Factores predictores de la calidad del sueño en pacientes con migraña crónica / Predictive factors of sleep quality in patients with chronic migraine

Introducción: Uno de los factores contribuyentes en la cronificación de la migraña son los trastornos del sueño que pueden actuar como un factor precipitante y/o perpetuador en estos sujetos. El objetivo primario de este estudio fue identificar los factores predictores relacionados con la calidad del sueño en pacientes con migraña crónica (MC) y el objetivo secundario fue identificar si existían diferencias en variables psicológicas y de discapacidad entre los pacientes con MC que presentaban menor o mayor calidad del sueño. Métodos: Se llevó a cabo un estudio observacional, transversal, formado por 50 participantes con MC. Se registraron una serie de variables demográficas, psicológicas y de discapacidad mediante cuestionarios de autorregistro. Resultados: Se observaron correlaciones directas, moderadas-fuertes, entre las diferentes variables de discapacidad y psicológicas analizadas (p < 0,05). En la regresión, se estableció como variable criterio la calidad del sueño y las variables predictores fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y el catastrofismo ante el dolor que, en conjunto, explican el 33% de la varianza. En cuanto a la comparación de los grupos de mayor y menor afectación del sueño, se encontraron diferencias estadísticamente significativas en la variable de síntomas depresivos (p = 0,016) y catastrofismo ante el dolor (p = 0,036). Conclusiones: Los factores predictores de la calidad del sueño en pacientes con MC fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y, en menor medida, el catastrofismo ante el dolor. Los sujetos con peor calidad de sueño presentaron mayores niveles de catastrofismo ante el dolor y síntomas depresivos. (AU)

Introduction: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. Methods: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. Results: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). Conclusions: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms. (AU)

Is time elapsed between cannabis use and sleep start time associated with sleep continuity? An experience sampling method.

BACKGROUND: A substantial proportion of people using cannabis report using it to improve sleep. Yet, little research exists on the associations between the timing of cannabis use and sleep. This study examines the time elapsed between cannabis use and sleep start time and its association with two of the main indicators of sleep continuity: (1) sleep onset latency (SOL) and (2) number of awakenings (NOA) throughout the night. METHODS: Each morning, for 7 consecutive days, daily cannabis users (n = 54) reported on the timing of previous night's cannabis use and sleep indicators on their smartphones. Mixed effects models examined the relations of within- and between-subjects' time elapsed between previous night cannabis use and sleep start time, with (1) SOL and (2) NOA. RESULTS: Within subjects, shorter time elapsed between cannabis use and sleep start time was associated with shorter SOL (ß = 0.519, p = 0.010), but not NOA (ß = -0.030, p = 0.535). Furthermore, between individuals, the time gap between the previous night cannabis use and sleep start time was not associated with SOL or NOA (p > 0.05). CONCLUSIONS: It is possible that cannabis use proximal to bedtime is associated with shorted sleep onset latency but not nighttime awakenings. Cannabis users should be informed about both the potential sleep aid effects of cannabis and its limitations. Pending further evidence of the effects of cannabis on sleep, cannabis users experiencing sleep problems should be provided with evidence-based alternatives to improve sleep, e.g., pharmacological and behavioral treatments.

Quality of life and contact with healthcare systems among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP).

