RESUMEN

INTRODUCTION: Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia; as well as whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious. MATERIALS AND METHODS: Single-site, randomized controlled trial. 117 postmenopausal women (56.34 ± 5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to three treatment conditions: sleep hygiene education control (SHE), SRT, and CBTI. Blinded assessments were performed at baseline, posttreatment, and six-month follow-up. RESULTS: CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until six months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved in the SRT group. Improvements in depression, maladaptive thinking, and hyperarousal were linked to improved sleep. SHE produced no durable treatment effects. CONCLUSIONS: CBTI and SRT reduce depressive symptoms, dysfunctional beliefs about sleep, and presleep somatic hyperarousal in postmenopausal women, with CBTI producing superior results. Despite its cognitive emphasis, cognitive arousal did not respond strongly or durably to CBTI. NAME: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov. REGISTRATION: NCT01933295.

Asunto(s)

Terapia Cognitivo-Conductual/métodos , Depresión/psicología , Educación del Paciente como Asunto/métodos , Posmenopausia/psicología , Trastornos del Despertar del Sueño/psicología , Higiene del Sueño/fisiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Depresión/epidemiología , Depresión/terapia , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Pesimismo/psicología , Trastornos del Despertar del Sueño/epidemiología , Trastornos del Despertar del Sueño/terapia , Privación de Sueño/epidemiología , Privación de Sueño/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Resultado del Tratamiento

RESUMEN

OBJECTIVES: Given the neurocognitive hyperarousal observed in patients with insomnia disorder and associations of nocturnal hot flashes with cardiovascular disease risk, we examined whether women with hot flash-associated insomnia disorder demonstrate exaggerated cardiovascular responsivity to acute stressors, and also a profile of psychological hyperarousal. METHODS: Peri and postmenopausal women with and without hot flash-associated insomnia disorder underwent assessments of cardiovascular autonomic responsivity to acute stress paradigms and psychological hyperarousal. Hemodynamic responses (heart rate, blood pressure) to nociceptive, social-evaluative, and cognitive stress paradigms were measured in the morning. Psychological hyperarousal was evaluated using questionnaires assessing daytime and presleep hyperarousal, anxiety, and sleep-related cognitions. RESULTS: Women (25 with and 15 without hot flash-associated insomnia) aged 53.4 ±â€Š4.8 years reported a range of insomnia symptoms. Resting-state hemodynamics were similar between groups. Heart rate and blood pressure responses to stress paradigms did not differ by group nor did they correlate with insomnia severity. Women with insomnia disorder had higher generalized anxiety disorder scores (mean 2.7 ±â€Š3.0 vs 1.0 ±â€Š1.4; P = 0.05) and sleep-related cognitions than those without insomnia (P ≤ 0.05). Insomnia symptom severity was moderately correlated with presleep and daytime hyperarousal, anxiety, and sleep-related cognition (all r ≥ 0.43). CONCLUSIONS: Though hot flash-associated insomnia is characterized by psychological hyperarousal before sleep and during the daytime, it does not relate to cardiovascular responsiveness to acute stressors. Our findings do not support the hypothesis that altered cardiovascular control is a potential mechanism by which hot flash-associated insomnia confers higher cardiovascular disease risk.

Asunto(s)

Nivel de Alerta/fisiología , Sistema Cardiovascular/fisiopatología , Sofocos/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Anciano , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/fisiopatología , Presión Sanguínea , Enfermedades Cardiovasculares , Cognición/fisiología , Femenino , Frecuencia Cardíaca , Humanos , Menopausia/fisiología , Persona de Mediana Edad , Factores de Riesgo , Sueño/fisiología , Trastornos del Despertar del Sueño/fisiopatología , Trastornos del Despertar del Sueño/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Encuestas y Cuestionarios

