Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30
Filtrar
1.
Neurology ; 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34675105

RESUMO

BACKGROUND AND OBJECTIVES: Sport-related concussions affect millions of individuals across the United States each year and current techniques to diagnose and monitor them rely largely on subjective measures. Our goal was to discover and validate objective, quantifiable non-invasive biomarkers with the potential to be used in sport-related concussion diagnosis. METHODS: Urine samples from a convenience series of healthy control collegiate athletes who had not sustained a concussion and athletes who sustained a concussion as diagnosed by a sports medicine physician within seven days were collected prospectively and studied. Participants also completed an instrumented single-task gait analysis as a functional measure. Participants were recruited from a single collegiate athletic program, were ≥18 years old, and were excluded if they had a concomitant injury, active psychiatric conditions or pre-existing neurological disorders. Using Tandem Mass Tags (TMT) mass spectroscopy and enzyme-linked immunosorbent assays (ELISA), urinary biomarkers of concussion were identified and validated. RESULTS: Forty-eight control and 47 concussion age- and sex-matched athletes were included in the study (51.6%F, 48.4%M, average age 19.6y). Participants represented both contact and non-contact sports. All but one of the post-concussion participants reported experiencing symptoms at the time of data collection. Insulin-like growth factor 1 (IGF-1) and IGF binding protein 5 (IGFBP5) were downregulated in the urine of athletes with concussions compared to healthy controls. Multivariable risk algorithms developed to predict the probability of sport-related concussion showed that IGF-1 multiplexed with single-task gait velocity predicts concussion risk across a range of post-injury timepoints (AUC=0.786; 95% CI:0.690-0.884). When IGF-1 and IGFBP5 are multiplexed with single-task gait velocity, they accurately distinguish between healthy controls and concussion at acute timepoints (AUC=0.835, 95% CI:0.701-0·968, p<0.001). DISCUSSION: These noninvasive biomarkers, discovered in an objective and validated manner, may be useful in diagnosing and monitoring sport-related concussions in both acute phases of injury in addition to several days post-injury. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that urinary IGF-1 and IGFBP5 multiplexed with single-task gait velocity may be useful in diagnosing sport-related concussion. TRIAL REGISTRATION INFORMATION: Clinicaltrials.gov identifier NCT02354469, submitted February 2015, first patient enrolled August 2015 (https://clinicaltrials.gov/ct2/show/NCT02354469).

2.
Sleep Adv ; 1(1): zpaa004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33345187

RESUMO

Study Objectives: Inadequate sleep is pervasive among teens worldwide, resulting in daytime sleepiness and, in some cases, depressive symptoms. In addition to their own behavioral choices, parent perceptions may also play a role in adolescent sleep. This study conducted a preliminary evaluation of the antecedents and consequences of sleep factors among adolescents in the United States and Taiwan. Methods: Participants were adolescents with self-reported sleep concerns from academically similar schools in Taiwan (n = 548) and northern California, United States (n = 128). Questionnaires on sleep and mood were administered to both the teens and parents. Results: While Taiwanese students' self-reported sleep behavior was generally better than U.S. students (p < .01), Taiwanese students had higher overall self-reported sleepiness (p < .01). Furthermore, Taiwanese parents reported teen sleep durations of 6.53 ± .827 hours per night during the week (with 45% perceiving this as sufficient), while U.S. parents reported teen sleep durations of 7.22 ± .930 hours (with 27% perceiving this as sufficient). Adolescents in both cohorts had high levels of symptoms consistent with depression (Taiwan: 70%, United States: 62%), which was associated with shorter sleep times for both cohorts and evening chronotype in the Taiwanese, but not U.S., adolescents. Conclusions: Some differences exist between Taiwanese and U.S. adolescents, with generally better sleep and less sleepiness reported among students in the United States, and Taiwanese students' sleep influenced more strongly by chronotype. Furthermore, Taiwanese parents reported less concern about their child's insufficient sleep, despite the fact that inadequate sleep is strongly associated with depressive symptoms for both cohorts.

