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Wang C, Wang X, Wang J, Li X, Lu D, Guo F, Yao Y, Zhu J, Shen C, Xie Q, Mao H, Zhang P, Yang X, Wu H, Lv Q, Yi Z. Prevalence and clinical correlates of benzodiazepine use in the patients with major depressive disorder. J Affect Disord 2024; 363:619-625. [PMID: 39043307 DOI: 10.1016/j.jad.2024.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is a serious and disabling condition characterized by abnormal mood changes. Clinical guidelines for depression treatment recommend antidepressant medications, with benzodiazepines acting as short-term synergists. However, little is currently known about the prevalence and associated clinical risk factors of benzodiazepine use among Chinese patients with MDD. This study aimed to explore the prevalence and clinical risk factors associated with benzodiazepine use in this population. METHODS A total of 2742 patients with MDD (males/females = 816/1926, aged 14-60 years) participated in this cross-sectional observational study. General information and psychosis assessments were collected online. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7), and sleep problems and suicidal tendencies using the third and ninth items of the PHQ-9. Multivariable logistic regression analysis models were employed to identify factors associated with benzodiazepine use. RESULTS The prevalence of benzodiazepine use among patients with MDD was 42.9 %. Among these patients, 99.6 % used a single benzodiazepine, with oxazepam being the most frequently prescribed. Age, severity of sleep problems, depressive symptoms, and anxiety symptoms were significantly correlated with benzodiazepine use (all P < 0.001). LIMITATIONS The cross-sectional design of this study precludes establishing causal relationships. CONCLUSION Our findings indicate a high prevalence of benzodiazepine use among Chinese patients with MDD. Factors such as severe depressive symptoms, anxiety symptoms, age, and sleep problems appear to be associated with benzodiazepine use. These results underscore the importance of vigilance regarding benzodiazepine use in patients with MDD.
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Affiliation(s)
- Chongze Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaoxiao Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Jinde Wang
- Shanghai Fengxian District Mental Health Center, Shanghai 201418, China
| | - Xin Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Daofeng Lu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Fang Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Yuan Yao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Jiayu Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Chengjia Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Qingfang Xie
- Shanghai Baoshan District Mental Health Center, Shanghai 201900, China
| | - Haiying Mao
- Shanghai Baoshan District Mental Health Center, Shanghai 201900, China
| | - Peiyun Zhang
- Nantong Fourth People's Hospital, Nantong 226005, Jiangsu, China
| | - Xiaolong Yang
- Taicang Third People's Hospital, Taicang 215488, Jiangsu, China
| | - Haisu Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Qinyu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China.
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China; Institute of Mental Health, Fudan University, Shanghai 200040, China.
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Gardner DM, Turner JP, Magalhaes S, Rajda M, Murphy AL. Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep: The YAWNS NB Randomized Clinical Trial. JAMA Psychiatry 2024:2823668. [PMID: 39292452 PMCID: PMC11411453 DOI: 10.1001/jamapsychiatry.2024.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Importance Direct-to-patient interventions enabling transitions from long-term benzodiazepine receptor agonist (BZRA) use to cognitive behavioral therapy for insomnia (CBTI) by older adults has the potential to reduce BZRA use and related harms while improving sleep outcomes without requiring prearranged clinician involvement. Objective To compare 2 direct-to-patient behavior change interventions with treatment as usual (TAU) on BZRA use, sleep, and other health outcomes, and uptake of CBTI techniques. Design, Setting, and Participants The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study was a 3-arm, pragmatic, open-label, minimum-contact, randomized clinical trial. The study began November 2020 and ended June 2022. Participants were randomly allocated to 1 of 3 groups, including 2 different mailed behavior change interventions or no intervention (TAU). Participants were from communities across the province of New Brunswick, Canada, and included adults 65 years and older living independently with long-term use of BZRAs and current or past insomnia. Interventions The Sleepwell package (YAWNS-1) consisted of a cover letter and 2 booklets ("How to Stop Sleeping Pills" and "How to Get Your Sleep Back"). The other package (YAWNS-2) included updated versions of the 2 booklets ("You May Be at Risk" and "How to Get a Good Night's Sleep Without Medication") used in the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study. Main Outcomes and Measures BZRA use at 6 months was the primary measure. Secondary measures included CBTI use, sleep, insomnia, daytime sleepiness, safety, anxiety, frailty, and quality of life. Results A total of 1295 individuals expressed interest in the study, and 565 (43.6%) completed a baseline assessment. Participants had a mean (SD) age of 72.1 (5.7) years, a mean (SD) BZRA use duration of 11.4 (9.1) years, and 362 (64.1%) were female. Discontinuations and dose reductions of 25% or greater were highest with YAWNS-1 (50 of 191 [26.2%]; 39 of 191 [20.4%]; total, 46.6%) compared with YAWNS-2 (38 of 187 [20.3%]; 27 of 187 [14.4%]; total, 34.8%, P = .02) and TAU (14 of 187 [7.5%]; 24 of 187 [12.8%]; total, 20.3%, P < .001). YAWNS-1 also demonstrated better uptake of CBTI techniques and sleep outcomes compared with YAWNS-2 (new CBTI techniques: 3.1 vs 2.4; P =.03; sleep efficiency change: 4.1% vs -1.7%; P =.001) and reduced insomnia severity and daytime sleepiness compared with TAU (insomnia severity index change: -2.0 vs 0.3; P <.001; Epworth Sleepiness Scale change: -0.8 vs 0.3; P =.001). Conclusions and Relevance Results of the YAWNS NB randomized clinical trial show that, as a simple, scalable, direct-to-patient intervention, YAWNS-1 substantially reduced BZRA use and improved sleep outcomes. It could be implemented to transform insomnia care for older adults at the population level. Trial Registration ClinicalTrials.gov Identifier: NCT04406103.
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Affiliation(s)
- David M Gardner
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Justin P Turner
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sandra Magalhaes
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Malgorzata Rajda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea L Murphy
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
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Barone M, Martucci M, Sciara G, Conte M, Medina LSJ, Iattoni L, Miele F, Fonti C, Franceschi C, Brigidi P, Salvioli S, Provini F, Turroni S, Santoro A. Towards a personalized prediction, prevention and therapy of insomnia: gut microbiota profile can discriminate between paradoxical and objective insomnia in post-menopausal women. EPMA J 2024; 15:471-489. [PMID: 39239112 PMCID: PMC11371979 DOI: 10.1007/s13167-024-00369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/23/2024] [Indexed: 09/07/2024]
Abstract
Background Insomnia persists as a prevalent sleep disorder among middle-aged and older adults, significantly impacting quality of life and increasing susceptibility to age-related diseases. It is classified into objective insomnia (O-IN) and paradoxical insomnia (P-IN), where subjective and objective sleep assessments diverge. Current treatment regimens for both patient groups yield unsatisfactory outcomes. Consequently, investigating the neurophysiological distinctions between P-IN and O-IN is imperative for devising novel precision interventions aligned with primary prediction, targeted prevention, and personalized medicine (PPPM) principles.Working hypothesis and methodology.Given the emerging influence of gut microbiota (GM) on sleep physiology via the gut-brain axis, our study focused on characterizing the GM profiles of a well-characterized cohort of 96 Italian postmenopausal women, comprising 54 insomniac patients (18 O-IN and 36 P-IN) and 42 controls, through 16S rRNA amplicon sequencing. Associations were explored with general and clinical history, sleep patterns, stress, hematobiochemical parameters, and nutritional patterns. Results Distinctive GM profiles were unveiled between O-IN and P-IN patients. O-IN patients exhibited prominence in the Coriobacteriaceae family, including Collinsella and Adlercreutzia, along with Erysipelotrichaceae, Clostridium, and Pediococcus. Conversely, P-IN patients were mainly discriminated by Bacteroides, Staphylococcus, Carnobacterium, Pseudomonas, and respective families, along with Odoribacter. Conclusions These findings provide valuable insights into the microbiota-mediated mechanism of O-IN versus P-IN onset. GM profiling may thus serve as a tailored stratification criterion, enabling the identification of women at risk for specific insomnia subtypes and facilitating the development of integrated microbiota-based predictive diagnostics, targeted prevention, and personalized therapies, ultimately enhancing clinical effectiveness. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-024-00369-1.
