Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors.

BACKGROUND: Depression and sleep disturbances are associated with increased risks of various diseases and mortality, but their impacts on mortality in cancer survivors remain unclear. The objective of this study was to characterize the independent and joint associations of depressive symptoms and sleep disturbances with mortality outcomes in cancer survivors. METHODS: This population-based prospective cohort study included cancer survivors aged ≥ 20 years (n = 2947; weighted population, 21,003,811) from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Depressive symptoms and sleep disturbances were self-reported. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9). Death outcomes were determined by correlation with National Death Index records through December 31, 2019. Primary outcomes included all-cause, cancer-specific, and noncancer mortality. RESULTS: During the median follow-up of 69 months (interquartile range, 37-109 months), 686 deaths occurred: 240 participants died from cancer, 146 from heart disease, and 300 from other causes. Separate analyses revealed that compared with a PHQ-9 score (0-4), a PHQ-9 score (5-9) was associated with a greater risk of all-cause mortality (hazard ratio [HR], 1.28; 95% CI, 1.03-1.59), and a PHQ-9 score (≥ 10) was associated with greater risk of all-cause mortality (HR, 1.37; 95% CI, 1.04-1.80) and noncancer mortality (HR, 1.45; 95% CI, 1.01-2.10). Single sleep disturbances were not associated with mortality risk. In joint analyses, the combination of a PHQ-9 score ≥ 5 and no sleep disturbances, but not sleep disturbances, was associated with increased risks of all-cause mortality, cancer-specific mortality, and noncancer mortality. Specifically, compared with individuals with a PHQ-9 score of 0-4 and no sleep disturbances, HRs for all-cause mortality and noncancer mortality in individuals with a PHQ-9 score of 5-9 and no sleep disturbances were 1.72 (1.21-2.44) and 1.69 (1.10-2.61), respectively, and 2.61 (1.43-4.78) and 2.77 (1.27-6.07), respectively, in individuals with a PHQ-9 score ≥ 10 and no sleep disturbances; HRs for cancer-specific mortality in individuals with a PHQ-9 score ≥ 5 and no sleep disturbances were 1.95 (1.16-3.27). CONCLUSIONS: Depressive symptoms were linked to a high risk of mortality in cancer survivors. The combination of a PHQ-9 score (≥ 5) and an absence of self-perceived sleep disturbances was associated with greater all-cause mortality, cancer-specific mortality, and noncancer mortality risks, particularly in individuals with a PHQ-9 score (≥ 10).

Interrelationship of Sleep Disturbances and Cognitive Status on Mortality.

Sleep disturbances may promote the development and advancement of Alzheimer's disease. Our purpose was to determine if sleep disturbances were associated with earlier mortality while accounting for cognition. The National Alzheimer's Coordinating Center database was used to evaluate mortality risk conferred by sleep, and the Montreal Cognitive Assessment score determined cognitive status. Demographics, sleep disturbances, cognitive status, and comorbid/other neuropsychiatric conditions were examined as predictors of survival time via Cox regression. The sample (N = 31,110) had a median age [interquartile range] of 72 [66, 79] years, MoCA score of 23 [16, 26], and survival time of 106.0 months [104.0,108.0]; 10,278 (33%) died during follow-up; 21% (n = 6461) experienced sleep disturbances. Sleep disturbances impacted survival time depending on cognition, with the greatest effect in transition from normal to cognitive impairment (P < .001). Findings support that sleep disturbances negatively impact survival time, and the impact of sleep disturbances on survival time is interrelated with cognition.

Mortality associated with nonrestorative short sleep or nonrestorative long time-in-bed in middle-aged and older adults.