RESUMEN

Given the recent evidence on the association between hyperarousal in insomnia disorder and neurocognitive deficits, we aimed to examine the effect of short sleep duration on neurocognitive reaction time tests in insomnia disorder sufferers. We recruited subjects with insomnia disorder (n = 35, mean age = 40.6 years) who scored ≥29 on a Hyperarousal Scale, and a group of controls (n = 54, mean age = 31.5 years) who had no sleep disorders and scored <26 on the Hyperarousal Scale. Participants completed two in-home polysomnograms and four daytime trials of neurocognitive tests, including simple reaction time, choice reaction time, big circle-little circle, rapid visual information processing, attention switching task, and spatial working memory tests. Total sleep time divided study cohorts into subgroups of short (total sleep time <6 hr) and normal (total sleep time ≥6 hr) sleepers. ANCOVA showed a significant interaction between participant type (insomnia disorder versus controls) and sleep duration (short versus normal) for spatial working memory-latency (p = 0.020) and spatial working memory-errors (p = 0.025). The short-sleeping insomnia disorder group had longer spatial working memory-latencies and more spatial working memory-errors than did normal-sleeping controls. Regardless of sleep duration, those with insomnia disorder had more attentional deficits with longer attention switching task-latency (p = 0.011) and more attention switching task-incorrect trials (p = 0.015) than the control group. Normal-sleepers only had longer attention switching task-latency than short-sleepers (p = 0.004). A phenotype of insomnia disorder with hyperarousal and short sleep duration is associated with daytime cognitive deficits in complex attentional and spatial working memory tasks.

Asunto(s)

Cognición/fisiología , Trastornos Neurocognitivos/epidemiología , Trastornos del Despertar del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Sueño/fisiología , Adulto , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Memoria a Corto Plazo/fisiología , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/psicología , Polisomnografía/métodos , Tiempo de Reacción/fisiología , Trastornos del Despertar del Sueño/diagnóstico , Trastornos del Despertar del Sueño/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Factores de Tiempo

RESUMEN

OBJECTIVE: To assess the sleeping habits of primary school children and establish link between sleeping hours and academic achievement. METHODS: The cross-sectional study was conducted between April and June 2007, involving 2422 students of 6-8th grades in 12 primary schools located in Kayseri, Turkey. A questionnaire was presented to the students on the basis of probability sampling method. Academic performance was evaluated with regard to their school grades. SPSS 20 was used for statistical analysis. RESULTS: Of the total 2422 questionnaires distributed, 1966 (81.2%) were used for further evaluation. The mean sleeping period of the students during school days was 8.86 +/- 1.10 hours. The number of students having difficulty in waking up in the morning was 940 (47.8%), while 910 (46.3%) were confused when they woke up during the night, and the 886 (45.1%) had nightmares, while 609 (31.0%) were sleepy all day long. As the sleeping period increased, the probability of a mediocre achievement in science lessons increased by 1.33 fold and poor achievement increased by 1.57 fold. Besides, the probability of a mediocre achievement in mathematics lessons increased by 1.36 fold, and poor achievement increased by 1.67 fold. For Turkish language lessons, these increases were found to be 1.40 and 1.60 respectively. Correlation analysis showed a significant negative relationship between sleeping time and successful scores in Turkish (r = -0.65, p < 0.025) and science (r = -0.061, p < 0.036) lessons. CONCLUSION: As the sleeping period increased, the academic achievement of the students was negatively affected. The academic success was low in children who felt sleepy throughout the day.

Asunto(s)

Logro , Trastornos de Somnolencia Excesiva/psicología , Trastornos del Despertar del Sueño/psicología , Sueño , Estudiantes/psicología , Adolescente , Niño , Estudios Transversales , Trastornos de Somnolencia Excesiva/epidemiología , Sueños/psicología , Femenino , Humanos , Masculino , Trastornos del Despertar del Sueño/epidemiología , Factores de Tiempo , Turquía/epidemiología

