Funnel Shaped Anterior Communicating Artery Fenestration Mistaken for an Aneurysm: A Cautionary Tale.

This report portrays a case of a funnel shaped anterior communicating artery (ACoA) fenestration which was mistaken as a small A1 aneurysm in a subarachnoid hemorrhage case. Although tridimensional rotational digital subtraction angiography improves aneurysm diagnosis specially at the ACoA complex, current spatial resolution might leave behind a considerable percentage of ACoA fenestrations. This may lead to diagnostic errors and unnecessary treatments risking iatrogenic complications. Luckily for our patient, a concomitant aneurysm warranted clipping and subsequent surgical exploration of the ACoA complex revealed the pitfall, thus preventing further action. Interestingly, another group of authors who reported similar misdiagnosis with ACoA aneurysms were able to prevent a third error, thanks to the experience acquired with 2 prior cases. Therefore, this clinical image aims to raise wider awareness of the need for very cautious consideration of imaging depicting small and/or atypical aneurysms in the ACoA complex.

Neurosurgical emergency management during the lockdown period in health care regions in Spain with different COVID-19 impact: lessons learned to improve outcomes on the future waves.

BACKGROUND: COVID-19 has overloaded health care systems, testing the capacity and response in every European region. Concerns were raised regarding the impact of resources' reorganization on certain emergency pathology management. The aim of the present study was to assess the impact of the outbreak (in terms of reduction of neurosurgical emergencies) during lockdown in different regions of Spain. METHODS: We analyzed the impact of the outbreak in four different affected regions by descriptive statistics and univariate comparison with same period of two previous years. These regions differed in their incidence level (high/low) and in the time of excess mortality with respect to lockdown declaration. That allowed us to analyze their influence on the characteristics of neurosurgical emergencies registered for every region. RESULTS: 1185 patients from 18 neurosurgical centers were included. Neurosurgical emergencies that underwent surgery dropped 24.41% and 28.15% in 2020 when compared with 2019 and 2018, respectively. A higher reduction was reported for the most affected regions by COVID-19. Non-traumatic spine experienced the most significant decrease in number of cases. Life-threatening conditions did not suffer a reduction in any health care region. CONCLUSIONS: COVID-19 affected dramatically the neurosurgical emergency management. The most significant reduction in neurosurgical emergencies occurred on those regions that were hit unexpectedly by the pandemic, as resources were focused on fighting the virus. As a consequence, life-threating and non-life-threatening conditions' mortality raised. Results in regions who had time to prepare for the hit were congruent with an organized and sensible neurosurgical decision-making.

Venous tortuosity as a novel biomarker of rupture risk in arteriovenous malformations: ARI score.

BACKGROUND: Risk of rupture in arteriovenous malformations (AVMs) varies considerably among series. Hemodynamic factors, especially within the venous side of the circuit, seem to be responsible but are not yet well defined. We analyzed tortuosity in the draining vein as a potential new marker of rupture in AVMs, and propose a simple index to predict AVM bleeding. METHODS: A retrospective analysis of the venous angioarchitecture of brain AVMs was carried out at our center from 2013 to 2021, with special attention to venous tortuosity. After univariate analysis, the features of interest were combined to construct several predictive models using multivariate logistic regression. The best model proposed was the new AVM rupture index (ARI), which was then validated in an independent cohort. RESULTS: 68 AVMs were included in the first step and 32 in the validation cohort. Venous tortuosity, expressed as at least one curve >180°, was a significant predictor of rupture (p=0.023). The proposed bleeding index consisted of: venous tortuosity (any curve of >180°), single draining vein, and paraventricular/infratentorial location. It seems to be a robust evaluation tool, with an area under the receiver operating characteristic (AUROC) curve of 0.806 (95% CI 0.714 to 0.899), consistently replicated in the independent sample (AUROC 0.759 (95% CI 0.607 to 0.911)), and with an inter-rater kappa coefficient of 0.81 . CONCLUSIONS: Venous tortuosity may serve as a predictor of bleeding in AVMs that warrants further investigation. This likely new marker was one of the three elements of the proposed ARI. ARI outperformed the predictive accuracy of previous scores, and remained consistent in an independent cohort.

Impact of axial spondyloarthritis on mental health in Europe: results from the EMAS study.