3.
Sleep Med ; 73: 154-161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32836083

RESUMO

OBJECTIVES: There has been a proliferation in the use of commercially-available accelerometry- and heart rate-based wearable devices to monitor sleep. While the underlying technology is reasonable at detecting sleep quantity, the ability of these devices to predict subjective sleep quality is currently unknown. We tested whether the fundamental signals from such devices are useful in determining subjective sleep quality. METHODS: Older, community-dwelling men (76.5 ± 5.77 years) enrolled in the Osteoporotic Fractures in Men Study (MrOS) participated in an overnight sleep study during which sleep was monitored with actigraphy (wrist-worn accelerometry) and polysomnography (PSG), including electrocardiography (N = 1141). Subjective sleep quality was determined the next morning using 5-point Likert-type scales of sleep depth and restfulness. Lasso and random forest regression models analyzed the relationship between actigraph-determined sleep variables, the shape of the activity patterns during sleep (functional principal component analysis), average heart rate, heart rate variability (HRV), demographics, and self-reported depression, anxiety, habitual sleep, and daytime sleepiness measures. RESULTS: Actigraphy data, in combination with heart rate, HRV, demographic, and psychological variables, do not predict well subjective sleep quality (R2 = 0.025 to 0.162). CONCLUSIONS: Findings are consistent with previous studies that objective sleep measures are not well correlated with subjective sleep quality. Developing validated biomarkers of subjective sleep quality could improve both existing and novel treatment modalities and advance sleep medicine towards precision healthcare standards.


Assuntos
Actigrafia , Transtornos do Sono-Vigília , Idoso , Frequência Cardíaca , Humanos , Vida Independente , Masculino , Polissonografia , Sono , Transtornos do Sono-Vigília/diagnóstico
4.
Curr Opin Psychol ; 34: 117-122, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32203912

RESUMO

Sleep and circadian disturbances in bipolar disorder are common and persistent within and between illness episodes. Insomnia, hypersomnia, reduced need for sleep, sleep schedule variability and circadian rhythm disorders are frequently observed. In this article, recent research is reviewed suggesting that the presence of sleep disturbance is associated with functional impairment, interacts with other physical and environmental systems (e.g. physical activity, light exposure), and may attenuate response to treatment. Established and emerging treatments for various sleep disturbances are reviewed, with emphasis on applications for light therapy and adapted cognitive behavioral therapy. There remains a critical need to understand the co-occurrence of various sleep disturbances, develop, and refine treatment approaches (especially for hypersomnia/long sleep duration) and adapt wearable and smartphone technologies to aid assessment and intervention.


Assuntos
Transtorno Bipolar , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Transtorno Bipolar/terapia , Humanos , Sono , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/terapia
5.
Psychiatry Res ; 281: 112547, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31494450

RESUMO

Hypersomnia is common in psychiatric disorders, yet there are few self-report measures that adequately characterize this sleep disturbance. The objective of this study was to validate the Hypersomnia Severity Index (HSI), a tool designed to measure severity, distress and impairment of hypersomnia in psychiatric populations. Psychometric properties were evaluated in an undergraduate Scale Development sample (N = 381) and two psychiatric Scale Validation samples: euthymic bipolar participants with a range of sleep complaints (N = 89), and unmedicated unipolar depressed participants (N = 21) meeting operational criteria for hypersomnolence disorder. Exploratory factor analysis and confirmatory factor analysis in the Scale Development and Validation samples, respectively, suggested a two-factor structure representing Hypersomnia Symptoms and Distress/Impairment best fit the data. Convergent validity was established by significant associations with the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and the Sheehan Disability Scale in both samples. Construct validity was further supported by significant correlations between the Scale Validation sample and two weeks of diary- and actigraphy-determined total sleep time and time in bed. A cutoff score of 10 maximally discriminated between those with hypersomnia and those without. The HSI shows promise as a measure of hypersomnia that is commonly seen in psychiatric disorders, and may be of use to both researchers and clinicians. SUPPORT: This work is supported by grants from the American Sleep Medicine Foundation (76-JF-12), the Brain and Behavior Research Foundation (19193), and NIMHK23MH099234 (DTP); National Science Foundation Graduate Research Fellowship Program and Stanford Child Health Research Institute (KAK); and R34MH080958 and R01MH105513 (AGH).