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Affiliation(s)
- Monica Barone
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Institute of Information Technologies, Mathematics and Mechanics, and Institute of Biogerontology, Lobachevsky State University, Nizhny Novgorod, Russia
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Interdepartmental Centre "Alma Mater Research Institute On Global Challenges and Climate Change (Alma Climate)", University of Bologna, Bologna, Italy
| | - Morena Martucci
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Institute of Information Technologies, Mathematics and Mechanics, and Institute of Biogerontology, Lobachevsky State University, Nizhny Novgorod, Russia
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Interdepartmental Centre "Alma Mater Research Institute On Global Challenges and Climate Change (Alma Climate)", University of Bologna, Bologna, Italy
| | - Giuseppe Sciara
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Maria Conte
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Lorenzo Iattoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Filomena Miele
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Cristina Fonti
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Claudio Franceschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Institute of Information Technologies, Mathematics and Mechanics, and Institute of Biogerontology, Lobachevsky State University, Nizhny Novgorod, Russia
| | - Patrizia Brigidi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Salvioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Federica Provini
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvia Turroni
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Aurelia Santoro
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Interdepartmental Centre "Alma Mater Research Institute On Global Challenges and Climate Change (Alma Climate)", University of Bologna, Bologna, Italy
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Meng R, Ying Y, Luo Y, Huang M, Miller CB, Xie Y, Jia Y, Fan L, Chen W, Yi J, Yang N, Xu J, Jiang C, Lu L, Ma H, Spruyt K, Lau EYY. A longitudinal examination of the measurement properties and invariance of the Sleep Condition Indicator in Chinese healthcare students. BMC Psychiatry 2024; 24:518. [PMID: 39039484 PMCID: PMC11264982 DOI: 10.1186/s12888-024-05844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/13/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Sleep Condition Indicator (SCI), an insomnia measurement tool based on the updated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria with sound psychometric properties when applied in various populations, was evaluated here among healthcare students longitudinally, to demonstrate its measurement properties and invariance in this particularly high-risk population. METHODS Healthcare students of a Chinese university were recruited into this two-wave longitudinal study, completing the simplified Chinese version of the SCI (SCI-SC), Chinese Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration (RU_SATED-C) scale, Chinese Patient Health Questionnaire-4 (PHQ-4-C), and sociodemographic variables questionnaire (Q-SV) between September and November 2022. Structural validity, measurement invariance (MI), convergent and discriminant validity, internal consistency, and test-retest reliability of the SCI-SC were examined. Subgroups of gender, age, home location, part-time job, physical exercise, and stress-coping strategy were surveyed twice to test cross-sectional and longitudinal MI. RESULTS We identified 343 valid responses (62.9% female, mean age = 19.650 ± 1.414 years) with a time interval of seven days. The two-factor structure was considered satisfactory (comparative fit index = 0.953-0.989, Tucker-Lewis index = 0.931-0.984, root means square error of approximation = 0.040-0.092, standardized root mean square residual = 0.039-0.054), which mostly endorsed strict invariance except for part-time job subgroups, hence establishing longitudinal invariance. The SCI-SC presented acceptable convergent validity with the RU_SATED-C scale (r ≥ 0.500), discriminant validity with the PHQ-4-C (0.300 ≤ r < 0.500), internal consistency (Cronbach's alpha = 0.811-0.835, McDonald's omega = 0.805-0.832), and test-retest reliability (intraclass correlation coefficient = 0.829). CONCLUSION The SCI-SC is an appropriate screening instrument available for assessing insomnia symptoms among healthcare students, and the promising measurement properties provide additional evidence about validity and reliability for detecting insomnia in healthcare students.
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Affiliation(s)
- Runtang Meng
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China.
