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Reynolds CF. Reflections on a journey as sleep researcher and geriatric psychiatrist. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad032. [PMID: 37954091 PMCID: PMC10636810 DOI: 10.1093/sleepadvances/zpad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/01/2023] [Indexed: 11/14/2023]
Abstract
After first recalling the origins of my interest in sleep and dreams at UVa (1969) and my MD thesis at Yale on sleep in mood disorders (1973), I will describe my service to the field of sleep disorders medicine, through various roles in the American Sleep Disorders Association, the Institute of Medicine, the National Institute of Mental Health, and the DSM-5 Task Force of the American Psychiatric Association. I will then present the broad themes of my contributions to psychiatric sleep research, focusing on the neurobiology of sleep as a dimension of the risk and protective architecture for depression in older adults, as a bridge to diagnostic and treatment issues in later-life depression, and to clinical and translational neuroscience addressing the intersections of sleep, aging, and mind/brain health. Throughout this narrative, I highlight many relationships with mentors and mentees. All of my scientific activity has been team-based, providing the social matrix for the physician-scientist I have become. This paper is part of the Living Legends in Sleep Research series, which is sponsored by Idorsia Pharmaceuticals and Jazz Pharmaceuticals.
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Affiliation(s)
- Charles F Reynolds
- Distinguished Professor of Psychiatry and UPMC Endowed Professor in Geriatric Psychiatry, Emeritus, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Di Bello F, Scandurra C, Muzii B, Colla’ Ruvolo C, Califano G, Mocini E, Creta M, Napolitano L, Morra S, Fraia A, Bochicchio V, Salzano G, Vaira LA, Mangiapia F, Motta G, Motta G, Maldonato NM, Longo N, Cantone E. Are Excessive Daytime Sleepiness and Lower Urinary Tract Symptoms the Triggering Link for Mental Imbalance? An Exploratory Post Hoc Analysis. J Clin Med 2023; 12:6965. [PMID: 38002580 PMCID: PMC10672561 DOI: 10.3390/jcm12226965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Both lower urinary tract symptoms (LUTS) and excessive daytime sleepiness (EDS) could negatively impair the patients' quality of life, increasing the sensitivity to psychological distress that results in mental health disorders. The relationships of both urinary and respiratory domains with psychological distress in obstructive sleep apnea patients is still underestimated. METHODS This study was a post hoc analysis of a web-based Italian survey, which included 1998 participants. Three hierarchical multiple linear regression analyses with psychological distress as dependent variable were performed on the study of 1988 participants enrolled in the final analysis. Cohen's f2 was used for the assessment of the effect size. RESULTS From the hierarchical multiple linear regression analyses, it emerged that the final statistical model (including sociodemographic characteristics, comorbidities, perceived urinary function, and excessive daytime sleepiness) for all dimensions accounted for 16.7% of the variance in psychological distress, with a medium effect size (f2 = 0.15). CONCLUSIONS People reported psychological distress was impaired by the presence of LUTS and EDS. Specifically, our study showed that higher levels of distress were scored especially in young women exhibiting urinary symptoms and with high values of daytime sleepiness.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Cristiano Scandurra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Benedetta Muzii
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Claudia Colla’ Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy;
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, 87036 Rende, Italy;
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, 80131 Naples, Italy;
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Gaetano Motta
- ENT Unit, Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (G.M.)
| | - Giovanni Motta
- ENT Unit, Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (G.M.)
| | - Nelson Mauro Maldonato
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
| | - Elena Cantone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.B.); (C.S.); (C.C.R.); (G.C.); (M.C.); (L.N.); (S.M.); (A.F.); (F.M.); (N.M.M.); (N.L.); (E.C.)
