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Warren JR, Link RC, Cheng AL, Sinclair MK, Sorensen AA. Carpal tunnel syndrome and sleep, a systematic review and meta-analysis. Hand Surg Rehabil 2024:101698. [PMID: 38641062 DOI: 10.1016/j.hansur.2024.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The most common symptom and reason patients seek treatment for carpal tunnel syndrome is lack of sleep. Our purpose was to determine how much sleep-related symptoms of carpal tunnel syndrome improve after carpal tunnel release using validated patient-reported outcome measures (PROMs) and objective sleep data as primary measures of interest. METHODS A PRISMA-guided literature search was conducted using Ovid MEDLINE, PubMed, Cochrane, and ClinicalTrials.gov. Only interventional clinical trials that examined primary outcome measures of interest were included. Patient-reported outcome measures underwent meta-analysis to determine how much scores improved following carpal tunnel release. RESULTS The Pittsburgh Sleep Quality Index improved significantly after carpal tunnel release, by 4.43 points and 6.02 points at 1-3 and 6-12 months postoperatively, respectively, and continued to improve up to 2 years. Improvement on the Insomnia Severity Index after carpal tunnel release was also significant, with improvement up to 1 year postoperatively, by 8.54 points and 9.05 points at 1-3 and 6-12 months, respectively. Insomnia Severity Index scores improved significantly after splinting as well. CONCLUSIONS The present meta-analysis determined to what extent patients can expect their sleep to improve after operative and non-operative intervention, as measured by various patient-reported outcome measures that assess sleep. The Pittsburgh Sleep Quality Index and Insomnia Severity Index correlated very well between studies and across hundreds of patients with carpal tunnel syndrome. Data are lacking to define the minimal clinically important difference and assess whether patients achieve a minimal clinically important difference for sleep questionnaires; more information on this topic is needed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonathan R Warren
- Department of Orthopaedic Surgery, University of Missouri Kansas City, 2301 Holmes St. Kansas City, MO 64063, USA.
| | - R Clayton Link
- Department of Orthopaedic Surgery, University of Missouri Kansas City, 2301 Holmes St. Kansas City, MO 64063, USA
| | - An-Lin Cheng
- Department of Orthopaedic Surgery, University of Missouri Kansas City, 2301 Holmes St. Kansas City, MO 64063, USA
| | - Micah K Sinclair
- Department of Orthopaedic Surgery, University of California Davis, 4860 Y St #1700, Sacramento, CA 95817, USA
| | - Amelia A Sorensen
- Department of Orthopaedic Surgery, University of Missouri Kansas City, 2301 Holmes St. Kansas City, MO 64063, USA
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Tański W, Tomasiewicz A, Jankowska-Polańska B. Sleep Disturbances as a Consequence of Long COVID-19: Insights from Actigraphy and Clinimetric Examinations-An Uncontrolled Prospective Observational Pilot Study. J Clin Med 2024; 13:839. [PMID: 38337533 PMCID: PMC10856322 DOI: 10.3390/jcm13030839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
The COVID-19 pandemic represents a global health and social challenge. However, the impact of a SARS-CoV-2 infection itself on mental health and sleep quality remains poorly understood. The purpose of the present uncontrolled prospective observational pilot study was to evaluate the impact of past COVID-19 disease on the incidence of quantitative and qualitative sleep disturbances. A group of 61 subjects (37 female, 24 male) reported sleep disturbances that had lasted for at least one month and had started after recovery from COVID-19. The study used self-reported instruments: the Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI), as well as an objective method-actigraphy-for quantitative analysis of sleep architecture. It was shown that sleep disturbances most commonly started after recovery (68.3%, n = 41) and lasted for more than one month (83.6%, n = 51). ESS scores of 7.8 ± 5.0 points indicate moderate daytime sleepiness, and ISI scores of 16.3 ± 5.8 points denote moderate insomnia. ESS scores were negatively correlated with total time in bed (r = -0.3780, p = 0.003), total sleep time (r = -0.2969, p = 0.020), and wakefulness after sleep onset (r = -0.2654, p = 0.039). In addition, ESS scores were correlated negatively with the respondents' age (B = -0.17, p = 0.000) and time from COVID-19 onset. A positive correlation was found between wakefulness after sleep onset and ESS scores (B = -0.05, p = 0.039). ISI scores were positively correlated with time in bed (r = 0.3275, p = 0.010). Female gender was found to be a significant predictor of insomnia's severity (B = 2.159, t = 3.04, p = 0.004). In conclusion, patients with a history of COVID-19 report long-lasting sleep disturbances that do not subside spontaneously. In the patient group studied, moderate levels of daytime sleepiness and insomnia were found. The most frequently reported problems included irregular sleep, frequent awakenings, and difficulty maintaining sleep, while normal sleep duration was preserved. These findings underscore the need for continued attention to the long-term consequences of COVID-19 on sleep health and emphasize the importance of targeted interventions to address these enduring sleep disturbances in affected individuals.
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Affiliation(s)
- Wojciech Tański
- Department of Internal Medicine, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland;
- Faculty of Medicine, Wrocław University of Science and Technology, 50-376 Wroclaw, Poland
| | - Anna Tomasiewicz
- Student Research Club of Surgical Specialties, Wroclaw Medical University, 50-532 Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Faculty of Medicine, Wrocław University of Science and Technology, 50-376 Wroclaw, Poland
- Center for Research and Innovation, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland
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Fernandes M, Placidi F, Mercuri NB, Liguori C. Daridorexant treatment for chronic insomnia: a real-world retrospective single-center study. Neurol Sci 2024:10.1007/s10072-024-07326-w. [PMID: 38280086 DOI: 10.1007/s10072-024-07326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Chronic insomnia disorder (CID) significantly impacts well-being and daily functioning. Daridorexant, a double orexin receptor blocker, has shown efficacy in randomized clinical trials and has been recently approved for the treatment of CID in adult patients. This retrospective observational study aimed to describe real-world data on daridorexant effectiveness and safety in adult patients with CID. METHODS Consecutive patients initiating on-label daridorexant at the Sleep Medicine Centre, University Hospital of Rome Tor Vergata were enrolled. Baseline and 30-day follow-up (FU) evaluations included patients' and CID characteristics, comorbidities, and clinicians' and patients' subjective ratings of changes with the Clinical and Patient Global Impression-Improvement scores (CGI-Is and PGI-Is), as well as Insomnia Severity Index (ISI) scores in a subgroup of patients. RESULTS Sixty-nine patients initiated 50-mg daily dosage. At FU, 58% of both patients and clinicians rated CID as improved on CGI-Is and PGI-Is, with no differences based on comorbidities, sex, or number of previous medications. No significant predictors of CGI-Is and PGI-Is improvement were identified. At FU, ISI scores (n = 24) significantly decreased from 18.25 ± 3.21 to 12.08 ± 6.12 (Z = 8.000; p < 0.001). Of these, eight patients (33.3%) had absence of insomnia symptoms, and no patients reported a worsening in ISI score categories. CONCLUSIONS This study suggests daridorexant to be effective and safe in real-world CID treatment whether used as a first-ever treatment, switch, or add-on, as reflected by subjective and objective measures and the absence of serious treatment-related adverse events. Future research on larger cohorts should explore daridorexant potential across diverse patient characteristics.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
- Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
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Tan B, Liu Q, Qin Y, Chen Q, Chen R, Jin Y, Li M, Jia X, Xu X, Zhang Q. Insomnia in epilepsy is associated with nocturnal seizures and anxiety. Epilepsy Behav 2024; 150:109559. [PMID: 38035537 DOI: 10.1016/j.yebeh.2023.109559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/26/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE The purpose of this study was to identify the factors associated with insomnia in patients with epilepsy (PWE) and provide evidence for clinical prevention and treatment. METHODS PWE who visited our epilepsy clinic from December 2021 to December 2022 were enrolled in our study. All participants completed the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Based on their ISI scores, they were categorized into two groups: PWE with insomnia (ISI score ≥ 10) and PWE without insomnia (ISI score < 10). Univariate analysis and stepwise logistic regression analysis were conducted to identify the factors associated with insomnia in PWE. RESULTS A total of 196 Chinese PWE were recruited in this study(men, 39.8 %). Of these, 39 PWE(19.9 %) had insomnia.The incidence of nocturnal seizures (43.6 %vs19.7 %), depression (46.2 %vs9.6 %), anxiety (59.0 %vs11.5 %), and excessive daytime sleepiness(EDS,28.2 %vs5.7 %) in PWE with insomnia were significantly higher than in those without insomnia(all p<0.01). Univariate regression analysis showed that seizures greater than or equal to once per month, nocturnal seizures, anxiety, depression, and EDS may associate with insomnia in PWE(all p<0.05). Stepwise logistic regression analysis demonstrated that nocturnal seizures (OR = 2.611,95 % CI 1.040-6.478, P = 0.038) and anxiety (mild OR = 4.830,95 %CI 1.741-13.186, P = 0.002;moderate OR = 24.239,95 %CI 4.719-183.935, P<0.001; severe OR = 37.653,95 %CI 4.931-782.741, P = 0.002) were independently associated with insomnia in PWE. CONCLUSION PWE with insomnia are more likely to experience depression and EDS. Nocturnal seizures and anxiety are identified as independent factors associated with insomnia in PWE. Furthermore, Anxiety has a greater impact on insomnia in PWE and the likelihood of insomnia has increased significantly with the aggravation of anxiety levels.
