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The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Abstract: Study objectives: To assess the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with non-malignant chronic pain.Methods: Twenty-eight subjects with chronic neck and back pain were stratified according to gender, age, and ethnicity, then assigned to one of the two treatment groups: CBT-I or a contact control condition.Intervention: Eight weeks of CBT-I including sleep restriction, stimulus control, sleep hygiene, and one session of cognitive therapy devoted to catastrophic thoughts about the consequences of insomnia.Measurements and results: Outcomes included sleep diary assessments of sleep continuity, pre–post measures of insomnia severity (ISI), pain (Multidimensional Pain Inventory), and mood (BDI and POMS). Subjects receiving CBT-I (n=19), as compared to control subjects (n=9), exhibited significant decreases in sleep latency, wake after sleep onset, number of awakenings, and significant increase in sleep efficiency. The diary findings were paralleled by significant changes in the ISI (p=0.05). Significant improvement (p=0.03) was found on the Interference Scale of the Multidimensional Pain Inventory. The groups did not significantly differ on mood measures or measures of pain severity.Conclusions: CBT-I was successfully applied to patients experiencing chronic pain. Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning. The observed effect sizes for the sleep outcomes appear comparable to or better than meta-analytic norms for subjects with Primary Insomnia.
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Peeling the artichoke
Research routinely reveals negative consequences from insufficient sleep. Chronic sleep restriction may even increase amyloid-β plaque formation , which should be a concern for aging candle burning academics and others. Even though these data may not apply, they do create concern for insomniacs and possibly their primary care providers. Insomnia is difficult to study and to treat, in part due to definition variability, patient variability, and this problem’s subjective nature. Although there are objective measures of sleep, which ones identify insomnia? Our latest polysomnographic system printed 408 variables in its default report. These did not include latency to persistent sleep or the longest time awake after sleep onset.
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Fundamentals of quality of life and daytime sleepiness measurements in older sleep apnea patients
To the Editor: Martínez-García et al. reported that sleep apnea syndrome (SAS) has little impact on quality of life in the elderly. Before any firm conclusions can be drawn from this study, the data presented in this article must be clarified.
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Sleep disorders in chronic kidney disease
Sleep problems are remarkably prevalent in patients with chronic kidney disease (CKD) . Numerous publications have demonstrated the high burden of sleep disorders in early stage disease, in patients on dialysis, and even in patients who have received renal transplants. Endstage renal disease (ESRD) produces dramatic compromise of patients’ quality of life, and sleep disorders represent a major and potentially treatable component of that impairment with implications for several quality of life indices, medication use, and even mortality . A survey of 883 dialysis patients from 20 Italian dialysis centers revealed that 80% endorsed symptoms of sleep disorders including 69.1% with insomnia, 23.6% with sleep apnea syndromes, 18.4% with restless legs, 11.8% with excessive daytime sleepiness, 13.3% with nightmares, 2.3% REM behavior disorder, 2.1% with somnambulation, and 1.4% with possible narcolepsy . A similarly high prevalence was found in a survey in Taiwan in which 66.6% of subjects complained of insomnia; 35% of respondents reported regular use of hypnotic medications . Unruh et al. evaluated subjective and objective measures of sleep quality in patients on thrice weekly hemodialysis compared to carefully matched controls from the Sleep Heart Health Study. Dialysis patients demonstrated shorter sleep, decreased sleep efficiency, more difficulty returning to sleep, and more premature awakening .
