Sleep Quality Index Total Score Research Articles

Evaluacija grupe pacijenata obolelih od epilepsije u pogledu kvaliteta sna, umora i depresije

Introduction: The aim of this study is to investigate the relationship between clinical features, sleep quality, fatigue and mental symptoms in epileptic patients. Material and Methods: This cross-sectional study was conducted at epilepsy outpatient clinic of Bozyaka Training and Research Hospital. 81 patients who were followed up for the diagnosis of epilepsy were included in the study. The patients were administered a sociodemographic data form, Pittsburgh Sleep Quality Index, Beck Depression Inventory, Fatigue Severity Scale. Results: The median age of the patients included in the study was 37.42 (51.9%) were women and 39 (48.1%) were men with an education period of 8 years. There was no previous family history of psychiatric illness. Seizure control was achieved in 34 (42%) patients. 53 (65.4%) patients were observed for focal type, 28 (34.6%) patients were for generalized type seizures. The median duration of epilepsy was 13 years. The median Beck Depression Inventory score of the patients was 13, and the number of patients with a Beck Depression Inventory score higher than 19 was 25 (30.9%). There was mild tiredness in 47 (58%) and chronic fatigue in 16 (19.8%) patients. The median of Pittsburgh Sleep Quality Index total score was 4 and 18.5% (15) had poor sleep quality. Chronic fatigue was higher in epilepsy patients without seizure control compared to those with seizure control (p = 0.001). Conclusion: The rate of patients with moderate and severe depression is high in our study. This indicates the significance of evaluating the diagnosis of depression in epilepsy patients. In the follow-up of these patients, it is crucial to investigate the causes of fatigue and depression carefully. Especially psychiatric expert opinion and multidisciplinary follow-up should be carried out without ignoring the presence of depression.

Effect of Internet Addiction on Sleep Quality in University Students

The objective of the research was to investigate the effect of the internet addiction on sleep quality in university students.
 Materials and Methods. The sample of the study consisted of the students who were studying in Erzincan Binali Yildirim University, 2017-2018 academic year (n=419). The study data were collected using the Personal Information Form, the Young Internet Addiction Questionnaire-Short Form and the Pittsburgh Sleep Quality Index. Analysis of the data was performed using percentile, averages, and Pearson correlation analysis.
 Results. The average age of the adolescents participated in the study was 20.54±1.92; 65.6% were female. Adolescents' Young İnternet Addiction Test total score average was 26.58±8.96 and the Pittsburgh Sleep Quality Index total score average was 6.51±2.99. A positive and statistically significant (26.2%) correlation was found between the Young İnternet Addiction Test total score and the Pittsburgh Sleep Quality Index total score of the adolescents.
 Conclusions. Internet addiction disrupts sleep quality in university students and causes sleep disorders.

Sleep quality across pregnancy and postpartum: effects of parity and race

BackgroundDespite high prevalence and clinical implications of disturbed sleep during pregnancy, information on changes in sleep across pregnancy and postpartum is incomplete. Moreover, predictors of differential patterns of sleep quality across the perinatal period are poorly defined. MethodsThis study examined subjective sleep quality using the Pittsburgh Sleep Quality Index during each trimester of pregnancy and at 4-11 weeks postpartum among 133 women inclusive of nulliparous and multiparous African Americans and Whites. ResultsAt any given assessment, 53%-71% of women reported poor overall sleep quality (Pittsburgh Sleep Quality Index total score > 5). Moreover, 92% reported poor overall sleep quality during at least 1 assessment, including 88% at some time during gestation. Compared to nulliparous women, multiparous women reported poorer overall sleep quality, shorter sleep duration, and poorer sleep efficiency during the first trimester; poorer overall sleep quality and longer sleep latency in the second trimester; and more frequent sleep disturbances (eg, night time and early morning awakenings) during the third trimester. Among nulliparous as well as multiparous women, specific aspects of sleep (eg, subjective sleep quality, sleep disturbances, sleep efficiency) were poorer in African American compared to White women at different time points during pregnancy. No effects of race or parity were observed on sleep parameters at postpartum. ConclusionsPoor sleep quality during pregnancy as well as early postpartum is highly prevalent among both African American and White women. Both multiparous status and African American race are associated with more disturbed sleep at some time points during pregnancy. These individual differences should be considered in future research and clinical efforts to promote perinatal sleep health.

