Positive Affect and Sleep in Spousal Alzheimer Caregivers: A Longitudinal Study.

This article examines the longitudinal relation between positive affect (PA) and sleep in 126 spousal Alzheimer's disease caregivers. Caregivers underwent 4 yearly assessments for the Positive and Negative Affect Schedule, the self-rated Pittsburgh Sleep Quality Index, and actigraphy to objectify nighttime total sleep time, wake after sleep onset, and percentage of sleep. Increased levels of PA and a greater positivity (i.e., positive-to-negative affect) ratio were significantly associated with better subjective sleep over the entire study period. Yearly increases in PA-even when controlling for negative affect (NA)-and in the positivity ratio were also associated with better subjective sleep. PA and actigraphy measures showed no significant relations. Increased PA is longitudinally associated with better sleep in dementia caregivers largely independent of NA.

Sleep respiratory disturbances and arousals at moderate altitude have overlapping electroencephalogram spectral signatures

An ascent to altitude has been shown to result in more central apneas and a shift towards lighter sleep in healthy individuals. This study employs spectral analysis to investigate the impact of respiratory disturbances (central/obstructive apnea and hypopnea or periodic breathing) at moderate altitude on the sleep electroencephalogram (EEG) and to compare EEG changes resulting from respiratory disturbances and arousals. Data were collected from 51 healthy male subjects who spent 1 night at moderate altitude (2590 m). Power density spectra of Stage 2 sleep were calculated in a subset (20) of these participants with sufficient artefact-free data for (a) epochs with respiratory events without an accompanying arousal, (b) epochs containing an arousal and (c) epochs of undisturbed Stage 2 sleep containing neither arousal nor respiratory events. Both arousals and respiratory disturbances resulted in reduced power in the delta, theta and spindle frequency range and increased beta power compared to undisturbed sleep. The similarity of the EEG changes resulting from altitude-induced respiratory disturbances and arousals indicates that central apneas are associated with micro-arousals, not apparent by visual inspection of the EEG. Our findings may have implications for sleep in patients and mountain tourists with central apneas and suggest that respiratory disturbances not accompanied by an arousal may, none the less, impact sleep quality and impair recuperative processes associated with sleep more than previously believed.

Impact of Acetazolamide and CPAP on Cortical Activity in Obstructive Sleep Apnea Patients

STUDY OBJECTIVES 1) To investigate the impact of acetazolamide, a drug commonly prescribed for altitude sickness, on cortical oscillations in patients with obstructive sleep apnea syndrome (OSAS). 2) To examine alterations in the sleep EEG after short-term discontinuation of continuous positive airway pressure (CPAP) therapy. DESIGN Data from two double-blind, placebo-controlled randomized cross-over design studies were analyzed. SETTING Polysomnographic recordings in sleep laboratory at 490 m and at moderate altitudes in the Swiss Alps: 1630 or 1860 m and 2590 m. PATIENTS Study 1: 39 OSAS patients. Study 2: 41 OSAS patients. INTERVENTIONS Study 1: OSAS patients withdrawn from treatment with CPAP. Study 2: OSAS patients treated with autoCPAP. Treatment with acetazolamide (500-750 mg) or placebo at moderate altitudes. MEASUREMENTS AND RESULTS An evening dose of 500 mg acetazolamide reduced slow-wave activity (SWA; approximately 10%) and increased spindle activity (approximately 10%) during non-REM sleep. In addition, alpha activity during wake after lights out was increased. An evening dose of 250 mg did not affect these cortical oscillations. Discontinuation of CPAP therapy revealed a reduction in SWA (5-10%) and increase in beta activity (approximately 25%). CONCLUSIONS The higher evening dose of 500 mg acetazolamide showed the "spectral fingerprint" of Benzodiazepines, while 250 mg acetazolamide had no impact on cortical oscillations. However, both doses had beneficial effects on oxygen saturation and sleep quality.

The effects of exercise on self-rated sleep among adults with chronic sleep complaints

Purpose The purpose of this study was to evaluate whether and to what extent the observed effects on self-rated sleep in a previous study using a combined treatment program with physical exercise and sleep education can be attributed by the physical activity (PA) component. Methods The present study reports supplementary analysis of an already described and published study. Data were provided by a nonclinical sample of 98 normal-active adults with chronic initiating and the maintaining of sleep complaints. The additional analysis included sleep log, exercise log, and daily pedometer data which were collected during a baseline week and 6-week of a combined intervention. Results The results indicate that the number of steps (p = 0.02) and the duration of PA (p = 0.01) is significantly related to the improvement in subjective sleep measures and therefore reveal an independent effect within this combined sleep program. Sleep diary data (recuperation of sleep, number of awakenings after sleep onset, and wake time after sleep onset time) improved significant (all p < 0.01) over the intervention program. About 50% of the participants stated that the PA had an effect on their improvement. Conclusion Improvements on subjective sleep quality after a combined intervention cannot be attributed to the cognitive component alone, but PA has an independent effect. Adults with chronic sleep complaints benefit from exercise. Therefore structured PA should be implemented in any sleep management programs.