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, China.
| | - Yiwei Ying
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yi Luo
- School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Mengyi Huang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | | | - Yuhuan Xie
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yuxin Jia
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Lianxia Fan
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Wukang Chen
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jiayu Yi
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Nongnong Yang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Jiale Xu
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Chen Jiang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Liping Lu
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Haiyan Ma
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, China
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot, INSERM, Paris, France
| | - Esther Yuet Ying Lau
- Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, China
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, China
- Centre for Religious and Spirituality Education, The Education University of Hong Kong, Hong Kong, China
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McPhillips MV, Petrovsky DV, Lorenz R, Lee J, George T, Smyth A, Bubu OM, Brewster GS. Treatment Modalities for Insomnia in Adults Aged 55 and Older: A Systematic Review of Literature from 2018 to 2023. CURRENT SLEEP MEDICINE REPORTS 2024; 10:232-256. [PMID: 39156226 PMCID: PMC11328977 DOI: 10.1007/s40675-024-00285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 08/20/2024]
Abstract
Purpose of Review Insomnia is the most common sleep disorder experienced by older adults. There is a wide range of pharmacological and non-pharmacological treatment options in existing literature. The purpose of this systematic review was to synthesize randomized controlled trials of insomnia treatment modalities for adults aged 55 and older over the last 5 years. We searched four databases, and after screening, there were 34 full-text manuscripts that met the inclusion/exclusion criteria. Recent Findings We found non-pharmacological interventions, including exercise and behavioral/psychoeducational therapies, remain effective and favorable. Complementary and alternative therapies ranged across studies and warrant further testing in larger, more diverse samples. Dual orexin receptor antagonist medications were tested in a few studies with positive benefits for sleep and minimal side effects. Finally, measures of insomnia/sleep disturbance outcomes varied among the studies, with the Pittsburgh Sleep Quality Index being used most frequently. Summary Non-pharmacological interventions for insomnia in older adults are effective, and some newer medications may be safer, with less side effects, at managing insomnia in this population.
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Affiliation(s)
| | - Darina V. Petrovsky
- Health Care Policy, and Aging Research, School of Nursing, Institute for Health, Rutgers University, New Brunswick, USA
| | | | - Jiwon Lee
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Tessy George
- Georgia Baptist College of Nursing, Mercer University, Macon, USA
| | - Aisling Smyth
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, USA
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Australia
| | - Omonigho Michael Bubu
- Departments of Psychiatry, NYU Grossman School of Medicine, Population Health & Neurology, New York, NY, USA
| | - Glenna S. Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 256, Atlanta, GA 30322, USA
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Brewster GS, Wang D, McPhillips MV, Epps F, Yang I. Correlates of Sleep Disturbance Experienced by Informal Caregivers of Persons Living with Dementia: A Systematic Review. Clin Gerontol 2024; 47:380-407. [PMID: 36314643 PMCID: PMC10148929 DOI: 10.1080/07317115.2022.2139655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This study aims to comprehensively review and update the literature concerning the correlates of sleep disturbance among caregivers of persons living with Alzheimer's disease and related dementias to identify gaps in the literature and antecedent targets for interventions. METHODS We searched PubMed, CINAHL, PsycINFO, and Embase using terms related to "sleep," "caregiver," and "dementia." RESULTS Thirty-six articles were included in this review. Based on the antecedents within the 3P model of insomnia, predisposing factors associated with caregiver sleep included caregiver demographics, and physiological factors like genotype and biomarkers. Precipitating factors related to caregiver sleep included caregiving status and responsibilities, and person living with dementia factors. CONCLUSIONS Sleep disturbance is a significant issue for caregivers of persons living with dementia. However, this review has identified multiple precipitating factors that are modifiable targets for interventions to improve or enhance caregiver sleep. CLINICAL IMPLICATIONS Numerous predisposing and precipitating factors contribute to caregivers of persons living with dementia being susceptible to sleep disturbance. Healthcare providers should ask patients about their caregiving status during annual visits. Healthcare providers should also evaluate caregivers' sleep patterns, and the predisposing and precipitating factors of sleep disturbance, with a focus on the modifiable factors, to enable timely intervention.
