We discussed two cases of symptomatic female carriers to Duchenne Muscular Dystrophy. The first case is a 20 year-old girl with classical phenotypic manifestation of the disease, similar to the condition in boys. The case 2 is a 62 year-old woman with progressive muscular weakness. The disease is much less common in woman than men so both cases described here are considered rare forms of the disease, with several clinical implications. In both cases, a progressive muscle weakness, impairment in walking and sleeping was observed, in addition to obstructive sleep apnea syndrome and alveolar hypoventilation, that required noninvasive ventilatory support.
Keywords: Duchenne, Muscular, Dystrophy, Female symptomatic, Sleep disorders, Noninvasive ventilatory support
Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).
Keywords: Maxillomandibular advancement, Obstructive Sleep Apnea Syndrome, Mandibular retrognathism
Parasomnias with sexual behavior or sexsomnias are considered a subtype of NREM parasomnias. Obstructive sleep apnea/hypopnea (OSAH) has been described as a known triggering factor for parasomnias including sexsomnia. Nasal continuous positive airway pressure (nCPAP) has been the standard of treatment for OSAH but mandibular advancement devices (MAD) are becoming an important treatment alternative. We present the case of a patient with mild OSAH and sexsomnia who had resolution of both conditions with a MAD. This patient had the added uniqueness of having REM-predominant OSAH
Keywords: Parasomnia, Obstructive sleep apnea, Dental device
Obstructive sleep apnoea (OSA) patients on opioid analgesic have an increased incidence of postoperative respiratory complications; prevention of these may be possible with appropriate post-operative monitoring. We recruited 4 OSA patients who had general anaesthesia for orthopaedic and septoplasty surgery. They required Patient Controlled Analgesia (PCA) or oral opioids in the post-operative period, hence continuous Saturation of Oxygen (Spo2), End Tidal Carbon dioxide (EtCo2) monitoring on Capnostream monitor with Integrated Pulmonary Index (IPI) was organized in high dependency unit. Overnight data was collected every 30 s which included pulse rate, respiratory rate, EtCo2, Spo2, and IPI. The nursing staff was also asked to document if any intervention was carried out due to altered IPI. For first two patient events occurred during various hours but there were no significant events in early night even though increased opioid use at that time. During the period of desaturation nurse intervention required to increase the O2 flow in the first patient but corrected spontaneously in the second patient. IPI index improved over a period of 2 min in most of the events. The duration of desaturation did not correspond with the IPI in only once, remaining period the clinical symptoms were consistent with fall in O2 saturation. The microstream capnography with IPI may provide complete respiratory status of the patient because of its comprehensive parameters on one screen. Main limitation was duration of monitoring was limited to overnight. Capnostream monitoring with IPI may have a role in patients monitoring with OSA on PCA in the postoperative ward but more trials are necessary.
Keywords: Obstructive sleep apnoea, Post operative analgesia, Opioid analgesia, Capnostream monitor, Respiratory complications, Integrated pulmonary index
Community-dwellers aged ≥ 60 years enrolled in the Atahualpa Project underwent brain MRI and were interviewed with the Pittsburgh Sleep Quality Index. Of 290 participants, 94 (32%) had poor sleep quality and 143 (49%) had global cortical atrophy (GCA). In a logistic regression model (adjusted for demographics, cardiovascular risk factor, severe edentulism, symptoms of depression, the MoCA score, and neuroimaging signatures of cerebrovascular damage), poor sleep quality was associated with GCA (p=0.004). A multivariate probability model showed that the probability of moderate-to-severe GCA significantly increased in individuals with poor sleep quality aged ≥ 67 years. This study provides evidence for an association between poor sleep quality and GCA in older adults and the important interaction of age in this association.
Keywords: Global cortical atrophy, Pittsburgh Sleep Quality Index, Population-based study, Sleep quality, Older adults
We evaluated the frequency of naps and features of nappers who took a nap in a Power Nap Center located in downtown area of S?o Paulo. Company database was retrospectively analyzed and 4.625 naps were evaluated (January-December 2014). Most naps (57%) lasted 30 min. 33% of subjects took a nap more than once a week (73% male). Progressive growth in the number of naps across the months was observed (January = 110 to December=505). Results suggest that the society is sleep deprived and taking a nap during the day could be an important strategy to improve quality of life and increase productivity.
Keywords: Nap, Sleep deprivation, Power Nap Center
This paper assesses hypothesis that sufficient sleep duration and proper circadian rhythms during the early stages of life are indispensable to a successful life. Successful life was defined according to the famous cohort studies of Mischel's and Dunedin. To assess the hypothesis, neuronal elements presumably affecting early daily habits and successful life are reviewed. The effect of sufficient sleep duration and proper circadian rhythms during early stages of life on the development of the prefrontal cortex has been found to be the key issue to verify the hypothesis. Socioeconomic status is found to be another issue to be studied.