Sleep Disturbance in the Homeless Population: The Relationship between Homelessness, Sleep and Health

Little is known about how sleep disruption impacts physical health among the homeless. The association between homelessness, quality of sleep and physical health were investigated in the current study. Convenience sampling was used to select participants from a pool of people attending the programs of Ecclesia Ministries. Interviews were conducted with 32 persons from the Boston metropolitan area, of whom 23 were currently homeless. The researcher assessed level of sleep disturbance, number of health problems and degree of homelessness using a standard demographic questionnaire, the General Health Questionnaire-12 (GHQ-12) and the Pittsburgh Sleep Quality Index (PSQI). Our results found evidence of significant sleep disturbance as well as significant mental and physical health problems in the sample. Correlational analyses provided partial support for the hypothesis that degree of homelessness impacts both sleep quality and physical health. Future work should investigate whether change in homelessness status alters sleep quality and physical health and also whether interventions may be utilized in this understudied and vulnerable population.

Baseline quality of life as a predictor of exercise intervention adherence among endometrial cancer survivors

Background: The objective of this analysis is to test whether baseline quality of life (QOL) measurements, body mass index (BMI) and prior exercise behavior are significantly associated with (1) telephone counseling adherence, and (2) activity at the final assessment, in a physical activity promoting intervention among endometrial cancer survivors.^ Methods: One hundred endometrial cancer survivors not currently meeting physical activity guidelines completed baseline QOL and anthropometric assessments to measure general physical and mental health [Medical Outcomes Survey (SF-36)], sleep patterns and sleep quality [Pittsburgh Sleep Quality Index (PSQI)], perceived stress [Perceived Stress Scale (PSS)], cancer-specific concerns of long-term survivors [Quality of Life in Adult Cancer Survivors (QLACS)], and psychological distress [Brief Symptom Inventory-18 (BSI-18)]. Survivors were counseled by telephone during the 6-month intervention and their completion rate determined their adherence. The primary variables of interest included age, baseline BMI, baseline activity level, time since diagnosis, education, treatment received, and the SF-36 physical and mental component scores.^ Results: Final activity was most closely linked with baseline activity (p<.001) and less invasive surgery, being leaner and older, and experiencing less pain and more vitality. Telephone counseling was also predicted well by baseline activity, working less and having better overall cancer-related functioning.^ Conclusion: Above and beyond the QOL measures, baseline activity was the strongest predictor of both final activity and telephone counseling adherence. While education, surgery treatment type and bodily pain were important predictors for final exercise and employment status and cancer-related quality of life were important predictors for telephone counseling adherence, considering adaptive exercise interventions that focus heavily on engaging inactive participants may be a way to produce better exercise-related outcomes in the endometrial cancer survivor population.^

The High Frequency Component of Heart Rate Variability and Delta EEG Power during Sleep in Healthy Women and Women with Irritable Bowel Syndrome

Thesis (Ph.D.)--University of Washington, 2016-06

Sleep Patterns and Parents’ Experience in Caring for Young Children Newly Diagnosed with Juvenile Idiopathic Arthritis

Thesis (Ph.D.)--University of Washington, 2016-05

Sleep problems among clinically depressed adults in China

BACKGROUND: The aim of the study was to explore which variables predict poor sleep among clinically depressed Chinese adults.

METHODS: In total, 100 participants were recruited from Shanghai Mental Health Centre. The dependent variables were number of hours spent sleeping as well as the quality of sleep and number of times the participants woke during the night. The independent variables were gender, age, length of depression and severity of depression. The use of antipsychotic medication was controlled for in all analyses.

RESULTS: The results demonstrated that depression severity was the most important predictor of sleep quality and night waking. Gender and age were also found to be predictors of sleep problems.

CONCLUSIONS: The findings demonstrated that depressed Chinese patients experienced similar relationships between sleep disturbance and depression to Westerners. Future studies should include other measures of sleep quality as well as variables consistently found to be associated with both depression and sleep difficulty, such as the use of addictive substances and psychosocial factors.

