Dreams content and emotional load in cardiac rehabilitation patients and their relation to anxiety and depression

The relationship between different bispectral index and the occurrence of dreams in elective surgery under general anesthesia: protocol for a randomized controlled clinical trial

INTRODUCTION

Dreaming reported after anesthesia remains a poorly understood phenomenon. At present, there is a hypothesis that dreaming occurs intraoperatively and is related to light or inadequate anesthesia; thus, in order to further verify the hypothesis, we choose elective surgery under general anesthesia to observe whether the generation of dreams is related to the dose of general anesthetics maintenance.

METHODS AND ANALYSIS

This randomized, double-blind controlled trial to observe whether the generation of dreams is related to the dose of general anesthetics maintenance in the elective surgery under general anesthesia. A total of 124 participants will be randomly allocated to a low bispectral index or high bispectral index group at a ratio of 1:1. The Hospital Anxiety and Depression Scale (HADS) is used to assess the anxiety and depression status of participants during the perioperative period. Ramsay score is used to assess patients' sedation level after surgery in the PACU. Modified Brice questionnaire and awareness classification are used to assess whether patients experienced dreaming during the surgery.

ETHICS AND DISSEMINATION

This randomized, double-blind controlled trial received prospective ethics committee approval at the Human Research Ethical Committee of Shengjing Hospital, Shenyang, Liaoning Province, China (Institutional Review Board registration number 2021PS664K), and was compliant with the Declaration of Helsinki. Written informed consent was obtained from all subjects participating in the trial.

Circadian and Sleep Modulation of Dreaming in Women with Major Depression

Growing evidence indicates an association between reduced dream recall and depressive symptomatology. Here, we tested the prediction that reduced dream recall in individuals experiencing major depressive disorder (MDD) is due to alterations in circadian and sleep processes. Nine young healthy women (20−31 years) and eight young unmedicated women (20−31 years) diagnosed with MDD underwent a 40 h multiple nap protocol with ten alternating cycles of 150 min wake/75 min sleep under a stringently controlled circadian laboratory protocol. After each nap, we assessed dream recall, number of dreams and dream emotional load using the Sleep Mentation Questionnaire. Dream recall and the number of dreams did not significantly differ between groups (pFDR > 0.1). However, there was a significant difference for the dream emotional load (interaction of “Group” vs. “Time”, pFDR = 0.01). Women with MDD had a two-fold higher (negative) emotional load as compared to healthy control women, particularly after naps during the circadian night (between ~22:00 h and ~05:00 h; Tukey−Kramer test, p = 0.009). Furthermore, higher (negative) dream emotional load was associated with impaired mood levels in both groups (R2 = 0.71; p < 0.001). Our findings suggest that the circadian and sleep modulation of dreaming may remain intact in unmedicated young women experiencing MDD.

Factors associated with quality of dreams during general anesthesia: a prospective observational study

Patients frequently report having dreams during general anesthesia, and the dreams are often reported to be pleasant dreams. However, factors associated with the quality of dreams during general anesthesia have not been clarified. The aim of this study was to determine the relationships between the quality of dreams during general anesthesia and perioperative factors. This prospective observational study included patients scheduled for elective surgery under general anesthesia. Preoperative mental status was assessed by the Hospital Anxiety and Depression Scale (HADS). A postoperative interview was carried out in the operating room after recovery from general anesthesia. Dreams and awareness during general anesthesia were assessed by a modified Brice interview. The quality of dreams was classified in accordance with the patient's own opinion as pleasant, indifferent, or unpleasant. A total of 1100 patients were included in the study, and 293 (25.4%) of the patients reported having dreams during anesthesia. Half of the patients who experienced dreams during anesthesia (50.2%, 147/293 patients) reported having a pleasant dream. Multivariate logistic regression analysis revealed that only HADS-depression score of less than 11 was related to pleasant dreams (OR: 3.3 [95% CI 1.3-10.0]).

Relationships between Dream and Previous Wake Emotions Assessed through the Italian Modified Differential Emotions Scale

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into wake and dream emotional experience remains unclear. Here, we aimed to assess dream emotions and their relationships with wake emotions through the modified Differential Emotions Scale (Fredrickson, 2003), which includes a broad array of both positive and negative emotions. The scale has been first validated on 212 healthy Italian participants, in two versions: a WAKE-2wks form, assessing the frequency of 22 emotions over the past 2 weeks, and a WAKE-24hr form, assessing their intensity over the past 24 h. Fifty volunteers from the wider sample completed the WAKE-24hr mDES for several days until a dream was recalled, and dream emotions were self-reported using the same scale. A bifactorial structure was confirmed for both mDES forms, which also showed good validity and reliability. Though Positive and Negative Affect (average intensity of positive and negative items, PA, and NA, respectively) were balanced in dreams, specific negative emotions prevailed; rmANOVA showed a different pattern (prevalence of PA and positive emotions) in wake (both WAKE-2wks and WAKE-24hr), with a decrease of PA and an increase of NA in the dream compared to previous wake. No significant regression model emerged between waking and dream affect, and exploratory analyses revealed a stable proportion of PA and NA (with prevailing PA) over the 3 days preceding the dream. Our findings highlight a discontinuity between wake and dream affect and suggest that positive and negative emotions experienced during wake may undertake distinct sleep-related regulation pathways.

Risk Factors and Psychosocial Correlates of Emotionally Negative Dreams in Patients Referred to a Cardiac Rehabilitation Centre

Introduction

Dream, as a kind of mental activity, includes various functions such as mood regulation, adjustment and integration of new information with the available memory system. The study was done for assessing the relationship between physiological and psychological components of cardiac diseases with emotionally negative dreams in cardiac rehabilitation.

Methods

At the baseline of this cross-sectional study, 156 patients from Western Iran participated during April–November 2016. People 20 years–80 years able to recall the emotional content of dreams after cardiac surgery entered the study. The Beck depression inventory (BDI), Beck anxiety inventory (BAI), Buss and Perry’s aggression questionnaire (BPAQ) and Schredl’s dream emotions manual were used for collecting data. A binary logistic regression analysis used for the study of the relationship between risk factors and emotionally negative dreams.

Results

The mean age of participants was 59 (SD = 9) years (men: 64.1%). The results showed that 25% of patients have negative emotional content. After adjustment for demographic variables, the results showed that increased anxiety [adjusted odds ratio (adj OR) = 1.08 [1.01–1.16], P = 0.020] and anger (adj OR = 1.03 [1.00–1.06], P = 0.024) and hypertension (adj OR = 2.71 [1.10–6.68], P = 0.030) can predict the dreams with negative content significantly.

Conclusion

The increasing rates of anxiety and anger and history of hypertension are related to increasing dreams with the negative emotional load. The control of risk factors of dreams with negative emotional load can be the target of future interventions.