Sleep Disturbance Symptoms Research Articles

FC14: Measuring the prevalence of sleep disturbance in people living with dementia in the community. A systematic review and meta-analysis

Objectives:Sleep disturbance affects all aspects of mental and physical functioning and quality of life and may lead to or worsen Alzheimer’s disease. Sleep disturbances in people with dementia living at home predicts care home admission and carer distress. Estimates of the prevalence of sleep disturbance vary, and it is unclear how prevalence rates differ according to setting. We conducted the first systematic review and meta-analysis on the prevalence of sleep disturbances in people living with dementia in the community. We aimed to examine demographic predictors and whether overall prevalence has changed over time.Methods:We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics.Results:Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26% (95% confidence intervals (CI): 23-30%; n= 2719) and of clinically significant sleep disturbance 19% (95% CI: 13-25%; n= 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer’s disease (24%; 95% CI: 16-33%, n=310) than Lewy body dementia (49%; 95% CI: 37-61%, n=65). Meta-regression analysis did not find that publication year, participant’s age, sex and study quality predicted prevalence.Conclusion:Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates (between 2002 and 2018). This suggests that possible advances in treatment of sleep disturbance are not reflected in improvements for people living with dementia. This highlights the need to develop effective intervention strategies, reducing the prevalence of sleep disturbances in people living with dementia living at home in the community.

Quality of Life in Emicizumab-Treated People with Hemophilia A in the ATHN 7 Hemophilia Natural History Study - an Assessment of Baseline PROMIS®-29 Scores

Background: People with hemophilia A (PwHA) experience frequent bleeding into joints, muscles and soft tissues due to a deficiency of factor (F)VIII, which has a substantial negative impact on their health-related quality of life (HRQoL). The American Thrombosis and Hemostasis Network (ATHN) ATHN 7 research study is: A Natural History Cohort Study of the Safety, Effectiveness, and Practice of Treatment for People with Hemophilia (NCT03619863). ATHN 7 prospectively monitors the use of hemophilia A (HA) and B therapies, including emicizumab. The aim of this abstract is to contribute to the literature on disease burden in PwHA. We describe baseline scores for a subset of adult PwHA enrolled in ATHN 7 who were receiving emicizumab and completed the Patient-Reported Outcomes Measurement Information System (PROMIS®) Profile-29 measure at the time of study entry. Methods: ATHN 7 is a longitudinal, prospective observational cohort study conducted at 26 ATHN-affiliated sites in the United States (US). Clinical and demographic information was collected at baseline. Participants completed patient-reported outcome measures, including PROMIS-29, at baseline. The PROMIS-29 Profile is a disease-agnostic measure capturing data across physical, mental, and social health domains: physical function, fatigue, sleep disturbance, pain intensity, pain interference, depressive symptoms, anxiety, and ability to participate in social roles/activities. PROMIS measures are scored using a standardized T-score metric with a reference population mean of 50 and a standard deviation (SD) of 10, based on the US general population. Higher scores indicate the participant is experiencing more of the concept being measured (positive or negative). No statistical comparisons were performed in this analysis. A mean standardized T-score of 0.5-1.0 SD worse than the reference population mean is defined as mild symptoms/impairment, 1.0-2.0 SD worse than the mean as moderate symptoms/impairment, and ≥2.0 SD worse than the mean as severe symptoms/impairment (HealthMeasures, 2023). Results: Overall, 67 participants in ATHN 7 receiving emicizumab at study entry completed PROMIS-29 at baseline ( Table 1). Participants had a median (min, max) age of 30.0 (18.0, 75.0) years. Disease severity at diagnosis was mild or moderate for 14 (20.9%) participants and severe for 53 (79.1%) participants. There were 12 (17.9%) PwHA with FVIII inhibitors. At time of study entry, participants had been receiving emicizumab for a median (min, max) of 126 (13.1, 254.0) weeks. Mean PROMIS-29 domain T-scores for the ability to participate in social roles and activities, and symptoms of anxiety, sleep disturbance, depression and fatigue at baseline all fell within 0.5 SD of the mean of the reference population ( Figure 1). PwHA in this analysis did however, demonstrate mild symptoms of pain interference (mean baseline T-score: 55.62; [normal: <55]). Mean baseline PROMIS-29 domain T-scores were also analyzed according to presence of FVIII inhibitors, disease severity, and age. PwHA with FVIII inhibitors had mild impairment of physical function (42.17 [normal: >45]) and mild symptoms of pain interference (58.64; [normal: <55]), while those without inhibitors had physical function (45.96; [normal: >45]) and pain interference (55.00; [normal <55]) within or on the boundary of 0.5 SD of the reference population. Similarly, people with severe HA without FVIII inhibitors had mild impairment of physical function (44.76; [normal >45]) and mild symptoms of pain interference (55.49; [normal: <55]), while people with mild/moderate HA without inhibitors had physical function (49.85; [normal: >45]) and pain interference (53.46; [normal: <55]) within 0.5 SD of the reference population. Physical function decreased with age, from 51.71 in the group aged ≤24 years (normal: >45) to 36.18 (moderate impairment) in the group aged ≥50 years, while pain interference increased with age, from 51.18 in the group aged ≤24 years (normal: <55) to 59.80 (moderate symptoms) in the group aged ≥50 years. Conclusions: In this analysis, we observed that HRQoL in PwHA receiving emicizumab, as measured by PROMIS-29 domain T-scores, generally did not differ from that of the US reference population. PwHA did report mild symptoms of pain interference. Results should be interpreted with caution given that no statistical tests were performed, and subgroup numbers are small.

