Dietary amino acid intake and sleep duration are additively involved in future cognitive decline in Japanese adults aged 60 years or over: a community-based longitudinal study.

BACKGROUND: Sleep duration and amino acid intake are independently associated with cognitive decline. This study aimed to determine the longitudinal association between sleep duration and cognitive impairment incidence and to examine the involvement of diet, particularly amino acid intake, in these associations in community dwellers. METHODS: In this longitudinal study in a community-based setting, we analyzed data from 623 adults aged 60-83 years without cognitive impairment at baseline. Sleep duration was assessed using a self-report questionnaire. Amino acid intake was assessed using 3-day dietary records. Cognitive impairment was defined as a Mini-Mental State Examination score ≤ 27. Participants were classified into short-, moderate-, and long-sleep groups according to baseline sleep duration (≤ 6, 7-8, and > 8 h, respectively). Using moderate sleep as a reference, odds ratios (ORs) and 95% confidence intervals (CIs) of short- and long-sleep for cognitive-impairment incidence were estimated using the generalized estimating equation. Participants were classified according to sex-stratified quartiles (Q) of 19 amino acid intake: Q1 and Q2-Q4 were low- and middle to high-intake groups, respectively. Using middle- to high-intake as a reference, ORs and 95% CIs of low intake for cognitive impairment incidence were estimated using the generalized estimating equation in each sleep-duration group. Follow-up period, sex, age, body mass index, depressive symptoms, education, smoking status, employment status, sleep aids use, physical activity, medical history, and Mini-Mental State Examination score at baseline were covariates. RESULTS: Mean follow-up period was 6.9 ± 2.1 years. Adjusted ORs (95% CIs) for cognitive impairment in short- and long-sleep groups were 0.81 (0.49-1.35, P = 0.423) and 1.41 (1.05-1.87, P = 0.020), respectively. Particularly in long sleepers (i.e., > 8 h), cognitive impairment was significantly associated with low cystine, proline, and serine intake [adjusted ORs (95% CIs) for cognitive impairment were 2.17 (1.15-4.11, P = 0.017), 1.86 (1.07-3.23, P = 0.027), and 2.21 (1.14-4.29, P = 0.019), respectively]. CONCLUSIONS: Community-dwelling adults aged ≥ 60 years who sleep longer are more likely to have cognitive decline, and attention should be paid to the low cystine, proline, and serine intake.

Parent-child co-sleeping in children with co-morbid conditions and sleep-disordered breathing.

PURPOSE: Co-sleeping is common in children with co-morbid conditions. The aim of the study was to analyze the prevalence and determinants of parent-child co-sleeping in children with co-morbid conditions and sleep-disordered breathing and the impact on parental sleep. METHODS: Parents of consecutive children undergoing a sleep study filled in a questionnaire on co-sleeping. RESULTS: The parents of 166 children (80 boys, median age 5.7 years (0.5-21) participated in this study. The most common co-morbid conditions of the children were Down syndrome (17%), achondroplasia (11%), and Chiari malformation (8%). The prevalence of parent-child co-sleeping was 46%. Reasons for co-sleeping were mainly reactive and included child's demand (39%), crying (19%), nightmares (13%), medical reason (34%), parental reassuring or comforting (27%), and/or over-crowding (21%). Sixty-eight percent of parents reported that co-sleeping improved their sleep quality because of reassurance/comforting (67%), reduced nocturnal awakening (23%), and child supervision (44%). Forty percent of parents reported that co-sleeping decreased their sleep quality because of nocturnal awakenings or early wake up, or difficulties initiating sleep (by 77% and 52% of parents, respectively), whereas both positive and negative associations were reported by 29% of the parents. Co-sleeping was more common with children < 2 years of age as compared to older children (p < 0.001). CONCLUSIONS: Parent-child co-sleeping is common in children with co-morbid conditions and sleep-disordered breathing. Co-sleeping was mainly reactive and had both positive and negative associations with parental sleep quality. Co-sleeping should be discussed on an individual basis with the parents in order to improve the sleep quality of the family.

Changes in sleep and fatigue in newly treated pediatric oncology patients.