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A double-blind, crossover study of Doxazosin and Enalapril on peripheral vascular tone and nocturnal blood pressure in sleep apnea patients
Abstract: Objective: Pulse wave attenuation, which occurs in association with obstructive sleep apnea (OSA), is sympathetically mediated. We compared the effect of Doxazosin (DO, a peripheral α-receptor inhibitor) and Enalapril (EN, an ACE inhibitor) on digital vasoconstriction and nocturnal blood pressure (BP) in hypertensive OSA patients.Methods: A double-blind, crossover study comparing equipotent dosages of DO (4mg/day for 2weeks with 8mg/day for an additional 2weeks) and EN (10mg/day and 20mg/day, respectively) was undertaken in 16 male OSA patients (age 55±7years, body mass index 30.1±3.8kg/m2) with hypertension. Assessments including ambulatory 24-h BP, full-night polysomnography with simultaneous peripheral arterial tone (PAT) and beat-to-beat finger BP monitoring (Finapres) were made at the end of each treatment period. Nighttime BP and digital vasoconstrictions associated with apneic events (measured as the ratio of PAT amplitudes during and after apneas) were analyzed.Results: There were no differences between the two treatments in the 24-h BP profile and OSA severity. But the nighttime average beat-to-beat finger BP was significantly higher under DO treatment (systolic BP 129±13 vs. 119±23mm Hg, P=0.02; diastolic BP 81±12 vs. 74±14mm Hg, P=0.04, DO and EN respectively). In a linear mixed effects regression model, the PAT ratio during apnea increased 5.3% under DO compared with EN (P<0.0001). Each percentage decrease of apneic related oxygen desaturation was associated with 0.9% decrease in the PAT ratio (P<0.0001). REM sleep was associated with 2.2% decrease of PAT ratio compared to NREM sleep (P=0.002).Conclusion: Digital vasoconstrictions associated with apneic events are α-receptor mediated. DO compared to EN has a proportionally poor effect on nocturnal BP control in OSA patients, which may be due to the enhanced sympathetic nervous system activity characteristic of this condition.
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Sleep apnea in Parkinson’s disease: When is it significant?
In this issue of Sleep Medicine, Cochen De Cock et al. present a study on obstructive sleep apnea (SA) in Parkinson’s disease (PD) . The authors are to be congratulated for their study and efforts to shed further light on the very complex issue of sleep disorders in PD. Nevertheless, the catchy title chosen for the manuscript might suggest deductions other than those intended by the authors, who warn of premature conclusions in their discussion.
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Short sleep duration is associated with poor performance on IQ measures in healthy school-age children
Abstract: Objective: To examine the associations between habitual sleep duration and intellectual functioning in healthy, well-rested, school-age children.Methods: The study group consisted of 39 healthy children, aged 7–11years old. Nightly actigraphic sleep recordings were taken for four consecutive nights to determine habitual week-night sleep duration in the home environment. Objective measures of cognitive functioning and sleepiness were used to measure daytime functioning.Results: Longer habitual sleep duration in healthy school-age participants was associated with better performance on measures of perceptual reasoning and overall IQ, as measured by the WISC-IV, and on reported measures of competence and academic performance. No association between sleep duration and the studied behavioral measures was found.Conclusions: These findings support the hypothesis that sleep duration is differentially related to some components of cognitive functioning, even in the absence of evidence for sleep deprivation or attention deficits.
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Using difficulty resuming sleep to define nocturnal awakenings
Abstract: Objective: Nocturnal awakenings are one of the most prevalent sleep disturbances in the general population. Little is known, however, about the frequency of these episodes and how difficulty resuming sleep once awakened affects subjective sleep quality and quantity.Method: This is a cross-sectional telephone study with a representative sample consisting of 8937 non-institutionalized individuals aged 18 or over living in Texas, New York and California. The interviews included questions on sleeping habits, health, sleep and mental disorders. Nocturnal awakenings were evaluated according to their frequency per week and per night, as well as their duration.Results: A total of 35.5% of the sample reported awakening at least three nights per week. Of this 35.5%, 43% (15.2% of the total sample) reported difficulty resuming sleep once awakened. More than 80% of subjects with insomnia symptoms (difficulty initiating or maintaining sleep or non-restorative sleep) also had nocturnal awakenings. Difficulty resuming sleep was associated with subjective shorter sleep duration, poorer sleep quality, greater daytime impairment, greater consultations for sleep disturbances and greater likelihood of receiving a sleep medication.Conclusions: Nocturnal awakenings disrupt the sleep of about one-third of the general population. Using difficulty resuming sleep identifies individuals with significant daytime impairment who are most likely to seek medical help for their sleep disturbances. In the absence of other insomnia symptoms, nocturnal awakenings alone are unlikely to be associated with daytime impairments.
