controls (HCs) were included. The Pittsburgh Sleep Quality Index (PSQI) questionnaire, sleep hygiene index (SHI), Epworth Sleepiness Scale (ESS) questionnaire, and the morningness-eveningness questionnaire (MEQ) were filled to assess sleep quality and circadian rhythm. CSU disease activity was evaluated by urticaria activity score-7 (UAS-7). Patients with concomitant diseases, e.g., psychiatric illnesses, that possibly affect sleep status or those who use related medications and at moderate or high risk of obstructive sleep apnea according to the STOP-Bang questionnaire were excluded from the study. Results: PSQI, SHI, and ESS scores were higher, and the MEQ score was lower in patients with CSU and patients with AR than those in the HCs (p < 0.001, for each score). However, the scores were not different among the patients with CSU and the patients with AR. UAS-7 was only correlated with PSQI scores (r = 0.402, p < 0.001). In addition, blood eosinophil counts and the serum C Reactive Protein (CRP) level were correlated with sleep quality (p = 0.02). Conclusion: The poor sleep quality, impaired sleep hygiene, increased daytime sleepiness, and intermediate type of circadian rhythm were observed in the patients with CSU and the patients with AR. Physicians should be aware of sleep problems in patients with CSU that might affect their quality of life and the success of their treatment.

Prevalence of different sleep problems in patients with respiratory diseases presented to a respiratory outdoor clinic

Introduction: A patient with compromised respiratory system due to some diseases, may have disturbed sleep to a great extent. It has been proved in various community based epidemiologic studies. Though most of such studies available had concentrated on single respiratory disease like Chronic Obstructive Pulmonary Disease (COPD) or Asthma in the community. But such studies are hardly available for patients attending a respiratory clinic, where all respiratory ailments were evaluated with concurrent sleep problems. The present study is one such. Methods: Total 163 patients were screened and among them 100 were selected as the study group. The patients were enquired with a standard questionnaire provided to them. In addition, they were given separate questionnaire as STOP BANG, Insomnia Severity Index Score, RLS questionnaire. Those persons with STOP BANG &gt; 5, were also advised for a polysomnography (PSG), if not already done. Descriptive statistical analysis has been carried out in the present study. Results: The present study is a cross-sectional depiction of relationships between various respiratory diseases and sleep problems. As per this study, most patients were asthmatic and commonest sleep problem was OSA. A subgroup analysis was done to determine the significance of difference of various parameters between the three groups of asthmatic patients, patients having COPD and the “Other” group. Discussion: Subjective sleep problems were significantly more in Asthma group than COPD group (P &lt; 0.0362). The mean STOP BANG was more in COPD group than the Asthma group (P &lt; 0.0301). Though OSA was the commonest sleep problem between the three groups, but the prevalence was not statistically significant between them. More patients in the COPD group had insomnia, but it was not statistically significantly more than in Asthma group. Sleeping pill use was significantly more in COPD group than the Asthma group (P &lt; 0.0039). Conclusion: Sleep problems are common in patients with respiratory diseases and OSA is the most common problem according to the present study. Asthma patients had more subjective sleep problems. Sleeping pill use was more common in COPD patients instead of having less subjective sleep complaints than asthma patients.

Changes in Sleep Problems in Patients Who Underwent Surgical Treatment for Degenerative Spinal Disease with a Concurrent Sleep Disorder: A Nationwide Cohort Study in 3183 Patients during a Two-Year Perioperative Period.

Sleep disturbance is prevalent in patients with degenerative spinal disease, and recent studies have reported that surgical treatment is more effective for improving sleep quality than conservative treatment. We aimed to investigate the perioperative changes of sleep problems in patients who underwent surgical treatment for degenerative spinal disease with a concurrent sleep disorder, and presented them according to various clinical profiles possibly associated with sleep disturbance. In addition, we identified factors associated with poor sleep improvement after surgery. This study used data from the Korea Health Insurance Review and Assessment Service database from 2016 to 2018. We included 3183 patients aged ≥19 years who underwent surgery for degenerative spinal disease and had a concurrent sleep disorder. Perioperative changes in the two target outcomes, including the use of sleep medication and hospital visits owing to sleep disorders, were precisely investigated according to factors known to be associated with sleep disturbance, including demographics, comorbidities, and spinal regions. Logistic regression analysis was performed to identify factors associated with poor improvement in terms of sleep medication after surgery. All estimates were validated using bootstrap sampling. During the 1-year preoperative period, the use of sleep medications and hospital visits owing to sleep disorder increased continuously. However, they abruptly decreased shortly after surgical treatment, and throughout the 1-year postoperative period, they remained lower than those in the late preoperative period. At the 1-year follow-up, 75.6% (2407 of 3183) of our cohort showed improvement in sleep medication after surgery. Multivariable analysis identified only two variables as significant factors associated with non-improvement in sleep medication after surgery: depressive disorder (odds ratio (OR) = 1.25 [1.06-1.48]; p = 0.008), and migraine (OR = 1.42 [1.04-1.94]; p = 0.028). We could not investigate the actual sleep quality and resultant quality of life; however, our results justify the necessity for further high-quality studies that include such information and would arouse clinicians' attention to the importance of sleep disturbance in patients with degenerative spinal disease.