Psoriasis (skin psoriasis, PsO) is a chronic inflammatory condition. In about one-third of cases, the joints are affected (psoriatic arthritis, PsA). Both conditions, especially PsA, profoundly impact patients' health-related quality of life (HRQoL). To describe the impact of psoriasis on HRQoL and patients' contact with the healthcare system in Sweden, Denmark, and Norway, the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP) asked 22,050 adults randomly selected in Sweden, Denmark and Norway if they had psoriasis. 1264 individuals who reported physician-diagnosed PsO/PsA were invited to the full survey; 1221 responded (74.6% diagnosed with PsO alone; 25.4% with PsA ± PsO). Respondents with PsA most frequently consulted a rheumatologist; however, 14.3% had never seen a rheumatologist. Respondents with PsO alone most frequently consulted a general practitioner and 10.7% had never seen a dermatologist (although those with severe symptoms visited dermatologists more often). Negative impacts on HRQoL were reported by 38.1% of respondents with PsO [mostly limitations on clothing (22.6%), sleep disorders (16%), and depression/anxiety (16%)] and by 73% of respondents with PsA [mostly limitations on clothing (41.8%), sports/leisure (44.0%), or daily routine (45.1%) and sleeping disorders]. Absence from work/education was more common with PsA ± PsO (51.9%) than PsO alone (15.1%). In this survey in Sweden, Denmark, and Norway, the impact of psoriasis on the respondents' HRQoL was profound and was greater for PsA than for PsO, as was sickness absence. Sleeping disorders and depression were common and should not be overlooked.

Perfiles de los estados de ánimo, depresión, calidad de sueño, somnolencia y ansiedad del equipo de atletismo paralímpico: un estudio longitudinal / Profiles of mood states, depression, sleep quality, sleepiness, and anxiety of the Paralympic athletics team: A longitudinal study

Introducción: Conocer el perfil psicobiológico de un deporte de equipo es importante para definir el trabajo y también en la preparación para las competiciones. El objetivo de este trabajo fue elaborar un perfil psicobiológico del equipo de atletismo paralímpico durante un período de 7 meses. Material y métodos: Diecinueve atletas del atletismo brasileño fueron evaluados al final de la temporada, al comienzo de la temporada, y previamente a la competición. Las evaluaciones se realizaron mediante los cuestionarios siguientes: Perfil de estados de ánimo, Escala de depresión de Beck, Cuestionario de Pittsburg de calidad de sueño, Escala de somnolencia de Epworth e Inventario de la escala de ansiedad rasgo-estado. Resultados: La mayoría de los atletas mostraron un nivel de ansiedad rasgo-estado medio en el final y el comienzo de la temporada. Hubo diferencia entre: época previa a la competición y el final de la temporada, en el dominio de vigor, que se incrementó en el período precompetición; previa a la competición y el comienzo de la temporada en la duración total del sueño, con un aumento en la precompetición; el principio y el final de la temporada, en la latencia del sueño con una disminución en el comienzo de la temporada. Conclusiones: El período durante la temporada deportiva puede alterar las variables psicobiológicas, tales como bajo vigor, somnolencia diurna, y una mayor latencia de sueño al final de la temporada y la mala calidad del sueño al comienzo de la temporada. Por el contrario, la buena calidad del sueño y alto vigor en la etapa previa a la competición favorecen el rendimiento deportivo (AU)

Introduction: Determining the psychobiological profile of a team sport is important for defining The work to be performed in each phase, as well as in preparation for future competitions. The aim of this study was to draw a profile of mood states, depression, sleep quality, sleepiness and anxiety, of a Paralympic athletics team over a seven-month period. Materials and methods: An assessment was made of 19 athletes from the Brazilian athletics team at the end of season, beginning of season, and pre-competition. The assessments were performed using following questionnaires: profile of mood states, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the State-Trait Anxiety Inventory. The results were expressed as the mean and standard deviation, and the significance level was set at p < 0.05. Results: Most of the athletes exhibited a median level of trait-state anxiety at the end and at the beginning of the season. There was difference between: pre-competition and the end of season in the vigor domain, which was increased in the pre-competition; pre-competition and the beginning of the season in the total duration of sleep, with an increase in the pre- competition; the beginning and the end of the season, in sleep latency, with a decrease at the beginning of the season (AU)

Sleep of Māori and non-Māori of Advanced Age.