Associations of sleep duration with human health could differ depending on whether sleep is restorative. Using data from 5804 participants of the Sleep Heart Health Study, we examined the longitudinal association of sleep restfulness combined with polysomnography-measured total sleep time (TST) or time in bed (TIB), representing different sleeping behaviors, with all-cause mortality. Among middle-aged adults, compared with restful intermediate TST quartile, the lowest TST quartile with feeling unrested was associated with higher mortality (hazard ratio [HR], 1.54; 95% confidence interval [CI] 1.01-2.33); the highest TST quartile with feeling rested was associated with lower mortality (HR, 0.55; 95% CI 0.32-0.97). Among older adults, the highest TIB quartile with feeling unrested was associated with higher mortality, compared with restful intermediate TIB quartile (HR, 1.57; 95% CI 1.23-2.01). Results suggest a role of restorative sleep in differentiating the effects of sleep duration on health outcomes in midlife and beyond.

Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States.

BACKGROUND: Sleep disturbance and deficiency are common among older adults and have been linked with dementia and all-cause mortality. Using nationally representative data, we examine the relationship between sleep disturbance and deficiency and their risk for incident dementia and all-cause mortality among older adults. METHODS: The National Health and Aging Trends Study (NHATS) is a nationally-representative longitudinal study of Medicare beneficiaries in the US age 65 and older. Surveys that assessed sleep disturbance and duration were administered at baseline. We examined the relationship between sleep disturbance and deficiency and incident dementia and all-cause mortality over the following 5 years using Cox proportional hazards modeling, controlling for confounders. RESULTS: Among the sample (n = 2,812), very short sleep duration (≤5 hours: HR = 2.04, 95% CI: 1.26 - 3.33) and sleep latency (>30 minutes: HR = 1.45, 95% CI: 1.03 - 2.03) were associated with incident dementia in adjusted Cox models. Difficulty maintaining alertness ("Some Days": HR = 1.49, 95% CI: 1.13 - 1.94 and "Most/Every Day": HR = 1.65, 95% CI: 1.17 - 2.32), napping ("Some days": HR = 1.38, 95% CI: 1.03 - 1.85; "Most/Every Day": HR = 1.73, 95% CI: 1.29 - 2.32), sleep quality ("Poor/Very Poor": HR = 1.75, 95% CI: 1.17 - 2.61), and very short sleep duration (≤5 hours: HR = 2.38, 95% CI: 1.44 - 3.92) were associated with all-cause mortality in adjusted Cox models. CONCLUSIONS: Addressing sleep disturbance and deficiency may have a positive impact on risk for incident dementia and all-cause mortality among older adults.

Prevalence of Sleep Disorders and Association With Mortality: Results From the NHANES 2009-2010.

OBJECTIVES: To determine the prevalence of sleep disorders in the United States and the association between sleep disorders and all-cause mortality. METHODS: A cross-sectional analysis of the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index (NDI) was performed. The 2009 to 2010 NHANES national household survey for adults ≥ 18 years was examined for the prevalence of sleep disorders as well as standard demographics and the presence of comorbidities (coronary artery disease [CAD], stroke, and emphysema). This dataset was linked to the 2015 NDI to associate the presence of sleep disorders with 5-year all-cause mortality. RESULTS: The study sample had a mean age of 46.1 years old, was 48.3% male, and had an average body mass index (BMI) of 28.7 (28.4-28.9). 7.1% (6.5%-7.7%) of adults reported being diagnosed with a sleep disorder, which represents an estimated 15.9 million (13.2-18.6) patients. The estimated mortality rate for those having a sleep disorder was 9.3% (7.2%-11.9%) compared to 5.2% (4.5%-5.9%) without a sleep disorder (odds ratio 1.89, P = <.001). After adjusting for age, sex, BMI, CAD, stroke, and emphysema, having a sleep disorder remained a significant predictor of increased mortality (hazard ratio, 1.5 [1.02-2.18], P = .042). CONCLUSION: This study reports a high prevalence of self-reported but physician-diagnosed sleep disorders; however, this likely represents an underestimate. Given the association with all-cause mortality, there is a need for increased recognition of undiagnosed sleep disorders within the United States. LEVEL OF EVIDENCE: 2b Laryngoscope, 131:686-689, 2021.