Substance Use and Sleep Problems in Patients With Psychotic Disorders.

Substance use and sleep problems are common in patients with psychotic disorders, but their associations in these patients have not been evaluated. We aimed to investigate associations between substance use and sleep problems in a large nationwide cohort of patients with a psychotic disorder. This study is part of the Finnish SUPER study, which belongs to the Stanley Global Neuropsychiatric Genomics Initiative. In this cross-sectional, multicenter study, participants (N = 8616) were recruited from primary and specialized healthcare. Patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression were included. Information on current alcohol (Alcohol Use Disorders Identification Test-Concise) and cigarette use as well as on lifetime illicit drug use, including cannabis, benzodiazepines, amphetamines, and opioids, was collected using questionnaires. The sleep outcomes in our logistic regression analysis were short (≤6 h) and long sleep (≥10 h) duration, difficulties initiating asleep, early morning awakenings, fatigue, and poor sleep quality (SQ). Self-reported substance use was associated with a higher prevalence of sleep problems. After adjustments with age, gender, diagnostic group, and living status, hazardous alcohol use (eg, poor SQ odds ratio [OR] = 1.80, 95% CI: 1.49 to 2.16, P < .001), current smoking (short sleep duration OR = 1.28, 95% CI: 1.08 to 1.52, P = .005), and lifetime benzodiazepine misuse (difficulties initiating sleep OR = 2.00, 95% CI: 1.55 to 2.48, P < .001) were associated with sleep problems. Substance use was associated with sleep problems. Our findings underline the potential benefits of screening substance use when treating sleep problems in patients with psychotic disorders.

Treatment with brodalumab is not associated with improved sleep problems in real-life patients with plaque psoriasis: Results of the ProLOGUE study.

Psoriasis impacts various aspects of patients' health-related quality of life and is associated with sleep problems. However, research discussing the associations between interleukin-17 blockage therapies and sleep problems in patients with psoriasis is insufficient. We aimed to assess the effectiveness of brodalumab in alleviating sleep problems in real-life patients with plaque psoriasis. This analysis was part of the single-arm, open-label, multicenter, prospective, cohort study, ProLOGUE (study period October 2017-March 2020), which involved Japanese patients with plaque psoriasis. Assessments included correlation of Medical Outcomes Study Sleep Scale-Revised (MOS Sleep-R) scores (Sleep Problems Index-II [SPI-II] and MOS Sleep-R subscale scores) with multiple patient-reported outcome scores and the Psoriasis Area and Severity Index (PASI) at baseline. Additionally, change from baseline in MOS Sleep-R scores was assessed at weeks 12 and 48 of brodalumab treatment. Seventy-three patients were enrolled (male 82.2%, median age 54.0 years). At baseline, the SPI-II score correlated with the Patient Health Questionnaire-8 score (Spearman correlation coefficient [ρ]=-0.474) and weakly correlated with the Itch Numeric Rating Scale (NRS; ρ=-0.366), Skin Pain NRS (ρ=-0.275), and all Treatment Satisfaction Questionnaire for Medication-9 domain scores (ρ=0.270, ρ=0.303, and ρ=0.322 for effectiveness, convenience, and global satisfaction, respectively) but did not correlate with the PASI score. The SPI-II score and MOS Sleep-R subscale scores, except the Snoring score (p=0.0319), did not significantly change from baseline to week 12 of brodalumab treatment. In conclusion, treatment with brodalumab did not improve overall sleep problems in real-life patients with plaque psoriasis, suggesting that sleep problems require attention in daily clinical practice (Japan Registry of Clinical Trials identifier, jRCTs031180037).