Study protocol for a systematic review of evidence for lifestyle interventions targeting smoking, sleep, alcohol/other drug use, physical activity, and healthy diet in people with bipolar disorder

BACKGROUND: People with bipolar disorder (BD) have a mortality gap of up to 20 years compared to the general population. Physical conditions, such as cardiovascular disease (CVD) and cancer, cause the majority of excess deaths in psychiatric populations and are the leading causes of mortality in people with BD. However, comparatively little attention has been paid to reducing the risk of physical conditions in psychiatric populations. Unhealthy lifestyle behaviors are among the potentially modifiable risk factors for a range of commonly comorbid chronic medical conditions, including CVD, diabetes, and obesity. This systematic review will identify and evaluate the available evidence for effective interventions to reduce risk and promote healthy lifestyle behaviors in BD.

METHODS/DESIGN: We will search MEDLINE, Embase, PsychINFO, Cochrane Database of Systematic Reviews, and CINAHL for published research studies (with at least an abstract published in English) that evaluate behavioral or psychosocial interventions to address the following lifestyle factors in people with BD: tobacco use, physical inactivity, unhealthy diet, overweight or obesity, sleep-wake disturbance, and alcohol/other drug use. Primary outcomes for the review will be changes in tobacco use, level of physical activity, diet quality, sleep quality, alcohol use, and illicit drug use. Data on each primary outcome will be synthesized across available studies in that lifestyle area (e.g., tobacco abstinence, cigarettes smoked per day), and panel of research and clinical experts in each of the target lifestyle behaviors and those experienced with clinical and research with individuals with BD will determine how best to represent data related to that primary outcome. Seven members of the systematic review team will extract data, synthesize the evidence, and rate it for quality. Evidence will be synthesized via a narrative description of the behavioral interventions and their effectiveness in improving the healthy lifestyle behaviors in people with BD.

DISCUSSION: The planned review will synthesize and evaluate the available evidence regarding the behavioral or psychosocial treatment of lifestyle-related behaviors in people with BD. From this review, we will identify gaps in our existing knowledge and research evidence about the management of unhealthy lifestyle behaviors in people with BD. We will also identify potential opportunities to address lifestyle behaviors in BD, with a view to reducing the burden of physical ill-health in this population.

Sleep Deprivation and Pain Intensity

Little or poor quality sleep is often reported in patients suffering from acute or chronic pain. Conversely, sleep loss has been known to elevate pain perception; thus a potential bi-direction relationship exists between sleep deprivation and pain. The effect of sleep deprivation on the thermal pain intensity has yet to be determined, furthermore, sex differences in pain have not been examined following sleep deprivation. There is also a higher prevalence of insomnia in women, and reports indicate that sleep quality is diminished and pain sensitivity may be greater during high hormone phases of the menstrual cycle. In Study 1 we examined the effects of 24-hour total sleep deprivation (TSD) on pain intensity during a 2-minute cold pressor test (CPT). We hypothesized that TSD would augment thermal pain intensity during CPT and women would demonstrate an elevated response compare to men. In Study 2 we investigated the effects of menstrual phase on pain intensity during CPT following TSD. We hypothesized that pain intensity would be augmented during the mid-luteal (ML) phase of the menstrual cycle. In Study 1, pain intensity was recorded during CPT in 14 men and 13 women after normal sleep (NS) and TSD. Pain intensity responses during CPT were elevated in both conditions; however, pain intensity was augmented (~ 1.2 a.u.) following TSD. When analyzed for sex differences, pain intensity was not different between men and women in either condition. In Study 2, pain intensity was recorded during CPT in 10 female subjects during the early follicular (EF) and ML phases of the menstrual cycle after TSD. Estradiol and progesterone levels were elevated during the ML phase, however, pain intensity was not different between the two phases. We conclude that TSD significantly augments pain intensity during CPT, but this response is not sex dependent. We further demonstrate that the collective effect of TSD and elevated gonadal hormone concentrations do not result in a differential pain response during the EF and ML phases of the menstrual cycle. Collectively, sleep loss augments pain intensity ratings in men and women and may contribute to sleep loss in painful conditions.

The effect of working on-call on stress physiology and sleep: a systematic review

On-call work is becoming an increasingly common work pattern, yet the human impacts of this type of work are not well established. Given the likelihood of calls to occur outside regular work hours, it is important to consider the potential impact of working on-call on stress physiology and sleep. The aims of this review were to collate and evaluate evidence on the effects of working on-call from home on stress physiology and sleep. A systematic search of Ebsco Host, Embase, Web of Science, Scopus and ScienceDirect was conducted. Search terms included: on-call, on call, standby, sleep, cortisol, heart rate, adrenaline, noradrenaline, nor-adrenaline, epinephrine, norepinephrine, nor-epinephrine, salivary alpha amylase and alpha amylase. Eight studies met the inclusion criteria, with only one study investigating the effect of working on-call from home on stress physiology. All eight studies investigated the effect of working on-call from home on sleep. Working on-call from home appears to adversely affect sleep quantity, and in most cases, sleep quality. However, studies did not differentiate between night's on-call from home with and without calls. Data examining the effect of working on-call from home on stress physiology were not sufficient to draw meaningful conclusions.