Cardiovascular Complications of Sleep Disorders: A Better Night's Sleep for a Healthier Heart / From Bench to Bedside.

Sleep is essential to and an integral part of life and when lacking or disrupted, a multitude of mental and physical pathologies ensue, including cardiovascular (CV) disease, which increases health care costs. Several prospective studies and meta-analyses show that insomnia, short (<7h) or long (>9h) sleep and other sleep disorders are associated with an increased risk of hypertension, metabolic syndrome, myocardial infarction, heart failure, arrhythmias, CV disease risk and/or mortality. The mechanisms by which insomnia and other sleep disorders lead to increased CV risk may encompass inflammatory, immunological, neuro-autonomic, endocrinological, genetic and microbiome perturbations. Guidelines are emerging that recommend a target of >7 h of sleep for all adults >18 years for optimal CV health. Treatment of sleep disorders includes cognitive-behavioral therapy considered the mainstay of non-pharmacologic management of chronic insomnia, and drug treatment with benzodiazepine receptor agonists binding to gamma aminobutyric acid type A (benzodiazepine and non-benzodiazepine agents) and some antidepressants. However, observational studies and meta-analyses indicate an increased mortality risk of anxiolytics and hypnotics, although bias may be involved due to confounding and high heterogeneity in these studies. Nevertheless, it seems that the risk incurred by the non-benzodiazepine hypnotic agents (Z drugs) may be relatively less than the risk of anxiolytics, with evidence indicating that at least one of these agents, zolpidem, may even confer a lower risk of mortality in adjusted models. All these issues are herein reviewed.

Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study.

BACKGROUND: Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. METHODS: Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline (< 2 chronic diseases). Baseline sleep disturbances were derived from the Comprehensive Psychiatric Rating Scale and categorized as none, mild, and moderate-severe. The number of chronic conditions throughout the 9-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic disease accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, or musculoskeletal diseases as the outcome. RESULTS: Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß/year = 0.041, p = 0.016) and musculoskeletal (ß/year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. CONCLUSION: The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.

[The role of sleep and sleep disorder management in reducing cardiovascular- and cardiometabolic risk and improving treatment outcomes]. / Má bæta árangur af meðferð hjarta- og æðasjúkdóma með aukinni áherslu á svefngæði? yfirlitsgrein

Despite extensive knowledge on the importance of quality sleep for health and wellbeing, sleep quality and sleep disorders are commonly overlooked in both prevention and treatment of chronic illnesses. The aim of this review is to draw attention to recently published literature focusing on how disrupted sleep contributes to the onset and progression of chronic diseases, with focus on cardiovascular- and -cardiometabolic diseases. Diagnosis and management of sleep disorders are an important part of prevention and chronic disease management to optimize outcomes and improve patients´ health and quality of life. Objective sleep disorder diagnosis is relevant to ensure appropriate therapy intervention, and for sleep disorders to be managed as other chronic diseases based on regular objective assessments of treatment efficacy. In light of the knowledge of how short sleep and/or low sleep quality negatively affects the cardiovascular system, including objective sleep evaluation in the -standard of care for risk assessment and management of cardiovascular diseases may improve cardiovascular risk prediction and improve outcomes.

The relationship between sleep duration and all-cause mortality in the older people: an updated and dose-response meta-analysis.