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Zick SM, Kruger G, Harte S, Sen A, Harris RE, Pearce CL. Acupressure for Cancer-fatigue in Ovarian Cancer Survivor (AcuOva) Study: A community-based clinical trial study protocol examining the impact of self-acupressure on persistent cancer-related fatigue in ovarian cancer survivors. Contemp Clin Trials 2021; 107:106477. [PMID: 34119716 DOI: 10.1016/j.cct.2021.106477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Background Persistent cancer-related fatigue is one of the most common and burdensome symptoms experienced by ovarian cancer survivors. Despite the high burden of fatigue in ovarian cancer survivors, there are few available treatments. Previous research has shown self-acupressure to be a safe method for improving persistent fatigue, sleep, and quality of life among fatigued breast cancer survivors, yet there are no studies examining self-acupressure for fatigue in ovarian cancer survivors. Methods A three group parallel, randomized controlled trial will be conducted to evaluate the efficacy of self-acupressure taught and delivered via a patient-designed, custom-built mobile app ("MeTime") and accompanying hand-held device ("AcuWand") to help guide correct pressure application. A sample of 165 ovarian cancer survivors, who have completed primary cancer treatment will be recruited from tumor registries in Michigan and Los Angeles. Participants will be mailed a tablet preloaded with the app and a device, and all visits will be conducted remotely. Participants will be randomized to 6-weeks of daily self-acupressure via the app and device, or a sham app and device, or no care group. Self-report measures will be completed at baseline, 6-weeks (post-intervention), 3-, and 6-months. Primary outcome is the Brief Fatigue Inventory; secondary outcomes are sleep, quality of life, and symptoms commonly associated with persistent fatigue. Discussion An app based self-acupressure treatment may be an easily-accessible and inexpensive treatment to reduce fatigue in ovarian cancer survivors. The results of the study will provide information on the possible benefits of app-based self-acupressure for fatigue in ovarian cancer survivors. Trial registration: This study is registered at ClinicalTrials.gov Identifier: NCT03763838, date registered on December 4, 2018.
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Affiliation(s)
- Suzanna Maria Zick
- Department of Family Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA; Department of Nutritional Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Grant Kruger
- Department of Mechanical Engineering, University of Michigan, 1043 H H Dow Bldg, Ann Arbor, MI 48109-2136, USA; Department of Anesthesiology, University of Michigan, 1043 H H Dow Bldg, Ann Arbor, MI 48109-2136, USA.
| | - Steven Harte
- Department of Anesthesiology, University of Michigan, Domino's Farms/Lobby M, Ann Arbor, MI 48106, USA; Department of Rheumatology, University of Michigan, Domino's Farms/Lobby M, Ann Arbor, MI 48106, USA.
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA; Department of Biostatistics, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA.
| | - Richard Edmund Harris
- Department of Anesthesiology, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA.
| | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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Poon SH, Quek SY, Lee TS. Insomnia Disorders: Nosology and Classification Past, Present, and Future. J Neuropsychiatry Clin Neurosci 2021; 33:194-200. [PMID: 33985347 DOI: 10.1176/appi.neuropsych.20080206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Insomnia is the most common sleep disorder in the adult population. However, the definition of insomnia disorder has varied across major classification systems and changed over time. In the present study, the investigators traced the evolution of insomnia disorder across classification systems, contemplated the empirical basis for its current definitions, and surveyed ongoing research efforts that may clarify insomnia nosology in the future. Three major classification systems for insomnia are the International Classification of Sleep Disorders, the International Classification of Diseases, and DSM. Despite their divergent origins, these classification systems have converged to nearly identical contemporary insomnia definitions. Over time, the emphasis in classification approaches has shifted from symptomatology to etiology to treatment implications. Additionally, the historical multitude of insomnia subtypes has gradually consolidated into a few core diagnoses, reflecting inadequate evidence with which to support subtyping. Current insomnia definitions include frequency and duration criteria to operationalize these diagnoses, while the diagnostic criterion of nonrestorative sleep has been eliminated (with some controversy). In ongoing research efforts, the quest for insomnia biomarkers has not thus far yielded clinically deployable breakthroughs. Data-driven insomnia subtyping suggests a promising new approach in deriving empirically based subtypes; conversely, the transdiagnostic perspective proposes the elimination of categorical distinctions in favor of finding common processes underlying all psychiatric disorders. The continual evolution of insomnia nosology highlights that much remains to be learned about these conditions; all current diagnostic classification systems are best regarded as "works in progress." Nevertheless, refinement and convergence of classification approaches is essential to standardizing insomnia research, diagnosis, and treatment.