RESUMEN

STUDY OBJECTIVES: Nightmares are disturbing mental experiences during sleep that usually result in abrupt awakenings. Frequent nightmares are associated with poor subjective sleep quality, and recent polysomnographic data suggest that nightmare sufferers exhibit impaired sleep continuity during nonrapid eye movement (NREM) sleep. Because disrupted sleep might be related to abnormal arousal processes, the goal of this study was to examine polysomnographic arousal-related activities in a group of nightmare sufferers and a healthy control group. DESIGN: Sleep microstructure analysis was carried out by scoring the cyclic alternating pattern (CAP) in NREM sleep and the arousal index in rapid eye movement (REM) sleep on the second night of the polysomnographic examination. SETTING: Hospital-based sleep research laboratory. PARTICIPANTS: There were 17 in the nightmare (NMs) group and 23 in the healthy control (CTLs) group. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The NMs group exhibited reduced amounts of CAP A1 subtype and increased CAP A2 and A3 subtypes, as well as longer duration of CAP A phases in comparison with CTLs. Moreover, these differences remained significant after controlling for the confounding factors of anxious and depressive symptoms. The absolute number and frequency of REM arousals did not differ significantly between the two groups. CONCLUSIONS: The results of our study indicate that NREM sleep microstructure is altered during nonsymptomatic nights of nightmares. Disrupted sleep in the NMs group seems to be related to abnormal arousal processes, specifically an imbalance in sleep-promoting and arousing mechanisms during sleep. CITATION: Simor P; Bódizs R; Horváth K; Ferri R. Disturbed dreaming and the instability of sleep: altered nonrapid eye movement sleep microstructure in individuals with frequent nightmares as revealed by the cyclic alternating pattern. SLEEP 2013;36(3):413-419.

Asunto(s)

Sueños/fisiología , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/fisiopatología , Adulto , Análisis de Varianza , Movimientos Oculares , Femenino , Humanos , Hungría/epidemiología , Masculino , Polisomnografía/métodos , Psicometría , Trastornos del Despertar del Sueño/epidemiología , Trastornos del Despertar del Sueño/psicología , Trastornos del Sueño-Vigilia/psicología , Adulto Joven

RESUMEN

Although generally considered as mutually exclusive, violence and sleep can coexist. Violence related to the sleep period is probably more frequent than generally assumed and can be observed in various conditions including parasomnias (such as arousal disorders and rapid eye movement sleep behaviour disorder), epilepsy (in particular nocturnal frontal lobe epilepsy) and psychiatric diseases (including delirium and dissociative states). Important advances in the fields of genetics, neuroimaging and behavioural neurology have expanded the understanding of the mechanisms underlying violence and its particular relation to sleep. The present review outlines the different sleep disorders associated with violence and aims at providing information on diagnosis, therapy and forensic issues. It also discusses current pathophysiological models, establishing a link between sleep-related violence and violence observed in other settings.

Asunto(s)

Trastornos del Sueño-Vigilia/psicología , Violencia/psicología , Trastornos Disociativos/psicología , Epilepsia/complicaciones , Epilepsia/psicología , Medicina Legal , Humanos , Parasomnias/epidemiología , Parasomnias/psicología , Polisomnografía , Trastornos del Despertar del Sueño/psicología , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/fisiopatología , Trastornos del Sueño-Vigilia/terapia , Sueño REM

RESUMEN

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities.

Asunto(s)

Parasomnias/diagnóstico , Parasomnias del Sueño REM/diagnóstico , Trastornos del Despertar del Sueño/diagnóstico , Trastornos Intrínsecos del Sueño/diagnóstico , Adolescente , Bruxismo/diagnóstico , Bruxismo/psicología , Bruxismo/terapia , Niño , Preescolar , Comorbilidad , Diagnóstico Diferencial , Humanos , Tamizaje Masivo , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Síndrome de Mioclonía Nocturna/diagnóstico , Síndrome de Mioclonía Nocturna/psicología , Síndrome de Mioclonía Nocturna/terapia , Parasomnias/psicología , Parasomnias/terapia , Polisomnografía , Parasomnias del Sueño REM/psicología , Parasomnias del Sueño REM/terapia , Síndrome de las Piernas Inquietas/diagnóstico , Síndrome de las Piernas Inquietas/psicología , Síndrome de las Piernas Inquietas/terapia , Factores de Riesgo , Trastornos del Despertar del Sueño/psicología , Trastornos del Despertar del Sueño/terapia , Privación de Sueño/psicología , Trastornos Intrínsecos del Sueño/psicología , Trastornos Intrínsecos del Sueño/terapia

RESUMEN

Enuretic children sleep "deeply" in the sense that they are difficult to arouse from sleep, but not in the sense that their sleep is necessarily polysomnographically different from other children. The enuretic children's arousal difficulties may be due to a disturbance at the brainstem level and/or to frequent arousal stimuli from the bladder. It may be hypothesised that the sleep disturbance of enuretic children may lead not only to the wetting of the sheets but to disturbances of daytime psychological functioning as well.