OBJECTIVE: To determine the presence of mental disorder risk and associated factors in European patients with axial spondyloarthritis (axSpA). METHODS: Data from 2,166 patients with axSpA in 12 European countries were collected from 2017 to 2018 through the European Map of Axial Spondyloarthritis online survey. Risk of mental disorders was assessed using the 12-item General Health Questionnaire. Possible predictors included age, gender, relationship status, patient organisation membership, job status, educational level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional limitation (0-54) and self-reported depression or anxiety. Bivariate analyses were conducted to determine predictors of risk of mental disorders (Mann-Whitney and χ2) and multivariable analysis identified factors associated with risk of mental disorders. RESULTS: 60.7% of patients reported risk of mental disorders: they were younger (41.7 vs 46.0 years), more likely female (68.2% vs 57.9%), unemployed (7.5% vs 2.7%), on temporary (15.9% vs 5.4%) or permanent sick leave (13.2% vs 8.0%), reported depression (45.2% vs 14.2%) or anxiety (41.3% vs 12.5%), higher disease activity (BASDAI ≥4; 87.6% vs 62.3%) and functional limitation (16.5 vs 10.8). The factors most associated with risk of mental disorders were disease activity (OR=2.80), reported depression (OR=2.42), anxiety (OR=2.39), being unemployed or on sick leave (OR=1.98), functional limitation (OR=1.02) and younger age (OR=0.97). CONCLUSIONS: Compared with the general population, patients with axSpA show disproportionately worse mental health associated mainly with disease activity and employment status. Healthcare professionals should pay close attention to patients with high disease activity and address internally or refer to specialist services, where appropriate to ensure optimal patient outcomes.

Dural Venous Sinus Variations in Idiopathic Subarachnoid Hemorrhage: A New Indicator of the Venous Origin with Diagnostic Usefulness?

OBJECTIVE: Venous hypertension associated with a primitive basal vein of Rosenthal (BVR) has been noted as the most likely cause of idiopathic subarachnoid hemorrhage (iSAH). Other types of venous drainage variations have been scarcely studied but may further explain the cases not associated with a BVR anomaly. Our aim was to investigate if dural venous sinus (DVS) anomalies are related with iSAH. METHODS: A total of 76 patients diagnosed with iSAH were identified from a prospectively maintained database and their angiographic findings compared with 76 patients diagnosed with aneurysmal subarachnoid hemorrhage. RESULTS: On top of the BVR variations, our data showed a higher prevalence of transverse sinus hypoplasia (47.4% vs. 28.9%; P = 0.019), superior petrosal sinus hypoplasia (32.9% vs. 13.2%; P = 0.003), and clival plexus hyperplasia (65.8% vs. 43.4%; P = 0.005) in patients with iSAH. Analyzing by total number of angiograms, the iSAH group showed also a higher prevalence of inferior petrosal sinus hyperplasia (36.2% vs. 25%; P = 0.003). Of the patients with iSAH without a primitive BVR, 84% harbored ≥1 perimesencephalic DVS variation and the overall number of venous drainage variations was significantly higher in patients with iSAH. CONCLUSIONS: In addition to the well-documented BVR anomalies, there seems to be a significant relationship of other DVS variations in patients with iSAH. Transverse sinus hypoplasia, superior petrosal sinus hypoplasia, inferior petrosal sinus hyperplasia, and clival plexus hyperplasia were significantly more frequent in patients with iSAH. The presence of ≥3 of those variations would increase the suspicion of a nonaneurysmatic subarachnoid hemorrhage and could help avoid a second angiogram.

Influence of Depression and Anxiety on Hemodialysis Patients: The Value of Multidisciplinary Care.

Affective disorders promote poorer outcomes in hemodialysis patients. According to the presence or not of depression/anxiety in these patients, aims were to analyze differences in sociodemographic, clinical and/or psychological factors and to identify predictors. One hundred eighty-six hemodialysis patients were classified based on their depression/anxiety status. Basal characteristics showed differences between groups where mainly male sex (Depression: OR 0.2; Anxiety: OR 0.3) albumin (Depression: OR 0.1; Anxiety: OR 0.2) and calcium levels (Depression: OR 0.5; Anxiety: OR 0.4), impaired quality of life (Depression: OR 1.4; Anxiety: OR 1.2) and psychological inflexibility (Depression: OR 1.3; Anxiety: OR 1.2) were associated (all p < 0.01) to these mental conditions. Multivariate models showed that worse quality of life (OR 1.3; p < 0.001) predicted depression while marital status (with a partner; OR 0.3; p = 0.025) and albumin levels (OR 0.1; p = 0.027) were protective factors. Depression represented a risk factor for anxiety (OR 1.2; p = 0.001), although calcium levels (OR 0.5; p = 0.039) would protect this state. Interestingly, psychological inflexibility predicted both disorders (Depression: OR 1.2, p < 0.001 and Anxiety: OR 1.1; p = 0.002). Results highlight the relevance of well-trained multidisciplinary hemodialysis units to control the influence of these factors on the presence of depression/anxiety, and thus, their impact on the patients' outcomes.

Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS).

INTRODUCTION/OBJECTIVES: To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. METHOD: Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017-2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity -BASDAI (0-10), spinal stiffness (3-12), functional limitations (0-54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. RESULTS: In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), as well as a greater use of alternative therapies. CONCLUSION: The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention. Key Points • Healthcare professionals' perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and management of the disease. However, evidence about male-female differences in axSpA is scarce. • EMAS results highlight how female axSpA patients report longer diagnostic delay and higher burden of the disease in a large sample of 2846 participants of 13 European countries. • Results reflect unmet needs of European female patients. Healthcare professionals should pay close attention in order to accurately diagnose and efficiently manage axSpA cases while further research should be developed on the cause of reported gender differences.

Patient-Reported Impact of Axial Spondyloarthritis on Working Life: Results From the European Map of Axial Spondyloarthritis Survey.

OBJECTIVE: To evaluate work-related issues (WRIs) and their determinants in patients with axial spondyloarthritis (SpA) across Europe. METHODS: The European Map of Axial Spondyloarthritis is a cross-sectional online survey (2017-2018) of unselected patients with self-reported axial SpA from 13 European countries. Participants were classified as active or inactive members of the labor force according to the International Labor Organization standards. Those employed reported WRIs due to axial SpA in the past 12 months. Sociodemographic characteristics and patient-reported outcomes were compared between patients with and without WRIs. Stepwise regression analysis was conducted to identify independent determinants of WRIs. RESULTS: The sample comprised 2,846 patients with axial SpA, 1,653 were active members of the labor force, 1,450 were employed, and of those employed, 67.7% reported at least 1 WRI. The most frequently reported WRIs were taking sick leave (56.3%), difficulty fulfilling working hours (44.6%), and missing work for doctor's appointments (34.6%). Of the total sample, 74.1% declared that they had faced or would face difficulties finding a job due to axial SpA. Patients with WRIs were more often female, were less likely to be married or in a relationship, and had a higher educational level, poorer patient-reported outcomes, and a greater prevalence of anxiety and depression. Multivariable regression showed that WRIs were associated with a higher Bath Ankylosing Spondylitis Disease Activity Index score (odds ratio [OR] 1.30 [95% confidence interval (95% CI) 1.16-1.45]) and the 12-item General Health Questionnaire score (OR 1.15 [95% CI 1.09-1.22]), and were negatively associated with inflammatory bowel disease (OR 0.58 [95% CI 0.36-0.91]). CONCLUSION: Approximately two-thirds of employed patients experienced WRIs due to axial SpA. Association between disease activity and psychological distress with WRIs suggests the need to ensure that axial SpA patients receive the required support to cope with their working life.

Iatrogenic Intracranial Aneurysm After External Ventricular Drain Placement: Traumatic or Mycotic Origin? Case Report and Literature Review.

BACKGROUND: Intracranial iatrogenic aneurysms (IIAs) developing after external ventricular drain (EVD) placement or removal have been only rarely reported. Most of these reports assumed a traumatic etiology; however, some have demonstrated an inflammatory origin. We have presented the case of an IIA that developed after an EVD had been inserted to treat acute hydrocephalus secondary to a ruptured arteriovenous malformation. We also performed a literature review and discussed how these IIAs might have an inflammatory rather than a traumatic etiology and how they might lie behind some of the cases of idiopathic hemorrhage observed after EVD manipulation. CASE DESCRIPTION: A 48-year-old woman had presented with acute hydrocephalus secondary to bleeding from a vermian arteriovenous malformation. The EVD inserted for hydrocephalus management required several revisions because of malfunction. Four weeks later, a diagnostic arteriogram had incidentally revealed the existence of a 5-mm aneurysm in an anterior branch of the right callosomarginal artery, coincidental to the EVD trajectory. The patient underwent emergent endovascular treatment of the aneurysm, with complete occlusion and no complications deriving from the procedure. CONCLUSIONS: IIAs associated with EVD placement or removal have been described as a rare complication of the procedure. Despite the scarce number of cases reported and the lack of histological examinations, common features such as a distal location, an incidental diagnosis, and a benign clinical course might suggest a mycotic or inflammatory origin rather than a traumatic etiology. Considering the high volume of EVDs placed annually, this complication might be more frequent than reported. Further studies investigating the association of risk factors for inflammatory aneurysms and hemorrhage incidence after EVD could provide information on this intriguing topic.