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Affiliation(s)
- Bofei Tan
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Qiang Liu
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China; Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Yameng Qin
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Qiuyan Chen
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Rong Chen
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Yanzi Jin
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Mengyun Li
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Xiaodan Jia
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Xianrui Xu
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China.
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Choi Y, Yu DJ, Ha KC, Min JM, Choi WY, Yun DS, Kwak BH, Kim SG, Yoon JW, Kim HK, Lim DK, Jeon KB, Kim SR, Lee SY, Kim S. Acupuncture for patients with insomnia and predictors of treatment response: a chart review. Acupunct Med 2023:9645284231210582. [PMID: 38159070 DOI: 10.1177/09645284231210582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Acupuncture is a potentially effective non-pharmacological treatment for insomnia. OBJECTIVE We observed the responses of patients with insomnia to acupuncture in routine clinical practice. In addition, we explored patient characteristics that might affect the treatment response to acupuncture for insomnia. METHODS Medical records of patients with insomnia in a Korean medicine clinic with baseline Insomnia Severity Index (ISI) scores ⩾8 and Pittsburgh Sleep Quality Index (PSQI) scores ⩾5 were reviewed. Acupuncture was applied at ST43, GB41, ST41, SI5, HT3, KI10, HT7 and ST3, for 1-2 months. The ISI and PSQI were measured monthly to assess insomnia severity. The effect of acupuncture over time was analyzed using a multilevel linear model for repeated measures. In addition, logistic regression was used to explore predictors of treatment response. RESULTS A total of 91 patients with insomnia aged 59.2 ± 12.5 years (mean ± standard deviation (SD)) (90.1% female) were included in the analysis. After the acupuncture treatment, ISI scores were significantly reduced by -3.75 (95% confidence interval (CI) = -4.99, -2.50) and -4.69 (95% CI = -6.22, -3.16) after the first and second month, respectively. The PSQI global scores also improved, and sleep duration showed a tendency to increase by 0.35 h (95% CI = -0.17, 0.86) after acupuncture treatment. Three cases of mild fatigue were reported. In addition, higher baseline pain/discomfort predicted a greater likelihood of response after acupuncture treatment (odds ratio (OR) = 1.66, 95% CI = 1.10, 2.60). CONCLUSION In a real-world setting, the insomnia of outpatients in a clinic was slightly alleviated after acupuncture treatment. These findings require validation by randomized controlled trials.
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Affiliation(s)
- Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Duk-Jong Yu
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Kee Chul Ha
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Jong-Min Min
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Woon-Yong Choi
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Dae-Sang Yun
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Bum-Hee Kwak
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Seung-Gyeom Kim
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Jong-Wuk Yoon
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Hang-Ki Kim
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Dong-Kwan Lim
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Kyung-Bae Jeon
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Seong-Rok Kim
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Sang-Yoon Lee
- Seongnam Korean Medicine Clinic, Gyeonggi, Republic of Korea
| | - Sungha Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Duus Holm Z, Zibert JR, Thomsen SF, Isberg AP, Andersen AD, Ali Z. Rapid Web-Based Recruitment of Patients With Psoriasis: Multinational Cohort Study. JMIR Dermatol 2023; 6:e44405. [PMID: 37632941 PMCID: PMC10335121 DOI: 10.2196/44405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Wide-ranging patient recruitment not restricted to the location of the investigator will provide a better representation of the patient population in clinical studies. OBJECTIVE Our goal was to assess the feasibility of a broad web-based recruitment strategy in an 8-week observational study of 500 study participants with psoriasis and healthy controls from locations remote from the investigator and to assess the cost associated with each participant. METHODS A decentralized team in Denmark recruited patients with psoriasis and healthy controls using Google and Facebook advertisements and posts to Facebook groups. All individuals were screened via the internet, and patients diagnosed with psoriasis were included. Questionnaires regarding itch and sleep were completed by both groups at inclusion, week 4, and week 8. RESULTS During a 2-week recruitment period, 12,887 unique advertisement views were registered, and 839 participants were enrolled, of which 507 completed the study (220 with psoriasis and 287 healthy controls) with a retention rate of 60.4%. Participants were recruited from 11 different countries on 4 separate continents, mainly from the United States, Canada, and the United Kingdom. The recruitment rate was 59.9 participants per day, and the conversion rate was 57.2%. Recruitment costs were US $13 per enrolled participant and US $22 per participant completing the study. CONCLUSIONS It is feasible and rapid to recruit a large number of participants from locations different from the investigator and to retain patients in an observational study with no visits to a clinical site at low costs.
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Affiliation(s)
- Zacharias Duus Holm
- Studies&Me A/S, Copenhagen, Denmark
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | | | - Simon Francis Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | | | | | - Zarqa Ali
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Oh JW, Kim SM, Lee D, Son NH, Uh J, Yoon JH, Choi Y, Lee S. Evaluating the Modified Patient Health Questionnaire-2 and Insomnia Severity Index-2 for Daily Digital Screening of Depression and Insomnia: Validation Study. JMIR Ment Health 2023; 10:e45543. [PMID: 37213186 DOI: 10.2196/45543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND The Patient Health Questionnaire-2 (PHQ-2) and Insomnia Severity Index-2 (ISI-2) are screening assessments that reflect the past 2-week experience of depression and insomnia, respectively. Retrospective assessment has been associated with reduced accuracy owing to recall bias. OBJECTIVE This study aimed to increase the reliability of responses by validating the use of the PHQ-2 and ISI-2 for daily screening. METHODS A total of 167 outpatients from the psychiatric department at the Yongin Severance Hospital participated in this study, of which 63 (37.7%) were male and 104 (62.3%) were female with a mean age of 35.1 (SD 12.1) years. Participants used a mobile app ("Mental Protector") for 4 weeks and rated their depressive and insomnia symptoms daily on the modified PHQ-2 and ISI-2 scales. The validation assessments were conducted in 2 blocks, each with a fortnight response from the participants. The modified version of the PHQ-2 was evaluated against the conventional scales of the Patient Health Questionnaire-9 and the Korean version of the Center for Epidemiologic Studies Depression Scale-Revised. RESULTS According to the sensitivity and specificity analyses, an average score of 3.29 on the modified PHQ-2 was considered valid for screening for depressive symptoms. Similarly, the ISI-2 was evaluated against the conventional scale, Insomnia Severity Index, and a mean score of 3.50 was determined to be a valid threshold for insomnia symptoms when rated daily. CONCLUSIONS This study is one of the first to propose a daily digital screening measure for depression and insomnia delivered through a mobile app. The modified PHQ-2 and ISI-2 were strong candidates for daily screening of depression and insomnia, respectively.