BACKGROUND: Fatigue has been reported as one of the most distressing symptoms in oncology patients, yet few have investigated the longitudinal course of sleep and fatigue in newly diagnosed pediatric oncology patients. PROCEDURE: To longitudinally assess presence and changes of sleep complaints and fatigue, we administered questionnaires designed to measure sleep complaints, sleep habits, daytime sleepiness, and fatigue to parents of pediatric oncology patients ages 2-18 and to pediatric oncology patients, themselves, ages 8-18 within 30 days of diagnosis (n = 170) and again 8 weeks later (n = 153). RESULTS: Bedtimes, wake times, and sleep duration remained relatively stable across the first 8 weeks of treatment. Sleep duration and fatigue were not related for the entire sample, though children's self-reported sleep duration was positively correlated with fatigue only at the baseline time point. Parent reports of fatigue significantly decreased for leukemia patients but remained rather high for solid tumor and brain tumor patients. CONCLUSIONS: Because fatigue remained high for solid tumor and brain tumor patients across the initial 8 weeks of treatment, this may highlight the need for intervention in this patient population.

Sleep, mood, and quality of life in patients receiving treatment for lung cancer.

PURPOSE/OBJECTIVES: To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer. DESIGN: Descriptive, correlational study. SETTING: Two ambulatory oncology clinics. SAMPLE: 35 patients with lung cancer. METHODS: The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), a sleep diary, and a motionlogger actigraph. MAIN RESEARCH VARIABLES: Sleep, mood, and QOL. FINDINGS: Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures. CONCLUSIONS: Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance. IMPLICATIONS FOR NURSING: Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL. KNOWLEDGE TRANSLATION: A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had lower QOL. Sleep disturbances may be more related to lung cancer symptoms than anxiety or depression. Improving lung cancer symptoms such as dyspnea may improve sleep.

Nighttime sleep disruptions, the hospital care environment, and symptoms in elementary school-age children with cancer.

PURPOSE/OBJECTIVES: To describe nighttime sleep-wake patterns during a 12-hour night shift among school-age children with cancer receiving inpatient chemotherapy and relationships among nighttime sleep, environmental stimuli, medication doses, and symptoms during that shift. DESIGN: Exploratory, descriptive, multiple-case study. SETTING: Inpatient pediatric oncology unit at a tertiary pediatric hospital in the western United States. SAMPLE: 15 elementary school-age children with cancer receiving inpatient chemotherapy. METHODS: Wrist actigraphs measured sleep-wake patterns. Data loggers and sound pressure level meters measured bedside light, temperature, and sound levels. Medication doses and occurrences of pain, nausea, and vomiting were identified through chart review. MAIN RESEARCH VARIABLES: Minutes of sleep. FINDINGS: Sleep varied based on time of night (F = 56.27, p < 0.01), with sleep onset delayed past 10 pm. A basic mixed linear model identified significant fixed effects for sound (F = 50.87, p < 0.01) and light (F = 7.04, p < 0.01) on minutes of sleep. A backward regression model including sound, light, medication doses, pain, and nausea accounted for about 57% of the variance in sleep minutes (F = 62.85, p < 0.01). CONCLUSIONS: Sleep was marked by frequent awakenings, limiting children's ability to experience full sleep cycles. Multiple factors-in particular, excessive sound levels-compromise sleep quantity and quality throughout the night. IMPLICATIONS FOR NURSING: Efforts to develop and test individualized and system-based interventions to modify the hospital care environment to promote nighttime sleep are needed. Oncology nurses have the opportunity to influence the care environment at an individual level and to influence unit-based practices to promote a healthy nighttime sleep environment.

The nasal obstruction symptom evaluation survey as a screening tool for obstructive sleep apnea.

OBJECTIVE: To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used to identify patients at risk for obstructive sleep apnea (OSA). DESIGN: Intake surveys using the NOSE, Epworth Sleepiness Scale (ESS), and Snore Outcomes Scale (SOS) were administered to new patients visiting a facial plastic surgery practice and a rhinology practice. SETTING: An academic facial plastic surgery practice and an academic rhinology practice. PATIENTS: New patients to both practices. MAIN OUTCOME MEASURES: NOSE score and presence of septal deviation. RESULTS: The odds ratio (OR) for an ESS score higher than 10 was 2.98 (95% confidence interval [CI], 1.17-7.57) when snoring was present; 5.5 (95% CI, 1.35-22.58) when the NOSE score was 10 or higher; and 3.3 (95% CI, 0.98-11.0) when a deviated septum was found on clinical examination. The probability of an elevated ESS score was 88% when all 3 factors were present and 56% when the NOSE score was not elevated. Receiver operating characteristic analysis with predictors "snore" and NOSE score of 10 or higher had an area under the curve of 0.72. With a probability cutoff of 0.5, the sensitivity was 30%, and the specificity 90%. CONCLUSIONS: Sinonasal surgery is among the most common outpatient procedures performed in the United States each year. Many patients undergoing sinonasal surgery have undiagnosed OSA or nasal obstruction, a known risk factor for OSA. Patients with OSA have unique perioperative needs. In patients with nasal obstruction, a deviated septum, and/or snoring, there is an association between the NOSE score and the ESS score. The NOSE survey may serve as a simple screening instrument instead of the ESS for patients at risk for undiagnosed OSA and special perioperative needs.