Evaluation of psychiatric symptoms in patients diagnosed with fibromyalgia during COVID-19 pandemic: a cross-sectional study

Objectives: Our aim was to assess depression, anxiety, trauma symptoms and sleep problems in patients with fibromyalgia during the COVID-19 pandemic.Methods: This study was conducted face-to-face with 62 SARS-CoV-2 negative fibromyalgia patients. Sociodemographic and Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), the American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia 2010 were applied to the subjects. Results: Patient mean scores on the HAD Depression and HAD Anxiety scales were 8.42 ± 3.73 and 9.58 ± 3.86, respectively. The patients' PSQI and PCL-5 scores were 8.10 ± 3.49 and 33.90 ± 16.91, respectively. While the CAS score average was found to be 1.13 ± 2.79, the OCS score average was found to be 1.81 ± 2.27. The mean scores for the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), and Visual Analog Scale (VAS) were 9.90 ± 3.03, 7.84 ± 2.07 and 7.37 ± 1.81, respectively. Poor sleep quality was identified in 75.8% and a risk of post-traumatic stress symptoms in 16.1%. SSS scores were found to be higher in those at risk of depression than those without (U=265, p = 0.003). OCS (U=256, p = 0.007), SSS (U=203.5, p = 0.001), VAS (U=263.5, p = 0.012), PCL-5 (U=144, p = 0.001) scores were found to be higher in those at risk of anxiety than those without. Conclusions: It was observed that depression was a predictor of fibromyalgia symptom severity and anxiety was a predictor of obsession with coronavirus, fibromyalgia symptom severity, VAS, and post-traumatic stress symptoms.

Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score-Matched Population-Based Cohort Study.

Simple SummaryWe aimed to estimate the effects of preexisting sleep disorders on the oncologic outcomes of patients with oral squamous cell carcinoma (OSCC) after receiving standard treatments. We conducted a head-to-head propensity-score-matching-based study to mimic a randomized trial to compare the survival, locoregional recurrence, and distant metastasis rates between OSCC patients with and without sleep disorders. The patients with sleep disorders receiving curative treatments for OSCC had poorer oncologic outcomes than did those without sleep disorders. Preexisting sleep disorders may be survival predictors in patients with OSCC. Studies on how pharmacological and behavioral treatments for sleep problems improve survival benefits in patients with OSCC are warranted.Purpose: To investigate the effects of preexisting sleep disorders on the oncologic outcomes of patients receiving standard treatments for oral squamous cell carcinoma (OSCC). Methods: The patients recruited from the Taiwan Cancer Registry Database who had received surgery for stage I–IVB OSCC. The Cox proportional hazards model was used to analyze all-cause mortality, locoregional recurrence (LRR), and distant metastasis (DM). The patients were categorized into those with and without sleep disorders (Groups 1 and 2, respectively) through propensity score matching. Results: In the multivariate Cox regression analysis, the adjusted hazard ratios for all-cause mortality, LRR, and DM for Group 1 compared with Group 2 were 1.19 (95% confidence interval (CI): 1.04–1.36; p = 0.011), 1.47 (95% CI: 1.23–1.75; p < 0.001), and 1.15 (95% CI: 1.02–1.44; p = 0.025), respectively. Conclusion: OSCC patients with sleep disorders demonstrated poorer oncologic outcomes than did those without sleep disorders. Therefore, before OSCC surgery, patients with OSCC should be screened for preexisting sleep disorders because they may serve as predictors for survival in these patients. Future studies investigating the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with OSCC are warranted.

Association of the Coexistence of Somnipathy and Diabetes With the Risks of Cardiovascular Disease Events, Stroke, and All-Cause Mortality: A Systematic Review and Meta-analysis.

Background Somnipathy and diabetes are independently associated with an increased risk of cardiovascular disease (CVD). However, whether a combination of both conditions is associated with a higher risk of CVD events remains uncertain. Therefore, the aim of this meta-analysis was to clarify this association. Methods and Results We searched MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials. We included randomized controlled trials, nonrandomized trials, and prospective observational cohort studies that assessed the combined effect of diabetes and comorbid somnipathy on CVD risk and mortality for at least 1 year. Outcomes included CVD, coronary heart disease, stroke, and all-cause mortality. Twelve studies involving 582 267 participants were included in the meta-analysis. Patients with somnipathy and comorbid diabetes exhibited increased risks of CVD, coronary heart disease, stroke, and all-cause mortality (risk ratio [RR], 1.27 [95% CI, 1.12-1.45], P<0.0001; RR, 1.40 [95% CI, 1.21-1.62], P<0.0001; RR, 1.28 [95% CI, 1.08-1.52], P=0.004, and RR, 1.56 [95% CI, 1.26-1.94], P<0.0001, respectively). Conclusions The coexistence of somnipathy and diabetes is associated with higher risks of CVD, coronary heart disease, stroke, and mortality than somnipathy or diabetes alone. Resolving sleep problems in patients with diabetes may reduce the risks of CVD, stroke, and mortality. Registration Information https://www.crd.york.ac.uk/prospero/. Identifier: PROSPERO CRD42021274566.