Assuntos
Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Transtornos do Humor/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Índice de Gravidade de Doença , Adulto , Distúrbios do Sono por Sonolência Excessiva/etiologia , Feminino , Humanos , Masculino , Transtornos do Humor/complicações , Reprodutibilidade dos Testes , Autorrelato , Adulto Jovem
6.
JAMA Netw Open ; 2(9): e1911944, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31553469

RESUMO

Importance: Owing to biological, behavioral, and societal factors, sleep duration in teenagers is often severely truncated, leading to pervasive sleep deprivation. Objective: To determine whether a novel intervention, using both light exposure during sleep and cognitive behavioral therapy (CBT), would increase total sleep time in teenagers by enabling them to go to sleep earlier than usual. Design, Setting, and Participants: This double-blind, placebo-controlled, randomized clinical trial, conducted between November 1, 2013, and May 31, 2016, among 102 adolescents enrolled full-time in grades 9 to 12, who expressed difficulty going to bed earlier and waking up early enough, was composed of 2 phases. In phase 1, participants were assigned to receive either 3 weeks of light or sham therapy and were asked to try to go to sleep earlier. In phase 2, participants received 4 brief CBT sessions in addition to a modified light or sham therapy. All analyses were performed on an intent-to-treat basis. Interventions: Light therapy consisted of receiving a 3-millisecond light flash every 20 seconds during the final 3 hours of sleep (phase 1) or final 2 hours of sleep (phase 2). Sham therapy used an identical device, but delivered 1 minute of light pulses (appearing in 20-second intervals, for a total of 3 pulses) per hour during the final 3 hours of sleep (phase 1) or 2 hours of sleep (phase 2). Light therapy occurred every night during the 4-week intervention. Cognitive behavioral therapy consisted of four 50-minute in-person sessions once per week. Main Outcomes and Measures: Primary outcome measures included diary-based sleep times, momentary ratings of evening sleepiness, and subjective measures of sleepiness and sleep quality. Results: Among the 102 participants (54 female [52.9%]; mean [SD] age, 15.6 [1.1] years), 72 were enrolled in phase 1 and 30 were enrolled in phase 2. Mixed-effects models revealed that light therapy alone was inadequate in changing the timing of sleep. However, compared with sham therapy plus CBT alone, light therapy plus CBT significantly moved sleep onset a mean (SD) of 50.1 (27.5) minutes earlier and increased nightly total sleep time by a mean (SD) of 43.3 (35.0) minutes. Light therapy plus CBT also resulted in a 7-fold greater increase in bedtime compliance than that observed among participants receiving sham plus CBT (mean [SD], 2.21 [3.91] vs 0.29 [0.76]), as well as a mean 0.55-point increase in subjective evening sleepiness as compared with a mean 0.48-point decrease in participants receiving sham plus CBT as measured on a 7-point sleepiness scale. Conclusions and Relevance: This study found that light exposure during sleep, in combination with a brief, motivation-focused CBT intervention, was able to consistently move bedtimes earlier and increase total sleep time in teenagers. This type of passive light intervention in teenagers may lead to novel therapeutic applications. Trial Registration: ClinicalTrials.gov identifier: NCT01406691.