72 Neurocognitive and Emotional Symptoms of Pediatric Concussion Due to Physical Assault: A Case Series

Objective:Much of the pediatric concussion literature focuses on sports and recreation related injuries, while there is a relative paucity of research on the cognitive and psychological sequelae associated with assault. However, it is understood that children with assault-related injuries demonstrate a longer recovery time. This case series reviews the data of four teenagers who were administered cognitive, emotional, and behavioral screeners after sustaining an assault related concussion.Participants and Methods:Four pediatric female patients (ages 13,14,15,15) with a recent history of concussion due to physical assault presented for evaluation at a hospital-based concussion clinic. All four patients were administered a computerized cognitive screener as well as self-report measures for mood, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbance.Results:All four of the pediatric cases reported significant symptoms of PTSD, depression, anxiety, and sleep disturbance. For all four patients, the most notable problems across cognitive performance measures were observed in the areas of simple and complex attention.Conclusions:Results of this case series revealed clinically significant anxiety, depression, PTSD-symptoms, and sleep disturbance in conjunction with poor simple and complex attention. These pediatric cases illustrate the potential link between assault-related concussions, emotional and behavioral symptoms, and cognitive functioning. Furthermore, assault-related concussions may elevate risk toward attentional problems associated with psychological distress. Early evaluation of PTSD and mood related symptomatology is suggested to best support treatment planning and recovery in this population. Future studies are needed to explore the nature of the relationship between cognitive and emotional sequelae in patients who present with assault-related concussions.

68 Interactive Effects of Sleep Apnea and Depression Symptoms on Cognition in Older Adults

Objective:Sleep deprivation and depressive symptoms have been shown to negatively impact cognitive function within older adult populations (Gilley, 2022; Donovan et al., 2016). However, there is minimal research on interactions between sleep disturbance and depressive symptoms in relation to their shared impact on cognitive impairment. The purpose of this study is to examine possible interactions between sleep disorders and depression and their relationship with cognition among relatively good functioning and healthy older adults.Participants and Methods:The sample was obtained from the Memory and Aging Project (Rush Alzheimer's Disease Center, Rush University, 2019) and consisted of 3,345 community dwelling older adults. The study analyzed data from 2552 women (76.3%) and 1093 men (23.7%). The average age of participants was 80 years and ranged from 45 to 98 years old. Measures used included the Berlin Questionnaire (risk for sleep apnea), Center for Epidemiological Studies Depression Scale (CES-D; depression), and a neuropsychological battery (visuospatial ability/perceptual reasoning and processing speed).Results:ANOVA analyses exhibited a significant main effect of depression on visuospatial ability/perceptual reasoning (p <.001), processing speed (p <.001), and semantic memory (p <.001). No significant main effect was found for sleep apnea on these cognitive domains. However, when sleep apnea was analyzed between those with any depressive symptoms versus those without, significant interactions were found for visuospatial ability/perceptual reasoning (p =.027), processing speed (p <.001), and semantic memory (p =.016). Sleep apnea symptoms had a greater detrimental effect on visuospatial skills and perceptual reasoning (F=4.90; p=.027) only when any depression symptom is present. In contrast, there was a steeper decline of processing speed when only depressive symptoms were present apart from sleep apnea symptoms (F=10.34; p =.001) Similarly, depressive symptoms had a greater negative effect on semantic memory for older adults who reported no sleep apnea symptoms compare to those who did (F=5.83, p=.016).Conclusions:The current study indicated that while sleep apnea was negatively related to several cognitive domains, the impact became greater with the presence of depression on visuospatial skills and perceptual reasoning among older adults. However, the detrimental impact of sleep apnea was somewhat less with the presence of depression for processing speed and semantic memory. This may be due to likely higher endorsements of depressive symptoms compared to sleep apnea symptoms within the study sample. These findings suggest that there are differential interactive effects of sleep impairment and depressive symptoms on cognitive domains among older adults. Considering the relationship that exists between depression and increased disease burden among older adults, it is crucial for clinicians to also take sleep behaviors into account when examining and treating their patients. Clinicians should be mindful of their older patient's sleep health and depression measures when cognitive declines are suspected. They also suggest that cognitive performance may be improved with treating any symptoms of sleep apnea and depression in older adults.