BACKGROUND: Short or long sleep duration is proposed as a potential risk factor for all-cause mortality in the older people, yet the results of published studies are not often reproducible. METHODS: Literature retrieval, study selection and data extraction were completed independently and in duplicate. Only prospective cohort studies were included. Effect-size estimates are expressed as hazard ratio (HR) and 95% confidence interval (CI). RESULTS: Summary data from 28 articles, involving a total of 95,259 older people, were meta-analyzed. Overall analyses revealed a remarkably significant association between long sleep duration and all-cause mortality (adjusted HR = 1.24, 95% CI: 1.16-1.33, P < .001), whereas only marginal significance was observed for short sleep duration (adjusted HR = 1.04; 95% CI: 1.00-1.09; P = .033). Funnel plots suggested no publication bias for short sleep duration (P = .392). The probability of publication bias was high for long sleep duration (P = .020), yet the trim-and-fill method strengthened its significance in predicting all-cause mortality. In subgroup analyses, the association of long sleep duration with all-cause mortality was statistically significant in both women (HR = 1.48; 95% CI: 1.18-1.86; P = .001) and men (HR = 1.31; 95% CI: 1.10-1.58; P = .003). By contrast, with regard to short sleep duration, statistical significance was observed in men (HR = 1.13; 95% CI: 1.04-1.24; P = .007), but not in women (HR = 1.00; 95% CI: 0.85-1.18; P = .999) (Two-sample Z test P = .099). Besides gender, geographic region, sleep survey method, baseline age and follow-up interval were identified as possible causes of between-study heterogeneity in subgroup analyses. Further dose-response regression analyses revealed that trend estimation was more obvious for long sleep duration (regression coefficient: 0.13; P < .001) than for short sleep duration (regression coefficient: 0.02; P = .046). CONCLUSIONS: Our findings indicate a significantly increased risk of all-cause mortality associated with long sleep duration, especially in women, as well as with short sleep duration in men only.

Association of sleep disturbance with risk of cardiovascular disease and all-cause mortality in patients with new-onset type 2 diabetes: data from the Korean NHIS-HEALS.

BACKGROUND: Sleep disturbance has been significantly associated with the incidence of cardiovascular disease (CVD) in the general population. However, despite the common prevalence of sleep disturbance in patients with type 2 diabetes, its relationship with the risk of CVD remains unclear. Here, we have examined the association of sleep disturbance with the incidence of all CVD and all-cause mortality in patients with newly-diagnosed type 2 diabetes. METHODS: We used the Korean National Health Insurance Service-Health Screening Cohort data and included 36,058 patients with new-onset type 2 diabetes aged ≥ 40 years between 2004 and 2007, along with follow-up examinations to 2013. We used the ICD-10 code to measure sleep disturbance as a primary diagnosis and the multivariable Cox proportional hazards regression models to estimate the adjusted hazard ratio (AHR) and 95% confidence interval (CI) of all CVD, coronary heart disease (CHD), stroke, and all-cause mortality. RESULTS: We identified 6897 cases of all CVD (CHD, n = 4138; stroke, n = 2759) and 2890 events of all-cause mortality during a mean follow-up period of 7.0 years. Sleep disturbance was associated with an increased risk of All CVD (AHR, 1.24; 95% CI, 1.06-1.46), CHD events (AHR, 1.24; 95% CI, 1.00-1.53), and all-cause mortality (AHR, 1.47; 95% CI, 1.15-1.87) in patients with new-onset type 2 diabetes. Furthermore, women (AHR, 1.33; 95% CI, 1.06-1.67) and middle-aged adults (AHR, 1.29; 95% CI, 1.02-1.64) with sleep disturbance had a significantly increased risk of CVD than those without; contrarily, men (AHR, 1.45; 95% CI, 1.09-1.95) and older adults (AHR, 1.51; 95% CI, 1.15-1.99) with sleep disturbance were associated with a significantly increased risk of all-cause mortality than those without. CONCLUSIONS: Our findings suggest that sleep disturbance is significantly associated with an increased risk of CVD and all-cause mortality in patients with new-onset type 2 diabetes.

Is Restless Legs Syndrome Associated with an Increased Risk of Mortality? A Meta-Analysis of Cohort Studies.