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Affiliation(s)
- Glenna S. Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Dingyue Wang
- School of Nursing, Duke University, Durham, North Carolina, USA
| | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Handa N, Ishizaki T, Mitsutake S, Ono K, Akishita M. Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in Japan: A retrospective propensity-matched cohort study. Int J Geriatr Psychiatry 2024; 39:e6085. [PMID: 38622754 DOI: 10.1002/gps.6085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community. METHOD AND PATIENTS Of the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score-matched cohorts (n = 214,723). Exclusion criteria included co-prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score-matched cohort without a prescription (control group). Participants were followed for more than 42 months. RESULTS During the 42-month follow-up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all-cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023-1.146] for mortality, 1.117 [1.014-1.230] for aspiration pneumonia, and 1.720 [1.559-1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient-years, respectively. CONCLUSIONS Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient-years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. CLINICAL TRIAL REGISTRATION UMIN-CTR UMIN000048398.
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Affiliation(s)
- Nobuhiro Handa
- Department of Digital Therapeutics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Kino-Medic Clinic, Ichigao, Yokohama, Japan
- Medical Technology Innovation Center, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | | | | | - Koki Ono
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Department of Social Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Choi NG, Choi BY, Marti CN. Mediation of the Association Between Physical Exercise and Depressive/Anxiety Symptoms by Pain and Sleep Problems Among Older Adults. Gerontol Geriatr Med 2024; 10:23337214241241397. [PMID: 38525486 PMCID: PMC10960979 DOI: 10.1177/23337214241241397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
In this study, based on the 2022 National Health and Aging Trend Study (N = 5,593, age 65+), we examined direct associations between moderate and vigorous physical exercise (PE) and depressive/anxiety symptoms as well as bothersome pain and sleep problems. We then examined if the association between PE and depressive/anxiety symptoms would be partially mediated by the effects of PE on bothersome pain and sleep problems. Results from a path model showed that controlling for sociodemographic and health statuses, PE was negatively associated with depressive/anxiety symptoms and bothersome pain, but it was not significantly associated with sleep problems. The mediation analysis showed that 10% of the total effects of PE on depressive/anxiety symptoms was indirect effects of PE on bothersome pain. This study is important as it examined the associations among PE, pain, sleep, and depression/anxiety in community-dwelling older adults in their natural environments. Healthcare and social service providers for older adults need to emphasize the importance and benefits of PE for older adults' physical and mental health. Easy access to venues for PE is also important.
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Affiliation(s)
| | - Bryan Y. Choi
- Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Correa-Muñoz E, Retana-Ugalde R, Mendoza-Núñez VM. Detection of Insomnia and Its Relationship with Cognitive Impairment, Depression, and Quality of Life in Older Community-Dwelling Mexicans. Diagnostics (Basel) 2023; 13:diagnostics13111889. [PMID: 37296740 DOI: 10.3390/diagnostics13111889] [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: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Sleep disturbances are one of the most frequent health problems in old age, among which insomnia stands out. It is characterized by difficulty falling asleep, staying asleep, frequent awakenings, or waking up too early and not having restful sleep, which may be a risk factor for cognitive impairment and depression, affecting functionality and quality of life. Insomnia is a very complex multifactorial problem that requires a multi- and interdisciplinary approach. However, it is frequently not diagnosed in older community-dwelling people, increasing the risk of psychological, cognitive, and quality of life alterations. The aim was to detect insomnia and its relationship with cognitive impairment, depression, and quality of life in older community-dwelling Mexicans. An analytical cross-sectional study was carried out in 107 older adults from Mexico City. The following screening instruments were applied: Athens Insomnia Scale, Mini-Mental State Examination, Geriatric Depression Scale, WHO Quality of Life Questionnaire WHOQoL-Bref, Pittsburgh Sleep Quality Inventory. The frequency of insomnia detected was 57% and its relationship with cognitive impairment, depression, and low quality of life was 31% (OR = 2.5, 95% CI, 1.1-6.6. p < 0.05), 41% (OR = 7.3, 95% CI, 2.3-22.9, p < 0.001), and 59% (OR = 2.5, 95% CI, 1.1-5.4, p < 0.05), respectively. Our findings suggest that insomnia is a frequent clinical disorder that is not diagnosed and a significant risk factor for cognitive decline, depression, and poor quality of life.