Effect of 8-h time-restricted feeding on sleep quality and duration in adults with obesity.

This study examined the effects of time-restricted feeding (TRF; 8-h feeding window/16-h fasting window daily) on sleep. Obese adults (n = 23) followed 8-h TRF for 12 weeks. Pittsburgh Sleep Quality Index (PSQI) total score was below 5 at week 1 (4.7 ± 0.5) and week 12 (4.8 ± 0.7), indicating good sleep quality throughout the trial. Subjective measures of wake time, bedtime, and sleep duration remained unchanged. Findings from this secondary analysis indicate that TRF does not alter sleep quality or duration in subjects with obesity. Novelty This study is the first to show that TRF (8-h feeding window/16-h fasting window daily) does not alter sleep quality or duration in subjects with obesity.

Sleep Quality Assessment of Adolescents Residing in an Urban Resettlement Colony, New Delhi, India.

Background:Sleep is essential for physical and psychological development of children as well as adolescents. Poor sleep has been noted to lead to poor diet, obesity, stunted growth, mental health issues, and substance abuse. Despite the knowledge regarding the importance of sufficient sleep, the prevalence of insufficient sleep has been noted to increase among children and adolescents.Objective and Aim:The aim of the study was to determine the prevalence of poor sleep quality among adolescents of an urban resettlement colony and to evaluate the association of poor sleep quality with the correlates.Materials and Methods:A community-based cross-sectional study was conducted including 620 adolescents aged 10–19 years, in an Urban Resettlement Colony, Dakshinpuri Extension, New Delhi. A self-reported interview was conducted with the pretested, semi-structured interview schedule. The interview focused on sociodemographic variable, sleep quality using Pittsburgh sleep quality index, Perceived stress scale, screen time, and anthropometric measurements.Results:The mean of Pittsburgh sleep quality index total score was 2.3 (standard deviation = 1.9). Among the adolescents, 7.3% of them were found to be poor sleepers. Poor sleep quality was observed to be higher during school days as compared to vacation (9.3%, 6.5%, respectively). Adolescents of age group equal to and > 15 years have higher odds of having poor sleep quality than those younger than 15 years of age (odds ratio = 4.9; 95% confidence interval: 2.2, 10.8).Conclusion:Significant difference in sleep duration was noted among adolescents of age ≥15 years as compared to the younger group in the present study.

Sleep Quality and Attention May Correlate With Hand Grip Strength: FARM Study.

ObjectiveTo determine the socio-demographic, psychologic, hematologic, or other relevant factors associated with hand grip strength in Korean farmers.MethodsA total of 528 healthy Korean farmers were enrolled. Hand grip strength was measured in both hands using a hydraulic dynamometer. Socio-demographic characteristics were assessed and anthropometric measurements were obtained. Psycho-cognitive measurements such as sleep quality (Pittsburgh Sleep Quality Index) and Go/No-Go test response time were conducted. In addition to physical measurements, serologic parameters including insulin-like growth factor 1 were measured. The factors associated with hand grip strength were analyzed using multiple linear regression analysis after adjusting for age, height, and weight.ResultsThe mean hand grip strength was associated with the Pittsburgh Sleep Quality Index total score (β=-0.12, p=0.01), the Go/No-Go test response time (β=-0.18, p=0.001), vitamin D (β=0.12, p=0.02), and insulin-like growth factor 1 levels (β=0.1, p=0.045). In female farmers, hand grip strength was only associated with the Pittsburgh Sleep Quality Index total score (β=-0.32, p<0.001).ConclusionThe results of this study demonstrate that hand grip strength was associated with sleep quality and attention in Korean farmers.

Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson's Disease.

BackgroundSleep dysfunctions impose a large burden on quality of life for patients with Parkinson’s disease (PD). Several studies on PD reported potential therapeutic effects of transcranial direct current stimulation (tDCS) on motor and non-motor functions, but not related to sleep quality. Therefore, the present study examined sleep quality, depression perception, and quality of life changes after bilateral anodal tDCS in patients with PD.Material/MethodsTwenty-one patients (n=21) with PD underwent 10 sessions (20 min each, 5 per week) of bilateral anodal tDCS stimulation applied simultaneously over the left and right prefrontal and motor areas. The Pittsburgh Sleep Quality Index (PSQI) total score and sub-scores, Geriatric Depression Scale (GDS), and Health-related quality of life questionnaire (SF-36) were measured pre/post bilateral tDCS anodal stimulation.ResultsPSQI total score (P=0.045), sleep latency sub-score (P=0.02), and GDS total score (P=0.016) significantly decreased, and physical and mental components scores of SF-36 (P=0.018 and P=0.001, respectively) significantly increased after bilateral anodal tDCS stimulation. The GDS score decrease was directly correlated with decrease in PSQI total score (P=0.01), sleep latency sub-score (P=0.002), and sleep disturbance sub-score (P=0.003). In addition, the GDS score decrease was inversely correlated with increasing mental component score of SF-36 (P=0.001), which was directly correlated with an increase in sleep efficiency sub-score (P=0.03) and the physical component score of SF-36 (P=0.0001).ConclusionsBilateral anodal tDCS stimulation showed potential therapeutic effects in patients with PD in terms of sleep quality and depression level improvement, which together improved mental and physical quality of life in patients with PD.

Preliminary evidence that vortioxetine may improve sleep quality in depressed patients with insomnia: a retrospective questionnaire analysis.

Insomnia is a frequent symptom in depressed patients. It can present with difficulty in initiating and/or maintaining sleep. We retrospectively evaluated a group of 15 patients affected by major depressive disorder and complaining of insomnia, who started vortioxetine (VOR) treatment for their depressive symptoms. The following questionnaires were captured at baseline and follow-up: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Beck Depression Inventory. Pittsburgh Sleep Quality Index total score significantly decreased between follow-up and baseline (P <0.01), and in several subitems related to sleep quality and continuity. Moreover, Epworth Sleepiness Scale decreased between follow-up and baseline (P <0.01). Finally, Beck Depression Inventory reduction was also evident between follow-up and baseline (P <0.01). This retrospective analysis showing the significant effect of VOR on both depressive symptoms and insomnia in patients showing comorbid major depressive disorder and insomnia invites further research in order to confirm this preliminary evidence. We hypothesize that the VOR mechanism of action may explain the improvement of subjective sleep, other than depressive symptoms.

Sleep, resilience, and psychological distress in United States military Veterans

ABSTRACTSleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.

Changes in Caregiving Status and Intensity and Sleep Characteristics Among High and Low Stressed Older Women.

To examine whether change in caregiving status and intensity among community-dwelling older women was associated with sleep characteristics at follow-up, and whether perceived stress modified these associations. The sample included 800 women aged 65 years or older who completed baseline and second follow-up interviews in the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF). Respondents were categorized into four groups based on change in caregiving status and intensity between the two time points: continuous noncaregivers, ceased caregivers, low-intensity caregivers (continuous caregivers with low/decreased intensity), and high-intensity caregivers (continuous caregivers with high/increased intensity or new caregivers). Perceived Stress Scale scores at the second follow-up were dichotomized into high versus low stress. Sleep outcomes at SOF Visit 8 (which overlapped with Caregiver-SOF second follow-up) included the Pittsburgh Sleep Quality Index total score; and actigraphy-measured total sleep time, sleep efficiency, wake after sleep onset, and sleep latency. Multivariate-adjusted sleep characteristics did not differ significantly across caregiving groups. Among high-intensity caregivers, however, those with high stress levels had significantly longer wake after sleep onset (mean 82.3 minutes, 95% confidence interval = 70.9-93.7) than those with low stress levels (mean 65.4 minutes, 95% confidence interval = 55.2-75.7). No other sleep outcomes were modified by stress levels. Further, higher stress was significantly associated with worse Pittsburgh Sleep Quality Index scores, regardless of the caregiving group. Overall, sleep characteristics did not differ among noncaregivers, ceased caregivers, or those with high-/low-intensity caregiving among older women. However, subgroups of caregivers may be vulnerable to developing sleep problems, particularly those with high stress levels.