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Affiliation(s)
- Shi-Hui Poon
- Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek)
| | - Shin-Yi Quek
- Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek)
| | - Tih-Shih Lee
- Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek)
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Mehta R, Giri S, Mallick BN. REM sleep loss-induced elevated noradrenaline could predispose an individual to psychosomatic disorders: a review focused on proposal for prediction, prevention, and personalized treatment. EPMA J 2020; 11:529-549. [PMID: 33240449 DOI: 10.1007/s13167-020-00222-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
Historically and traditionally, it is known that sleep helps in maintaining healthy living. Its duration varies not only among individuals but also in the same individual depending on circumstances, suggesting it is a dynamic and personalized physiological process. It has been divided into rapid eye movement sleep (REMS) and non-REMS (NREMS). The former is unique that adult humans spend the least time in this stage, when although one is physically asleep, the brain behaves as if awake, the dream state. As NREMS is a pre-requisite for appearance of REMS, the latter can be considered a predictive readout of sleep quality and health. It plays a protective role against oxidative, stressful, and psychopathological insults. Several modern lifestyle activities compromise quality and quantity of sleep (including REMS) affecting fundamental physiological and psychopathosomatic processes in a personalized manner. REMS loss-induced elevated brain noradrenaline (NA) causes many associated symptoms, which are ameliorated by preventing NA action. Therefore, we propose that awareness about personalized sleep hygiene (including REMS) and maintaining optimum brain NA level should be of paramount significance for leading physical and mental well-being as well as healthy living. As sleep is a dynamic, multifactorial, homeostatically regulated process, for healthy living, we recommend addressing and treating sleep dysfunctions in a personalized manner by the health professionals, caregivers, family, and other supporting members in the society. We also recommend that maintaining sleep profile, optimum level of NA, and/or prevention of elevation of NA or its action in the brain must be seriously considered for ameliorating lifestyle and REMS disturbance-associated dysfunctions.
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Affiliation(s)
- Rachna Mehta
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110 067 India.,Present Address: Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, India
| | - Shatrunjai Giri
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110 067 India
| | - Birendra N Mallick
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110 067 India
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The association between antidepressants use and development of cognitive impairment among older women diagnosed with breast cancer. Eur Geriatr Med 2020; 11:1017-1026. [PMID: 32572725 DOI: 10.1007/s41999-020-00349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to evaluate the association between the development of cognitive impairment and the use of antidepressants among older women with breast cancer. METHODS This retrospective cohort study used the United States National Cancer Institute's Surveillance, Epidemiology, and End Results-Medicare database to identify women who were 67 years old and older and had breast cancer between 2008 and 2013. Propensity scoring was used to account for confounding pre-treatment factors, and Cox proportional hazards modeling was used to examine the risk of developing cognitive impairment among patients based on whether they used antidepressants. RESULTS A total of 3174 women taking antidepressants (mean age 75.2 ± 6.4) were matched with 3174 women not taking antidepressants (mean age 75.4 ± 6.7). Antidepressant use was associated with a significantly increased risk of cognitive impairment (hazard ratio [HR]: 1.33, 95%; confidence interval [CI]: 1.18-1.48). Additionally, we found that older women without a history of depression or anxiety who use antidepressants have a higher risk of developing cognitive impairment than those who did not use antidepressants (HR: 1.53, 95%; CI: 1.34-1.75 and HR: 1.39, 95%; CI: 1.23-1.56, respectively). Subgroup analysis showed that the use of non-tricyclic antidepressants (TCAs) was associated with a higher risk of cognitive impairment. CONCLUSION We found that non-TCA antidepressant use in older women with breast cancer was associated with a higher risk of cognitive impairment. This association was also observed among older women without depression or anxiety who used antidepressants.
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Cvejic E, Huang S, Vollmer-Conna U. Can you snooze your way to an 'A'? Exploring the complex relationship between sleep, autonomic activity, wellbeing and performance in medical students. Aust N Z J Psychiatry 2018. [PMID: 28649873 DOI: 10.1177/0004867417716543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Medical training brings with it multiple stressors, including demanding workloads in highly competitive environments, with well-documented impact on psychiatric morbidity. This study evaluated the impact of sleep-related factors on psychological wellbeing, cognitive task performance and academic standing in medical students. METHODS A total of 59 undergraduate medical students took part in this cross-sectional study over two consecutive days. Participants responded to questionnaires about their physical and psychological health, sleep, functioning and academic performance at the initial visit. Participants then wore an ambulatory bioharness overnight (to derive heart rate variability measures), before returning to complete a computerised battery of cognitive tasks. A sleep diary was completed for the next 7 days. RESULTS Poor sleep quality in the month preceding assessment correlated with psychological distress ( p < 0.001) and reduced nocturnal heart rate variability ( p = 0.007). Psychological distress also correlated with reduced nocturnal heart rate variability ( p = 0.031) and less refreshing sleep during the monitoring week ( p < 0.001), but not with sleep timing parameters. A greater increase in heart rate variability during the transition from awake to sleep significantly predicted better spontaneous cognitive performance ( p = 0.021). Better academic standing was predicted by consistently short, less refreshing sleep (all p < 0.001), along with earlier bedtimes ( p = 0.004) and greater psychological wellbeing ( p = 0.009). CONCLUSION Unrefreshing, short-duration sleep and psychological distress are prevalent in medical students during university training and were associated with reduced nocturnal parasympathetic autonomic activity. Achieving higher academic grades was associated with high psychological wellbeing despite consistently short, unrefreshing sleep. The long-term repercussions of such sleep behaviours on later professional functioning remain unclear, warranting further research.