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Affiliation(s)
- Jae Won Oh
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Sun Mi Kim
- Department of Nursing, Andong Science College, Andong, Republic of Korea
| | - Deokjong Lee
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Department of Psychiatry and the Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Jinsun Uh
- Mobigen Co, Ltd, Seongnam, Republic of Korea
| | - Ju Hong Yoon
- Korea Electronics Technology Institute, Seongnam, Republic of Korea
| | - Yukyung Choi
- Department of Intelligent Mechatronics Engineering, Sejong University, Seoul, Republic of Korea
| | - San Lee
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Department of Psychiatry and the Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Cerri LQ, Justo MC, Clemente V, Gomes AA, Pereira AS, Marques DR. Insomnia Severity Index: A reliability generalisation meta-analysis. J Sleep Res 2023:e13835. [PMID: 36737257 DOI: 10.1111/jsr.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/22/2022] [Accepted: 01/08/2023] [Indexed: 02/05/2023]
Abstract
The aim of the current study was to conduct a reliability generalisation (RG) meta-analysis of Cronbach's alpha for the Insomnia Severity Index (ISI). A systematic search of three databases (PubMed, Scopus, and Web of Science) from inception to 12 March 2021 was performed. Publications that reported Cronbach's alpha for the total ISI score were included. Only psychometric-focussed studies were considered. Meta-analysis was carried out using a random-effects model to derive a pooled estimate of Cronbach's alphas. The number of participants in the included publications ranged from 25 to 12,056, with 33 studies (42 estimates) comprising internal consistency coefficients, and a combined sample size of N = 29,688. The age range of the included publications was from 13.4 to 74.3 years. Data extraction implied 33 publications out of 706 found through the database search. Cronbach's alphas ranged from 0.65 to 0.92. The majority of the reported coefficients were ≥0.7 and presented a low risk of bias (n = 32). The pooled alpha coefficient was 0.83 (IC [0.81-0.85]; SE = 0.009) with high heterogeneity among the included publications (I2 = 97%). Subgroup analyses including moderators such as continent, setting, risk of bias, and age did not affect significantly the overall result. In general, the cumulative estimate of Cronbach's alpha for the ISI is good. However, this finding should be interpreted with caution since there is a high heterogeneity level and some of the studies might not have checked the assumptions underlying Cronbach's alphas.
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Affiliation(s)
- Luíza Quinália Cerri
- Department of Education and Psychology, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
| | - Mariana Carvalho Justo
- Department of Education and Psychology, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
| | - Vanda Clemente
- Sleep Medicine Centre, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal.,CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Allen Gomes
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Anabela Sousa Pereira
- Department of Psychology, Colégio Pedro da Fonseca, Rua da Barba Rala, University of Évora, Évora, Portugal.,Center for Research in Education and Psychology (CIEP), University of Évora, Evora, Portugal.,William James Center for Research - WJCR/UA, Aveiro, Portugal
| | - Daniel Ruivo Marques
- Department of Education and Psychology, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal.,CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Kalmbach DA, Cheng P, Roth A, Roth T, Swanson LM, O'Brien LM, Fresco DM, Harb NC, Cuamatzi-Castelan AS, Reffi AN, Drake CL. DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection. Sleep Adv 2022; 3:zpac006. [PMID: 35391758 PMCID: PMC8981986 DOI: 10.1093/sleepadvances/zpac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/18/2022] [Indexed: 11/23/2022]
Abstract
Study Objectives The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. Methods Ninety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale's Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. Results DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. Conclusions Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA.,Department of Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MIUSA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Andrea Roth
- Pediatric Sleep Medicine, Thriving Minds Behavioral Health, Livonia, MIUSA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MIUSA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, University of Michigan, Ann Arbor, MIUSA
| | - David M Fresco
- Department of Psychiatry, University of Michigan, Ann Arbor, MIUSA
| | - Nicholas C Harb
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | | | - Anthony N Reffi
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MIUSA
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Habbash F, Ben Salah A, Almarabheh A, Jahrami H. Insomnia and Related Factors During the Delta Wave of the COVID-19 Pandemic in the Kingdom of Bahrain: A Cross-Sectional Study. Nat Sci Sleep 2022; 14:1963-1975. [PMID: 36340636 PMCID: PMC9635386 DOI: 10.2147/nss.s380141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study aims to estimate the prevalence of insomnia and related risk factors during the Delta wave of the COVID-19 pandemic in the Kingdom of Bahrain. METHODS An analytical cross-sectional study included 646 individuals from the general population aged 18 years and over, living in the Kingdom of Bahrain during the Delta wave of the pandemic. Data were collected by an anonymous online questionnaire using the snowball-sampling technique between June and August 2021. We used the Insomnia Severity Index (ISI) and the generalized anxiety disorder scale (GAD-7) to measure the level of insomnia and anxiety, respectively. RESULTS A total of 646 individuals participated in the study. Most of the participants were females (86%). The mean age was 38.7 ± 12.7 years (age range 18-89) and around half of the participants were 35 years or older. Clinical insomnia was reported by 20% [95% CI, 16.9-20.0] of the participants, and 50.1% [95% CI, 46.2-50.1] had subclinical insomnia according to ISI. The proportion of insomnia was significantly higher among females, healthcare workers, participants with lower educational levels, a lower or decreased monthly income during the pandemic, or participants who reported anxiety symptoms (all P < 0.01). Scales of anxiety and insomnia revealed a high correlation (r2 = 0.347, P< 0.01). The logistic regression model confirmed that factors independently associated with insomnia are female gender (OR=1.94, 95% CI, 1.00-3.76, P < 0.050) as well as presence of anxiety (GAD-7 score ≥ 5) [OR=12.98, 95% CI, 5.61-30.00, P < 0.001]. CONCLUSION The burden of insomnia was significant among the general population in the Kingdom of Bahrain during the Delta wave of the COVID-19 pandemic despite the low severity of this variant. Mental health programs are a high priority during the pandemic and afterward. Detection of insomnia could be used to treat some mental health problems at an early stage.