Subjective and Objective Evaluation of Driving Behaviour in Depression

Abstract Introduction Road traffic collisions and related casualties are a major issue for public health and society. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Among its symptoms sleep disturbance is very common. Objectives The current study examined behaviour and attitude towards driving in a group of patients with depression and a group of controls, considering sleep disturbances. Methods Participants (patients N = 39 and controls N = 30) were asked to complete the Driver Stress Inventory (DSI) and Driver Behavior Questionnaire (DBQ). Afterwards, they were asked to drive on a driving simulator in a motorway scenario, and in urban and rural scenarios under low and high traffic load, all in good weather conditions. Driving simulator data included speed, lateral position (LP) and safety distance from the preceding vehicle. Results Gender, age and, to a lesser extent, body mass index influenced almost all variables. Patients with depression did not differ from the controls regarding driving behaviour as assessed through the DSI and DBQ questionnaires. Subjective fatigue was found to be positively correlated with aggression (β = 0.027, p = 0.005), dislike of driving (β = 0.036, p = 0.006), hazard monitoring (β = 0.046, p = 0.001) and traffic violations (β = 0.010, p = 0.020). On the driving simulator, patients maintained a longer distance from the preceding vehicle. Epworth Sleepiness Scale and Athens Insomnia Scale scores were positively associated with safety distance and with the Standard Deviation of LP, denoting lower ability to keep a stable vehicle track (β = 2.108, p = 0.003 and β = 0.047, p = 0.004 respectively). Conclusions It seems that although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, this effect is lessened by patients driving more carefully. There are parameters (age and sex) which influence driving behaviour and attitude similarly for both groups. Key messages • Patients with depression did not differ from controls regarding driving behaviour and attitude. • Patients seem to realize the effects of symptoms of depression on their driving ability and, consequently, drive more carefully.

Adverse childhood experiences and psychological functioning among women with schizophrenia or bipolar disorder: population-based study.

Adverse childhood experiences (ACEs) are well-known risk factors for schizophrenia and bipolar disorder. The aim was to study the associations between specific ACEs and psychological functioning in women with schizophrenia or bipolar disorder. Among 29 367 women (mean age 44 years) from the Icelandic Stress-And-Gene-Analysis (SAGA) study, 534 (1.8%, mean age 40) reported having been diagnosed with schizophrenia or bipolar disorder, which were combined to 'severe mental disorders'. Participants reported on 13 types of ACEs, childhood deprivation and psychological functioning (defined as coping ability and current symptoms of depression, anxiety and sleep disturbances). Adjusted Poisson regression calculated prevalence ratios (PRs) between ACEs and severe mental disorders. Linear regression assessed the association between ACEs and psychological functioning among women with a severe mental disorder. Women with a severe mental disorder reported more ACEs (mean 4.57, s.d. = 2.82) than women without (mean 2.51, s.d. = 2.34) in a dose-dependent manner (fully-adjusted PR = 1.23 per ACE, 95% CI 1.20-1.27). After mutual adjustment for other ACEs, emotional abuse, sexual abuse, mental illness of a household member, emotional neglect, bullying and collective violence were associated with severe mental disorders. Among women with severe mental disorders, a higher number of ACEs was associated with increased symptom burden of depression (β = 2.79, 95% CI = 1.19-4.38) and anxiety (β = 2.04, 95% CI = 0.99-3.09) including poorer sleep quality (β = 0.83, 95% CI = 0.07-1.59). Findings were similar for schizophrenia and bipolar disorder separately. Women with schizophrenia or bipolar disorder show a strong history of ACEs, which may interfere with their psychological functioning and, therefore, need to be addressed as part of their treatment, for example, with trauma-focused psychotherapy.