Psychometric properties of the medical outcomes study sleep scale in Spanish postmenopausal women.

This study aimed to analyze the reliability and validity of the Spanish version of the Medical Outcomes Study Sleep Scale (MOS-SS), and its ability to discriminate between poor and good sleepers among a Spanish population with vestibular disorders. In all, 121 women (50-76 years old) completed the Spanish version of the MOS-SS. Internal consistency, test-retest reliability, and construct validity (exploratory factor analysis) were analyzed. Concurrent validity was evaluated using the Pittsburgh Sleep Quality Index and the 36-item Short Form Health Survey. To analyze the ability of the MOS-SS scores to discriminate between poor and good sleepers, a receiver-operating characteristic curve analysis was performed. The Spanish version of the MOS-SS showed excellent and substantial reliability in Sleep Problems Index I (two sleep disturbance items, one somnolence item, two sleep adequacy items, and awaken short of breath or with headache) and Sleep Problems Index II (four sleep disturbance items, two somnolence items, two sleep adequacy items, and awaken short of breath or with headache), respectively, and good internal consistency with optimal Cronbach's alpha values in all domains and indexes (0.70-0.90). Factor analysis suggested a coherent four-factor structure (explained variance 70%). In concurrent validity analysis, MOS-SS indexes showed significant and strong correlation with the Pittsburgh Sleep Quality Index total score, and moderate with the 36-item Short Form Health Survey component summaries. Several domains and the two indexes were significantly able to discriminate between poor and good sleepers (P < 0.05). Optimal cut-off points were above 20 for "sleep disturbance" domain, with above 22.22 and above 33.33 for Sleep Problems Index I and II. The Spanish version of the MOS-SS is a valid and reliable instrument, suitable to assess sleep quality in Spanish postmenopausal women, with satisfactory general psychometric properties. It discriminates well between good and poor sleepers.

Eveningness and poor sleep quality independently contribute to self-reported depression severity in psychiatric inpatients with affective disorder

Background Chronotype and insomnia have been related to the development and to an unfavourable course of depression. However, the mutual relationship of both risk factors is as yet unclear, especially in acute, clinically manifest depressive disorders. Aims The present study was carried out to elucidate the separate direct and indirect influence of chronotype and poor sleep quality on depression severity in patients hospitalized for depression. Methods Depression severity (BDI-II), chronotype (Morningness–Eveningness Questionnaire), and subjective sleep quality (Pittsburgh Sleep Quality Index total score) were assessed concurrently in inpatients with a depressive syndrome and insomnia during routine treatment. Correlations, multiple regression and bootstrapping methods for testing mediation models were applied to assess the independent direct and indirect effects of chronotype and sleep quality on depression severity, after adjusting for effects of age and gender. Results Data from 57 consecutively admitted patients (88% with major depression) were analyzed (68% women, mean age 41 ± 13 years). Significant correlations between morningness–eveningness (p <0.05) or sleep quality (p <0.01) and depression severity were found; in a multiple regression model comprising chronotype, sleep quality, age and gender, only chronotype (p <0.05) and sleep disturbances (p <0.01) remained as independent significant concurrent predictors of depression severity (R2 = 0.184, p <0.01). Two mediation models revealed no significant results. Conclusions Eveningness and poor subjective sleep quality were independently and directly associated with higher depression severity in inpatients with depressive syndromes. Chronotype and sleep quality should be taken into account not only in risk assessment and prevention but also in hospitalized patients to develop and improve treatment options.