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Affiliation(s)
- Fatema Habbash
- Family and Community Medicine Department, Arabian Gulf University, Manama, Kingdom of Bahrain.,Family Medicine Department, King Abdullah University Medical Center, Manama, Kingdom of Bahrain
| | - Afif Ben Salah
- Family and Community Medicine Department, Arabian Gulf University, Manama, Kingdom of Bahrain.,Institute Pasteur de Tunis, Department of Medical Epidemiology, 13 Place Pasteur, Belvedere, Tunis, Tunisia
| | - Amer Almarabheh
- Family and Community Medicine Department, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Haitham Jahrami
- Department of Psychiatry, Ministry of Health, Manama, Kingdom of Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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11
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Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. ISI-3: evaluation of a brief screening tool for insomnia. Sleep Med 2021; 82:104-109. [PMID: 33910159 PMCID: PMC8141095 DOI: 10.1016/j.sleep.2020.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/04/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES We evaluated the performance of the Insomnia Severity Index-3 (ISI-3) as a short screening tool to identify clinically significant insomnia derived from the 7-item ISI in an older primary care population. METHODS We used results from two surveys including the 7-item ISI: Sample 1 (n = 3197) and Sample 2 (n = 247) individuals aged ≥60 years with a diagnosis of osteoarthritis from electronic health records. The 7 items were: difficulty falling asleep, difficulty staying asleep, waking too early, sleep satisfaction, sleep interference with daytime functioning, noticeability of sleep problems by others, and worry about sleep. The ISI-3 included items with highest item-total correlations to the 7-item ISI from Sample 1. A 7-item ISI score ≥15 was defined as clinically significant insomnia and served as the primary criterion for the ISI-3. We derived operating characteristics to determine the diagnostic accuracy and cut-points to maximize sensitivity and specificity for both samples. RESULTS The items with the highest item-total correlations were: sleep dissatisfaction, sleep interference with daily functioning, and worry about sleep problems (r = 0.78-0.81); while difficulty falling asleep, difficulty staying asleep, waking too early and noticeability of sleep problems by others showed lower correlations (r = 0.60-0.74). The ISI-3 achieved high discriminant validity in identifying insomnia (AUC = 0.97-0.98). An ISI-3 score of ≥7 maximized sensitivity (0.94-0.97) and specificity (0.88-0.91) with kappa = 0.68-0.71, 89.1-91.5% agreement. CONCLUSIONS The ISI-3 can effectively screen for insomnia to trigger a more thorough diagnostic evaluation including the 7-item ISI for research or clinical purposes. Future validation studies are needed in other community and clinical populations. CLINICAL TRIAL This manuscript describes secondary analyses of data two National Institutes on Aging-funded clinical trials (ClinicalTrials.gov identifier: NCT01142349, NCT02946957).
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Affiliation(s)
- Manu Thakral
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Susan M McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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12
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Chehri A, Goldaste N, Ahmadi S, Khazaie H, Jalali A. Psychometric properties of insomnia severity index in Iranian adolescents. Sleep Sci 2021; 14:101-106. [PMID: 34381573 PMCID: PMC8340898 DOI: 10.5935/1984-0063.20200045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Sleep deprivation and insomnia have negative impacts on mental and physical health in adolescents. In order to examine the problems caused by insomnia, we need tools with acceptable validity and reliability for the target population. The aim of this study was to evaluate the psychometric properties of Insomnia Severity Index (ISI) in Iranian adolescent population. MATERIAL AND METHODS The study was carried out as a descriptive-analytic normalization. Study group consisted of 701 adolescents aged 12 to 19, who were selected through cluster sampling. The participants completed ISI, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Inventory (PSQI), Adolescent sleep hygiene scale (ASHS) and global sleep assessment questionnaire (GSAQ). In addition, SPSS ver.22 and AMOSS ver.10 were used to analyze the data. RESULTS The reliability of the test was obtained equal to 0.77 based on Cronbach's alpha and a good reliability (0.84) was obtained through test/retest method. Exploratory and confirmatory factor analyses with seven items were computed. The models fitness indexes were suitable for the structural model (CFI=0.99%, NFI=0.98%, GFI=0.99%, TLI=0.98%, RMSEA=0.049%). Moreover, there was a direct and significant correlation between the ISI index and the total score of other indexes. As to gender-based reliability, Cronbach's alpha was 0.78 in female adolescents and 0.85 in male adolescents. CONCLUSION The results indicated that the Persian version of the insomnia severity index can be used as a reliable and valid tool for assessing the severity of insomnia in Persian-speaking adolescents.
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Affiliation(s)
- Azita Chehri
- Department of Psychology, Kermanshah Branch, Islamic Azad
University, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical
Sciences, Kermanshah, Iran
| | - Nastaran Goldaste
- Department of Psychology, Kermanshah Branch, Islamic Azad
University, Kermanshah, Iran
| | - Saman Ahmadi
- Department of Psychology, Kermanshah Branch, Islamic Azad
University, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical
Sciences, Kermanshah, Iran
| | - Amir Jalali
- Substance Abuse Prevention Research Center, Research Institute for
Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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13
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Krupa S, Filip D, Mędrzycka-Dąbrowska W, Lewandowska K, Witt P, Ozga D. Sleep disorders among nurses and other health care workers in Poland during the COVID-19 pandemic. Appl Nurs Res 2021; 59:151412. [PMID: 33947509 PMCID: PMC7875712 DOI: 10.1016/j.apnr.2021.151412] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/06/2020] [Accepted: 02/08/2021] [Indexed: 01/07/2023]
Abstract
Background The profession of nurses involves exposure to harmful agents. Despite numerous international studies on the occurrence of sleep disorders in nurses, most studies lacked an assessment of the dependence on the occurrence of the situation causing fear and anxiety which is a highly contagious. Aim Determining the relationship between the occurrence of sleep disorders and socio-demographic variables of medical personnel during the COVID-19 epidemic. Design This is a cross-sectional study conducted online involving 336 health professionals. Results Insomnia among staff was determined at the level of Subthreshold insomnia and Clinical insomnia (moderate severity). Suspicion or confirmed COVID-19 had an effect on the occurrence of sleep disorders in the study group of medical personnel. Conclusion Taking into account the statistical error of 6%, the sleep disorders concern about 40% of professionally active nurses and midwives in Poland. Worsening of insomnia was observed in people with the possibility of contact with a patient with COVID-19 in the workplace. Insomnia was more common in respondents over 25 years of age. Psychosocial interventions are needed to help healthcare staff better respond to COVID-19 and future epidemics.
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Affiliation(s)
- Sabina Krupa
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland; Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland.
| | - Dawid Filip
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland.
| | - Wioletta Mędrzycka-Dąbrowska
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland; Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, Poland.
| | - Katarzyna Lewandowska
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland; Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, Poland
| | - Paweł Witt
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland; Medical University of Warsaw, Department of Pediatric Anaesthesiology and Intensive Therapy, Poland
| | - Dorota Ozga
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland; Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland
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14
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Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:664499. [PMID: 34163383 PMCID: PMC8215288 DOI: 10.3389/fpsyt.2021.664499] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Study Objectives: We conducted a meta-analysis to assess the effects of different regular exercise (lasting at least 2 months on a regular basis) on self-reported and physiological sleep quality in adults. Varied exercise interventions contained traditional physical exercise (e.g., walking, cycling) and mind-body exercise characterized by gentle exercise with coordination of the body (e.g., yoga). Methods: Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematical searches were conducted in three electronic databases (PubMed, Embase, and Web of Science) for relevant research that involved adult participants without pathological diseases receiving exercise intervention. The search strategy was based on the population, intervention, comparison, and outcome study design (PICOS) framework. The self-reported outcomes included varied rating scales of Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Subgroup meta-analyses of PSQI scores were conducted based on type of exercise, duration of intervention, and participants' age and gender. The physiological outcomes were measured by Actigraph. All meta-analyses were performed in a fixed or random statistic model using Revman software. Results: Twenty-two randomized controlled trials were included in the analysis. The overall analysis on subjective outcomes suggests that exercise interventions significantly improved sleep quality in adults compared with control interventions with lower PSQI (MD -2.19; 95% CI -2.96 to -1.41), ISI (MD -1.52; 95% CI -2.63 to -0.41), and ESS (MD -2.55; 95% CI -3.32 to -1.78) scores. Subgroup analyses of PSQI scores showed both physical and mind-body exercise interventions resulted in improvements of subjective sleep to the same extent. Interestingly, short-term interventions (≤3 months) had a significantly greater reduction in sleep disturbance vs. long-term interventions (>3 months). Regarding physiological sleep, few significant effects were found in various sleep parameters except the increased sleep efficiency in the exercise group vs. control group. Conclusions: Results of this systematic review suggest that regular physical as well as mind-body exercise primarily improved subjective sleep quality rather than physiological sleep quality in adults. Specifically, self-reported sleep quality, insomnia severity, and daytime sleepiness could be improved or ameliorated with treatment of exercise, respectively, evaluated by PSQI, ISI, and ESS sleep rating scales.