Asunto(s)

Enuresis Nocturna/etiología , Enuresis Nocturna/fisiopatología , Trastornos del Despertar del Sueño/complicaciones , Trastornos del Despertar del Sueño/fisiopatología , Tronco Encefálico/fisiopatología , Niño , Humanos , Polisomnografía , Trastornos del Despertar del Sueño/psicología

RESUMEN

Enuresis nocturna is a common problem. Numerous etiologic factors have been investigated, and various theories have been proposed. The objectives of our study were to establish the differences in the sleep quality of nocturnal enuretic patients from that of healthy voluntary subjects, and the changes after treatment with desmopressin acetate (DDAVP), among primary school children. The study comprised 19 children with primary nocturnal enuresis and 32 healthy children in the control group. Subjective assessment of sleep was determined with the Pittsburgh Sleep Quality Index (PSQI) questionnaire. PSQI scores for each patient and control subject were determined before the study was started and after a month time interval. The sleep quality of the nocturnal enuretic children was poor. We found lower scores after a month's treatment with DDAVP, and significant differences in two dimensions in the patient group: 'subjective sleep quality' and 'sleep disturbances'. When we asked the patients' group what caused the sleep disturbance, they replied 'the fear or the anxiety of bedwetting during sleep'. This anxiety or fear seemed to be a factor that probably affected their sleep quality. So, active treatment (medical or behavioral) should be started as soon as the child is ready to receive it or when the enuretic child wants to be dry when asleep.

Asunto(s)

Fármacos Antidiuréticos/administración & dosificación , Desamino Arginina Vasopresina/administración & dosificación , Enuresis Nocturna/tratamiento farmacológico , Enuresis Nocturna/etiología , Trastornos del Despertar del Sueño/complicaciones , Trastornos del Despertar del Sueño/psicología , Ansiedad/prevención & control , Niño , Miedo , Femenino , Humanos , Masculino , Sueño , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

INTRODUCCIÓN. Explorar las características de los personajes de los sueños relacionadas con la ansiedad en el momento del despertar, así como la posibilidad de utilizar estas características para confeccionar un cuestionario administrado a los soñantes, alternativo a los métodos tradicionales de codificación del contenido mediante jueces entrenados, como el de Hall y Van Castle y el de Gottschalk Gleser. MÉTODO. Una muestra de 169 voluntarios calificaron con adjetivos a los personajes de sus sueños; se analizaron mediante un análisis factorial exploratorio, con rotación ortogonal, aquellas características de los personajes relacionadas con la ansiedad al despertar. RESULTADOS. Con 37 características de los personajes se obtuvieron un índice de adecuación de la muestra KMO (Kaiser-Meyer-Olkin) de .83 y un 33.87% de la varianza explicada. Se extrajeron cuatro factores: Amenaza Psicológica, Auxiliar, Amenaza Terrorífica y Espectador/Víctima. Sus correspondientes coeficientes Alpha oscilaron entre .85 y .73, y se halló una correlación significativa (p .05) entre tres de los factores y la ansiedad de los sujetos al despertar. CONCLUSIONES. Nuestros resultados indican que los cuestionarios administrados a los sujetos sobre sus propios sueños son una alternativa fiable y válida en la evaluación del contenido de los sueños. La información obtenida de los personajes permite la evaluación del sueño y aporta unos indicadores que permiten una interpretación sencilla, que no contiene sesgos debidos al evaluador ni a la habilidad del sujeto para crear un relato (AU)