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Affiliation(s)
- Erin Cvejic
- 1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,2 University of Sydney, School of Public Health. Sydney, NSW, Australia
| | - Shiny Huang
- 1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Uté Vollmer-Conna
- 1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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Plante DT, Finn LA, Hagen EW, Mignot E, Peppard PE. Longitudinal associations of hypersomnolence and depression in the Wisconsin Sleep Cohort Study. J Affect Disord 2017; 207:197-202. [PMID: 27723544 PMCID: PMC5107142 DOI: 10.1016/j.jad.2016.08.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/03/2016] [Accepted: 08/27/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hypersomnolence is common in depression, however longitudinal associations of excessive daytime sleepiness (EDS), long habitual sleep duration, and objective sleep propensity with depressive symptomatology are not well established. METHODS Data from adults participating in the Wisconsin Sleep Cohort Study who had multiple assessments at 4-year intervals were utilized in analyses. Conditional (intrasubject) logistic regression estimated the likelihood of development of depression and three primary hypersomnolence measures: subjective EDS [Epworth Sleepiness Scale (ESS) >10], habitual sleep duration ≥9h/day, and increased physiological sleep propensity [multiple sleep latency test (MSLT) mean sleep latency <8min]. RESULTS After adjusting for all covariates, the odds for development of depression were significantly increased 1.67-fold (95% CI 1.02-2.73, p=0.04) in participants who also developed subjective EDS. However, development of increased physiological sleep propensity on the MSLT was associated with a trend towards reduced odds for development of depression (odds ratio 0.50, 95% CI 0.24-1.06, p=0.07). No significant longitudinal association between excessive sleep duration and depression was observed. LIMITATIONS Depression was not verified by psychiatric interview and an objective measure of sleep duration was not utilized. CONCLUSIONS Our results demonstrate a significant longitudinal association between increased subjective EDS and depression. However, increased physiological sleep propensity on the MSLT was paradoxically marginally protective against the development of depression. Further research is indicated to determine the mechanism underling divergent effects of various aspects of hypersomnolence on the course of mood disorders.
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Affiliation(s)
- David T. Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Laurel A. Finn
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Erika W. Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Paul E. Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
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Plante DT, Finn LA, Hagen EW, Mignot E, Peppard PE. Subjective and Objective Measures of Hypersomnolence Demonstrate Divergent Associations with Depression among Participants in the Wisconsin Sleep Cohort Study. J Clin Sleep Med 2016; 12:571-8. [PMID: 26888592 PMCID: PMC4795285 DOI: 10.5664/jcsm.5694] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/25/2015] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES To examine associations of depression with habitual sleep duration, daytime sleepiness, and objective sleep propensity in a nonclinical population. METHODS Data from adults participating in the Wisconsin Sleep Cohort Study were utilized in analyses. There were 1,287 adults (3,324 observations) who were used in the analysis of subjective hypersomnolence measures; 1,155 adults (2,981 observations) were used in the analysis of objective sleep propensity assessed by the multiple sleep latency test (MSLT). Repeated-measures logistic regression estimated associations between presence of depression (defined as modified Zung Self-Rating Depression Scale ≥ 50 or use of antidepressant medications) and three primary hypersomnolence measures: subjective excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11), self-reported sleep duration ≥ 9 h/d, and objective sleep propensity (MSLT mean sleep latency < 8 min). RESULTS After adjusting for age, sex, body mass index, chronic medical conditions, sedative hypnotic medication use, caffeine, tobacco, and alcohol use, sleep disordered breathing, as well as insomnia and sleep duration when appropriate, estimated odd ratios (95% confidence interval) for depression were: 1.56 (1.31,1.86) for ESS ≥ 11; 2.01 (1.49, 2.72) for habitual sleep time ≥ 9 h; and 0.76 (0.63-0.92) for MSLT mean sleep latency < 8 min. CONCLUSIONS Our results demonstrate divergent associations between subjective and objective symptoms of hypersomnolence and depression, with subjective sleepiness and excessive sleep duration associated with increased odds of depression, but objective sleep propensity as measured by the MSLT associated with decreased odds of depression. Further research is indicated to explain this paradox and the impact of different hypersomnolence measures on the course of mood disorders. COMMENTARY A commentary on this article appears in this issue on page 467.