AIM: To estimate prevalence and identify predictors and outcomes of reporting sleep problems in Māori and non-Māori of advanced age. METHOD: Participants were 251 Māori, and 398 non-Māori adults (79-90 years) from Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: A Cohort Study in New Zealand. Multiple logistic regression identified predictors of reporting a current sleep problem and investigated relationships between current sleep problems and physical and mental health. RESULTS: 26.3% of Māori and 31.7% of non-Māori reported a current sleep problem. Reporting a current sleep problem was associated with ethnicity (non-Māori, adjusted OR=0.52, 95% CI=0.30-0.90), and reporting a past sleep problem (adjusted OR=2.67, 95% CI=1.25-5.72). Sleep problems were related to poorer physical and mental health, and falling. CONCLUSION: Sleep problems are commonly reported and associated with poorer health. Early recognition and management of sleep problems could improve physical and mental health.

Bed Partner "Gas-Lighting" as a Cause of Fictitious Sleep-Talking.

A case report highlighting a rare and striking, but perhaps under-recognized, cause of reported sleep-talking to a specialist sleep clinic, involving "gas-lighting" by the bed partner.

Women would like their partners to be more synchronized with them in their sleep-wake rhythm

Men sleep shorter and go to bed and get up later than women, thus they are later chronotypes. This difference between the sexes is most pronounced between puberty and menopause indicating the possibility that morningness is subject to sexual dimorphism related to reproductive aspects. The objective of the study was to compare the sleep-wake behavior of women with their actual partners and with their preferred partners. As a hypothesis, we expect some assortment in mating concerning chronotype (with the actual partner), but we also expect a higher synchronization with a preferred ideal partner. 167 women were analyzed in this study (mean age: 23.0 ± 2.57 (SD) years). Mated women were earlier chronotypes than their partners (t = -2.051, p = .042, d = .34) but the difference was small (11:02 min ± 1:04 min). The results of the present study showed women preferring a partner synchronized to their own sleep-wake-rhythm more than their actual partners were. The above result was true either for single facets of the sleep-wake rhythm (e.g. bed time, sleep onset) or for midpoint of sleep on free days - an indicator of actual chronotype: women's and their partners' correlation of midpoint of sleep was lower (r = .513) than women's and their ideal partners' correlation (r = .855). Amongst various sleep-wake measures, women particularly preferred a partner going to bed at the same time. Assortative mating according to sleep-wake rhythm exists, but women for long-term pair-bonds would like their partners far more synchronized (AU)

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Relaciones entre el sueño y la adicción / Relationships between sleep and addiction

La interacción entre los trastornos del sueño y el abuso de sustancias es ya conocida, pero seguramente más compleja de lo que se pensaba. Existe tanto una relación positiva entre tener un trastorno por uso de substancias y sufrir un trastorno de sueño, como viceversa. Los efectos sobre el sueño dependen de la substancia utilizada, pero se ha demostrado que tanto durante su uso como en período de abstinencia los consumidores tienen diferentes problemas de sueño y fundamentalmente un sueño más fragmentado. Sabemos que hay que tener en cuenta los problemas de sueño para evitar recaídas en la adicción. Investigaciones recientes indican que el sistema hipocretinérgico definido por el neuropéptido hipocretina/orexina (Hcrt/ox), localizado en el hipotálamo lateral e implicado entre otros en la regulación del ciclo sueño- vigilia, jugaría un papel importante en las conductas adictivas. Diferentes estudios han demostrado interacciones entre el sistema hipocretinérgico, los circuitos de respuesta aguda al estrés y los sistemas de recompensa. También sabemos que la activación optogenética selectiva del sistema hipocretinérgico incrementa la probabilidad de la transición del sueño a la vigilia, y también es suficiente para iniciar un comportamiento compulsivo de recaída adictiva. La activación del sistema hipocretinérgico podría explicar la hipervigilia asociada al estrés y a la adicción. El mayor conocimiento de esta interacción permitiría entender mejor los mecanismos de la adicción y encontrar nuevas estrategias para el tratamiento de las adicciones(AU)