Amateur Endurance Athletes: At Higher Risk of Suffering Dural Arteriovenous Fistulas? Report of 3 Cases.

BACKGROUND: The present study aims to draw attention to the fact that endurance sport could be a risk factor for dural arteriovenous fistula (DAVF) development. DAVFs have been correlated with acquired dural venous sinus anomalies owing to trauma, infection, neoplasia, or other classic risk thrombogenic factors. Here we report 3 cases of intracranial DAVF in young healthy patients who had no known thrombogenic risk factors other than amateur intensive sports practice. CASE DESCRIPTION: Three young healthy individuals not fitting into the classical clinical picture of a DAVF patient presented to our institution. One was a 40-year-old man with an acute subdural hematoma secondary to an ethmoidal DAVF. Another 41-year-old man presented with a cerebellar hematoma due to a tentorial DAVF. A third 41-year-old man presented with numbness of his right arm in relationship to a superior sagittal sinus DAVF. None of them had a relevant medical history. All the usual thrombogenic risk factors for DAVF development were ruled out. Interestingly, the 3 patients had outstanding training and practice routines for endurance sports. CONCLUSIONS: Dehydration, microfractures, muscular contractures, low heart rate, long distance travel, and high altitudes are all well documented thrombogenic risk factors affecting endurance sports amateur athletes and might represent a plausible mechanism for the development of DAVF. Despite its limitations, to our knowledge, this is the first work suggesting a possible link between such sport practice and DAVF development. Further prospective research from larger dedicated vascular centers might shed further light on this hypothetic but intriguing link.

Psychological inflexibility and clinical impact: Adaptation of the acceptance and action questionnaire-II in a sample of patients on haemodialysis treatment. / Inflexibilidad psicológica e impacto clínico: adaptación del Cuestionario de Aceptación y Acción-II en una muestra de pacientes en tratamiento de hemodiálisis.

BACKGROUND AND OBJECTIVES: Few studies have investigated the role psychological inflexibility (PI) could have in the context of chronic renal failure. The primary objective of this study was to analyse the psychometric features, the reliability and the validity of the Spanish version of the Acceptance and Action Questionnaire-II (AAQ-II) adapted to the context of patients undergoing haemodialysis (HD). The secondary objective was to assess the relationship between PI and parameters related to the adherence to treatment and quality of life in these types of patients. MATERIALS AND METHODS: Prospective cross-sectional study with patients on haemodialysis (n=186). RESULTS: The fat tissue index (15.56±5.72 vs. 18.99±8.91, P=.033), phosphorus levels (3.92±1.24 vs. 4.66±1.38; P=.001) and interdialytic weight gain (1.56±0.69 vs. 1.89±0.93, P=.016) were higher in patients with a higher PI score. Phosphorus levels (P=.013) significantly explained the variability of PI levels. PI was also shown as a significant predictor (P=.026) of the variability of phosphorus levels. CONCLUSIONS: The adaptation of the AAQ-II questionnaire to the HD context led to a valid and reliable measurement of PI in these types of patients and our results also seem to support the relationship between PI and health and quality of life parameters in patients with chronic conditions.

Growth prediction in asymptomatic meningiomas: the utility of the AIMSS score.