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INTRODUCTION. To explore the attributes of dream characters related with anxiety at the time of awakening, and the possibility of using these attributes in order to construct a questionnaire administered to dreamers as an alternative to traditional methods of dream content coding by means of trained judges, such as the Hall-Van de Castle method and the Gottschalk-Gleser method. METHOD. A sample of 169 volunteers described their dream characters with adjectives. The attributes of the characters related with anxiety upon awakening were analysed by means of an exploratory factor analysis with orthogonal rotation. RESULTS. With 37 character attributes a KMO (Kaiser-Meyer-Olkin) measure of sampling adequacy of .83 was obtained and 33.87% of the variance was explained. Four factors were extracted: Psychological Threat, Auxiliary, Terrifying Threat and Spectator/Victim. Their corresponding Alpha coefficients ranged between .85 and .73, and a significant correlation was found (p ?.05) between three of the factors and subjects' anxiety upon awakening. CONCLUSIONS. Our results indicate that questionnaires administered to subjects about their dreams are a reliable and valid alternative for the evaluation of dream content. The information obtained about the characters allows for the evaluation of dreams and provides indicators allowing for a simple interpretation which is free from biases associated with the coder or the ability of the subject to create a report (AU)

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Sueño/fisiología , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/psicología , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/psicología , Ansiedad/complicaciones , Ansiedad/psicología , Trastornos de Ansiedad/complicaciones , Trastornos del Despertar del Sueño/complicaciones , Trastornos del Despertar del Sueño/diagnóstico , Encuestas y Cuestionarios , Análisis Factorial , Terrores Nocturnos/complicaciones , Terrores Nocturnos/psicología , Trastornos del Despertar del Sueño/psicología , Sueños/psicología

RESUMEN

STUDY OBJECTIVES: To review medical and legal case reports to determine how many appear to support the belief that violence against other individuals that occurs during Disorders of Arousal - sleepwalking, confusional arousal, and sleep terrors - is triggered by direct physical contact or close proximity to that individual and does not occur randomly or spontaneously. DESIGN: Historical review of case reports in the medical and legal literature. MEASUREMENTS AND RESULTS: A total of 32 cases drawn from medical and legal literature were reviewed. Each case contained a record of violence associated with Disorders of Arousal; in each, details of the violent behavior were available. Violent behaviors associated with provocations and/or close proximity were found to be present in 100% of confusional arousal patients and 81% of sleep terror patients. Violent behaviors were associated with provocation or close proximity in 40%-90% of sleepwalking cases, depending on whether the legal verdict and other factors were taken into account. Often the provocation was quite minor and the response greatly exaggerated. The specific manner in which the violence was triggered differed among sleepwalking, confusional arousals, and sleep terrors. CONCLUSIONS: In the cases reviewed, violent behavior directed against other individuals associated with Disorders of Arousal most frequently appeared to follow direct provocation by, or close proximity to, another individual. Sleepwalkers most often did not seek out victims, but rather the victims sought out or encountered the sleepwalker. These conclusions are tempered by several limitations: the selection of cases was not random and may not represent an accurate sample of violent behaviors associated with Disorders of Arousal. Also, final verdicts by juries in reported legal cases should not be confused with scientific proof of the presence or absence of sleepwalking. The pathophysiology of Disorders of Arousal with and without violent behavior could be associated with normally occurring deactivation of the frontal lobes during slow wave sleep (SWS) connected via atypically active thalamocortical pathways to the limbic areas. It is not known if the violent sleepwalker, confusional arousal patient, or sleep terror patient differs from other patients with these disorders. The conclusions of this case series await confirmation by the results of future sleep laboratory based studies.