While it is well known that there is an interaction between sleep disorders and substance abuse, it is certainly more complex than was previously thought. There is a positive relationship both between having a substance use disorder and suffering from a sleep disorder, and vice versa. The effects on sleep depend on the substance used, but it has been shown that both during use and in withdrawal periods consumers have various sleep problems, and basically more fragmented sleep. We know that sleep problems must be taken into account to prevent addiction relapses. Recent research shows that the hypocretinergic system defined by neuropeptide hypocretin / orexin (Hcrt / ox), located in the lateral hypothalamus and involved in, among other things, the regulation of the sleep-wake cycle, may play an important role in addictive behaviors. Different studies have demonstrated interactions between the hypocretinergic system, acute response to stress circuits and reward systems. We also know that selective optogenetic activation of the hypocretinergic system increases the probability of transition from sleep to wakefulness, and is sufficient for initiating an addictive compulsive behavior relapse. Hypocretinergic system activation could explain the hyperarousal associated with stress and addiction. Improved knowledge of this interaction would help us to understand better the mechanisms of addiction and find new strategies for the treatment of addictions(AU)

Noise and stress effects on preschool personnel.

The aim of the study was to analyze the presence of stress-related health problems among preschool employees and the way in which these reactions are related to noise and other work parameters. The investigation included 101 employees at 17 preschools in Umeå County, located in northern Sweden. Individual noise recordings and recordings in dining rooms and play halls were made at two departments from each preschool. The adverse effects on the employees were analyzed by use of different validated questionnaires and by saliva cortisol samples. Stress and energy output were pronounced among the employees, and about 30% of the staff experienced strong burnout syndromes. Mental recovery after work was low, indicated by remaining high levels of stress after work. The burnout symptoms were associated with reduced sleep quality and morning sleepiness. Cortisol levels supported the conclusion about pronounced daily stress levels of the preschool employees.

An unusual clinical phenomenon: a case of bedtime ritual with apparent sexual overtones.

A 6-year-old boy attended a psychology clinic with a history of separation anxiety, delayed bedtime and problematic daytime behaviour. In addition, his mother described that at bedtime he would rock over a particular soft toy (teddy bear) on the floor of his bedroom with the bear straddled between his legs in what appeared to be a sexualized ritual. Clinical history taking and a psychological assessment led to a diagnosis of Separation Anxiety and sleep related Rhythmic Movement Disorder (RMD). Systematic desensitization, token-reward systems and play therapy were used to reduce separation anxiety. Alternative bedtime rocking routines without sexual overtones were developed and resulted in reduced time for sleep initiation, increased total sleep time and improved daytime behaviour. This case study demonstrates a case of severe RMD used as a self-soothing and anxiety-reduction strategy which was initially misinterpreted as a sexualized activity. Caution should be exercised in misinterpreting similar case presentations. Correct diagnosis was increased in this case with a psychologist with expertise in sleep and therefore presents a potentially unmet clinical need for sleep psychologists.

Maternal separation anxiety as a regulator of infants' sleep.

BACKGROUND: The regulation of infants' sleep is determined not only by biological factors but by relational aspects too. This study focused on maternal separation anxiety and examined its association with sleep-wake regulation at 10 months of age. METHOD: In a community sample comprising 52 infants and their mothers, sleep was measured objectively with an activity monitor, as well as through questionnaires. The mothers reported on their own separation anxiety and on the child's perceived distress. RESULTS: The main finding was that maternal separation anxiety was linked to settling to sleep routines and to night-waking. The contribution of the mothers' own separation anxiety to their infants' night-waking remained significant after controlling for the child's fussiness. CONCLUSIONS: Consistent with the transactional perspective, the current research documented an interplay between maternal separation anxiety and aspects of the child's sleep-wake transitions.