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Affiliation(s)
- Elsa Correa-Muñoz
- Unidad Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico
- Facultad de Humanidades, Ciencias Sociales y Empresariales, Universidad Maimónides, Hidalgo 775-CABA, Buenos Aires B1686IGC, Argentina
| | - Raquel Retana-Ugalde
- Unidad Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico
| | - Víctor Manuel Mendoza-Núñez
- Unidad Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico
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Saito T, Nojiri S, Kasai T, Hiratsuka Y, Ishijima M, Daida H. Association between the Use of Suvorexant and Hip Fracture in Older Adults in Japan Using a Nationwide Administrative Claims Database: A Matched Case-Control Study. Drugs Aging 2023; 40:439-447. [PMID: 37121956 DOI: 10.1007/s40266-023-01033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVE The use of benzodiazepines and nonbenzodiazepines increases the risk for hip fracture, but the effect of suvorexant, an orexin receptor antagonist, is not clear. The objective of this study was to investigate the association between suvorexant use and hip fractures in older adults. METHODS A case-control study was conducted using real-world data (RWD) from Medical Data Vision Co., Ltd. with patients hospitalized between January 2019 and December 2020. Patients were aged 65-84 years and had been prescribed suvorexant at least once. Patients with hip fracture (cases) and those without (controls) were identified by matching up to 1:4 for sex, age (± 2 years), and hospital size category. Suvorexant exposure was identified the day before hospitalization. Hip fracture risk associated with suvorexant was presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI) using conditional logistic regression analysis. RESULTS Matching identified 389 cases and 1509 controls. The risk of hip fracture was not increased in patients treated with suvorexant [aOR: 0.86, 95% confidence interval (CI) 0.61-1.20]. Additionally, concomitant use of suvorexant with other hypnotics did not increase the risk. Benzodiazepines (1.01, 0.46-2.22), nonbenzodiazepines (1.16, 0.57-2.34), and melatonin (1.80, 0.82-3.94) were combined with suvorexant. The risk was increased for the use of benzodiazepine without suvorexant (1.88, 1.10-3.21). CONCLUSIONS Using RWD in Japanese older adults, we showed that sleep therapy with suvorexant was not associated with an increased risk of hip fracture. The results provide evidence-based drug safety information for the selection of hypnotics for sleep disorders, which increase with age.
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Affiliation(s)
- Tomoyuki Saito
- Medical Technology Innovation Center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Yang S, Xiu M, Li X, Shi Y, Wang S, Wan S, Han S, Yang D, Liu Y, He J. The antioxidant effects of hedysarum polybotrys polysaccharide in extending lifespan and ameliorating aging-related diseases in Drosophila melanogaster. Int J Biol Macromol 2023; 241:124609. [PMID: 37105250 DOI: 10.1016/j.ijbiomac.2023.124609] [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: 11/02/2022] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
Hedysarum polybotrys polysaccharide (HPS) is one of the main active ingredients of Hedysarum with many health-beneficial properties, including antioxidant property, immunomodulatory, anti-inflammatory, and anti-tumor. However, the effect of HPS on anti-aging is still unclear. This study was to explore the protective function of HPS on aging and age-related diseases using Drosophila melanogaster. The results demonstrated that HPS supplementation promoted hatchability and prolonged lifespan by enhancing the antioxidative capacity. Administraction of HPS ameliorated age-related symptoms such as imbalanced intestinal homeostasis, sleep disturbances, and beta-amyloid (Aβ) induced Alzheimer's disease (AD) in flies, but did not modulate neurobehavioral deficits in the AD model of tauopathy and the Parkinson's disease (PD) model of Pink1 mutation. Overall, this study reveals that HPS has strong potential in the prevention of aging and age-related diseases, and provided a new candidate for the development of anti-aging drugs.