Assuntos
Terapia Cognitivo-Comportamental , Terapia Combinada/métodos , Fototerapia , Transtornos do Sono do Ritmo Circadiano/terapia , Adolescente , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Resultado do Tratamento
7.
Ecol Appl ; 29(6): e01949, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31188493

RESUMO

Adaptive management of marine protected areas (MPAs) requires developing methods to evaluate whether monitoring data indicate that they are performing as expected. Modeling the expected responses of targeted species to an MPA network, with a clear timeline for those expectations, can aid in the development of a monitoring program that efficiently evaluates expectations over appropriate time frames. Here, we describe the expected trajectories in abundance and biomass following MPA implementation for populations of 19 nearshore fishery species in California. To capture the process of filling in the age structure truncated by fishing, we used age-structured population models with stochastic larval recruitment to predict responses to MPA implementation. We implemented both demographically open (high larval immigration) and closed (high self-recruitment) populations to model the range of possible trajectories as they depend on recruitment dynamics. From these simulations, we quantified the time scales over which anticipated increases in abundance and biomass inside MPAs would become statistically detectable. Predicted population biomass responses range from little change, for species with low fishing rates, to increasing by a factor of nearly seven, for species with high fishing rates before MPA establishment. Increases in biomass following MPA implementation are usually greater in both magnitude and statistical detectability than increases in abundance. For most species, increases in abundance would not begin to become detectable for at least 10 years after implementation. Overall, these results inform potential indicator metrics (biomass), potential indicator species (those with a high fishing : natural mortality ratio), and time frame (>10 yr) for MPA monitoring assessment as part of the adaptive management process.


Assuntos
Conservação dos Recursos Naturais , Pesqueiros , Animais , Biomassa , California , Peixes , Dinâmica Populacional
8.
Behav Res Ther ; 111: 106-112, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30399503

RESUMO

Sleep inertia involves decreased performance or disorientation upon waking that lasts several hours and impairs functioning. Though sleep inertia is common in insomnia and may interfere with treatment, Cognitive Behavioral Therapy for Insomnia (CBTI) does not routinely include a component to address sleep inertia. The present study evaluates such a component, the RISE-UP routine, in CBTI for insomnia comorbid with bipolar disorder. We hypothesized that the RISE-UP routine would increase physical activity in the morning and reduce the duration and severity of self-reported sleep inertia. Sleep and sleep inertia were monitored in the week prior to and following the intervention with daily sleep diaries, actigraphy, and ecological momentary assessment (EMA). Participants were randomized to a bipolar-specific modification of CBT-I (CBTI-BP) with RISE-UP (N = 20) or a psychoeducation (PE) comparison condition (N = 20). The treatment experiment (RISE-UP vs PE) was completed in the first treatment session. RISE-UP reduced the duration and severity of self-reported sleep inertia, as measured by diary reports and by EMA ratings, and was rated as acceptable and credible. Compliance was high, and increases in morning activity levels were verified via actigraphy. Addressing morning sleep inertia via behavioral modifications upon waking may be a useful addition to CBTI.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Bipolar/terapia , Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Actigrafia , Adulto , Comorbidade , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Registros Médicos , Cooperação do Paciente , Satisfação do Paciente , Polissonografia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
9.
Sleep Med ; 34: 162-167, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28522086

RESUMO

OBJECTIVES: In older adults, traditional metrics derived from polysomnography (PSG) are not well correlated with subjective sleep quality. Little is known about whether the association between PSG and subjective sleep quality changes with age, or whether quantitative electroencephalography (qEEG) is associated with sleep quality. Therefore, we examined the relationship between subjective sleep quality and objective sleep characteristics (standard PSG and qEEG) across middle to older adulthood. METHODS: Using cross-sectional analyses of 3173 community-dwelling men and women aged between 39 and 90 participating in the Sleep Heart Health Study, we examined the relationship between a morning rating of the prior night's sleep quality (sleep depth and restfulness) and polysomnographic, and qEEG descriptors of that single night of sleep, along with clinical and demographic measures. Multivariable models were constructed using two machine learning methods, namely lasso penalized regressions and random forests. RESULTS: Little variance was explained across models. Greater objective sleep efficiency, reduced wake after sleep onset, and fewer sleep-to-wake stage transitions were each associated with higher sleep quality; qEEG variables contributed little explanatory power. The oldest adults reported the highest sleep quality even as objective sleep deteriorated such that they would rate their sleep better, given the same level of sleep efficiency. Despite this, there were no major differences in the predictors of subjective sleep across the age span. CONCLUSION: Standard metrics derived from PSG, including qEEG, contribute little to explaining subjective sleep quality in middle-aged to older adults. The objective correlates of subjective sleep quality do not appear to systematically change with age despite a change in the relationship between subjective sleep quality and objective sleep efficiency.