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Affiliation(s)
- Yi Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Liu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue-Jiao Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Han Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Dai N, Li Y, Sun J, Li F, Xiong H. Self-Designed Ningxin Anshen Formula for Treatment of Post-ischemic Stroke Insomnia: A Randomized Controlled Trial. Front Neurol 2020; 11:537402. [PMID: 33240190 PMCID: PMC7680871 DOI: 10.3389/fneur.2020.537402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
This study aimed to assess the efficacy and safety of self-designed Ningxin Anshen (NXAS) Formula for post-ischemic stroke insomnia of blood-deficient and liver-heat syndrome. Ninety patients were randomized into NXAS group, Placebo group and Zopiclone group. Patients in the NXAS group, Placebo group and Zopiclone group were treated with Ningxin Anshen Formula, placebo and zopiclone for 4 weeks, respectively. The scores of the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and traditional Chinese Medicine (TCM) Syndromes of self-designed scale and the number of adverse events (AEs) were determined. Results showed that the overall effective rate in the NXAS group and Placebo group was 76.67 and 30.00%, respectively, showing significant difference (P < 0.01). There was no marked difference between Zopiclone group (80.00%) and NXAS group. In both NXAS group and Zopiclone group, the scores of PSQI, ISI, and TCM Syndromes of self-designed scale after 4-week treatment were significantly different from those before treatment (P < 0.01). After 4-week treatment, the scores of PSQI, ISI, and TCM Syndromes of self-designed score were comparable between NXAS group and Zopiclone group (P > 0.05). Only one patient in the NXAS group developed gastrointestinal discomfort, which resolved without treatment discontinuation. In conclusion, self-designed NXAS Formula is effective and safe and has little adverse effect in treating post-stroke insomnia of blood-deficient and liver-heat syndrome.
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Affiliation(s)
- Ning Dai
- College of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine (TCM), Beijing, China
| | - Yuanyuan Li
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Traditional Chinese Medicine (TCM), Beijing, China
| | - Jing Sun
- Department of Medical Neurology, Tongzhou District of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine (TCM), Beijing, China
| | - Feng Li
- College of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine (TCM), Beijing, China
| | - Hang Xiong
- Department of Medical Neurology, Tongzhou District of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine (TCM), Beijing, China
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Okajima I, Miyamoto T, Ubara A, Omichi C, Matsuda A, Sumi Y, Matsuo M, Ito K, Kadotani H. Evaluation of Severity Levels of the Athens Insomnia Scale Based on the Criterion of Insomnia Severity Index. Int J Environ Res Public Health 2020; 17:E8789. [PMID: 33256097 PMCID: PMC7730071 DOI: 10.3390/ijerph17238789] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022]
Abstract
The Athens Insomnia Scale (AIS) can be regarded as a highly useful instrument in both clinical and research settings, except for when assessing the severity level. This study aims to determine the severity criteria for AIS by using the Insomnia Severity Index (ISI). A total of 1666 government employees aged 20 years or older were evaluated using the AIS and ISI, the Patient Health Questionnaire for depressive symptoms, the Epworth Sleepiness Scale for daytime sleepiness, and the Short Form Health Survey of the Medical Outcomes Study for health-related quality of life (QoL). A significant positive correlation (r) was found between the AIS and the ISI (r = 0.80, p < 0.001). As a result of describing receiver-operator curves, the severity criteria of the AIS are capable of categorizing insomnia severity as follows: absence of insomnia (0-5), mild insomnia (6-9), moderate insomnia (10-15), and severe insomnia (16-24). In addition, compared to all scales across groups categorized by AIS or ISI, it was revealed that similar results could be obtained (all p < 0.05). Therefore, the identification of the severity of AIS in this study is important in linking the findings of epidemiological studies with those of clinical studies.
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Affiliation(s)
- Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo 173-8602, Japan
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga 520-2192, Japan; (A.U.); (C.O.); (A.M.); (K.I.); (H.K.)
| | - Towa Miyamoto
- Department of Psychiatry, Shiga University of Medical Science, Shiga 520-2192, Japan; (T.M.); (Y.S.); (M.M.)
| | - Ayaka Ubara
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga 520-2192, Japan; (A.U.); (C.O.); (A.M.); (K.I.); (H.K.)
- Graduate School of Psychology, Doshisha University, Kyoto 610-0394, Japan
- JSPS Research Fellowships, Tokyo 102-0083, Japan
| | - Chie Omichi
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga 520-2192, Japan; (A.U.); (C.O.); (A.M.); (K.I.); (H.K.)
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural, University of Medicine, Kyoto 602-8566, Japan
| | - Arichika Matsuda
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga 520-2192, Japan; (A.U.); (C.O.); (A.M.); (K.I.); (H.K.)
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Shiga 520-2192, Japan; (T.M.); (Y.S.); (M.M.)
| | - Masahiro Matsuo
- Department of Psychiatry, Shiga University of Medical Science, Shiga 520-2192, Japan; (T.M.); (Y.S.); (M.M.)
| | - Kazuki Ito
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga 520-2192, Japan; (A.U.); (C.O.); (A.M.); (K.I.); (H.K.)
- Department of Anesthesiology, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Hiroshi Kadotani
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Shiga 520-2192, Japan; (A.U.); (C.O.); (A.M.); (K.I.); (H.K.)
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Azizoğlu Şen İ, Özsürekci C, Balcı C, Çalışkan H, Eşme M, Ünsal P, Halil MG, Cankurtaran M, Doğu BB. Sleep quality and sleep-disturbing factors of geriatric inpatients. Eur Geriatr Med 2021; 12:133-41. [PMID: 33000426 DOI: 10.1007/s41999-020-00400-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Insomnia, a common problem in older adults, may be precipitated by multiple factors including medical conditions, social, behavioral, and environmental factors. The aims of our study were to evaluate sleep pattern changes during hospitalization, determine the predictors of sleep quality and sleep disorders in geriatric inpatients. METHODS In this prospective observational study, all ≥ 65-year-old patients hospitalized in internal medicine wards were assessed at the time of hospitalization and after 1 week. Insomnia Severity Index and Pittsburgh Sleep Quality Index (PSQI) were used to define insomnia and subjective sleep quality. All patients underwent comprehensive geriatric assessment. Data of factors contributing sleep disturbances during hospitalization were recorded. RESULTS Totally 101 patients were recruited. Mean ± SD age was 73.5 ± 5.2 years and 53.5% were female. Frequency of poor sleepers was 58.4% at baseline and 64.7% after 1 week according to PSQI score (p 0.804). Although the total scores and frequency of insomnia did not change in the first week of hospitalization, sleep duration was significantly shortened (6.4 ± 2.6 h vs. 5.9 ± 2.7 h, respectively; p < 0.001). Age, pain, restless legs syndrome, Katz ADL, and Lawton-Brody IADL scores were independent correlates of insomnia during hospitalization. CONCLUSION The study showed that insomnia was associated with geriatric syndromes in hospitalized geriatric patients, and hospitalization reduced duration of sleep. Sleep quality and insomnia evaluation should be a fundamental part of assessment in hospitalized older adults. Considering the negative outcomes of insomnia, sleep disrupting factors should be identified and corrected.