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Affiliation(s)
- David T. Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Laurel A. Finn
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI
| | - Erika W. Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI
| | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Paul E. Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI
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Plante DT. Sleep propensity in psychiatric hypersomnolence: A systematic review and meta-analysis of multiple sleep latency test findings. Sleep Med Rev 2016; 31:48-57. [PMID: 26883161 DOI: 10.1016/j.smrv.2016.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/08/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022]
Abstract
Hypersomnolence plays a sizeable role in the course and morbidity of psychiatric disorders. Current sleep medicine nosology is reliant on the multiple sleep latency test (MSLT) to segregate hypersomnolence associated with psychiatric disorders from other central nervous system causes. However, the evidence base regarding sleep propensity in psychiatric hypersomnolence as measured by the MSLT has not been systematically evaluated, which is vital to clarify the utility and validity of current nosological schema. In this review, the use of sleep propensity assessed by the MSLT in patients with psychiatric hypersomnolence is systematically evaluated, using both qualitative and quantitative assessment. Findings demonstrate high heterogeneity and potential for bias among studies, with a pooled estimate of sleep propensity among patients with psychiatric hypersomnolence similar to normative values. Additionally, approximately 25% of patients with psychiatric hypersomnolence demonstrate a mean sleep latency below 8 min, the current cutpoint to define pathologic sleepiness. These data underscore the limitations of the MSLT in segregating psychiatric hypersomnolence from other central nervous system hypersomnias. Further research is warranted to evaluate novel measures and biomarkers of excessive sleepiness to advance clinical practice, as well as dimensional approaches to classification of hypersomnolence disorders.
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Affiliation(s)
- David T Plante
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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11
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Tramonti F, Maestri M, Gronchi A, Fabbrini M, Di Coscio E, Carnicelli L, Bonanni E. Psychological well-being of patients with insomnia and its relationship with anxiety and depression. PSYCHOL HEALTH MED 2015. [PMID: 26222934 DOI: 10.1080/13548506.2015.1069856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aims of the present study are to evaluate the impact of insomnia on psychological well-being and to examine the associations of insomnia and psychological well-being with anxiety and depression. Forty-one patients attending our hospital-based Centre for sleep medicine were administered scales for the evaluation of insomnia (ISI), anxiety (STAI-Y), depression (BDI-II) and psychological well-being (PWB). The scores were compared to those of a control group of 68 subjects attending the hospital for routine examinations or as accompanying persons. Significant differences between patients and controls were detected for anxiety and depression, as well as for psychological well-being. Even if subclinical on average, anxiety and depression symptoms were significantly related to poor psychological well-being, whereas insomnia per se was not. These findings suggest that patients with insomnia report a relevant impact on their psychological well-being, and that such an impact seems to be strongly associated with concomitant subthreshold symptoms of anxiety and depression. The implications for diagnosis and treatment are discussed.
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Affiliation(s)
- Francesco Tramonti
- a Clinical Psychology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Michelangelo Maestri
- b Centre for Sleep Medicine - Neurology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | | | - Monica Fabbrini
- b Centre for Sleep Medicine - Neurology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Elisa Di Coscio
- b Centre for Sleep Medicine - Neurology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Luca Carnicelli
- b Centre for Sleep Medicine - Neurology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Enrica Bonanni
- b Centre for Sleep Medicine - Neurology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
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12
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Hysing M. Review: recommendations for the assessment and management of sleep disorders in ADHD. EVIDENCE-BASED MENTAL HEALTH 2013; 17:22. [PMID: 24282180 DOI: 10.1136/eb-2013-101560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health, , Bergen, Norway;
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13
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Feige B, Baglioni C, Spiegelhalder K, Hirscher V, Nissen C, Riemann D. The microstructure of sleep in primary insomnia: An overview and extension. Int J Psychophysiol 2013; 89:171-80. [DOI: 10.1016/j.ijpsycho.2013.04.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 04/02/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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14
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Halter MJ, Rolin-Kenny D, Dzurec LC. An Overview of the
DSM-5
: Changes, Controversy, and Implications for Psychiatric Nursing. J Psychosoc Nurs Ment Health Serv 2013; 51:30-9. [DOI: 10.3928/02793695-20130226-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/07/2013] [Indexed: 11/20/2022]
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15
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