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Altered eyeblink reflex conditioning in restless legs syndrome patients
Abstract: Background: Restless legs syndrome (RLS) is characterized by abnormal leg sensations and an uncontrollable urge to move the lower extremities during rest periods. Evidence suggests that reflex tasks that involve sensory–motor integration may be altered in RLS patients. This led us to determine if RLS patients show alterations in a sensory–motor reflex conditioning task called differential eyeblink conditioning.Methods: RLS subjects were washed out of treatment medication for 7days prior to testing. Subjects (20 RLS and 19 Control) received 120 discrimination conditioning trials consisting of 60 CS+ trials (i.e., an auditory stimulus paired with the airpuff-US separated by a silent 900ms trace interval) and 60 CS− trials (i.e., a different auditory stimulus that was NOT paired with the US).Results: Control subjects showed normal differential responding to the CS+ and CS−, but the RLS patients showed little or no differential responding. A post-test questionnaire provides evidence that symptomatic interference was not responsible for the eyeblink conditioning deficits in the RLS subjects, and further suggests that neurophysiological factors were responsible for these deficits.Conclusions: Together these results suggest that deficits in eyeblink conditioning are related to the pathophysiology of RLS. The eyeblink conditioning test may also be useful for supporting a clinical diagnosis or treatment strategy for RLS.
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Different melatonin rhythms and sleep–wake rhythms in patients on peritoneal dialysis, daytime hemodialysis and nocturnal hemodialysis
Abstract: Background: Little comparative data on sleep–wake rhythms in different dialysis groups exist. The aim of this study was to investigate sleep–wake parameters measured with actigraphy and sleep questionnaires as well as melatonin rhythms in automated peritoneal dialysis, conventional daytime hemodialysis and nocturnal hemodialysis patients.Methods: Conventional daytime dialysis (n=20), nocturnal hemodialysis (n=13) and automated peritoneal dialysis patients (n=6) were included in the study. Melatonin in saliva was sampled at 5 time points (21:00, 23:00, 1:00, 7:00 and 9:00h). Furthermore, actigraphy measurements and sleep questionnaires were performed. All parameters were tested by Kruskall–Wallis test (followed by post hoc Dunn test) to find significant differences (p<0.05).Results: Although most sleep parameters were impaired in all three groups, conventional daytime dialysis patients had the worst sleep. In nocturnal hemodialysis patients a normal nocturnal melatonin rise was found. In daytime hemodialysis and automated peritoneal dialysis patients this rise was absent.Conclusions: The study showed impaired sleep parameters in all dialysis patient groups. As automated peritoneal dialysis is also performed during night time, the same effect on normalized melatonin was anticipated as was found in nocturnal hemodialysis. Melatonin seems to play a subordinate role in the sleep–wake rhythm of automated peritoneal dialysis patients.
