Characteristics of sleep disturbances in Poland - results of the National Health Interview Survey

Subjective sleep quality and fatigue assessment in Polish adult patients with primary immunodeficiencies: A pilot study

Introduction

Primary immunodeficiencies (PIDs) are clinically heterogeneous disorders caused by abnormalities in the immune system. However, PIDs are genetically determined and may occur at any age from early childhood to elderly age. Due to chronic patterns, the risk of malignancy and organ damage in patients with PIDs may affect any aspect of life, including sleep patterns. To our knowledge, the prevalence of insomnia and subjective sleep quality have not been investigated in patients with PIDs. Therefore, this pilot study was conducted to investigate sleep quality, the prevalence of sleep disturbances, and fatigue in adult patients with PIDs in Poland.

Methods

All participants were surveyed using the Athens Insomnia Scale, Pittsburgh Sleep Quality Index, Fatigue Severity Scale, and a questionnaire concerning general health and demographic data. We included 92 participants: 48 women (52.2%) and 44 men (47.8%).

Results

Participants' mean age was 41.9 ± 13.9 years. The mean sleep duration was 7.0 ± 1.5 hours, and the mean sleep latency was 41.2 ± 53.1 minutes. Additionally, 44.6% of patients (n=41) had symptoms of insomnia and 44.6% (n=42) had poor sleep quality. Less than one-fourth (n=22; 23.9%) of the patients reported the use of sleeping pills; moreover, clinically significant fatigue was reported in 52.2% (n=48).

Discussion

Our investigation provides insight into the problem of sleep disturbances in patients with PIDs. Data have demonstrated that sleeping disorders with concomitant fatigue are common in patients with PID. Further studies are needed to determine the determinants of poor sleep quality in this specific group of patients.

Emotional Dysregulation, Anxiety Symptoms and Insomnia in Individuals with Alcohol Use Disorder

Alcohol craving is associated with insomnia symptoms, and insomnia is often reported as a reason for alcohol relapse. The current study examined associations between emotional regulation, anxiety, and insomnia among a group of 338 patients with alcohol use disorder (AUD). Because insomnia most often develops after stressful experiences, it was expected that anxiety symptoms would mediate the association between emotional dysregulation and insomnia severity. It was also expected that an insomnia diagnosis would moderate the association between emotional dysregulation and anxiety symptoms, namely that higher anxiety levels would be found in individuals with insomnia than in those without insomnia. Insomnia severity was assessed with a total score based on the Athens Insomnia Scale (AIS). Additionally, an eight-point cut-off score on the AIS was used to classify participants as with (n = 107) or without (n = 231) an insomnia diagnosis. Moreover, participants completed the Emotion Regulation Scale (DERS; total score) and the Brief Symptoms Inventory (BSI; anxiety). Individuals with insomnia did not differ from those without insomnia in age (p = 0.86), duration of problematic alcohol use (p < 0.34), mean days of abstinence (p = 0.17), nor years of education (p = 0.41). Yet, individuals with insomnia endorsed higher anxiety (p < 0.001) and higher emotional dysregulation (p < 0.001). Anxiety symptoms fully mediated the association between emotional dysregulation and insomnia severity (p < 0.001). Furthermore, insomnia diagnosis positively moderated the association between emotional dysregulation and anxiety (p < 0.001). Our results suggest that emotional dysregulation can lead to insomnia via anxiety symptoms. Treating anxiety symptoms and emotional dysregulation could help to prevent or alleviate symptoms of insomnia in people with AUD. Moreover, treating insomnia in people with AUD may also have a positive effect on anxiety symptoms.

Sleep Duration and Bedtime in the PURE Poland Cohort Study and the Link with Noncommunicable Diseases

(1) Background: The objective was to investigate the association between sleep duration, bedtime, and noncommunicable diseases in the PURE Poland cohort study. (2) Methods: The baseline study was conducted in 2007-2010. The study group comprised 2023 adult inhabitants of urban and rural areas in Lower Silesia, Poland. The study protocol included questionnaires, blood pressure measurements, blood draws, and anthropometric measurements. Sleep duration and bedtime were self-reported. (3) Results: The median sleep duration of women was 30 min longer than men (8 h vs. 7.5 h; p = 0.001). The average time of sleep increased along with the age of the participants. A sleep duration of >8 h was more common in rural than in urban participants (40.2% vs. 27.1%; respectively; p < 0.001). The relative risk of diabetes, stroke, hypertension, cardiovascular diseases (CVD), and obesity was significantly higher in participants who went to bed between 6 p.m. and 10 p.m. in comparison to those who went to bed between 10 p.m. and 12 a.m. (RR 2.23, 95% CI 1.06-4.67; RR 2.52, 95% CI 1.28 to 4.97; RR 1.12, 95% CI 1.04-1.20; RR 1.36; 95% CI 1.1-1.68; RR 1.38; 95% CI 1.15-1.66, respectively). The relative risk of respiratory diseases was two-fold higher in those who went to bed after midnight in comparison to those who went to bed between 10 p.m. and 12 a.m. (RR 2.24; 95% CI 1.19-4.22). (4) Conclusions: In our study, an earlier bedtime was associated with a higher risk of diabetes, stroke, obesity, hypertension, and CVD.