Sleep quality after initial chemotherapy for breast cancer.

GOALS OF WORK: The goal of this study is to characterize sleep quality and quantity prior to and in the first three nights after initial chemotherapy for breast cancer. MATERIALS AND METHODS: This study makes use of secondary analysis of data from two separate randomized clinical trials (RCT) of behavioral interventions to improve fatigue and sleep. Patients came from two comprehensive cancer centers, three clinical cancer centers, and 10 community clinics in five states. Participants were women with stage I-IIIA breast cancer treated with anthracycline and/or cyclophosphamide-based regimens. MAIN RESULTS: Baseline data from each RCT were used in the analysis. Sixty-five percent of women self-reported poor sleep in the month preceding chemotherapy using the Pittsburgh Sleep Quality Index (PSQI) score >5. Three nights of actigraphy data indicated a wide range of sleep experience with an average of 10 awakenings and time (minutes) awake after sleep onset (WASO-M) averaging 61 min per night. The first night's sleep was the worst. There was no statistically significant relationship between self-reported poor sleep and sleep measures obtained by actigraphy. Women with poor sleep at baseline (global PSQI >5) had significantly lower (p < 0.001) physical (PCS) and mental (MCS) health status. However, neither the PCS nor MCS was associated with any of the average actigraphy sleep parameters or night 1 parameters in the aggregated sample. Increasing age was also associated with poorer sleep. CONCLUSIONS: A high percent of women with breast cancer begin chemotherapy with disturbed sleep and the initial nights after chemotherapy are characterized by sleep fragmentation that disrupts sleep maintenance. Interventions should focus on strategies to decrease the number and duration of night awakenings. Further research is needed to identify predictors of poor sleep during this time.

The validity and clinical utility of night eating syndrome.

OBJECTIVE: To review the empirical literature for evidence in support of inclusion of Night Eating Syndrome (NES) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. METHOD: Based on a literature search using PubMed, 47 empirical studies of NES were identified. RESULTS: The literature reflects use of varying definitions; progress has been made toward reliable measurement of night eating symptoms; evidence regarding a differentiation of NES from "normalcy" or from other eating disorders is based largely on samples of convenience; only one controlled treatment study has been published. DISCUSSION: There are limited data supporting the clinical utility and validity of NES; several options regarding the inclusion of NES in DSM-V are discussed.

Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer.

PURPOSE/OBJECTIVES: To describe nocturnal awakenings and sleep environment interruptions experienced by children and adolescents hospitalized for two to four days to receive chemotherapy and to assess the relationships among nocturnal awakenings, sleep environment interruptions, sleep duration, and fatigue. DESIGN: Longitudinal, descriptive design. SETTING: St. Jude Children's Research Hospital and Texas Children's Cancer Center. SAMPLE: 25 patients with solid tumors and 4 with acute myeloid leukemia. METHODS: Actigraphy, fatigue instruments, sleep diary, room entry and exit checklists, and blood samples. MAIN RESEARCH VARIABLES: Nocturnal awakenings, sleep environment interruptions, sleep duration, and fatigue. FINDINGS: The number of nocturnal awakenings per night as measured by actigraphy ranged from 0-40. The number of room entries and exits by a staff member or parent was 3-22 times per eight-hour night shift. The number of nocturnal awakenings was related to fatigue by patient report; patients who experienced 20 or more awakenings had significantly higher fatigue scores than those with fewer awakenings. Nocturnal awakenings also were significantly associated with sleep duration by patient and parent report. CONCLUSIONS: Hospitalized pediatric patients with cancer who experience more nocturnal awakenings are more fatigued and sleep longer. IMPLICATIONS FOR NURSING: Nurses may be able to control some of the factors that contribute to nocturnal awakenings and sleep environment interruptions that affect fatigue and sleep duration in hospitalized pediatric patients with cancer.