MO864: Sleep Disorders in a Haemodialysis Unit

Abstract BACKGROUND AND AIMS There is a high prevalence of sleep disorders in patients with CKD. Sleep apnea, restless legs syndrome and daytime sleepiness are much more common in haemodialysis patients than the general population. OBJECTIVE To know the prevalence of sleep problems in patients in our hospital haemodialysis unit through surveys carried out on patients. METHOD We designed a cross-sectional study on the prevalence of sleep disorders. Exclusion criteria age under 18 years. We gave 4 questionnaires to the patients in our unit: restless legs, Epworth daytime sleepiness, Berlin and Pittsburg Sleep quality. We collected demographic and clinical variables, dialysis parameters and laboratory data that could be related. Student's t-test and X-squared were applied for qualitative variables. SSps Version 15.0. RESULTS Of those surveyed, 12 had criteria for restless leg syndrome. The difference between ferritin and CRP among the RLS group was striking. Excessive daytime sleepiness is met in 10 patients. Only the CRP values were significantly higher in the group with the normal test. When associating the Epworth test and the Berlin questionnaire, we had a total of 3 patients with high risk of OSAS. 15 patients meet the criteria for poor quality of sleep in the Pittsburg questionnaire where we assess: quality, latency, efficacy and duration of sleep as well as use of medication and daytime impairment. CONCLUSION Highlight the high prevalence of sleep disorders: 24% restless leg syndrome, 20% daytime sleepiness and 30% with poor sleep quality. We must assess sleep disorders in haemodialysis patients since they present a significant deterioration in quality of life.

The Interaction between Sleep and Pain: How Nurses Can Improve Patient Outcomes

There is a close inter-dependent relationship between sleep and pain. Patients in pain are more likely to have fragmented sleep and altered breathing during sleep. Patients with sleep disorders are more likely to have decreased tolerance to pain and increased incidence of negative outcomes related to interventions for pain. This presentation will include the most recent research on the underlying physiologic reasons for the relationship, the potential negative patient outcomes, and ways that nurses can assess and manage sleep problems in patients with acute and chronic pain.

Targeting sleep patterns to promote mental health in vulnerable groups of older adults

Sleep is widely acknowledged as a pillar of health. Decades of prospective observational research demonstrates that sleep-wake disturbances predict increased risk for major health outcomes in aging. Sleep problems are generally acknowledged as a pertinent issue by patients and clinicians alike. But sleep-wake disturbances are not an inevitable consequence of aging and are relatively rare in healthy older adults. Instead, certain patterns of sleep-wake disruption are predictably common in subgroups of older adults, i.e., those who are burdened with risk factors to begin with. As sleep-wake patterns are theoretically modifiable using both pharmacological and behavioral techniques, they represent a promising avenue for targeted treatment and prevention approaches. Despite significant advances, little progress has been made in terms of reducing clear disparities in sleep health among older adults, wherein sleep problems and related sequalae disproportionately affect vulnerable subgroups. Specific sleep-wake targets and interventions that improve health in key groups of vulnerable elders have not been established. In this general session, we report on recent progress within the overarching theme that targeted sleep medicine approaches are needed to improve health outcomes across subgroups older adults who have known health disparities. In the first talk, we examine the role of sleep as it relates to the disproportionate burden of depression symptoms in dementia caregivers. This presentation by Stephen Smagula, Ph.D. covers sleep target identification and biomarker studies; rationale for adapting a targeted behavioral approach; and preliminary data showing target engagement and depression symptom improvements in a pilot study of older caregivers. Next, Sarah Stahl, PhD. reviews evidence indicating that sleep-wake rhythm disruption may explain the excess burden of depression risk in older adults who were recently spousally bereaved. Dr. Stahl covers preliminary data for, and the development/implementation of an efficacy trial designed to prevent depression by stabilizing rhythms in bereaved elders. Third, Ellen Lee, M.D. reviews the area of sleep problems in patients aging with schizophrenia. Dr. Lee presents data relating a novel sleep-wake target with biomarkers and other clinical outcomes in adults aged 41-70 years with schizophrenia. Finally, William (Vaughn) McCall, M.D. reviews links between insomnia and elevated suicide rates in older adults. Dr. McCall addresses insomnia as an under-examined risk factor and treatment target for suicide prevention in older adults. Through these presentations and audience interaction, symposium attendees will learn about novel approaches for treating sleep-wake factors in older adults at high/difficult-to-mitigate risk for averse health outcomes.