Historia clínica básica y tipos de insomnio / Insomia types and clinical evaluation

El objeto de la revisión es relatar los objetivos y los instrumentos clínicos para una correcta evaluación del insomnio. El primero y más importante aspecto de la evaluación es la entrevista clínica y la historia de sueño. La evaluación completa del insomnio requiere un abordaje multifactorial (psiquiátrico, físico, medicamentos, etc.), debido a que los aspectos de la alteración del sueño que son más perturbadores pueden variar de unos sujetos a otros. El médico necesita y debe tener un conocimiento claro de los tipos de insomnio para un correcto diagnóstico y tratamiento. Se describe los tipos de insomnio (AU)

The aim of revision is to describe the objectives and clinical instruments for a correct insomnia evaluation. The first and most important aspect of the evaluation is the clinical interview and sleep history. Full evaluation of the insomnia requires a multidimensional (psychiatric, physical, drugs...) approach because those aspects of the sleep disorder that are most distressing to the patient will vary among individuals. The clinician need and must have a clear understanding of insomnia types for a correct diagnosis and treatment. Insomnia types are described (AU)

Rhythmic movement disorder in sleep persisting into childhood and adulthood.

STUDY OBJECTIVES: To evaluate the type, duration, and distribution of rhythmic movements in sleep stages in school-aged children and young adults; to find out if cases of rhythmic movement disorder persisting beyond infancy are associated with any daytime symptoms or psychopathology. DESIGN: All participants underwent neurologic examination, biochemical screening, electroencephalography, neuroimaging, overnight videopolysomnography, and psychologic examination. SETTING: Department of Neurology and Sleep Laboratory, 1st Medical Faculty, Charles University, Prague. PATIENTS OR PARTICIPANTS: Ten subjects referred to the sleep disorders center because of rhythmic movement disorder. Five males, 5 females; age range, 7-24 years; mean age 14.7 +/- 5.69 years. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Biochemical screening, electroencephalogram, and neuroimaging were unremarkable in all cases. According to duration, 2 types of rhythmic movements were observed on polysomnography: longer episodes appeared in wakefulness and in non-rapid eye movement stage 1 sleep, while shorter episodes (2-80 seconds) occurred during non-rapid eye movement stage 2, non-rapid eye movement stage 3-4, and rapid eye movement sleep. According to sleep-stage distribution, we defined (a) rhythmic movements prevailing in the first half of the night and in the morning hours, usually associated with wakefulness or superficial sleep; (b) rhythmic movements occurring throughout the night in all sleep stages; (c) rhythmic movements prevailing in the second half of the night and mainly associated with rapid eye movement sleep. Psychologic examination showed symptoms of the attention-deficit/hyperactivity disorder in 6 cases. CONCLUSIONS: According to our study, rhythmic movement disorder persisting beyond infancy may be connected with various daytime symptoms; a strong association between rhythmic movement disorder and attention-deficit/hyperactivity disorder was found in school-aged children. We speculate that pathogenetic mechanisms similar to those in attention-deficit/hyperactivity disorder are involved in rhythmic movement disorder or that symptoms of attention-deficit/hyperactivity disorder may be secondary to rhythmic movement disorder.

[Sleep disorders and mental disorders]. / Søvnforstyrrelser og psykiske lidelser.

BACKGROUND: Recent research has revealed a lot of the secrets of sleep and how sleep influences our daily life and mental functioning. MATERIAL AND METHODS: Current knowledge on the interaction between sleep disturbances and mental disorders is reviewed. The review is based on relevant literature identified by search in Medline and PsycInfo. RESULTS: Research shows that sleep as a psychobiological phenomenon interacts with the processes of mental disorders. The best evidence for interactions between sleep disturbances and mental problems is found in depression, and sleep disturbances over some weeks have been found to be a predictor for depressive disorders. INTERPRETATION: Clinicians must distinguish between primary chronic sleep disorders of functional origin and secondary sleep disorders as part of a psychiatric condition. The former category should be treated by non-pharmacological interventions, while the latter should be adequately treated in a biopsychosocial model.

Antecedent control of sleep-awakening disruption.

The sleep-awakening disruption of an adolescent with developmental disabilities was treated using an antecedent control intervention that identified his consistent time of wake-up, provided the presence of a preferred staff in his bedroom, and prompted social interaction from staff before challenging behaviors occurred. Positive findings were documented using a combined reversal and multiple baseline across settings design, with results maintained through a 9-month follow-up. A partial component analysis of the intervention plan suggested that the presence of preferred staff was the influential antecedent variable.