Urinary incontinence and sleep complaints in community dwelling older adults

Sleep disorder is associated with poor quality of life in old age. Therefore, it is imperative to identify contributing factors leading to sleep disorder. The current study aimed to examine the impact of urinary incontinence on sleep complaint after controlling for potential sociodemographic and health covariates. Materials and Methods: A cross-sectional study was conducted on a sample of 184 community dwelling older adults 60 years and older in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional random sampling technique was employed. Sociodemographic characteristics, sleep complaint, and urinary incontinence were collected from medical records. Statistical analyses were performed using SPSS version 24. A multiple logistic regression analysis was used to examine the impact of urinary incontinence on sleep complaint after controlling for potential covariates. Findings: A total of 184 respondents with a mean age of 68.48±6.65 years (age range, 60-87 years) were included in the study. About 70% of the respondents were women, 72.8% were married, 68.5% were not formally educated, and 21.7% were living alone. The prevalence of sleep complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI: 17-29), respectively. The results of the multiple logistic regression analysis revealed respondents with urinary incontinence were four times more likely to suffer from sleep complaint than those without urinary incontinence after adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35, p<0.001). Conclusion: Based on the results of this present study, which showed that urinary incontinence independently contributed to sleep complaint among older adults, it is necessary to employ effective interventions for controlling urinary incontinence to reduce sleep complaints.

Insomnia in Pregnancy Is Associated With Depressive Symptoms and Eating at Night

STUDY OBJECTIVES

Deterioration in sleep quality seems to be a natural consequence of physical changes during pregnancy. It is still unclear if insomnia in pregnancy is associated with the same factors as chronic insomnia in the general population. The aim of this study was to explore the determinants of insomnia during pregnancy.

METHODS

The study included 266 women (mean age: 30.6 ± 5 years, weeks of pregnancy: 36 [interquartile range 32-38]) recruited at the Department of Gynecology and Obstetrics, Medical University of Warsaw. The assessment of variables was performed using the Athens Insomnia Scale (AIS), Beck Depression Inventory (BDI), Regestein Hyperarousal Scale (HS), Epworth Sleepiness Scale (ESS), General Practice Physical Activity Questionnaire, and a semi-structured interview about different sleep disorders.

RESULTS

Almost 40% of the women in our study received a diagnosis of insomnia based on AIS cutoff scores. The between-group analyses indicated that HS score, BDI score, eating at night, legs tingling, nightmares, snoring, and myoclonus differentiated the groups of individuals with insomnia from those without insomnia. Other variables were not significantly different between the groups. We divided individuals with insomnia in terms of insomnia duration: 49% developed insomnia at least 1 year before the study onset and 39.6% during pregnancy. For further analyses we used only the women in whom insomnia developed during pregnancy. Logistic regression confirmed that depressive symptoms (BDI) and eating at night were significant predictors of insomnia in pregnancy.

CONCLUSIONS

Depressive symptoms and night eating are key factors related to insomnia developed during pregnancy.

Associations of common chronic non-communicable diseases and medical conditions with sleep-related problems in a population-based health examination study

A cross-sectional population-based survey, the National FINRISK 2012 Study, designed to monitor chronic diseases and their risk factors in Finland. A random sample of 10,000 adults aged 25-74 years, and of them, 64% (n=6424) participated the study. Participants subjectively reported the total durations for sleep and naps (n=6238), sleep quality (n=5878), bedtimes and wake-up times separately for working days and weekends yielding the amount of sleep debt (n=5878), and the seasonal variation in sleep duration (n=4852). The participants were asked whether they were diagnosed or treated for common chronic diseases in the past 12 months. Logistic regression models were adopted to analysis and adjusted for a range of covariates as potential confounding factors. Total sleep duration and nap duration prolonged in depression and other mental disorder (p<.001 for all). Seasonal variation in sleep duration was associated with depression (p=.014), hypertension (p=.018) and angina pectoris (p=.024). Participants with gallstones, cardiac insufficiency, depression, or degenerative arthritis had poor sleep quality (odds ratios of 1.6-6.3, p=.001 or less for each). Those with degenerative arthritis had sleep debt less (p<.05) and those with angina pectoris more (p<.05) than individuals without these medical conditions. Depression is significantly associated with sleep problems, albeit no sleep debt. Cardiovascular diseases, degenerative arthritis, and gallstones had significant associations with one or more sleep problems. There is therefore a need for more successful management of sleep problems in chronic diseases to improve the quality of life, to reduce treatment relapses, and to increase health and longevity in a population.

Low estradiol levels in women of reproductive age having low sleep variation

Higher exposure to light at night, for example, owing to night shift work or decrease in sleep duration, may suppress melatonin production, which in turn may increase the reproductive hormone levels. High levels of steroid hormones, especially estrogens, may be associated with an increase of the breast cancer risk. This study investigated whether variation in the sleep duration during one entire menstrual cycle corresponds to estradiol saliva concentrations in healthy, urban women of reproductive age. During 2000-2001, 95 regularly menstruating women aged 24-36 in Poland collected daily saliva samples for one entire menstrual cycle. Saliva samples were analyzed for concentration of 17-beta estradiol (E2) using radio immunoassay. Information on the number of hours of sleep per night (sleep duration) was collected daily by questionnaires for one entire menstrual cycle. Using covariance analysis, after adjustments for sleep duration, we documented a positive relationship between the sleep variation (sleep coefficient of variation) and E2 levels in women of reproductive age. Mean levels of E2 differed significantly in women from the lowest sleep coefficient of variation quartile (13.93 pmol/l) in comparison with other quartiles (22.35 pmol/l), (P<0.001). The low sleep variation group, that is, the women who sleep regularly, had mean E2 levels 60% lower than other groups. These results suggest that sleep variation significantly correlates with E2 levels, whereas sleep duration does not show a statistically significant relationship. This study suggests that sleep variation may influence endogenous estrogens, which is of importance for risk of breast cancer.