Toward greater specificity in the nonspecific: Estimating the prevalence of diagnostic irritability and sleep symptoms in adolescents.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) descriptive criterial approach to diagnosis has been criticized for contributing to comorbidity, heterogeneity within conditions, and nonspecificity across conditions. Much research has examined comorbidity and heterogeneity, but less is known about nonspecificity. Here, we examined two nonspecific symptoms: irritability and sleep disturbance. Both are common, clinically significant, and appear in several DSM disorder criteria sets, but their transdiagnostic prevalence is unknown. Leveraging a nationally representative epidemiological study of adolescents (n = 10,148; ages = 13-18), we first identified all instances where irritability or sleep disturbance appears in DSM-5-TR criteria for bipolar, depressive, anxiety, traumatic stress, or disruptive/impulse-control disorders; then found their DSM-IV equivalents in study variables; and finally estimated their prevalence individually and cumulatively across categories. Weighted lifetime prevalence estimates were 79.5% (95% CI [77.8, 81.2]) for irritability and 60.8% [58.7, 62.9] for sleep disturbance. Associations with age and gender were significant but small. Most youth reported multiple symptoms of irritability (weighted M = 3.04, Mdn = 2) and at least one symptom of sleep disturbance (weighted M = 1.61, Mdn = 1). Both problems were extremely common among individuals with specific disorders but were underestimated by the criteria for those conditions. Results suggest that the high prevalence of DSM-defined irritability and sleep problems may be obfuscated by these symptoms being scattered across diagnostic entities. There is a need for more research on assessing, treating, and understanding problems related to irritability and sleep in their own right, cutting across, rather than confined to, particular diagnoses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance.

This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.

326 Pre-morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study

Abstract Background We have previously shown that disturbances in sleep to be associated with acute stroke, but their association with stroke severity is less certain. In the INTERSTROKE study, we evaluated the association of pre-morbid sleep disturbance with stroke severity and functional outcome in acute stroke patients. Methods INTERSTROKE was an international case–control study of first acute stroke. This analysis comprised cases who completed a standardised questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration and quality, nocturnal awakening, napping, snoring, snorting and breathing cessation) in the prior month (n = 2,361). Two indices were derived representing sleep disturbance (range 0–9) and Obstructive Sleep Apnoea (OSA; range 0–3) symptoms. The modified-Rankin score (m-RS) was used to measure stroke severity at initial assessment and functional outcome at 1-month follow-up. Severe stroke was defined as an m-RS of >3, and functional deterioration was defined as an increase in m-RS at 1-month. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity. Results The mean age of participants was 62.9 years, with 42% female, 80% diagnosed with ischaemic stroke and 17% reporting >5 sleep symptoms. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2–3: Odds Ratio [OR]:1.44; 95% CI [Confidence Interval]:1.07–1.94, 4–5: OR:1.66; CI:1.23–2.25, >5: OR:2.58; CI:1.83–3.66). Having >5 sleep disturbance symptoms was associated with a significant increased odds of functional deterioration at 1-month (OR:1.54; CI:1.01–2.34). A higher OSA score (2–3 vs 0–1) was also associated with a significant increased odds of initially severe stroke (OR:1.48; CI:1.20–1.83) but not functional deterioration at 1-month (OR:1.19; CI:0.93–1.52). Conclusion Symptoms of sleep disturbance were common and associated with an increased odds of severe stroke and functional deterioration at 1-month. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcome after stroke, and should be the subject of future research.

Effects of Aphrodite (an Herbal Compound) on SSRI-Induced Sexual Dysfunctions and Depression in Females with Major Depressive Disorder: Findings from a Randomized Clinical Trial.