Association between Pre-Existing Sleep Disorders and Survival Rates of Patients with Breast Cancer.

Simple SummaryThis is the first study to estimate the effects of pre-existing sleep disorders on the survival outcomes of patients with breast cancer after receiving standard treatments. We conducted a head-to-head propensity score matching study to mimic a randomized trial to compare the survival rates of women with both sleep disorders and breast cancer. Women with pre-existing sleep disorders receiving curative treatments for breast cancer had poorer survival outcomes than those without sleep disorders. Therefore, patients should be screened and evaluated for pre-existing sleep disorders prior to breast surgery, with such disorders serving as survival predictors in patients with breast cancer. Future studies may investigate the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with breast cancer.PURPOSE: To investigate the effects of pre-existing sleep disorders on the survival outcomes of women receiving standard treatments for breast invasive ductal carcinoma (IDC). METHODS: We recruited patients from the Taiwan Cancer Registry Database who had received surgery for clinical stage I–III breast IDC. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into those with and without sleep disorders (Groups 1 and 2, respectively) through propensity score matching. RESULTS: In the multivariate Cox regression analysis, the adjusted hazard ratio for all-cause mortality for Group 1 compared with Group 2 was 1.51 (95% confidence interval: 1.19, 1.91; p < 0.001). CONCLUSION: Our study demonstrated that the sleep disorder group had poorer survival rates than the non-sleep disorder group in breast cancer. Therefore, patients should be screened and evaluated for pre-existing sleep disorders prior to breast surgery, with such disorders serving as a predictor of survival in patients with breast cancer. Future studies may investigate the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with breast cancer.

Extent of sleep problems and relationship with severity of chronic pain using three validated sleep assessment tools

ObjectiveChronic pain can impact on sleep, but the extent and nature of sleep problems in patients with chronic pain are incompletely clear. Several validated tools are available for sleep assessment but they each capture different aspects. We aimed to describe the extent of sleep issues in patients with chronic non-malignant pain using three different validated sleep assessment tools and to determine the relationship of sleep issues with pain severity recorded using the Brief Pain Inventory (BPI), a commonly used self-assessment tool in pain clinics. The BPI has a single question on the interference of pain on sleep and we also compared this with the validated sleep tools.DesignProspective, cross-sectional study.SettingPain management clinic at a large teaching hospital in the United Kingdom.SubjectsAdult patients (with chronic non-malignant pain of at least 3 months’ duration) attending clinic during a 2-month period.MethodsParticipants completed the Pittsburgh Sleep Quality Index (PSQI), the Pain and Sleep Questionnaire-3 (PSQ-3) and the Verran Snyder-Halpern (VSH) sleep scale, plus the BPI. Duration and type of pain, current medications and demographic data were recorded.ResultsWe recruited 51 patients and 82% had poor sleep quality as shown by PSQIscores above five. PSQI (p = 0.0002), PSQ-3 (p = 0.0032), VSH sleep efficiency (p = 0.012), sleep disturbance (p = 0.0014) and waking after sleep onset (p = 0.0005) scores were associated with worse BPI pain scores. BPI sleep interference scores concurred broadly with the validated sleep tools. Median [range] sleep duration was 5.5 [3.0–10.0] hours and was also related to pain score (p = 0.0032).ConclusionChronic pain has a marked impact on sleep regardless of the assessment tool used. The sleep interference question in the BPI could be used routinely for initial identification of sleep problems in patients with chronic pain.

Evaluation of habitual sleep and factors influencing it in patients awaiting acute or planned abdominal surgery

Background and aims: This study aimed to clarify the incidence and severity of habitual sleep disturbances in patients undergoing surgery. Methods: A survey was conducted to collect data in a cohort of patients awaiting abdominal surgery. The Insomnia Severity Index score was used as primary measurement, while the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index scores were used as secondary measurements. Findings: Overall, 119 patients were included in the analysis. The habitual sleep in the study cohort revealed high incidence of sleep difficulties and insomnia. Female sex and incidence of anxiety and depression were significantly related to all three scores, while age and employment were associated with Epworth Sleepiness Scale and Insomnia Severity Index scores, respectively. Conclusions: Female sex, experiencing depression or anxiety had severe negative impact on sleep in patients scheduled for elective or planned surgery. The prevalence of sleep problems in patients should be considered for optimising sleep to improve rehabilitation and reduce stress associated with surgery.