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Batalla-Martín D, Belzunegui-Eraso A, Miralles Garijo E, Martínez Martín E, Romaní Garcia R, Heras JSM, Lopez-Ruiz M, Martorell-Poveda MA. Insomnia in Schizophrenia Patients: Prevalence and Quality of Life. Int J Environ Res Public Health 2020; 17:E1350. [PMID: 32093111 DOI: 10.3390/ijerph17041350] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 11/22/2022]
Abstract
Sleep disorders are often not regarded as an important health problem, despite their impact on heath. Insomnia is the most frequent sleep disorder in mental health. The aim is to quantify the prevalence of insomnia in a population with schizophrenic disorder and assess its influence on quality of life. This is a descriptive, analytical and cross-sectional study conducted in a sample of 267 schizophrenic patients over 18 years of age using consecutive non-probabilistic sampling. The variables of interest were collected by means of the "Cuestionario Oviedo de Sueño," "Insomnia Severity Index" and EuqoQol-5D. The estimation of insomnia in our schizophrenic population according to the International Classification of Disease (ICD-10) criteria was 23.2%. The likelihood of insomnia when there are problems in the quality of life is significant in all its dimensions: mobility OR: 3.54 (95% CI 1.88– 6.65), self-care OR: 2.69 (95% CI 1.36–5.32), usual activities OR: 3.56 (95% CI 1.97–6.44), pain/discomfort OR: 4.29 (95% CI 2.37–7.74) and anxiety/depression OR: 3.01 (95% CI 1.61–5.65). The prevalence of insomnia fluctuates depending on the diagnostic criteria; however, the schizophrenic population shows high prevalence in some clinical characteristics. People with insomnia have a lower quality of life.
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Korkmaz Aslan G, İncİ FH, Kartal A. The prevalence of insomnia and its risk factors among older adults in a city in Turkey's Aegean Region. Psychogeriatrics 2020; 20:111-117. [PMID: 31137084 DOI: 10.1111/psyg.12464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/23/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023]
Abstract
AIM Experienced by many older adults, insomnia is a significant public health problem that requires the attention of health-care professionals and researchers. This study aimed to identify insomnia and its risk factors among community-dwelling older adults. METHODS This cross-sectional study was conducted in Denizli, Turkey. The study sample consisted of 360 elderly individuals aged 60 years and older who were admitted to one of six family health centres for any reason between 29 March 2016 and 17 June 2016. Data were collected by using a descriptive form for the elderly and the Insomnia Severity Index. The χ2 test was used to compare independent variables and insomnia status. Logistic regression analysis was used for the variables that were found to be significant at the end of the single-variable analysis. RESULTS The mean age of the subjects, all of whom lived at home, was 69.52 ± 8.36 years. Insomnia was quite common among them (51%), and its severity was low (8.51 ± 5.56). At the end of logistic regression analysis, a moderate perception of health (OR = 10.859, 95%CI: 3.532-33.385) and the number of medications used (OR = 3.326, 95%CI: 1.014-10.907) were identified as risk factors for insomnia. CONCLUSION Based on the results of this study, we can state that insomnia is common among older adults. Therefore, older adults who are admitted to health-care institutions should be evaluated for insomnia. Factors identified as affecting insomnia were health perception and the number of medications used. Given that health perception and polypharmacy are associated with chronic disease management, helping the elderly to effectively manage chronic diseases may alleviate insomnia.
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Affiliation(s)
| | - Fadime H İncİ
- Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Asiye Kartal
- Pamukkale University Faculty of Health Sciences, Denizli, Turkey
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Yusufov M, Zhou ES, Recklitis CJ. Psychometric properties of the Insomnia Severity Index in cancer survivors. Psychooncology 2019; 28:540-546. [PMID: 30597686 DOI: 10.1002/pon.4973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Insomnia is commonly associated with cancer treatment. Cancer treatments increase risk for numerous psychological and medical late effects, thus making cancer survivors psychologically and medically vulnerable. Prior research examined psychometric properties of the Insomnia Severity Index (ISI) with various populations, including the French version of the ISI, with participants undergoing active cancer treatment. However, no prior studies examined insomnia exclusively with cancer survivors, using the English version of the ISI. METHODS This study examined internal consistency and factor structure of an English version of the ISI in 100 cancer survivors (Mage = 51.1; SD = 14.92). This final analytic sample was composed of participants from three different insomnia interventions. Survivors ranged from less than 1 year off treatment (17%) to 21+ years off treatment (6%), with most participants off treatment for 1 to 2 years (24%). RESULTS The mean ISI score for the total sample was 16.69 (SD = 4.47), indicating clinical insomnia, with moderate severity. Principal Components Analysis (PCA) indicated two factors (five items loading on Factor I and two items loading on Factor II) and acceptable reliability (α = .73). Item-total correlations ranged from .15 to .63. CONCLUSIONS Findings support the reliability of the ISI in cancer survivors. However, its factor structure warrants additional research with larger samples of cancer survivors. Results suggest inconsistency across participant responses and that ISI items may be functioning differently with this unique population of cancer survivors. Findings indicate that sleep maintenance problems are central to the experience of insomnia in our survivor sample.
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Affiliation(s)
- Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Eric S Zhou
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Department of Pediatrics, Boston, MA, USA
| | - Christopher J Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Department of Pediatrics, Boston, MA, USA
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Lam T, Ogeil RP, Allsop S, Chikritzhs T, Fischer J, Midford R, Gilmore W, Lenton S, Liang W, Lloyd B, Aiken A, Mattick R, Burns L, Lubman DI. Insomnia and Regulation of Sleep-Wake Cycle With Drugs Among Adolescent Risky Drinkers. J Clin Sleep Med 2018; 14:1529-1537. [PMID: 30176972 DOI: 10.5664/jcsm.7330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to explore symptoms of insomnia in a group of youths characterized as engaging in risky drinking, their use of drugs as sleep/ wake aids, and the relationships between alcohol and other drug use and insomnia. METHODS Face-to-face interviews were conducted with 596 Australian 14 to 19-year-olds identified as engaging in regular risky drinking. They completed the Insomnia Severity Index and were assessed for recent alcohol and other drug use, including drugs used specifically as sleep aids or to stay awake. Alcohol-related problems, emotional distress, self-control, and working outside of traditional hours were also assessed using validated scales. RESULTS More than one-third of the study participants (36%) reported moderate to very severe sleep-onset insomnia, and 39% screened positive for clinical insomnia using adolescent criteria. Three-fourths used drugs in the past 2 weeks to regulate their sleep cycle (65% used stimulants to stay awake, mainly caffeine, and 32% used a depressant to get to sleep, mainly cannabis). Regression analyses showed that after controlling for variables such as sex, emotional distress, self-control, alcohol use problems, and past 6-month illicit or non-prescribed drug use, those who used drugs specifically to get to sleep or to stay awake were 2.0 (P < .001) and 1.7 (P = .02) times more likely to report clinical insomnia, respectively. CONCLUSIONS Insomnia was commonly reported in this community sample of adolescents characterized as engaging in risky drinking. Those with symptoms of insomnia appeared to be managing their sleep-related symptoms through alcohol and other drug use, which may have further exacerbated their sleep issues.