Impact of sleep quality on functional capacity, peripheral muscle strength and quality of life in patients with chronic obstructive pulmonary disease

Purpose: The purpose of this study was to assess the impact of quality of sleep on functional capacity, peripheral muscle strength and quality of life in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: Forty patients with COPD (61.6 ± 8.28 years) were included in this study. Subjective sleep quality (Pittsburgh sleep quality index), quality of life (Nottingham health profile), quadriceps muscle strength (QMS) and functional capacity (6-min walk test) were assessed. Results: Poor sleep quality (Pittsburgh sleep quality index total >5) was present in 57% of the patients. Patients with a poor sleep quality had significantly lower QMS and higher exercise heart rate (p < 0.05). The Pittsburgh sleep quality index total score was associated with QMS, Nottingham health profile physical mobility and sleep scores, exercise fatigue and dyspnea (p < 0.05). Conclusion: Sleep quality is affected in a majority of patients with COPD. It is related with symptoms, functional capacity, peripheral muscle strength and general quality of life.

Restorative Yoga for Symptom Management in Fibromyalgia: Results of an 8-week Intervention

Objective: The aim of this study was to determine the feasibility of an 8-week restorative yoga intervention and to collect preliminary data on its effects on the fibromyalgia-related symptoms of chronic widespread pain, sleep disturbance, and fatigue, and health-related quality of life. In a mixed methods, single-arm, feasibility study, participants completed pre- and post-intervention semi-structured interviews and self-report assessments at baseline, weeks 4 and 8, and at a 1-month follow-up telephone interview. Results: In this group of participants (N = 12), recruitment, retention, and adherence rates were comparable to those of other fibromyalgia yoga studies: recruitment 57.14%; retention 75%; adherence to group class 87.5%; and home practice adherence 93.33%. A ratio of 1:2 yoga instructor to participants was required for the five-posture 90-minute class sequence as compared with a ratio of 1-2:10-25 yoga instructors to study participants reported in other fibromyalgia yoga studies. Statistically significant trends and minimal clinically important differences were found at week 8 when comparing participant baseline to week 8 self-report questionnaire scores for the Revised Fibromyalgia Impact Questionnaire total score (p = 0.01; 18.51%), the Pain Numeric Rating Scale for the subscales pain now (p = 0.04; 36.36%) and average pain over the past week (p = 0.04; 19.61%), the General Sleep Disturbance Scale total score (p = 0.04; 17.40%), and the Pittsburgh Sleep Quality Index total score (p = 0.02; 27.06%). Conclusion: Although the 8-week, five-posture, 90-minute restorative yoga group class was found not to be feasible as a symptom self-management strategy in this study, the findings support the need for further investigation of the home practice format. Future longitudinal, randomized, controlled trials of a restorative yoga home practice format to establish intervention efficacy and symptom-self management potential as well as those examining restorative yoga intervention resource utilization in persons with fibromyalgia are recommended

Effects of comprehensive sleep management on sleep quality in university students in mainland China

The purpose of the study was to explore the effects of comprehensive sleep management on sleep quality in university students in mainland China. Eighty-four full-time university students were randomly allocated to the intervention group (n = 42), which received comprehensive sleep management, and the control group (n = 42) with no intervention. The comprehensive sleep management program was delivered by a researcher in lecture sessions (45 min per session) over a consecutive 3-day period. The first session included sleep hygiene education and music therapy, the second session included stimulus control therapy, and the third session included progressive muscle relaxation training. Based on sleep hygiene education, the students were instructed to do music therapy and progressive muscle relaxation training (i.e. taking a deep breath, and contracting and relaxing 16 muscle groups) within 1 h before night-time sleep daily, 30 min per session; stimulus control therapy was conducted through six steps and repeated daily. Sleep quality was assessed using the Chinese version of the Pittsburgh Sleep Quality Index. After 1 month, between-group comparisons showed that the intervention group had improvement in subjective sleep quality (mean difference: −0.31, 95% confidence interval: −0.58, −0.04) (P = 0.027), sleep latency (−0.60 [−0.86, −0.33]) (P < 0.001), daytime dysfunction (−1.14 [−1.39, −0.89]) (P < 0.001), and Pittsburgh Sleep Quality Index total score (−1.98 [−2.64, −1.31]) (P < 0.001). The comprehensive use of sleep hygiene education, music therapy, stimulus control therapy, and progressive muscle relaxation training has positive effects on improving sleep quality in university students.

Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia

In a primary care population of 367 older adults (aged ⩾60years) with osteoarthritis (OA) pain and insomnia, we examined the relationship between short-term improvement in sleep and long-term sleep, pain, and fatigue outcomes through secondary analyses of randomized controlled trial data. Study participants, regardless of experimental treatment received, were classified either as improvers (⩾30% baseline to 2-month reduction on the Insomnia Severity Index [ISI]) or as nonimprovers. After controlling for treatment arm and potential confounders, improvers showed significant, sustained improvements across 18months compared with nonimprovers in pain severity (P<0.001, adjusted mean difference=−0.51 [95% CI: −0.80, −0.21), arthritis symptoms (P<0.001, 0.63 [0.26, 1.00]), and fear avoidance (P=0.009, −2.27 [−3.95, −0.58]) but not in catastrophizing or depression. Improvers also showed significant, sustained improvements in ISI (P<0.001, −3.03 [−3.74, −2.32]), Pittsburgh Sleep Quality Index Total (P<0.001, −1.45 [−1.97, −0.93]) and general sleep quality (P<0.001, −0.28 [−0.39, −0.16]) scores, Flinders Fatigue Scale (P<0.001, −1.99 [−3.01, −0.98]), and Dysfunctional Beliefs About Sleep Scale (P=0.037, −2.44 [−4.74, −0.15]), but no improvements on the Functional Outcomes of Sleep Questionnaire or the Epworth Sleepiness Scale. We conclude that short-term (2-month) improvements in sleep predicted long-term (9- and 18-month) improvements for multiple measures of sleep, chronic pain, and fatigue. These improvements were not attributable to nonspecific benefits for psychological well-being, such as reduced depression. These findings are consistent with benefits of improved sleep for chronic pain and fatigue among older persons with osteoarthritis pain and comorbid insomnia if robust improvements in sleep are achieved and sustained. Trial Registration: ClinicalTrials.gov Identifier: NCT01142349.

Sleep Disturbance Among Older Adults in Assisted Living Facilities

To evaluate whether objectively and subjectively measured sleep disturbances persist among older adults in assisted living facilities (ALFs) and to identify predictors of sleep disturbance in this setting. Prospective, observational cohort study. A total of 121 residents, age ≥ 65 years, in 18 ALFs in the Los Angeles area. Objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index) sleep measures were collected at baseline and 3- and 6-month follow-up. Predictors of baseline sleep disturbance tested in bivariate analyses and multiple regression models included demographics, Mini-Mental State Examination score, number of comorbidities, nighttime sedating medication use, functional status (activities of daily living; instrumental activities of daily living), restless legs syndrome, and sleep apnea risk. Objective and subjective sleep measures were similar at baseline and 3- and 6-month follow-up (objective nighttime total sleep [hours] 6.3, 6.5, and 6.4; objective nighttime percent sleep 77.2, 77.7, and 78.3; and Pittsburgh Sleep Quality Index total score 8.0, 7.8, and 7.7, respectively). The mean baseline nighttime percent sleep decreased by 2% for each additional unit increase in baseline comorbid conditions (measured as the number of conditions), and increased by 4.5% for each additional unit increase in baseline activities of daily living (measured as the number of activities of daily living), in a multiple regression model. In this study, we found that objectively and subjectively measured sleep disturbances are persistent among ALF residents and are related to a greater number of comorbidities and poorer functional status at baseline. Interventions are needed to improve sleep in this setting.