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CPAP and quality of life: A still unresolved issue
In their recent study on “Health related quality of life (QoL) in Greek patients with sleep apnea–hypopnea syndrome treated with continuous positive airway pressure,” Tsara and colleagues found an impaired QoL at baseline and a significant improvement following 3months of CPAP therapy in sleep apnea–hypopnea syndrome (SAHS) patients. This is a well acknowledged observation, but replication on a Greek population is welcome and therefore of merit. Several issues, however, may limit the significance of their findings. First, the authors report data from a prospective study of unselected, consecutive SAHS patients who were screened only for respiratory diseases but not for other diseases, co-morbidities (e.g., chronic medical or neuropsychiatric conditions), concomitant medications or even for other sleep disorders , which may seriously affect QoL and therefore influence their results. Second, it would have been more interesting to study outcome in SAHS following a longer treatment period than 3months. In a recent meta-analysis on the impact of CPAP treatment on general QoL it is suggested that long-term trials are able to provide more solid evidence on this issue and that such studies are important because of their ability to capture important information regarding persistence of benefits from CPAP. Thus, studies with longer follow-ups are crucial given the debatable advantage of CPAP over conservative treatment . Third, data on the outcome of the GHQ-30 in the 3-month follow-up of the patients who underwent conservative therapy are not explicitly presented, which does not allow for clear comparisons between the two types of treatment. Finally, due to the large difference in sample size between the two treatment subgroups on the 3-month follow-up (140 patients on CPAP vs. 15 patients on conservative therapy), a power calculation of the statistical comparisons should be provided.
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Is obstructive sleep apnea a problem in Parkinson’s disease?
Abstract: Background: Parkinson’s disease (PD) is associated with sleep disorders and daytime sleepiness. Upper airway dysfunction in PD may promote obstructive sleep apnea. However, the frequency and clinical relevance of sleep-disordered breathing in PD remains unclear.Methods: Sleep apnea symptoms, cardiovascular events and treatment were collected in 100 patients with PD (50 unselected, consecutive patients matched for age, sex and body mass index with 50 patients referred for sleepiness) and 50 in-hospital controls. The motor and cognitive status was evaluated in patients with PD. The 150 subjects underwent a video-polysomnography.Results: Sleep apnea (defined as an apnea–hypopnea index greater than 5) was less frequent in the PD group (27% patients, including 6% with mild, 11% with moderate and 10% with severe sleep apnea) than in the control group (40% in-hospital controls, p<0.002). Sleep apnea was not associated with increased sleepiness, nocturia, depression, cognitive impairment and cardiovascular events in patients with PD. Sleep apnea was more frequent and severe in the most disabled patients. Patients with PD did not display sleep hypoventilation, stridor and abnormal central sleep apnea. In patients with REM sleep behavior disorders, snoring and obstructive sleep apnea occurred during REM sleep, although the chin muscle tone was maintained.Conclusion: Obstructive sleep apnea does not seem to be a clinically relevant issue in PD. Daytime sleepiness, nocturia and cognitive impairment are mostly caused by other, non-apneic mechanisms. The maintenance of chin muscle tone during REM sleep behavior disorder has no influence on the frequency of apneic events.
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Editorial Board
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Automatic slow eye movement (SEM) detection of sleep onset in patients with obstructive sleep apnea syndrome (OSAS): Comparison between multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT)
Abstract: Objective: To determine whether automatic slow eye movement (SEM) analysis performs comparably to standard sleep onset criteria at the multiple sleep latency test (MSLT) and at the maintenance of wakefulness test (MWT) in patients with obstructive sleep apnea syndrome (OSAS).Methods: We compared sleep latencies obtained upon standard analysis of MSLT and MWT recordings with automatically detected SEM latencies in a population of 20 severe OSAS patients that randomly underwent the two tests 1week apart.Results: Eight of 20 OSAS patients had EDS as answered by the Epworth Sleepiness Scale (ESS). Mean SEM latency performed comparably to standard sleep onset in both the MSLT (6.4±5.5min versus 7.4±5.1min, p=0.25) and the MWT (25.2±14.5min versus 24.4±14.0min, p=0.45) settings. Mean SEM latency significantly correlated with the sleep latency at the MSLT (r=0.52, p<0.05) and at the MWT (r=0.74, p<0.001). Finally, the Epworth Sleepiness Scale score correlated with SEM latency at the MWT (r=−0.62, p<0.01), but not at the MSLT.Conclusions: Automatic SEM detection performed comparably to standard polysomnographic assessment of sleep onset, thus providing a simplified technical requirement for the MSLT and the MWT. Further studies are warranted to evaluate SEM detection of sleep onset in other sleep disorders with excessive daytime sleepiness.