Background and Objectives: Almost by default, people with major depression disorder (MDD) also report sexual health issues. This holds even more true when sexual dysfunctions are SSRI-induced. Herbal compounds may have the power to counterbalance such sexual dysfunctions, though research is still scarce. Therefore, we assessed females with diagnosed MDD treated with a standard SSRI (sertraline) and reporting SSRI-induced sexual dysfunctions, and we asked whether compared to placebo, Aphrodite (a blend of ginger, saffron, cinnamon, thistle, and Tribulus terrestris) may favorably impact on sexual dysfunctions, and on symptoms of depression, anxiety, and sleep disturbances. Materials and Methods: A total of 41 females (mean age: 35.05 years) with diagnosed MDD, treated with sertraline (a standard SSRI) at therapeutic dosages, and reporting SSRI-induced sexual dysfunction, were randomly assigned either to Aphrodite or to the placebo condition. At baseline and four and eight weeks later (study end), participants completed a series of self-rating questionnaires covering symptoms of sexual dysfunction, depression, anxiety, and sleep complaints. Results: Symptoms of sexual dysfunction, depression, and anxiety decreased over time, but more so in the Aphrodite condition, compared to the placebo condition (significant p-values and large effect sizes). Over time, sleep disturbances decreased irrespective of the study condition. Conclusions: The pattern of results suggests that compared to placebo, Aphrodite appeared to improve symptoms of sexual dysfunction, depression, and anxiety among females with diagnosed MDD and SSRI-induced sexual dysfunction. Further and similar studies should investigate the underlying psychophysiological mechanisms.

Associations between non-motor symptoms and patient characteristics in Parkinson's disease: a multicenter cross-sectional study.

Parkinson's disease (PD) is characterized by various non-motor symptoms (NMS), such as constipation, olfactory disturbance, sleep disturbance, mental disorders, and motor symptoms. This study aimed to investigate factors associated with NMS in patients with PD. Symptoms of PD were evaluated using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parts I-IV. NMS was assessed using the MDS-UPDRS Part I (self-assessment of NMS) and rapid eye movement sleep behavior disorder (RBD) questionnaires. Patients were categorized by age into <70 years and ≥ 70 years (older adults) groups, according to disease duration into early-stage and advanced-stage groups with a cut-off value of 5 years for motor symptoms, and by sex into male and female groups. A total of 431 patients with PD (202 males and 229 females) with a mean age of 67.7 years, a mean disease duration of 6.4 years, and a mean Part I total score of 9.9 participated in this study. The Part I total score was significantly positively correlated (p < 0.01) with disease duration and Part II, III, and IV scores. For Part I sub-item scores, the older group had significantly higher scores for cognitive impairment, hallucinations, sleep problems, urinary problems, and constipation than the <70 years group, whereas the advanced-stage group had significantly higher scores for hallucinations, sleep problems, daytime sleepiness, pain, urinary problems, and constipation (p < 0.05) than the early-stage group. Anxiety was higher in female patients than in male patients, whereas daytime sleepiness, urinary problems, and RBD were higher in male patients than in female patients (p < 0.05). Factors affecting Part I included disease duration, Part II total scores, Part IV total scores, and RBD. According to the self-questionnaire assessment, NMS was highly severe in older adult patients, those with longer illness duration, subjective and objective motor function impairments, and RBD. Sex-based differences were also observed.

Depression and anxiety as mediators of the relationship between sleep disturbance and somatic symptoms among adolescents on a psychiatric inpatient unit.

Background: This study investigated the relationship between sleep disturbance and somatic symptoms among adolescents residing on a psychiatric inpatient unit. Given the evidence that sleep disturbance may precede the onset of depression and anxiety and the clear associations between mood and somatic symptoms, depression and anxiety were considered as potential mediators of this relationship. Gender was tested as a potential moderator of the relationship between sleep disturbance and depression and anxiety, respectively. Method: A convenience sample of 83 adolescents completed a packet of self-report measures after admission to the unit. Measures assessed depression, sleep disturbance, anxiety, and somatic symptoms. Mediation and moderation analyses were conducted using SPSS PROCESS macro. Results: With anxiety included as a covariate, the overall indirect effect of sleep disturbance on somatic symptoms through depression was significant. No significant moderation effects were found, although females reported significantly higher levels of sleep disturbance, depression, anxiety, and somatic symptoms than males. Conclusions: Results indicated that depression mediated the relationship between sleep disturbance and somatic symptoms above and beyond the effects of anxiety. These findings suggest that interventions aimed at reducing the negative effects of sleep disturbance should also target mood in this population. Individual differences including gender should be considered when developing interventions.

The association of self-reported symptoms of central sensitization and sleep disturbances in neuropathic pain.