Poor Self-Reported Sleep Quality Predicts Mortality within One Year of Inpatient Post-Acute Rehabilitation among Older Adults

To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival. Prospective, observational cohort study. Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration). Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation. None. Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk. Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored.

Long-term efficacy and safety of gabapentin enacarbil in Japanese restless legs syndrome patients

Several short- and long-term studies conducted in Europe/North America have demonstrated good efficacy and tolerability of 600-1800 mg gabapentin enacarbil (GEn). However, no studies have evaluated the efficacy of long-term treatment with GEn in Asian patients. Therefore, the objective of this study was to evaluate the efficacy and safety of long-term treatment with GEn in Japanese patients with restless legs syndrome (RLS) in a multicenter open-label study. RLS patients aged 20-80 years were allocated to receive oral GEn 1200 mg/day for a treatment period of 52 weeks. International Restless Legs Syndrome Scale (IRLS) score, investigator- and patient-rated Clinical Global Impression (CGI) scores, Pittsburgh Sleep Quality Index (PSQI) total scores and subscores, and short form (SF)-36 subscores were assessed, and adverse events (AEs) were monitored. In 181 patients (mean age, 54.9±12.2 years; BMI, 23.0±2.6 kg/m²) IRLS score decreased from 24.4±0.4 at baseline to 6.3±0.6 at week 52, with a reduction of -18.0±0.6. The IRLS responder rate was 80.3% at week 52. ICGI and PCGI responder rates were 87.1% and 87.1%, respectively. PSQI and SF-36 also showed significant improvements. AEs were reported in 96.2% of patients but remained mild-to-moderate in nearly all the cases. Serious AEs occurred in 1.6%. Dizziness and somnolence were noted in 46.2% and 41.2% of patients, respectively, and mostly occurred during the first 4 weeks. No episodes of augmentation were reported. In conclusion, long-term treatment with GEn improved RLS symptoms as well as investigator- and patient-reported outcomes in Japanese patients with moderate-to-severe RLS, with an acceptable safety profile. Randomized, double-blind, placebo/active-controlled trials are desirable to confirm these preliminary results.

Sleep disturbances in asymptomatic BRCA1/2 mutation carriers: women at high risk for breast-ovarian cancer

This study investigated the association between positive genetic diagnosis for BRCA1/2 mutations and sleep quality in Ashkenazi asymptomatic women. Seventy-three women, including 17 asymptomatic BRCA1/2 carriers and 20 non-carriers from the oncogenetic clinic, and 36 community controls, participated in a cross-sectional design. Women completed sociodemographic, clinical, general psychological distress, cancer-related worry (CRW), fatigue and sleep questionnaires in their homes, and wore actigraphs for 5-7 nights. Impaired global subjective sleep quality was demonstrated in BRCA1/2 carriers compared to non-carriers and controls [mean Pittsburgh sleep quality index (PSQI) total scores 7.29 +/- 4.34; 3.94 +/- 2.49; 4.21 +/- 2.80, respectively, P = 0.021] and poor sleep quality (PSQI total score >5) was significantly higher in carriers (53%) compared to non-carriers (20%) and controls (28%, P = 0.03). Based on actigraphic measures, sleep latency tended to be longer in carriers compared to counterparts, albeit not significantly. Increased sleep disturbance was related significantly to increased fatigue in the entire sample and in the control group; to psychological distress in the entire sample and in non-carriers; and to CRW in the entire sample. In carriers, sleep disturbance was related strongly but non-significantly to fatigue, psychological distress and CRW. Fatigue and carrier status were significant predictors of sleep quality, accounting for 15.7% of the variance. In conclusion, asymptomatic BRCA1/2 carriers experience poor sleep quality compared to non-carriers and controls. Our study design is unique in that it offers insight regarding the nature of being an asymptomatic carrier, and affords the opportunity to examine factors that may contribute to the development of insomnia in women at risk for breast-ovarian cancer.