BACKGROUND: Management of asymptomatic meningiomas represents a challenge due to the absence of a solid consensus on which is the best management strategy. There are various known factors predicting meningiomas growth risk. However, the Asian Intracranial Meningioma Scoring System (AIMSS) is the only described score to quantify such risk thus emerging as a potential tool for management decisions. This study aims to validate this score on our series of asymptomatic meningiomas. METHOD: We performed a retrospective review of asymptomatic meningiomas diagnosed at our institution between January 2008 and October 2016 and followed by an annual cerebral Magnetic Resonance Imaging (MRI). For each lesion, the AIMSS score was calculated thus classifying them in low (0-2), intermediate (3-6) or high risk (7-11) of rapid growth (>2cm3/year). We investigated the correlation between the expected Average Growth Rate (AGR) according to the score and the one obtained in our study. The mean growth velocity over the different risk groups was also compared. RESULTS: Overall, 69 asymptomatic meningiomas found incidentally in 46 patients were included in the study; 31 were assigned to the low-risk group, 34 to the intermediate-risk group and 4 to the high-risk group. Attending to the AGR, 0% showed rapid growth in the low-risk group, 12% in the intermediate-risk group, and 25% in the high-risk group. The mean growth velocity showed a significant difference over the different risk groups (p < 0,001). CONCLUSIONS: According to our finding, the AIMSS score is a valid tool to estimate the risk of rapid growth of asymptomatic meningiomas. It is especially useful distinguishing between low- and intermediate-risk meningiomas. This feature would allow physicians to adjust the periodicity of radiological and clinical controls. Adding more known risk factors of rapid growth to the score might improve its predictive capabilities with the high-risk group.

The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective-an Analysis of 2846 Patients Across 13 Countries.

PURPOSE OF REVIEW: Scientific research in axial spondyloarthritis (axSpA) has grown significantly. Nevertheless, the patient perspective remains insufficiently explored. Using a cross-sectional survey, the European Map of Axial Spondyloarthritis (EMAS) describes how patients living with self-reported axSpA experience their disease physically, psychologically, and socially. RECENT FINDINGS: 2846 patients participated: mean age 43.9 ± 12.3 years, 61.3% female, mean disease duration was 17.2 ± 12.4 years, and 71.3% were HLA-B27 positive. Mean diagnostic delay was 7.4 ± 8.4 years. Mean BASDAI score was 5.5 ± 2.0 and 75.7% reported moderate/severe spinal stiffness throughout the day. Daily life was substantially impaired: 74.1% reported difficulties finding a job due to the disease, and 61.5% reported psychological distress. EMAS results showed long diagnostic delay and substantial physical and psychological burden, indicating important unmet needs for patients. Furthermore, axSpA restricted patients' ability to participate in their daily routine and lead a productive work life. Understanding the patient's perspective can improve both health outcomes and shared decision-making between patient and rheumatologist.

Escala de actitud favorable hacia la violación: primeras evidencias acerca de su fiabilidad y validez en muestras salvadoreñas / Rape supportive attitude scale: first evidence on its reliability and validity in the salvadorian samples

Las actitudes tolerantes hacia la violencia sexual ejercida contra las mujeres constituyen un factor de riesgo importante a considerar en la explicación de este tipo de conductas agresivas. Uno de los instrumentos para evaluar estas actitudes es la Escala de Actitud Favorable hacia la Violación (EAFV) de Lottes, la cual ha mostrado buenos índices de fiabilidad y validez, tanto en muestras de estudiantes universitarios estadounidenses como españoles. El objetivo de este estudio es explorar sus características psicométricas en El Salvador, para lo cual fue aplicada conjuntamente con la Escala de Doble Moral de Caron, Davis, Haltelman y Stickle (1993) y la Escala de Deseabilidad Social de Crowne y Marlowe (1960) a dos muestras de 505 y 1.499 estudiantes universitarios, respectivamente. Los resultados indican que la estructura unidimensional de la escala se mantiene estable en las dos muestras, alcanzando coeficientes de consistencia interna superiores a 0.80, aunque incluye dos ítems que requieren de una revisión en futuros estudios. En cuanto a la validez, la EAFV es capaz de diferenciar a hombres y mujeres en este tipo de actitudes, y muestra una correlación positiva significativa con la doble moral sexual.

The tolerant attitudes towards sexual violence on women are important risk factor which should be considered whileexplaining this type of aggressive behaviour. One of the instruments to evaluate these attitudes is Rape Supportive Attitude Scale (RSAS) by Lottes. The scale has showed good indexes of reliability and validity in both American and Spanish university students. The purpose of the study is to explore the psychometric characteristics in El Salvador as it has been applied together with the Double Standard Scale by Caron, Davis, Haltelman and Stickle (1993) and Crowne and Marlowe (1960) Social Desirability Scale in two samples which consisted of 505 and 1499 students, respectively. The results indicate that the one-dimensional structure of the scale stays stable in the two samples reaching the coefficients of internal consistence higher than .80, although it includes two items which requires to be reviewed in future studies. Concerning the validity, the RSAS differentiates men and women in these types of attitudes and shows significant positive correlation with double sexual standard.