Patients with neuropathic pain (NP) report a higher impairment of quality of life and sleep than patients with chronic pain without neuropathic characteristics. These include somatosensory peculiarities like allodynia, a surrogate marker for central sensitization. This study aimed to investigate the relation between symptoms of central sensitization and sleep disturbances in patients with NP. Within this cross-sectional study, data sets of 3339 patients with chronic NP syndromes (painful diabetic polyneuropathy, n = 543; postherpetic neuralgia, n = 1480) or complex regional pain syndromes (CRPS, n = 1316) were analyzed. Neuropathic pain symptoms were assessed with the painDETECT questionnaire (PD-Q), depression with the Patient Health Questionnaire-9, and sleep impairment with items of the Medical Outcomes Study Sleep Scale in 4 subscales. The association of demographic/clinical data, somatosensory phenotype, depression, and pain intensity with sleep impairment was assessed by unadjusted Spearman correlation analyses and multivariable regression analyses. Sleep impairment was observed in all pain aetiologies although with some significant differences in the single sleep items. The intensity of the individual PD-Q items differed to some extent between the 3 pain entities, whereas the PD-Q sum score was similar. Thermal hyperalgesia and burning assessed by the PD-Q were significantly associated with sleep disturbance, adequacy, and quantity but not with sleep somnolence. Only depression and self-reported allodynia had a significant relation to all 4 sleep elements. Beside depression, allodynia as a surrogate marker hints to a possible impact of central sensitization on the sleep disruption of patients with NP.

Prevalence and associated factors of depressive and anxiety symptoms among Chinese secondary school students

BackgroundDepressive and anxiety symptoms affect about one-fourth of Chinese secondary school students. However, the prevalence and correlates of mental distress among secondary school students from Western China remain largely unexplored. This study aimed to examine the prevalence and associations of depressive and anxiety symptoms with demographic, family, school, life, and behavior factors in a large, representative sample of secondary school students in Zigong, a city in Western China.MethodsSecondary school students were recruited using cluster sampling. The 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire, Multidimensional Peer-Victimization Scale, the Pittsburgh Sleep Quality Index, and Nine-Item Internet Gaming Disorder Scale-Short Form were used. Descriptive statistic was used to describe the sociodemographic characteristics of participants. The clustering effect was adjusted by the “survey” package of R to calculate weighted prevalence. Univariate and multivariate logistic regression were used to explore associated factors of depression and anxiety, respectively.ResultsA total of 63,205 participants were involved, in which the weighted prevalence of depression in all subjects was 23.0% (95% CI: 19.6- 27.0%), and the weighted prevalence of anxiety was 13.9% (95% CI: 11.2- 17.0%). Logistic regression results showed girls, being single-child, non-nuclear family, peer bullying, sleep disturbance, and internet gaming disorder symptoms were positively associated with depressive and anxiety symptoms.ConclusionDepressive and anxiety symptoms were prevalent among secondary school students in Western China. Our results can guide policy strategies for the assessment, prevention, and intervention of psychological status among Chinese secondary school students.

Decisional conflict and its determinants among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy: a cross-sectional study

Decisional conflict might occur during shared decision-making (SDM) because immunotherapy is a rather novel treatment option for patients with cancer. To explore the prevalence and severity of physical and psychological symptoms and the effort invested in SDM in relation to decisional conflict among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy. This was a cross-sectional survey study. The SURE version of the Decisional Conflict Scale was used to screen cancer patients’ decisional conflict status. Demographic or clinical characteristics, physical symptoms and psychological distress; efforts invested in the SDM process were also assessed as potential factors related to decisional conflict. One hundred seventeen patients surveyed, the prevalence of fatigue (79.5%), sleep disturbance (78.6%), poor appetite (67.5%), and pain (58.1%) symptoms were high and the severity was at moderate levels. The prevalence of pruritus (40.2%), rash (34.2%), dry skin (41.9%), and diarrhea (17.1%) symptoms were low and the severity was at mild levels. 65.8% of patients reported uncertainty, with mild to moderate levels. Furthermore, 97.4% of the patients made some effort in SDM, and the effort level was moderate (mean: 5.56 ± 2.02). 64.1% of patients were certain that immunotherapy was the best option. Age, uncertainty, and effort in the SDM process were major factors related to decisional conflict. We observed that older patients (age: ≥ 65) and those with higher uncertainty levels and less effort in SDM reported higher levels of decisional conflict. Future studies should explore older patients’ decisional related needs of immunotherapy. Interventions should be designed to reduce the uncertainty experienced by patients with cancer and enhance their understanding of immunotherapy to enable them to take more effort in the SDM process.