Background: Restless legs syndrome (RLS) is a common sleep disorder,. although controversial, growing evidence relates the presence of RLS to an increased risk of mortality, mainly due to cardiovascular events. The aim of this article was to review the role of RLS as a risk factor of mortality according to independent cohort studies. Methods: We performed a literature review via PubMed database for articles relating RLS and mortality. We used the random-effects model to calculate the pooled effect estimates on mortality. Heterogeneity between studies was assessed using quantitative and qualitative analysis. Results: Out of 100 articles identified, 13 were finally included. Although studies were heterogeneous (p = 0.001), no significant publication bias was found. When all cohort studies were considered, the random-effects model yielded a significantly increased risk of mortality in RLS versus non-RLS patients (13 studies, hazard ratio [HR] = 1.52, 95% confidence interval [CI] 1.28-1.80). However, this association was not statistically significant when only cohort studies using the international RLS diagnostic criteria were considered (5 studies, HR = 1.63, 95% CI 0.94-2.81). Discussion: The results of this meta-analysis suggest that RLS seems to be a risk factor of mortality, although this association is conditioned by the diagnostic criteria used in the studies. Future long-term follow-up standardized mortality studies are needed to address this important question that carries potential impact on population global health.

Working time mismatches and self-assessed health of married couples: Evidence from Germany.

Underemployment and overemployment are widespread in developed countries and have detrimental consequences on health. This article tackles the question of the relationship between health and own, spousal and cross working time mismatches in bi-active couples. Using 83,000 observations from the German SOEP (1997-2012) I demonstrate that self-assessed health is reduced in case of overemployment and underemployment. I find that living with an overemployed partner is negatively correlated with own health. However, I show that the effect of overemployment is lower for those who live with an overemployed partner. This positive cross-effect is consistent with the existence of a comparison norm effect within household. Those results are robust to a battery of sensitivity checks and mostly transit via mental health. This article concludes that overemployment does not only affect the overemployed workers but also their partner and not accounting for such spillovers leads to an underestimation of the total health costs of overemployment.

Prophylactic use of exogenous melatonin and melatonin receptor agonists to improve sleep and delirium in the intensive care units: a systematic review and meta-analysis of randomized controlled trials.

To investigate the efficacy of exogenous administration of melatonin and melatonin receptor agonists for the improvement of delirium, sleep, and other clinical outcomes of subjects in the intensive care unit (ICU). We carefully searched three electronic databases, i.e., Pubmed/Medline, Embase, and Cochrane library, to retrieve randomized controlled trials (RCTs) administrating melatonin or melatonin receptor agonists to adult subjects admitted to the ICU. Useful data such as the prevalence of delirium, duration of sleep, number of awakenings per night, duration of mechanical ventilation, and ICU stay as well as in-ICU mortality were extracted and pooled by using a random effect model. Eight RCTs were included in the qualitative analysis. Administration of exogenous melatonin and melatonin receptor agonists was associated with a trend towards elongated duration of sleep (pooled weighted mean difference/WMD = 0.43; 95% confidence intervals/CIs, - 0.02~0.88, p = 0.063) and could decrease the number of awakenings per night (pooled WMD = - 2.03; 95% CIs, - 3.83~- 0.22, p = 0.028). Meanwhile, participants in the treatment group showed a significantly reduced prevalence of delirium (pooled risk ratio/RR = 0.49; 95% CIs, 0.28~0.88, p = 0.017) and duration of ICU stay (pooled WMD = - 0.32; 95% CI, - 0.56~- 0.07, p = 0.002) in comparison with those in the control group. Exogenous administration of melatonin and melatonin receptor agonists could improve the sleep of subjects in the intensive care units, which may play an important role in decreasing the prevalence of delirium and shortening duration of ICU stay.

Non-Apnea Sleep Disorder associates with increased risk of incident heart failure-A nationwide population-based cohort study.