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Affiliation(s)
- Tina Lam
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Rowan P Ogeil
- Turning Point and Monash University, Melbourne, Australia
| | - Steve Allsop
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Jane Fischer
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Richard Midford
- Charles Darwin University and the Menzies School of Health Research, Darwin, Australia
| | - William Gilmore
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Wenbin Liang
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Belinda Lloyd
- Turning Point and Monash University, Melbourne, Australia
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Dan I Lubman
- Turning Point and Monash University, Melbourne, Australia
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Nayak MK, Kapadia JD, Desai CK, Desai MK, Shah BJ. An Evaluation of Efficacy and Safety of Commonly Prescribed Drugs and Effect of These Drugs on Quality of Sleep in Patients Suffering From Zoster-Associated Pain. J Clin Pharmacol 2018; 58:1406-1417. [PMID: 29799622 DOI: 10.1002/jcph.1255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/06/2018] [Indexed: 12/12/2022]
Abstract
This observational, prospective, single-center study was conducted to evaluate the efficacy and safety of commonly prescribed drugs for zoster-associated pain and their impact on quality of sleep at a tertiary care hospital in western India. Patients ≥18 years of age, newly diagnosed with zoster-associated pain were evaluated on days 0, 7, 14, 30, 60, 90, 120, 150, and 180 or until resolution of pain, whichever was earlier, using the Wong Baker FACES Pain Rating Scale, Neuropathic Pain Scale, and Insomnia Severity Index for intensity of pain, quality of pain, and quality of sleep, respectively. A total of 78 patients (46.0 [16.3] years) completed the study. They received nonsteroidal anti-inflammatory drugs (65), gabapentin (30), amitriptyline (27), and amitriptyline + gabapentin (21) for mean durations of 7.7 (3.0), 89.2 (7.2), 107.6 (46.3), and 104.5 (46) days, respectively. Improvement in the Wong Baker FACES Pain Rating Scale and Neuropathic Pain Scale score was similar among treatment groups except for a greater fall in Wong Baker FACES Pain Rating Scale score at days 7 and 120 and that in deep pain score at day 7 in combination treatment group vs the amitriptyline group. Clinically significant insomnia was detected in 35 patients at baseline and demonstrated progressive and similar improvement among groups. Treatment modification was required in 20 patients. Zoster-associated pain resolved in 69 patients. Nine adverse drug reactions, mostly mild, nonserious, and nonpreventable, were reported. To conclude, drugs commonly used for zoster-associated pain are effective and well tolerated. These have a similar effect on pain and quality of sleep, except for a possible greater effect of combination treatment in the early phase of intense and deep pain.
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Affiliation(s)
- Mithilesh K Nayak
- Department of Pharmacology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Jigar D Kapadia
- Department of Pharmacology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Chetna K Desai
- Department of Pharmacology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Mira K Desai
- Department of Pharmacology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Bela J Shah
- Department of Skin and Venereal Diseases, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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Chen PY, Jan YW, Yang CM. Are the Insomnia Severity Index and Pittsburgh Sleep Quality Index valid outcome measures for Cognitive Behavioral Therapy for Insomnia? Inquiry from the perspective of response shifts and longitudinal measurement invariance in their Chinese versions. Sleep Med 2017; 35:35-40. [PMID: 28619180 DOI: 10.1016/j.sleep.2017.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/20/2017] [Accepted: 04/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) are valid outcome measures for Cognitive Behavioral Therapy for Insomnia (CBT-I). Specifically, we tested whether the factorial parameters of the ISI and the PSQI could remain invariant against CBT-I, which is a prerequisite to using their change scores as an unbiased measure of the treatment outcome of CBT-I. METHODS A clinical data set including scores on the Chinese versions of the ISI and the PSQI obtained from 114 insomnia patients prior to and after a 6-week CBT-I program in Taiwan was analyzed. A series of measurement invariance (MI) tests were conducted to compare the factorial parameters of the ISI and the PSQI before and after the CBT-I treatment program. RESULTS Most factorial parameters of the ISI remained invariant after CBT-I. However, the factorial model of the PSQI changed after CBT-I treatment. An extra loading with three residual correlations was added into the factorial model after treatment. CONCLUSIONS The partial strong invariance of the ISI supports that it is a valid outcome measure for CBT-I. In contrast, various changes in the factor model of the PSQI indicate that it may not be an appropriate outcome measure for CBT-I. Some possible causes for the changes of the constructs of the PSQI following CBT-I are discussed.
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Affiliation(s)
- Po-Yi Chen
- Department of Psychology University of Kansas, USA
| | - Ya-Wen Jan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Chien-Ming Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan; The Research Center for Mind, Brain, and Learning, National Chengchi University, Taipei, Taiwan.
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Dragioti E, Levin LÅ, Bernfort L, Larsson B, Gerdle B. Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: cross-sectional population-based results from the PainS65+ cohort. Ann Gen Psychiatry 2017; 16:15. [PMID: 28250802 PMCID: PMC5324239 DOI: 10.1186/s12991-017-0137-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/16/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Insomnia is a major cause of concern in the elderly with and without pain. This study set out to examine the insomnia and its correlates in a large sample of community adults aged ≥65 years. METHODS A cross-sectional postal survey was completed by 6205 older individuals (53.8% women; mean age = 76.2 years; SD = 7.5). The participants also completed the Insomnia Severity Index (ISI) and questionnaires assessing pain intensity, pain spreading, anxiety, depression, and basic demographic information. The sample was divided into three groups based on the presence and duration of pain: chronic pain (CP; n = 2790), subacute pain (SP; n = 510), and no pain (NP; n = 2905). RESULTS A proportion of each of the groups had an ISI score of 15 or greater (i.e., clinical insomnia): CP = 24.6%; SP = 21.3%; and NP = 13.0%. The average scores of ISI differed significantly among CP, SP, and NP groups (p < 0.001). Stratified regression analyses showed that pain intensity, pain spreading, anxiety, and depression were independently related to insomnia in the CP group. Anxiety and depression were independently related to insomnia in the SP group, but only anxiety was significantly associated with insomnia in the NP group. Age and sex were not associated with insomnia. CONCLUSIONS This study confirms that insomnia is not associated with chronological aging per se within the elderly population. Although the possible associations of insomnia with pain are complex, ensuing from pain intensity, pain spreading, anxiety, and depression, our results highlighted that anxiety was more strongly associated with insomnia in all groups than the depression and pain characteristics. Therapeutic plans should consider these relations during the course of pain, and a comprehensive assessment including both pain and psychological features is essential when older people are seeking primary health care for insomnia complaints.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden
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Yang KI, Grigg-Damberger M, Andrews N, O'Rourke C, Bena J, Foldvary-Schaefer N. Severity of self-reported insomnia in adults with epilepsy is related to comorbid medical disorders and depressive symptoms. Epilepsy Behav 2016; 60:27-32. [PMID: 27176881 DOI: 10.1016/j.yebeh.2016.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/12/2016] [Accepted: 03/14/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies have systematically investigated insomnia in adults with epilepsy. METHODS We performed a prospective cross-sectional investigation of the prevalence, severity, and comorbidities of insomnia in 90 adults with epilepsy using a battery of self-reported instruments and polysomnography. We quantified insomnia severity using the Insomnia Severity Index (ISI). RESULTS Fifty-nine of 90 (65.5%) adults with epilepsy reported insomnia (ISI≥8), moderate or severe (ISI≥15) in 28.9%. Good agreement between standard clinical diagnostic criteria and ISI was found for patients with ISI scores <8 and ≥15. Scores on the modified Beck Depression Inventory (mBDI) (r=0.25, p=0.021), the original BDI (r=0.32, p=0.002), and self-reported total sleep duration (TSD) (r=-0.3, p=0.006) were significantly related to ISI score. A multiple regression model found that decreased TSD (ß=-0.93, p=0.007), head trauma (ß=4.37, p=0.003), sedative-hypnotic use (ß=4.86, p=0.002), AED polytherapy (ß=3.52, p=0.005), and asthma/COPD (ß=3.75, p=0.014) were predictors of a higher ISI score. For 63 patients with focal epilepsy, an increased mBDI (ß=0.24, p=0.015), decreased TSD (ß=-1.11, p=0.008), asthma/COPD (ß=4.19, p=0.02), and epilepsy surgery (ß=5.33, p=0.006) were significant predictors of an increased ISI score. Patients with temporal lobe epilepsy (TLE) showed a trend for greater severity compared with those with extra-TLE (ß=-2.92, p=0.054). CONCLUSIONS Our findings indicate that severity of insomnia in adults with epilepsy is more likely to be associated with comorbid medical and depressive symptoms and less likely to be directly related to epilepsy. Good agreement between standard clinical diagnostic criteria for insomnia and the ISI for subjects without insomnia symptoms and for those with moderate-to-severe symptoms supports the use of this instrument in epilepsy research.