Asunto(s)

Espacio Personal , Trastorno de la Conducta del Sueño REM/diagnóstico , Trastornos del Despertar del Sueño/diagnóstico , Medio Social , Sonambulismo/diagnóstico , Violencia/psicología , Testimonio de Experto/legislación & jurisprudencia , Homicidio/legislación & jurisprudencia , Homicidio/psicología , Terrores Nocturnos/diagnóstico , Terrores Nocturnos/psicología , Trastorno de la Conducta del Sueño REM/psicología , Trastornos del Despertar del Sueño/psicología , Sonambulismo/psicología , Estados Unidos , Violencia/legislación & jurisprudencia

RESUMEN

STUDY OBJECTIVE: Sleep inertia refers to impairments in cognitive/motor performance and the tendency to return to sleep after awakening. As part of a project studying the effect of different types of 100 decibel (dB) sounds on awakening children during stage 4 sleep (S4S), we hypothesized that children with the greatest impairment in auditory arousal during S4S, manifested by the inability to either awaken to 100 dB sounds or successfully perform a self-rescue sequence (SRS), would have greater impairments in reaction time (RT) upon awakening than children who awoke and successfully accomplish a SRS. DESIGN: Observational study. SETTING: Pediatric hospital-based sleep center. PARTICIPANTS: Healthy children aged 6-12 years. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: RT was measured in 44 children approximately 90 minutes before bedtime and again after awakening by either 100 dB alarms or manually during the first and second cycles of S4S. Overall, mean and median RT slowed significantly by 37% and 22%, respectively, from baseline. Slowing of RT was most evident in the youngest children (aged 6-7 years) and after awakening from the second S4S cycle. Impairments in RT were not significantly different among children who successfully awakened to the alarm and performed a SRS compared with children who did not. CONCLUSIONS: The degree of slowing of RT was not significantly different among children who awakened and performed an SRS compared with children who did not. The greatest slowing of RT was seen among younger children and after awakening from the second S4S cycle.

Asunto(s)

Desempeño Psicomotor , Tiempo de Reacción , Fases del Sueño , Vigilia , Estimulación Acústica , Factores de Edad , Niño , Femenino , Humanos , Masculino , Seguridad , Trastornos del Despertar del Sueño/psicología , Espectrografía del Sonido

RESUMEN

Sleep bruxism (SB) subjects show a higher incidence of rhythmic masticatory muscle activity (RMMA) than control subjects. RMMA is associated with sleep micro-arousals. This study aims to: (i) assess RMMA/SB episodes in relation to sleep cycles; (ii) establish if RMMA/SB and micro-arousals occur in relation to the slow wave activity (SWA) dynamics; (iii) analyze the association between RMMA/SB and autonomic cardiac activity across sleep cycles. Two nights of polygraphic recordings were made in three study groups (20 subjects each): moderate to high SB, low SB and control. RMMA episodes were considered to occur in clusters when several groups of RMMA or non-specific oromotor episodes were separated by less than 100 s. Correlations between sleep, RMMA/SB index and heart rate variability variables were assessed for the first four sleep cycles of each study group. Statistical analyses were done with SYSTAT and SPSS. It was observed that 75.8% of all RMMA/SB episodes occurred in clusters. Micro-arousal and SB indexes were highest during sleep cycles 2 and 3 (P < 0.001). Within each cycle, micro-arousal and RMMA/SB indexes showed an increase before each REM sleep (P

Asunto(s)

Nivel de Alerta/fisiología , Corazón/inervación , Bruxismo del Sueño/fisiopatología , Bruxismo del Sueño/psicología , Sistema Nervioso Simpático/fisiopatología , Adulto , Estudios de Casos y Controles , Electrocardiografía , Femenino , Humanos , Masculino , Caracteres Sexuales , Trastornos del Despertar del Sueño/complicaciones , Trastornos del Despertar del Sueño/fisiopatología , Trastornos del Despertar del Sueño/psicología , Bruxismo del Sueño/complicaciones , Fases del Sueño/fisiología