Assuntos
Eletroencefalografia , Aprendizado de Máquina , Polissonografia , Sono , Envelhecimento/fisiologia , Encéfalo/fisiologia , Estudos de Coortes , Estudos Transversais , Eletroencefalografia/métodos , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polissonografia/métodos , Autorrelato , Sono/fisiologia
11.
Biol Psychol ; 123: 37-46, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27889439

RESUMO

BACKGROUND: Reports of subjective sleep quality are frequently collected in research and clinical practice. It is unclear, however, how well polysomnographic measures of sleep correlate with subjective reports of prior-night sleep quality in elderly men and women. Furthermore, the relative importance of various polysomnographic, demographic and clinical characteristics in predicting subjective sleep quality is not known. We sought to determine the correlates of subjective sleep quality in older adults using more recently developed machine learning algorithms that are suitable for selecting and ranking important variables. METHODS: Community-dwelling older men (n=1024) and women (n=459), a subset of those participating in the Osteoporotic Fractures in Men study and the Study of Osteoporotic Fractures study, respectively, completed a single night of at-home polysomnographic recording of sleep followed by a set of morning questions concerning the prior night's sleep quality. Questionnaires concerning demographics and psychological characteristics were also collected prior to the overnight recording and entered into multivariable models. Two machine learning algorithms, lasso penalized regression and random forests, determined variable selection and the ordering of variable importance separately for men and women. RESULTS: Thirty-eight sleep, demographic and clinical correlates of sleep quality were considered. Together, these multivariable models explained only 11-17% of the variance in predicting subjective sleep quality. Objective sleep efficiency emerged as the strongest correlate of subjective sleep quality across all models, and across both sexes. Greater total sleep time and sleep stage transitions were also significant objective correlates of subjective sleep quality. The amount of slow wave sleep obtained was not determined to be important. CONCLUSIONS: Overall, the commonly obtained measures of polysomnographically-defined sleep contributed little to subjective ratings of prior-night sleep quality. Though they explained relatively little of the variance, sleep efficiency, total sleep time and sleep stage transitions were among the most important objective correlates.


Assuntos
Envelhecimento/fisiologia , Polissonografia/normas , Transtornos do Sono-Vigília/diagnóstico , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Aprendizado de Máquina , Masculino
12.
Breast Cancer Res Treat ; 158(1): 43-50, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27314577

RESUMO

While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p's > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = -0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.


Assuntos
Neoplasias da Mama/metabolismo , Ritmo Circadiano , Hidrocortisona/análise , Sono/fisiologia , Idoso , Neoplasias da Mama/fisiopatologia , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica , Metástase Neoplásica , Polissonografia
13.
Sleep Med Clin ; 10(1): 101-5, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25750600

RESUMO

Bipolar disorder is a severe and chronic disorder, ranked in the top 10 leading causes of disability worldwide. Sleep disturbances are strongly coupled with interepisode dysfunction and symptom worsening in bipolar disorder. Experimental studies suggest that sleep deprivation can trigger manic relapse. There is evidence that sleep deprivation can have an adverse impact on emotion regulation the following day. The clinical management of the sleep disturbances experienced by bipolar patients, including insomnia, hypersomnia delayed sleep phase, and irregular sleep-wake schedule, may include medication approaches, psychological interventions, light therapies and sleep deprivation.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/terapia , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/terapia , Transtorno Bipolar/complicações , Humanos , Sono/fisiologia , Transtornos do Sono-Vigília/complicações
14.
Ment Health Phys Act ; 7(3): 183-190, 2014 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-25506392