PURPOSE: Non-apnea sleep disorder (NASD) increases the risk of cardiovascular events, such as hypertension and ischemic heart disease (IHD). Patients with heart failure (HF) are at higher risk for sleep disorder; however, there is no documentation on NASD's association with HF to date. Therefore, our study aimed to determine whether NASD increases the risk of incident HF. MATERIALS AND METHODS: Using the outpatient and inpatient data from Taiwan's Longitudinal Health Insurance Database, we conducted a nationwide cohort study of patients with a first-time diagnosis of NASD in the year 2000 and followed up the risk of incident heart failure until December 31, 2013. We calculated risks and incidence ratios of HF for patients with NASD compared with the general population. The cumulative incidence of NASD and the subsequent risk of HF are assessed by the Kaplan-Meier method and Cox regression using a matched comparison cohort of HF patients without NASD. RESULTS: The NASD cohort had an adjusted hazard ratio (HR) of incident HF 19.7% higher than that of the cohort without NASD (95% CI = 1.130-1.270; p<0.001). In the NASD population, the mean interval to HF in males and females were 5.00±3.69 years and 5.00±3.66 years, respectively. The Kaplan-Meier analysis indicated that after the seventh year, the incidence of HF was higher in the NASD cohort than in the control cohort till the end of the follow up. CONCLUSIONS: Our study demonstrates that NASD patients are associated with a higher risk of incident HF.

Mortality of Haemodialysis Patients With and Without Chronic Itch: A Follow-up Study of the German Epidemiological Hemodialysis Itch Study (GEHIS).

The GEHIS (German Epidemiological Hemodialysis Itch Study) is a representative cohort study started in 2013 with 860 haemodialysis (HD) patients in 25 German dialysis units. Chronic itch (CI) has been reported to be a poor prognostic marker for patients on HD; however, this has not been investigated in a representative patient cohort. In 2017, all HD patients were contacted again to investigate mortality in those with and without CI and to identify its determinants. Patients' characteristics, study instruments and CI were assessed, as in 2013. The response rate was 84.2% (n = 724). One-year mortality was 15.3%. Mortality was significantly higher in those with secondary scratch lesions compared with those with non-affected skin. This was also true after controlling for age and sex in a multivariate model. This study demonstrates a high mortality in HD patients; however, mortality depends on itch intensity, not on the occurrence of CI itself.

Sleep duration and risk of all-cause mortality: a systematic review and meta-analysis.

AIMS: To determine the association between the sleep duration and the risk of all-cause mortality in adults. METHODS: A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. Cohort studies were included without language, time or setting restrictions. The risk of bias was evaluated with a modified Cochrane Collaboration's tool. An analysis of random effects was conducted. The primary outcome was all-cause mortality. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned comparisons were 7-9 h of sleep v. <7 h and the same reference v. >9 h. RESULTS: Thirty-nine studies were included in our qualitative analysis, regarding the quantitative analysis, 19 studies were included in <7 v. 7-9 h analysis, and 18 studies in the >9 v. 7-9 h. A low risk of bias was shown for most of the study items. The overall RD for all-cause mortality was 0.09 (95% CI 0.07-0.11) favouring the >9 h group compared with our reference. In contrast, no differences were found between the <7 h and the reference sleep duration groups (RD 0.00, 95% CI 0.00-0.01). CONCLUSION: We found a probable association of long sleep duration and higher mortality; however, it could reflect an underlying systemic or neurological disease that cause sleep fragmentation, deterioration in quality and micro-awakenings.

Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality.