RESUMEN

PRIMARY OBJECTIVE: To investigate the impact of disorders of arousal and sleep disturbance on everyday living and participation in rehabilitation. RESEARCH DESIGN: Survey of rehabilitation centres based on naturalistic observation. METHOD: One hundred and thirty-five adults with acquired brain injury were reported by rehabilitation staff in seven centres across the UK for presence of arousal and/or sleep disturbance, the impact on rehabilitation and daily living and treatment strategies in use. OUTCOMES: Disturbance of arousal or sleep patterns was reported in 47% of the sample, with significant adverse effect on activity evident in two-thirds of such cases. Prevalence of disordered arousal was consistent over time for up to 10 years post-injury. Concurrent psychiatric illness, but not epilepsy, was associated with arousal and sleep disorder. Non-pharmacological interventions and benzodiazepine/hypnotic drugs were in use in 34% and 20% of cases respectively. In all cases of prescribed hypnotic drugs, period of use exceeded recommended UK guidelines. CONCLUSIONS: Long-term outcome from severe brain injury can be compromised by enduring disturbance of arousal, most commonly evidenced as sleep disorder. Treatment should be based on judicious use of medication (beyond hypnotic drugs) and greater emphasis on non-pharmacological management.

Asunto(s)

Lesiones Encefálicas/rehabilitación , Trastornos del Sueño-Vigilia/psicología , Actividades Cotidianas , Adulto , Lesiones Encefálicas/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Centros de Rehabilitación , Trastornos del Despertar del Sueño/psicología , Encuestas y Cuestionarios , Reino Unido

RESUMEN

AIM: Research focusing on hyperarousability in association with general sensitivity to stress has increased. This study aimed to: (i) describe values for self-reported hyperarousal behaviour traits, depression, sleeplessness behaviour and health-related quality of life [The Short Form 36 Health Survey Questionnaire (SF-36)] in a gender-stratified random sample from the Swedish population; and (ii) test the validity and reliability of the Swedish version of the Hyperarousal Behavioural Trait Scale (H-scale). METHODS: In this study, 402 women and 391 men from Sweden were included. A test-retest study was performed on 297 subjects. RESULTS: The total mean score on the H-scale was 29.5 (SD 10.0, 95% CI 28.8-30.2). Compared to men, women scored higher on the H-scale (total score, sub-scales and many items), whereas no evidence of an age trend was seen. The H-scale has proven to be a valid and reliable scale. Pearson's correlation coefficient showed similar magnitude and direction between the H-scale and the Zung's Self-rating Depression Scale, as between the H-scale and the Vicious Cycle of Sleeplessness Behaviour Scale, Vitality, Mental Health and the Mental Component Summary index on the SF-36 respectively. The Cronbach's alpha for the H-scale was 0.84 and estimated stability test-retest point of time varies between 0.73 and 0.80. CONCLUSIONS: This study indicates gender differences in response style in association with altered health-related quality of life. The H-scale is a valid and reliable self-reported scale for measuring hyperarousal behavioural trait research outcome in clinical practice.

Asunto(s)

Trastorno Depresivo/diagnóstico , Escalas de Valoración Psiquiátrica/normas , Calidad de Vida , Trastornos del Despertar del Sueño/diagnóstico , Encuestas y Cuestionarios/normas , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Nivel de Alerta , Estudios de Casos y Controles , Trastorno Depresivo/complicaciones , Trastorno Depresivo/psicología , Análisis Discriminante , Femenino , Estado de Salud , Humanos , Introversión Psicológica , Masculino , Salud Mental , Persona de Mediana Edad , Calidad de Vida/psicología , Índice de Severidad de la Enfermedad , Factores Sexuales , Trastornos del Despertar del Sueño/complicaciones , Trastornos del Despertar del Sueño/psicología , Suecia , Traducción

RESUMEN

Sleep is known to be severely altered in temporal lobe epilepsy (TLE). Furthermore, sleep deprivation is one of the key factors contributing to cognitive deficits and drug resistance in TLE. In the past, "non-ictal" parasomnias, as well as parasomnia-like nocturnal episodes ultimately diagnosed as seizures, have been documented in epileptic patients. However, recurrence of possibly "ictal" parasomnias in TLE has not been adequately appreciated. Through questionnaires and diaries distributed to TLE patients and their families in a tertiary center for epilepsy, 20 out of 168 patients seen in the last 2 years have been identified as, probands and extensively recorded during sleep. Patients presented with confusional arousals were 16, 14 with nightmares, and 2 with sleep walking episodes. Episodes (25) corresponding to clinical or subclinical seizures have been video-polygraphically recorded in 10/20 patients. Therapy optimization, pharmacological or surgical, resolved the episodes in 17/20 patients. A better seizure control with improved quality of life can be achieved by increasing and extending the practice of nocturnal recording in TLE patients.