The Heavy Vehicle Study : a case-control study investigating risk factors for crash in long distance heavy vehicle drivers in Australia

Background Heavy vehicle transportation continues to grow internationally; yet crash rates are high, and the risk of injury and death extends to all road users. The work environment for the heavy vehicle driver poses many challenges; conditions such as scheduling and payment are proposed risk factors for crash, yet the precise measure of these needs quantifying. Other risk factors such as sleep disorders including obstructive sleep apnoea have been shown to increase crash risk in motor vehicle drivers however the risk of heavy vehicle crash from this and related health conditions needs detailed investigation. Methods and Design The proposed case control study will recruit 1034 long distance heavy vehicle drivers: 517 who have crashed and 517 who have not. All participants will be interviewed at length, regarding their driving and crash history, typical workloads, scheduling and payment, trip history over several days, sleep patterns, health, and substance use. All participants will have administered a nasal flow monitor for the detection of obstructive sleep apnoea. Discussion Significant attention has been paid to the enforcement of legislation aiming to deter problems such as excess loading, speeding and substance use; however, there is inconclusive evidence as to the direction and strength of associations of many other postulated risk factors for heavy vehicle crashes. The influence of factors such as remuneration and scheduling on crash risk is unclear; so too the association between sleep apnoea and the risk of heavy vehicle driver crash. Contributory factors such as sleep quality and quantity, body mass and health status will be investigated. Quantifying the measure of effect of these factors on the heavy vehicle driver will inform policy development that aims toward safer driving practices and reduction in heavy vehicle crash; protecting the lives of many on the road network.

Assessment of the health impacts of the 2011 summer floods in Brisbane

Background: During December 2010 and January 2011, torrential rainfall in Queensland resulted in the worst flooding in over 50 years. We carried out a community-based survey to assess the health impacts of this flooding in the city of Brisbane. Methods: A community-based survey was conducted in 12 flood-affected electorates using postal questionnaires. A random sample of residents in these areas was drawn from electoral rolls. Questions examined sociodemographic information, the direct impact of flooding on the household, and perceived flood-related health impacts. Outcome variables included perceived flood-related effects on overall and respiratory health, along with mental health outcomes measured by psychosocial distress, reduced sleep quality and probable post-traumatic stress disorder (PTSD). Multivariable logistic regression was used to examine the association between flooding and health outcome variables, adjusted for current health status and socioeconomic factors. Results: 3000 residents were invited to participate in this survey, with 960 responses (32%). People whose households were directly impacted by flooding had a decrease in perceived overall health (OR 5.3, 95% CI: 2.8–10.2), along with increases in psychological distress (OR 1.9, 1.1–3.5), decreased sleep quality (OR 2.3, 1.2–4.4), and probable PTSD (OR 2.3, 1.2–4.5). Residents were also more likely to increase usage of both tobacco (OR 6.3, 2.4–16.8) and alcohol (OR 7.0, 2.2–22.3) after flooding. Conclusions: There were significant impacts of flood events on residents’ health, in particular psychosocial health. Improved support strategies may need to be integrated into existing disaster management programs to reduce flood‐related health impacts.

Assessment of the health impacts of the 2011 summer floods in Brisbane

Background: During December 2010 and January 2011, torrential rainfall in Queensland resulted in the worst flooding in over 50 years. We carried out a community-based survey to assess the health impacts of this flooding in the city of Brisbane. Methods: A community-based survey was conducted in 12 flood-affected electorates using postal questionnaires. A random sample of residents in these areas was drawn from electoral rolls. Questions examined sociodemographic information, the direct impact of flooding on the household, and perceived flood-related health impacts. Outcome variables included perceived flood-related effects on overall and respiratory health, along with mental health outcomes measured by psychosocial distress, reduced sleep quality and probable post-traumatic stress disorder (PTSD). Multivariable logistic regression was used to examine the association between flooding and health outcome variables, adjusted for current health status and socioeconomic factors. Results: 3000 residents were invited to participate in this survey, with 960 responses (32%). People whose households were directly impacted by flooding had a decrease in perceived overall health (OR 5.3, 95% CI: 2.8–10.2), along with increases in psychological distress (OR 1.9, 1.1–3.5), decreased sleep quality (OR 2.3, 1.2–4.4), and probable PTSD (OR 2.3, 1.2–4.5). Residents were also more likely to increase usage of both tobacco (OR 6.3, 2.4–16.8) and alcohol (OR 7.0, 2.2–22.3) after flooding. Conclusions: There were significant impacts of flood events on residents’ health, in particular psychosocial health. Improved support strategies may need to be integrated into existing disaster management programs to reduce flood-related health impacts.