Patterns of patient-reported symptoms and association with sociodemographic and systemic sclerosis disease characteristics: a scleroderma Patient-centered Intervention Network (SPIN) Cohort cross-sectional study

Systemic sclerosis is a heterogenous disease in which little is known about patterns of patient-reported symptom clusters. We aimed to identify classes of individuals with similar anxiety, depression, fatigue, sleep disturbance, and pain symptoms and to evaluate associated sociodemographic and disease-related characteristics. This multi-centre cross-sectional study used baseline data from Scleroderma Patient-centered Intervention Network Cohort participants enrolled from 2014 to 2020. Eligible participants completed the PROMIS-29 v2.0 measure. Latent profile analysis was used to identify homogeneous classes of participants based on patterns of anxiety, depression, fatigue, sleep disturbance, and pain scores. Sociodemographic and disease-related characteristics were compared across classes. Among 2212 participants, we identified five classes, including four classes with "Low" (565 participants, 26%), "Normal" (651 participants, 29%), "High" (569 participants, 26%), or "Very High" (193 participants, 9%) symptom levels across all symptoms. Participants in a fifth class, "High Fatigue/Sleep/Pain and Low Anxiety/Depression" (234 participants, 11%) had similar levels of fatigue, sleep disturbance, and pain as in the "High" class but low anxiety and depression symptoms. There were significant and substantive trends in sociodemographic characteristics (age, education, race or ethnicity, marital or partner status) and increasing disease severity (diffuse disease, tendon friction rubs, joint contractures, gastrointestinal symptoms) across severity-based classes. Disease severity and sociodemographic characteristics of "High Fatigue/Sleep/Pain and Low Anxiety/Depression" class participants were similar to the "High" severity class. Most people with systemic sclerosis can be classified by levels of patient-reported symptoms, which are consistent across symptoms and highly associated with sociodemographic and disease-related variables, except for one group which reports low mental health symptoms despite high levels of other symptoms and substantial disease burden. Studies are needed to better understand resilience in systemic sclerosis and to identify and facilitate implementation of cognitive and behavioural strategies to improve coping and overall quality of life. National Institute of Nursing Research (F31NR019007), Canadian Institutes of Health Research, Arthritis Society Canada, the Lady Davis Institute for Medical Research, the Jewish General Hospital Foundation, McGill University, Scleroderma Society of Ontario, Scleroderma Canada, Sclérodermie Québec, Scleroderma Manitoba, Scleroderma Atlantic, Scleroderma Association of BC, Scleroderma SASK, Scleroderma Australia, Scleroderma New South Wales, Scleroderma Victoria, and Scleroderma Queensland.

The relationship between sleep disturbance and obsessive- compulsive symptoms: the mediation of repetitive negative thinking and the moderation of experiential avoidance.

Studies have found that sleep disturbance is associated with obsessive-compulsive symptoms. This study aimed to elaborate on the mediating and moderating mechanisms between these two variables. We hypothesized that repetitive negative thinking plays a mediating role in the relationship between sleep disturbance and obsessive-compulsive symptoms, and experiential avoidance plays a moderating role. This study included 639 Chinese adults. A questionnaire survey was used to assess sleep quality, obsessive-compulsive symptoms, experiential avoidance, repetitive negative thinking, and depression symptoms. A moderated mediation model was established. After controlling for depressive symptoms, repetitive negative thinking partially mediated the positive correlation between sleep disturbance and obsessive-compulsive symptoms. This indirect relationship was significant in individuals with lower experiential avoidance levels. Particularly, the relationship between sleep disturbance and repetitive negative thinking was significant among individuals with lower experiential avoidance levels, but not among individuals with higher experiential avoidance levels. This study demonstrated that repetitive negative thinking partially mediated the impact of sleep disturbance on obsessive-compulsive symptoms. The findings suggest that when providing support to individuals with sleep disturbance and obsessive-compulsive symptoms, assessing their level of experiential avoidance is necessary for performing targeted interventions. Individuals with low experiential avoidance may benefit from a clinical intervention targeting repetitive negative thinking to improve sleep quality and obsessive-compulsive symptoms.