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Sleep and body mass index in depressed children and healthy controls
Abstract: Objective: Higher body mass index (BMI) has been associated with more sleep disturbance and depressive symptoms, but the combined effects of depression and BMI on sleep have not been studied in children. This study evaluated the relationship between BMI and polysomnography in children with major depressive disorder (MDD), compared to healthy controls (HCs).Method: The sample of 104 subjects included 72 children, 8–17years old, with MDD and 32 similarly aged HCs with no personal or family history of psychopathology. BMI was adjusted using the CDC formula for percentiles by age. Subjects were categorized as (1) normal weight (5–84th percentile) or (2) high weight, which included at risk of overweight and overweight (⩾85th percentile). All analyses were adjusted for sex and Tanner maturational stage scores.Results: In the MDD group only, higher BMI was significantly correlated with decreased sleep efficiency, decreased percentage of rapid eye movement sleep (REM%), and higher percentage of time spent awake and moving (TSPAM). In the HC group only, higher BMI correlated with higher total sleep time. Multivariate analyses revealed significant interactions between the BMI and diagnostic groups for several REM sleep parameters, such that high-weight children from the HC and MDD groups had increases and decreases in REM sleep, respectively. TSPAM increased in the high-weight MDD group, but decreased in the high-weight HC group.Conclusions: Although limited by small sample size, these findings suggest that children and adolescents with MDD and a high BMI have more fragmented sleep than other children. The increased REM sleep patterns observed with MDD in this and other studies normalized in high-weight children with MDD. Prevention and treatment strategies should target both sleep and weight as factors that can potentially influence the development and course of MDD.
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Serum nitrite and nitrate levels in children with obstructive sleep-disordered breathing
Abstract: Background: Diminished nitric oxide (NO) levels have been reported in adults with obstructive sleep apnea but no data are available for children with obstructive sleep-disordered breathing (SDB).Objectives: To assess levels of serum NO metabolites in children with SDB and to explore the effects of NO metabolites, SDB and their interaction on blood pressure.Methods: Morning nitrite, the sum of nitrite and nitrate (NOx), and the average of evening and morning blood pressure were assessed in children with SDB referred for polysomnography and in controls without SDB.Results: Forty-three children with SDB (age: 5.8±2.1years) had moderate-to-severe nocturnal hypoxemia (SpO2 nadir: 85.6±4%), 54 subjects (6.6±2.7years) had mild hypoxemia (SpO2 nadir: 91.4±1.3%) and 20 subjects were controls free of SDB (6.7±3.7years). Subjects with moderate-to-severe hypoxemia had significantly lower ln-transformed NO metabolites (1.4±0.7, nitrites; 2.6±0.5, NOx) compared to those with mild hypoxemia (1.9±0.8, nitrites; 3±0.6, NOx) and controls (2.2±0.7, nitrite; 3±0.6, NOx; p<0.05). The effects of NO metabolites and SDB or their interaction on blood pressure were not significant (p>0.05).Conclusions: Moderate-to-severe hypoxemia accompanying SDB is associated with reduced concentrations of morning serum NO metabolites, but NO levels do not seem to affect blood pressure.