Propriedades piscométricas de la dysfunctional beliefs and atitudes about sleep scale (DBAS) en una muestra española de sujetos normales / Psychometric properties of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) in healthy Spanish subjects

There exists evidence supporting the relationship between dysfunctional thoughts concerning sleep and insomnia sustenance. The Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) is used to detect these thoughts, which according to the author contains five dimensions: Consequences of insomnia, Control and predictability of sleep, Sleep requirement expectations, Causal attributions of insomnia, and Sleep-promoting practices. This study presents the first psychometric data for the Spanish version of the DBAS, in which an item analysis, a factorial analysis, and a reliability study are included, and with the resultant scale structure "good" and "bad" sleepers are distinguished in order to provide validity. The results indicate that the theoretical dimensions proposed by Morin (1993) do not present an adequate homogeneity, as presented in the moderate, low, and even nonexistent total item correlation values. Therefore, reflecting a low internal consistency in three of the five supposed dimensions. The exploratory factorial analysis only obtained one factor of the 15 items with adequate psychometric guarantees (DBAS-15), from which we can differentiate "bad sleeper" from "good sleeper" subjects.

Existe evidencia acerca de la asociación entre pensamientos disfuncionales sobre el sueño y el mantenimiento del insomnio. En la detección de estos pensamientos se suele utilizar la Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) que según su autor incluye cinco dimensiones: Consecuencias del insomnio, Control y predicción del sueño, Expectativas no realistas sobre el sueño, Atribuciones causales del insomnio y Creencias sobre las prácticas que promueven el sueño. En este estudio se presentan los primeros datos psicométricos de la versión española de la DBAS, en donde se incluye un análisis de ítem, un análisis factorial, un estudio de la fiabilidad y, con la estructura resultante de la escala, se diferencia entre "buenos" y "malos" dormidores, con el fin de darle validez. Los resultados indican que las dimensiones teóricas propuestas por Morin (1993), no presentan una homogeneidad adecuada, encontrándose valores de correlación ítem-total moderados, bajos o incluso inexistentes, lo que se refleja en una consistencia interna baja en tres de las cinco supuestas dimensiones. El análisis factorial exploratorio permite obtener solamente un factor de 15 ítems con unas adecuadas garantías psicométricas (DBAS-15), a partir del cual podemos diferenciar a sujetos "malos dormidores" de "buenos dormidores".

Evaluación de la relación entre rasgos psicopatológicos de la personalidad y la calidad del sueño