RESUMO

OBJECTIVE: To evaluate the relative role of psychopathology in the relationship between physical activity and sleep, the present study investigated the day-to-day relationship between physical activity and sleep in individuals without a psychiatric disorder and individuals with bipolar disorder using a longitudinal, naturalistic design. METHOD: Participants in two groups-a healthy group with no psychiatric illness (N=36) and an inter-episode bipolar disorder group (N=32)- were studied over a two-month period. Physical health was assessed by the SF-36. Daily subjective and objective measures of physical activity and sleep were collected. A total of 6,670 physical activity measurements and 6,548 sleep measurements were logged. RESULTS: The bipolar disorder group exhibited poorer physical health on the SF-36 and more sleep disturbance relative to the healthy group. No group differences were found in physical activity, nor in models examining the relationship between physical activity and sleep. Hierarchical linear models indicated that for every standard deviation increase in sleep disturbance (i.e., increased total wake time), there was a three percent decrease in subsequent day physical activity, in both the healthy and bipolar groups. Increased physical activity was associated with improved sleep for participants who reported greater average sleep disturbance. CONCLUSIONS: The results for all participants in the study suggest that reduced physical activity and sleep difficulties may be mutually maintaining processes, particularly for individuals who suffer from poor sleep. Findings also raise the potential importance of targeting physical activity and sleep concurrently in interventions aimed at improving physical and mental health.

16.
J Addict Med ; 8(6): 389-94, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25369938

RESUMO

Accruing evidence indicates that insomnia is prevalent and persistent in early recovery from substance use disorders and may predict relapse. As such, insomnia treatment after abstinence represents an important area for intervention. This article reviews the literature on insomnia predicting new-onset alcohol and substance use disorders, along with evidence for insomnia predicting relapse in recovering populations. Pharmacological and psychological treatment options are presented, and cognitive-behavioral therapy for insomnia applied to recovering populations is described in detail.


Assuntos
Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Terapia Cognitivo-Comportamental , Medicina Baseada em Evidências , Humanos , Hipnóticos e Sedativos/uso terapêutico , Recidiva , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações
17.
J Affect Disord ; 167: 93-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24953480

RESUMO

BACKGROUND: The aim was to examine the prevalence and consequences of co-occurring insomnia and hypersomnia symptoms in depressed adults drawn from a representative sample of the U.S. population. METHOD: Data from 687 National Comorbidity Survey Replication (NCS-R) respondents meeting criteria for a major depressive episode (MDE) in the past year were included. Respondents completed clinical interviews that assessed 12-month DSM-IV disorders, impairment, mental health treatment, and depressive symptom severity. Outcomes were compared between respondents who experienced insomnia symptoms-only (N=404), hypersomnia symptoms-only (N=44), both insomnia and hypersomnia symptoms (N=184) and no sleep problems (N=55) during an MDE. RESULTS: Insomnia and hypersomnia symptoms co-occurred in 27.7% of respondents with past-year MDEs, most frequently in bipolar spectrum disorders and major depressive disorder with dysthymia. Similar to the insomnia-only group, respondents with co-occurring sleep disturbances had more severe depression, and higher rates of past-year impulse control disorders and suicide planning. Similar to the hypersomnia-only group, respondents with co-occurring sleep disturbances had higher rates of past-year drug use disorders and suicide attempts. Compared to the insomnia-only and no sleep problem groups, respondents with both sleep disturbances were more frequently in mental health treatment, seeing a general practitioner, and taking antidepressants. LIMITATIONS: The NCS-R is cross-sectional and did not evaluate sleep disorder diagnoses. CONCLUSIONS: Co-occurring insomnia and hypersomnia symptoms were associated with a more severe MDE. Further research is warranted to more fully understand the joint presentation of insomnia and hypersomnia in depression.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adolescente , Adulto , Idoso , Antidepressivos/administração & dosagem , Antidepressivos/efeitos adversos , Comorbidade , Estudos Transversais , Depressão/complicações , Transtorno Depressivo Maior/complicações , Distúrbios do Sono por Sonolência Excessiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Autorrelato , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/etiologia , Ideação Suicida , Tentativa de Suicídio , Estados Unidos/epidemiologia , Adulto Jovem
18.
FEMS Microbiol Ecol ; 89(1): 80-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24713021