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Affiliation(s)
- Shipei Yang
- Provincial-level Key Laboratory for Molecular Medicine of Major Diseases and The Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and University, Gansu University of Chinese Medicine, Lanzhou 730000, China; College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Minghui Xiu
- College of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China; Key Laboratory of Dunhuang Medicine, Ministry of Education, Lanzhou 730000, China
| | - Xu Li
- College of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Yan Shi
- Provincial-level Key Laboratory for Molecular Medicine of Major Diseases and The Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and University, Gansu University of Chinese Medicine, Lanzhou 730000, China; College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Shuwei Wang
- College of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Shengfang Wan
- College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Shuzhen Han
- Provincial-level Key Laboratory for Molecular Medicine of Major Diseases and The Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and University, Gansu University of Chinese Medicine, Lanzhou 730000, China; College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Dan Yang
- Provincial-level Key Laboratory for Molecular Medicine of Major Diseases and The Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and University, Gansu University of Chinese Medicine, Lanzhou 730000, China; College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Yongqi Liu
- Provincial-level Key Laboratory for Molecular Medicine of Major Diseases and The Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and University, Gansu University of Chinese Medicine, Lanzhou 730000, China; College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China; Key Laboratory of Dunhuang Medicine, Ministry of Education, Lanzhou 730000, China.
| | - Jianzheng He
- Provincial-level Key Laboratory for Molecular Medicine of Major Diseases and The Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and University, Gansu University of Chinese Medicine, Lanzhou 730000, China; College of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China; Key Laboratory of Dunhuang Medicine, Ministry of Education, Lanzhou 730000, China.
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Okuda S, Qureshi ZP, Yanagida Y, Ito C, Homma Y, Tokita S. Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database. BMC Psychiatry 2023; 23:278. [PMID: 37081408 PMCID: PMC10120113 DOI: 10.1186/s12888-023-04683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/14/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND There is limited consensus regarding the optimal treatment of insomnia. The recent introduction of orexin receptor antagonists (ORA) has increased the available treatment options. However, the prescribing patterns of hypnotics in Japan have not been comprehensively assessed. We performed analyses of a claims database to investigate the real-world use of hypnotics for treating insomnia in Japan. METHODS Data were retrieved for outpatients (aged ≥ 20 to < 75 years old) prescribed ≥ 1 hypnotic for a diagnosis of insomnia between April 1st, 2009 and March 31st, 2020, with ≥ 12 months of continuous enrolment in the JMDC Claims Database. Patients were classified as new or long-term users of hypnotics. Long-term use was defined as prescription of the same mechanism of action (MOA) for ≥ 180 days. We analyzed the trends (2010-2019) and patterns (2018-2019) in hypnotics prescriptions. RESULTS We analyzed data for 130,177 new and 91,215 long-term users (2010-2019). Most new users were prescribed one MOA per year (97.1%-97.9%). In 2010, GABAA-receptor agonists (benzodiazepines [BZD] or z-drugs) were prescribed to 94.0% of new users. Prescriptions for BZD declined from 54.8% of patients in 2010 to 30.5% in 2019, whereas z-drug prescriptions remained stable (~ 40%). Prescriptions for melatonin receptor agonist increased slightly (3.2% to 6.3%). Prescriptions for ORA increased over this time from 0% to 20.2%. Prescriptions for BZD alone among long-term users decreased steadily from 68.3% in 2010 to 49.7% in 2019. Prescriptions for ORA were lower among long-term users (0% in 2010, 4.3% in 2019) relative to new users. Using data from 2018-2019, multiple (≥ 2) MOAs were prescribed to a higher proportion of long-term (18.2%) than new (2.8%) users. The distribution of MOAs according to psychiatric comorbidities, segmented by age or sex, revealed higher proportions of BZD prescriptions in elderly (new and long-term users) and male (new users) patients in all comorbidity segments. CONCLUSION Prescriptions for hypnotics among new and long-term users in Japan showed distinct patterns and trends. Further understanding of the treatment options for insomnia with accumulating evidence for the risk-benefit balance might be beneficial for physicians prescribing hypnotics in real-world settings.
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Affiliation(s)
| | - Zaina P Qureshi
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
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