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Abstract: Introduction. Diverse studies llave demonstrated the relationship between psychopathology and sleep alterations. Data proceeding from the ambulatory psychiatric field show that 70-75% of the patients experience sleep problems. The most frequent complaints refer to nighttime sleep alterations, excessive daytime sleep, difficulty with morning waking, and disturbances in the circadian rhythm of the sleep-wake cycle. Many studies, most of which use patient samples, have associated psychopathological personality traits and sleep disorders. All of these studies reveal that subjects with sleep disorder tend to be characterized by psychopathological traits (anxiety, psychasthenia, depression, etc.). There is some evidence that the structure of some dream dysfunctions (such as insomnia) is similar among general population and psychiatric samples; differences are more quantitative than qualitative. In samples of university students, the percentage of individuals who report bad sleep quality has been similar to the percentage of insomniacs in general population. With the aim to delve more deeply into the analogy between the sleep quality of normal subjects and clinical samples, and given the shortage of studies relating psychopathological traits of personality and sleep quality in normal population, this study intends to explore the relationship between the psychopathological personality variables included in the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the sleep quality evaluated with the Pittsburg Sleep Quality Index in a sample ofsubjects who have no diagnosed sleep disorder. The psychopathological variables included in the MMPI-2 which predict sleep quality in a non-clinical sample are also determined. Methodology. A sample of 222 individuals (186 women and 36 men) with a mean age of 21.65 years (SD=2.81) completes the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Pittsburg Sleep Quality Index (PSQI), which provide an overall sleep quality measure and seven partial scores for different dimensions: Subjective sleep quality, Sleep latency, Sleep duration, Sleep habit efficiency, Sleep alterations, the use of hypnotic medication, and daytime dysfunction. Results. Some psychopathological traits (hypochondria, anxiety, and depression) correlate positively with almost all of the sleep quality dimensions comprising the PSQI. From a logistic regression model developed to predict the probability of being a good or bad sleeper, hypochondria and anxiety are the only statistically significant predictors. Discussion and conclusions. Human sleep, from a behavioral perspective, would be explained from four different dimensions: Circadian time (sleep-wake cycle situation on the nictemero), Organism (intrinsic factors such as age, sleep patterns, emotional states, etc.), Behavior (facilitating or inhibiting behaviors), and Environment (temperature, light, noise, etc.). Psychopathological personality traits, the main objective of this study, can also be included within the second component (organism). Previous studies using the MMPI have associated insomnia to high anxiety levels, depression, hypochondria, hysteria, and psychasthenia. The MMPI has also been considered to be a useful instrument in identifying different personality profiles ininsomnia subjects. There are, however, only a few studies focusing on the relationship between these personality traits and sleep quality in normal subjects. The results indicate that this study sample the subjects do not present serious sleep disorders. All of the components pertaining to the Pittsburg Sleep Quality Index present mean scores below the middle response range, situated in 1.5. However, if we consider the total score and bear in mind that a score of five is the cut-off point used to differentiate good sleepers from bad sleepers, we can classify 45.94% of the sample as bad sleepers. In considering the scores for the different MMPI-2 clinical scales, we should mention that none of them reached the typical score of 60; therefore no trait was found to be clinically significant. Some psychopathological traits are linked to almost all of the sleep quality dimensions. Hypochondria, anxiety, and depression are present in the associations with subjective sleep quality, disturbances, or daytime sleepiness. Though no stronger relations between use of hypnotic medication and psychopathological traits have been found (none of them above 0.30), a similar trend on patients dependent on benzodiazepines (predominating traits as depression, psychasthenia and schizophrenia) has been showed. It is also important to point out the relationship between daily dysfunction and the WRK scale (work interferences), which reveals the negative effects of daytime sleepiness, even in subjects who do not present important sleep disorders, as in this sample. On the other hand, the relationship between daily dysfunction and hypochondria, depression, and schizophrenia found in this study has previously been verified in patients with excessive daytime sleepiness. When considering the global score, we can clearly inform that health concerns (reflected in the Hs, HEA, and Hy scales) and the negative emotional states (D, ANX, and DEP scales) are related to sleep quality. These two factors (health concerns and anxiety) are part of the regression model, revealing that an increase in hypochondria and anxiety scores significantly increases the probability of being a bad sleeper, that is to say, of having a poor sleep quality. This explicative model presents a good predictive capacity which allows us to correctly classify 68.50% of the sample. We can correctly predict 78.30% of the good sleepers and 53.90% ofthe bad sleepers (scores higher than 5 on the Pittsburg global index), which grants the model an adequate specificity and sensibility. It is, however, necessary to consider that data used for the estimation respond to a range of restricted scores, causing any effect to be much less important than if we had worked with a more heterogeneous group of subjects. For example, global sleep quality scores can oscillate between 0 and 21, but in our sample they are comprised between 0 and 15. It is possible that, in including subjects who present high scores on the scales used in this study, a greater number of significant sleep quality predictors with greater magnitudes would be emphasized. Nevertheless, our interest resides in exploring the relationship between health concerns, anxiety and depression levels, and sleep quality in a non-clinical sample. So far, this relationship has not been explored in depth. One common limitation of these non-randomized studies is the difficulty to generalize findings to the normal population. Nevertheless, we assume higher possibilities to generalize findings if our study results are similar to those obtained from other non-clinical samples. In conclusion, health concerns and anxiety levels are the psychopathological traits most related to sleep quality and which hold a certain capacity to determine this quality in a sample of normal subjects. Both variables are clearly related to insomnia, as has been revealed in many insomnia patient studies. Therefore, we can verify that the pattern followed in the relationship between psychopathological traits and sleep quality in a non-clinical sample is similar to that found in sleep disorder patient samples, supporting that relationship between psychopathological traits and sleep quality in normal subjects opposite to patients with dream disorders can be drawn more easily from a quantitative than a qualitative approach.