RESUMO

Cyanobacteria are biogeochemically significant constituents of coral reef ecosystems; however, little is known about biotic and abiotic factors influencing the abundance and composition of cyanobacterial communities in fringing coral reef waters. To understand the patterns of cyanobacterial biogeography in relation to coastal environmental factors, we examined the diversity of planktonic and benthic cyanobacteria at 12 sites along the west coast of Hawaii's Big Island. We found distinct cyanobacterial communities in sediments compared to the water column. In both sediments and water, community structure was strongly related to overall biomass (chlorophyll a concentration), although both these communities corresponded to different sets of biotic/abiotic variables. To examine the influence of freshwater input on planktonic cyanobacterial communities, we conducted a mesocosm experiment where seawater was amended with freshwater from two sources representing high- and low-human population influence. Planktonic cyanobacterial abundance decreased over time in mesocosms, although chlorophyll a concentration significantly increased with time, indicating cyanobacteria were likely outcompeted by other phytoplankton in incubations. Our results show that cyanobacterial community structure may be affected by runoff from terrestrial habitats, but that the composition of cyanobacterial communities inhabiting these locations is also structured by factors not measured in this study.


Assuntos
Cianobactérias/genética , Água do Mar/microbiologia , Biomassa , Recifes de Corais , Ecossistema , Água Doce , Sedimentos Geológicos/microbiologia , Hawaii , Humanos , Ilhas , Tipagem Molecular , Filogeografia , Fitoplâncton/genética , Microbiologia da Água
19.
Am J Psychiatry ; 170(7): 716-20, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23820830

RESUMO

Sleep disturbance is common in bipolar disorder. Stimulus control and sleep restriction are powerful, clinically useful behavioral interventions for insomnia, typically delivered as part of cognitive-behavioral therapy for insomnia (CBT-I). Both involve short-term sleep deprivation. The potential for manic or hypomanic symptoms to emerge after sleep deprivation in bipolar disorder raises questions about the appropriateness of these methods for treating insomnia. In a series of patients with bipolar disorder who underwent behavioral treatment for insomnia, the authors found that regularizing bedtimes and rise times was often sufficient to bring about improvements in sleep. Two patients in a total group of 15 patients reported mild increases in hypomanic symptoms the week following instruction on stimulus control. Total sleep time did not change for these individuals. Two of five patients who underwent sleep restriction reported mild hypomania that was unrelated to weekly sleep duration. Sleep restriction and stimulus control appear to be safe and efficacious procedures for treating insomnia in patients with bipolar disorder. Practitioners should encourage regularity in bedtimes and rise times as a first step in treatment, and carefully monitor changes in mood and daytime sleepiness throughout the intervention.


Assuntos
Terapia Comportamental , Transtorno Bipolar/complicações , Distúrbios do Início e da Manutenção do Sono/terapia , Adulto , Afeto , Terapia Comportamental/métodos , Transtorno Bipolar/terapia , Feminino , Humanos , Escalas de Graduação Psiquiátrica , Sono , Privação do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/complicações
20.
Sleep Med Clin ; 8(3): 361-371, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25302060

RESUMO

In psychiatric illness, there is a growing body of evidence indicating that sleep disturbances exert a detrimental influence on the course of these disorders and contribute to impaired function. Even when psychiatric disorders are successfully treated or stabilized, insomnia and other sleep disturbances often fail to remit. The present review focuses on sleep in two severe mental illnesses, namely bipolar disorder and schizophrenia. This article discusses the role of sleep disturbances and altered sleep architecture in relation to symptom status, functional impairment, quality of life, and the course of these disorders. Current evidence regarding pharmacological and psychological treatment approaches for insomnia in these populations is presented. This review also notes considerations for adapting Cognitive Behavioral Therapy for insomnia (CBT-I) procedures for severe mental illness and proposes directions for future research.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...