The bridge symptoms of childhood trauma, sleep disorder and depressive symptoms: a network analysis

BackgroundThis study aimed to elucidate the characteristics of symptom network of childhood trauma (CT) and sleep disorder (SD) in Chinese adolescents, with the influence of depressive symptoms taken into account.MethodA total of 1301 adolescent students were included, and their CT, SD and depressive symptoms were measured using the Pittsburgh sleep quality index (PSQI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and The Patient Health Questionnaire-9 (PHQ-9), respectively. Central symptoms and bridge symptoms were identified based on centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure.ResultsIn CT and SD symptom network, emotional abuse and sleep quality symptoms had the highest centrality values, and two bridge symptoms, i.e., emotional abuse and sleep disturbance symptoms, were also identified. In symptom network for CT, SD, and depressive symptoms, sleeping difficulty symptoms, daily dysfunction symptoms, and emotional abuse appeared to be potential bridge symptoms. In symptom network of CT, SD, and depressive symptoms (excluding the symptom of sleeping difficulty), daily dysfunction symptoms, emotional abuse, and sleep disturbance symptoms appeared to be bridge symptoms.ConclusionsIn this study, emotional abuse and poor sleep quality were found to be central symptoms in the CT-SD network structure among Chinese adolescent students, with daytime dysfunction as the bridge symptom in the CT-SD-depression network structure. Systemic multi-level interventions targeting the central symptoms and bridge symptoms may be effective in alleviating the co-occurrence of CT, SD and depression in this population.

Predictors of cognitive dysfunction one-year post COVID-19.

(a) To characterize the frequency of objective cognitive deficits and self-perceived cognitive difficulties and (b) to explore demographic and clinical predictors of cognitive dysfunction and cognitive complaints. One hundred and ten adults diagnosed with COVID-19 between March and November 2020, aged ≤ 74 years underwent a brief neuropsychological evaluation 12 months after infection, which included: Brief Visuospatial Memory Test-Revised, California Verbal Learning Test, and Symbol Digit Modalities Test. T scores < 38 were considered abnormal performance; cognitive dysfunction was defined as ≥ 2 abnormal tests. Participants also completed Broadbent's Cognitive Failure Questionnaires (CFQ), Hospital Anxiety and Depression Scale, Modified Fatigue Impact Scale, and Short-Form Health Survey. CFQ ≥ 43 was considered indicative of cognitive complaints. Twenty participants (18.2%) had cognitive dysfunction and 36 (33.3%) had cognitive complaints. Cognitive dysfunction was related to lower education, preinfection history of headache/migraine, and acute COVID-19 symptoms of headache and sleep disturbance. Cognitive complaints were more likely to occur in women, those with fewer years of education, and acute COVID-19 symptoms of headache and sleep disturbance. Cognitive complaints were also significantly related to symptoms of anxiety, depression, and fatigue. Sex and psychopathology were not significant predictors of cognitive dysfunction. Modest associations were found between CFQ total score and cognitive test performance. A subset of individuals develops cognitive difficulties in the context of post-COVID syndrome. Results may support the protective effect of education, a known proxy of cognitive reserve. COVID-19 infection symptoms of headache and sleep disturbance appear to be risk factors for long-term cognitive difficulties. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of yogic practices in the management of fibromyalgia: A review

ABSTRACT Fibromyalgia (FM) is characterized by widespread pain, fatigue, stiffness, sleep irregularities, and tenderness of joints and muscles due to dysregulation of neurophysiological functions. It is more common in women compared to men. Till now, there is no specific treatment available for FM. The review aimed to review the literature on the effect of yogic practices on FM. The search was done in the following databases: Google Scholar and PubMed. The articles were searched using the keywords, FM, FM syndrome, Yoga, Pranayama, Yogic practices, and alternative therapy, without date restrictions which yielded 28 results, and eight articles were included in the final review. A review of the included articles showed the significant role of yogic practices in managing symptoms of FM, including stiffness, pain, sleep disturbance, fatigue, and depression. The yogic interventions such as asanas, Surya Namaskar, Nadi Shodhana Pranayama, and mindfulness meditation of specific duration were helpful in relieving the symptoms of FM. Yogic practices are helpful in the management of FM symptoms. Future randomized controlled trials contrasting various forms of yoga or exercise, however, will enable the identification of the most efficient treatments for FM and allow for more precise targeting of the patients who will benefit most from them.