Sleep patterns in critically ill patients' polysomnographic sleep studies (PSG) are severely abnormal. PURPOSE: We aimed to investigate the association of atypical sleep patterns, micro-sleep phenomena (sleep spindles and K-complexes) and rapid eye movement (REM) sleep with intensive care unit (ICU), in-hospital and 90-day mortality in conscious critically ill patients on mechanical ventilation. METHOD: This was a prospective descriptive study. We analysed 52 PSGs recorded in conscious critically ill patients on mechanical ventilation. PSGs were scored according to standard classification when possible. Otherwise, modified classification proposed for scoring sleep in critically ill patients was used. The association of PSG findings with mortality was studied using logistic regression and Weibull model of survival analysis. RESULTS: The presence of atypical sleep patterns in accordance with modified sleep scoring classification was associated with higher odds for ICU mortality (odds ratio 11.63; p = 0.03). The absence of K-complexes was associated with higher odds for ICU mortality (odds ratio 11.63; p = 0.03), while the absence of sleep spindles was associated with higher odds for in-hospital (odds ratio 7.80; p = 0.02) and 90-day mortality (odds ratio 5.51; p = 0.02). Loss of sleep spindles was associated with higher mortality risk with cutoff point 90 days (hazard ratio 3.87; p = 0.03). CONCLUSIONS: The presence of atypical sleep and absence of normal PSG sleep characteristics in conscious critically ill patients on mechanical ventilation indicates involvement of sleep producing brain structures in the pathological process and is associated with poor outcome.

Association of sleep disturbances within 4 weeks prior to incident acute myocardial infarction and long-term survival in male and female patients: an observational study from the MONICA/KORA Myocardial Infarction Registry.

BACKGROUND: Sleep-related investigations in acute myocardial infarction (AMI) patients are rare. The aim of this study was to examine sex-specific associations of patient-reported sleep disturbances within 4 weeks before AMI and long-term survival. METHODS: From a German population-based, regional AMI registry, 2511 men and 828 women, aged 28-74 years, hospitalized with a first-time AMI between 2000 and 2008 and still alive after 28 days, were included in the study (end of follow-up: 12/2011). Frequency of any sleep disturbances within 4 weeks before AMI was inquired by a 6-categorical item summarized to 'never', 'sometimes' and 'nightly'. Cox regression models were calculated. RESULTS: Over the median follow-up time of 6.1 years (IQR: 4.1) sleep disturbances were reported by 32.3% of male and 48.4% of female patients. During the observation period, 318 men (12.7%) and 131 women (15.8%) died. Men who 'sometimes' had sleep disturbances showed a 56% increased mortality risk compared to those without complaints in an age-adjusted model (HR 1.56; 95%-CI 1.21-2.00). Additional adjustment for confounding variables attenuated the effect to 1.40 (95%-CI 1.08-1.81). Corresponding HRs among women were 0.97 (95%-CI 0.65-1.44) and 0.99 (95%-CI 0.66-1.49). HRs for patients with nightly sleep disturbances did not suggest any association for both sexes. CONCLUSIONS: Our study found that nightly sleep disturbances have no influence on long-term survival in male and female AMI patients. Contrary to women, men who reported sometimes sleep disturbances had a higher mortality. Further investigations on this topic taking into account the role of obstructive sleep apnoea are needed.

Association between death and loss of stage N2 sleep features among critically Ill patients with delirium.

PURPOSE: Critically ill patients experience significant sleep disruption. In this study of ICU patients with delirium, we evaluated associations between the loss of stage N2 features (K-complexes, sleep spindles), grade of encephalopathy based on electroencephalography (EEG), and intensive care unit (ICU) outcomes. We hypothesized that loss of stage N2 features is associated with more severe grades of encephalopathy and worse ICU outcomes including death. MATERIALS AND METHODS: This was an observational cohort study of 93 medical ICU patients without primary acute brain injury who underwent continuous EEG. Type and severity of critical illness, sedative-hypnotic use, length of stay, modified Rankin Scale at hospital discharge, and death during hospitalization were abstracted from the medical record. EEG was evaluated for grade of encephalopathy and sleep features. RESULTS: Patients without K-complexes or without sleep spindles had more severe encephalopathy and higher odds of death. The odds ratio for patients without K-complexes was 18.8 (p = .046). The odds ratio for patients without sleep spindles was 6.3 (p = .036). CONCLUSIONS: Loss of stage N2 features is common and associated with more severe encephalopathy and higher odds of death. The absence of either Stage N2 feature, K complexes or sleep spindles, may have important prognostic value.