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Pregnancy accounts for most of the gender difference in prevalence of familial RLS
Abstract: Objective: This study was designed to evaluate the associated risk of RLS with pregnancy in relation to the family history and the age of symptom onset of RLS.Methods and subjects: Data from a prior RLS family history study in which 1019 subjects (527 males, 492 females) were interviewed, provided a diagnosis and characterization of RLS and determination of pregnancy status on which the current study analysis was undertaken.Results: In the family members of RLS probands, the prevalence of RLS was significantly higher for parous women than for nulliparous women (49.5% vs. 33.7%, OR=1.92, 95% CI=1.16–3.19) or for men (49.5% vs. 30.0%, OR 2.29, 1.69–3.10), but no different for nulliparous women compared to men (33.7% vs. 30.0%, OR 1.19, 0.72–1.96). When only those whose RLS started at or after age 30 were considered, similar differences occurred. These differences were not observed among family members of control probands.Conclusions: These data indicate pregnancy has a major impact on the risk of developing RLS for those with a family history of RLS. This pregnancy effect appears to account for most of the gender differences often reported in overall RLS prevalence data.
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Sleep-disordered breathing symptoms frequency and growth among prematurely born infants
Abstract: Background: Children who were born prematurely are at higher risk for sleep-disordered breathing (SDB) compared to their same-age peers who were born fullterm.Objective: The objective of the present study was to assess the frequency of SDB symptoms and effects on growth among preterm infants while they are still infants, with a goal of identifying risk factors to facilitate prevention and early intervention.Methods: The Louisville pediatric SDB risk survey was administered to the primary caretakers of prematurely born infants attending the Neonatal Follow-Up Clinic at West Virginia University Children’s Hospital.Results: Participation was 100% among 173 consecutive patients invited to participate in the study. At 9.13months corrected age, 8.1% of infants born at a mean of 31.6weeks gestation were reported to snore ⩾3days/week, a rate consistent with diagnosis of sleep-disordered breathing among older children. A composite of nine parent-reported symptoms was created based on factor analysis. Birth weight and size for gestational age at birth did not differ between snoring groups or correlate with the composite score. But a significant negative correlation between the composite risk for SDB score and current weight for adjusted age percentile score indicate that infants with higher SDB symptom profiles have lower weight for age (r=−.18, p=.028).Conclusions: SDB symptoms are detectable among infants born preterm, while they are still infants. Because of their preferential risk for SDB and its somatic consequences, a primary research goal should be description of the natural history of SDB and identification of modifiable risk factors and treatment options.
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Initial use of portable monitoring versus polysomnography to confirm obstructive sleep apnea in symptomatic patients: An economic decision model
Abstract: Background: When using portable (level III and level IV) studies to “rule in” obstructive sleep apnea (OSA) in symptomatic patients, the pre-test probability (P) needs to be sufficiently high to minimize patients with negative tests who require full polysomnography.Methods: We used a theoretical decision analysis model to assess the pre-test probability above which it would be appropriate to use portable studies to rule in disease in symptomatic patients with suspected OSA. For the base case, we considered a symptomatically sleepy patient referred with a probability of OSA of P. We determined the lower threshold of P appropriate for a clinical algorithm based upon an initial ambulatory study compared to initial diagnosis with PSG by comparing costs using the PSG algorithm with a diagnostic algorithm involving initial assessment with a portable study.Results: In our base case, the pre-test probability above which portable testing would be less costly than initial diagnostic PSG would be 0.47. When an initial split night study was compared to portable testing, the pre-test probability above which portable testing was more economically attractive was greater (0.68). Values of P, however, varied considerably depending on values of many variables, including costs of diagnostic testing and CPAP compliance.Conclusions: Using a decision model, we have developed a theoretical framework to ascertain the pre-test disease probability above which portable studies would be economically attractive as an initial test in the assessment of patients with suspected OSA.