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Affiliation(s)
- Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | | | - Noah Andrews
- Sleep Disorders and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Colin O'Rourke
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nancy Foldvary-Schaefer
- Sleep Disorders and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Güler S, Nesrin Turan F. Turkish version of the Johns Hopkins Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): validity and reliability study. Qual Life Res 2015; 24:2789-94. [PMID: 25999305 DOI: 10.1007/s11136-015-1003-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Restless legs syndrome (RLS), as well as problems secondary to RLS, may worsen the quality of life. Our aim was to modify the Restless Legs Syndrome Quality of Life (RLS-QoL) questionnaire advanced by Abetz (Health Qual Life Outcomes 3:79, 2005) and to analyse the validity and reliability of the questionnaire. METHODS Two hundred and one consecutive patients with RLS and forty-three control subjects were included in the study. Permission regarding the translation and validation of the RLS-QoL questionnaire was obtained. The translation was conducted according to the guidelines provided by the publisher. RESULTS For the RLS subjects, the mean Insomnia Severity Index (ISI) score, the International Restless Legs Syndrome Severity Rating Scale (IRLSSG) score and the computed score of the RLS-QoL questionnaire were 22.60 ± 3.39, 24.83 ± 5.28 and 45.93 ± 17.62, respectively. Among the RLS subjects without insomnia, the mean (±standard deviation) ISI score, IRLSSG score and computed score of the RLS-QoL questionnaire were 6.67 ± 2.34, 15.11 ± 4.03 and 41.93 ± 16.12, respectively. A significant difference was identified between both groups on all scores (ISI: p = 0.001, RLS: p = 0.001). The groups with and without insomnia were similar regarding the computed score of the RLS-QoL questionnaire (p = 0.140). According to a correlation analysis, a significant correlation was identified between the ISI and IRLSSG or RLS-QoL scores (r = 0.513, p = 0.001 and r = -0.383, p = 0.001, respectively). Although the coefficient of correlation is significant between IRLSSG score and RLS-QoL scale score, it should not be considered as a powerful enough correlation (r = 0.190, p = 0.007). Most items also exhibited a strong correlation with each other. The internal consistency determined by Cronbach's alpha indicated an extremely good correlation (0.975). DISCUSSION These findings suggest the Turkish version of the RLS-QoL questionnaire is a valid and reliable tool for the assessment of the quality of life in patients with RLS.
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Affiliation(s)
- Sibel Güler
- Department of Neurology, Faculty of Medicine, Trakya University , Edirne, Turkey.
| | - F Nesrin Turan
- Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Belcher R, Gumenyuk V, Roth T. Insomnia in shift work disorder relates to occupational and neurophysiological impairment. J Clin Sleep Med 2015; 11:457-65. [PMID: 25665690 DOI: 10.5664/jcsm.4606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/17/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether occupational and neurophysiological decrements within shift work disorder (SWD) are differentially related to its two diagnostic symptoms, insomnia and excessive sleepiness. METHODS Thirty-four permanent night workers participated in an overnight lab protocol including a multiple sleep latency test (MSLT) and an event-related brain potential (ERP) task testing auditory target detection (P3a and P3b). At 16:00, each subject completed an Endicott Work Productivity Scale (EWPS), two Insomnia Severity Indices (ISI-Day, ISI-Night), and an Epworth Sleepiness Scale (ESS). Subjects were grouped by ISI and ESS scores into clinical phenotypes. This study compared EWPS and ERP results between alert insomniacs ("AI," reporting insomnia without sleepiness), sleepy insomniacs ("SI," reporting both insomnia and sleepiness), and controls. RESULTS The AI group was most impaired on the EWPS, significantly more impaired than controls (25.8 ± 14.8 vs. 12.3 ± 9.4, p < 0.05). SI were not statistically different from controls (19.5 ± 8.7 vs. 12.3 ± 9.4, p > 0.05). Compared to controls, AI showed significantly attenuated P3a response (Fcz, Czp, Cpz, mean difference [MD] 1.62-1.77, p < 0.05) and target-detection P3b response (Fcz, Czp, Cpz, MD 1.28-1.64, p < 0.05). P3b in SI was not different from controls (p > 0.10), and P3a was only different at one electrode site (Cpz, MD 1.43, p < 0.01). Neither the MSLT nor the ESS correlated with EWPS scores or ERP (P3a/P3b) amplitudes (p > 0.10). However, the mean of the ISI measurements correlated with the EWPS (r = 0.409, p < 0.01) and the attention-to-novelty P3a (r = -0.410, p < 0.01). CONCLUSIONS Among shift work disorder patients, insomnia is linked to functional and cognitive impairments. Insomniacs with normal sleepiness showed more severe impairments than insomniacs who also reported excessive sleepiness.
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Affiliation(s)
- Ren Belcher
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.,Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Valentina Gumenyuk
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.,Magnetoencephalography Laboratory, Meadowlands Hospital, Secaucus, NJ
| | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
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Yazdi Z, Sadeghniiat-Haghighi K, Zohal MA, Elmizadeh K. Validity and reliability of the Iranian version of the insomnia severity index. Malays J Med Sci 2012; 19:31-36. [PMID: 23613647 PMCID: PMC3629678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 07/11/2012] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The Insomnia Severity Index (ISI) is a short subjective questionnaire which helps physicians in making decisions about patients suffering from insomnia. The present study was an attempt to test the reliability and validity of the Iranian version of the ISI and to measure the correlation between ISI items and polysomnography results in chronic insomnia patients. METHODS Two groups responded to the Persian translation of four questionnaires; ISI, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and General Health Questionnaire (GHQ). The first group consisted of 135 patients diagnosed with chronic insomnia, and the second group was comprised of 55 normal people. After completing the questionnaires, the insomniac patients underwent standard overnight polysomnography. RESULTS The internal consistency demonstrated by Cronbach's alpha coefficient was above 0.8 for both groups. The Intra-class correlation coefficient was above 0.7 after two weeks for both groups. The correlations between ISI, PSQI, ESS, and GHQ were high. In addition, close correlations were found between scores obtained from the ISI questionnaire items in insomniac patients with corresponding polysomnographic variables. CONCLUSION The Iranian version of the ISI is a reliable and valid instrument. It is a valuable short and first-line questionnaire for insomnia research and clinical work.
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Affiliation(s)
- Zohreh Yazdi
- Qazvin University of Medical Sciences, Qazvin, Iran
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