Asunto(s)

Sueños/fisiología , Epilepsia del Lóbulo Temporal/fisiopatología , Trastornos del Despertar del Sueño/fisiopatología , Encuestas y Cuestionarios , Adolescente , Adulto , Sueños/psicología , Epilepsia del Lóbulo Temporal/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Estudios Retrospectivos , Trastornos del Despertar del Sueño/psicología

RESUMEN

OBJECTIVES: Sleep disorders are frequently observed in Attention Deficit-Hyperactivity Disorder (ADHD). At the same time, however, there is little evidence of their prevalence and their specific characteristics. Also unclear is a possible pathogenetic relationship between disturbed sleep and the core symptoms of ADHD. There are still very few findings on the role of comorbid internal and neurological disorders like sleep apnea and restless legs syndrome in the differential diagnosis of ADHD. METHODS: We present an overview of the current literature, describing the most important results concerning sleep disorders in ADHD. RESULTS: A principal goal of future assessments is to ascertain whether sleep problems in children with ADHD represent unspecific concurrent symptoms or whether they play a substantial role in the pathogenesis of ADHD. CONCLUSIONS: Moreover a possibly increased risk of comorbid sleep-disordered breathing disorder might be an important issue in the differential diagnostic considerations with regard to ADHD.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastornos del Despertar del Sueño/diagnóstico , Trastornos del Sueño-Vigilia/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Causalidad , Niño , Comorbilidad , Estudios Transversales , Humanos , Trastornos del Despertar del Sueño/epidemiología , Trastornos del Despertar del Sueño/psicología , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/psicología

Asunto(s)

Epilepsias Mioclónicas , Epilepsias Parciales , Trastornos del Despertar del Sueño/diagnóstico , Diagnóstico Diferencial , Humanos , Trastornos del Despertar del Sueño/fisiopatología , Trastornos del Despertar del Sueño/psicología

RESUMEN

BACKGROUND: Sleep-related eating disorder is a little-described syndrome combining features of sleep disorders and eating disorders. The behaviour consists of partial arousals from sleep followed by rapid ingestion of food, commonly with at least partial amnesia for the episode the following day. The aim of this study was to provide an estimate of the prevalence of sleep-related eating disorder. METHODS: The Inventory of Nocturnal Eating, a self-report questionnaire addressing nocturnal eating and sleep disturbance, was administered to out-patients (N = 126) and in-patients (N = 24) with eating disorders, obese subjects (N = 126) in a trial of an anorexic agent, depressed subjects (N = 207) in an antidepressant trial, and an unselected group (N = 217) of college students. Sleep-related eating disorder was operationally defined as nocturnal eating with a self-reported reduced level of awareness, occurring at least once per week. RESULTS: Almost 5.0% (33/700) of the sample described symptoms consistent with sleep-related eating disorder. The in-patient eating disorders group had nearly twice the prevalence (16.7%) of the out-patient eating disorder sample (8.7%), which had nearly twice the prevalence of the next highest group, the student sample (4.6%). Subjects with sleep-related eating disorder endorsed more symptoms consistent with sleep disorders and had higher levels of depression and dissociation than those without nocturnal eating. CONCLUSIONS: Sleep-related eating disorder is more common than is generally recognized, especially in those with a daytime eating disorder. Sleep disorder symptoms are often associated with sleep-related eating disorder, as are depression and dissociation. Evaluation of individuals with eating disorders should include assessment for sleep-related eating.

Asunto(s)

Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Adulto , Comorbilidad , Estudios Transversales , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Humanos , Masculino , Inventario de Personalidad , Trastornos del Despertar del Sueño/diagnóstico , Trastornos del Despertar del Sueño/epidemiología , Trastornos del Despertar del Sueño/psicología , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/psicología