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Smoking and sleep disorders in Chinese adolescents
Abstract: Objective: To investigate the association between adolescent smoking and sleep disorders.Methods: In the Hong Kong student obesity surveillance project, 29,397 Chinese students, aged 12–18years, completed a health survey. Insomnia was defined as having any of the following three symptoms: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The presence of snoring and difficulty breathing during sleep (DBS) was also reported. Logistic regression yielded adjusted odds ratios (ORs) for each sleep disorder by smoking status.Results: Compared with never smokers, the ORs (95% CI) of insomnia were 1.39 (1.25–1.54) for experimenters (smoked once or a few times) and 0.91 (0.83–1.00) for current smokers. The corresponding ORs were 1.42 (1.16–1.74) and 3.58 (3.15–4.06) for snoring (P for trend<0.001) and 1.40 (1.10–1.79) and 3.39 (2.97–4.03) for DBS (P for trend<0.001). Current smokers compared with never smokers were less likely to report DIS (OR=0.43, 95% CI=0.38–0.50, P<0.001) and EMA (OR=0.83, 95% CI=0.73–0.94, P=0.003), but more likely to report DMS (OR=1.45, 95% CI=1.28–1.63, P<0.001).Conclusions: In terms of dosage, adolescent smoking was associated with snoring and DBS, with increasing ORs from never smokers to experimental and current smokers. Current smoking was associated positively with DMS, but negatively with DIS and EMA.
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Yawning, sleep, and symptom relief in patients with multiple sclerosis
Abstract: Background: Patients with multiple sclerosis (MS) suffer from thermoregulatory dysfunction, and repetitive yawning and sleep problems are symptoms of MS. Because yawning and sleep are involved in thermoregulation, we investigated the association between yawning, sleep, and symptom relief in patients with MS.Methods: Sixty patients filled out a questionnaire about how often they yawned, whether yawning provided relief of MS symptoms, and how sleep affected these symptoms.Results: Results showed that over one in three patients reported that their MS symptoms improved following a yawn, and of those experiencing relief, nearly half reported that it lasted for several minutes or longer. Not getting a good night’s sleep often made MS symptoms worse, while napping during the day provided symptom relief.Conclusion: This is the first study showing that yawning provides symptom relief in patients with multiple sclerosis.
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Cross-cultural differences in infant and toddler sleep
Abstract: Background: To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries.Methods: Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.Results: Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p<.001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p<.0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China).Conclusions: Overall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences.
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Response to “CPAP and quality of life: A still unresolved issue”
We thank Economou and Paparrigopoulos for their letter regarding our paper on health related quality of life in Greek patients with sleep apnea–hypopnea syndrome and CPAP therapy. We appreciate their comments and our response to them is as follows:
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Association between sleep patterns and daytime functioning in children with insomnia: The contribution of parent-reported frequency of night waking and wake time after sleep onset
Abstract: Objective: The aim of this study was to investigate the association between sleep patterns and daytime functioning in children with insomnia. Furthermore, the role of frequency of night waking and wake time after sleep onset for daytime functioning was analyzed in the context of total sleep time and sleep onset latency.Methods: Families with children with parent-perceived sleep problems were recruited for diagnostic clarification and subsequent treatment (if indicated) at an outpatient clinic. Out of 49 families seeking help, 34 children (age 5.2–10.9years, mean 7.1years) and their parents were included in the present study. Sleep and sleep problems were assessed by a structured clinical interview according to the diagnostic criteria of the International Classification of Sleep Disorders (ICSD-II). Parents kept a sleep diary over two weeks. In addition, they answered the Child Behavior Checklist, questions concerning the daytime sleepiness of their children, as well as a structured clinical interview assessing comorbid mental disorders.Results: Reduced parent-reported total sleep time predicted more delinquent behavior and more concentration problems. Independent of total sleep time and frequency of night waking, longer parent-reported wake time after sleep onset was associated with greater daytime sleepiness, which in turn predicted more social problems.Conclusions: Besides total sleep time, wake time after sleep onset could be another important determinant for specific aspects of daytime functioning in children with insomnia.
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Response to “Fundamentals of quality of life and daytime sleepiness measurements in older sleep apnea patients”
Firstly, the author thanks Drs. Fanie Onen and S. Hakki Onen for their cordiality and interest in sending this letter, since they seem as interested as we are in a topic as important and not fully understood as sleep apnea in the elderly.
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