Keywords: Serotonin, Oxytocin, Prefrontal cortex, Marshmallow test, The dorsal striatum, Socioeconomic status
OBJECTIVE: To analyze the relationship between epilepsy, sleep disorders, and attention deficit hyperactivity disorder (ADHD).
BIBLIOGRAPHIC SEARCH: A literature search of the PubMed database was performed using the following key words: epilepsy, sleep, and ADHD. In total, 91 articles were located in PubMed, 34 were selected for abstract reading and twelve articles were reviewed, in which the main objectives were examine the relationship between epilepsy, sleep and ADHD from several perspectives, including epidemiology, effect of comorbidities on academic performance and the factors leading to diagnostic difficulties among these three disorders
RESULTS: Among the main findings, there were difficulties to start and maintain sleep in patients with epilepsy and ADHD, reduction in sleep efficiency, decreased seizure threshold, as well as behavioral and cognitive deficits in both groups.
CONCLUSIONS: It is important to know which symptom is the predominant one. For this reason, children and adolescents with epilepsy, ADHD and sleep disorders need to be assessed carefully before initiating treatment. Our review concluded that there is an important link in this pathological triad.
Keywords: Epilepsy, Sleep, ADHD
To date, shift workers represent between 15% and 25% of the modern day workforce. Work time poses a great challenge to workers as it requires that they balance productivity and sleep time between shifts. As a result, these workers experience chronic sleep deprivation with increased fatigue and drowsiness due to this sleep deprivation. The impact of this kind of work on the immune system is not yet known. We conducted a literature review with the aim of evaluating articles on this specific type of work's effects on sleep and immunity.
Keywords: Sleep, Immunity, Shift work
To identify the scales to assess sleep disorders applied to women with climacteric stage. Bibliographical research without intervention, the available information in scientific databases. Performed in PubMed, ScienceDirect, Scopus, Ebscohos OvidSP and Health Library. The words used in this article: insomnia, adjustment sleep disorder, questionnaires, studies and menopause. Publications of all types were included. Seven scales were identified: Insomnia Severity Index, Athens Insomnia Scale, Pittsburgh Quality of sleep Index, Epworth Sleepiness Scale, Jenkins Sleep Scale, Basic Nordic Sleep Questionnaire and The St Mary's Hospital Sleep Questionnaire. There are validated scales in multiple languages and considered appropriate for studying sleep disorders.
Keywords: Climacteric, Sleep, Quality of life, Menopause
BACKGROUND: Chronic insomnia is associated with consequential experience that may affect quality of life. Understanding such experience can be helpful in planning effective interventions for patients with chronic insomnia.
OBJECTIVE: The study aimed to describe and illuminate the experience of living with chronic insomnia.
METHOD: The study was conducted using a descriptive phenomenology approach. Participants were selected purposefully from patients with chronic insomnia who had been referred to the sleep disorders research center at Kermanshah University of Medical Sciences in Iran in 2014. Data were gathered through in-depth unstructured interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology.
RESULTS: Two main themes were found in this study, from which five sub themes were constructed: first, an upset mind, with the subthemes of insomnia as an unpleasant experience and insomnia as a worrying experience; and second, an unwanted new lifestyle with treatment seeking behavior, a boring new daily routine and being overshadowed by depressed mood as the subthemes.
CONCLUSION: The study identified the experience of living with chronic insomnia as a painful one with both mental and practical aspects. The experience also explains how mental engagement and practical outcomes of chronic insomnia may interfere with well-being and quality of life in sufferers. It is recommended that patients' experiences would be considered in assessment and treatment of chronic insomnia. Therefore, therapeutic interventions should pay attention to this area.
Keywords: Chronic insomnia, Experience, Iran, Qualitative study, Phenomenology
Insomnia is a sleep disorder in which the subject encounters problems in sleeping. The aim of this study is to identify insomnia events from normal or effected person using time frequency analysis of PSD approach applied on EEG signals using channel ROC-LOC. In this research article, attributes and wave-form of EEG signals of Human being are examined. The aim of this study is to draw the result in the form of signal spectral analysis of the changes in the domain of different stages of sleep. The analysis and calculation is performed in all stages of sleep of PSD of each EEG segment. Results indicate the possibility of recognizing insomnia events based on delta, theta, alpha and beta segments of EEG signals.
Keywords: Classification of Insomnia, Analysis of EEG Signal, Estimation of PSD
This study was aimed at assessment of sleep schedule, pre-sleep behavior, co-sleeping and parent's perception of sleep of school going children.
METHOD: Four schools each, from urban and rural area were included. Sleep patterns were assessed using the validated Hindi version of Childhood-Sleep-Habit-Questionnaire. Comparison was made between urban and rural group and between boys and girls. Interaction of gender, domicile and school-type was examined on the sleep patterns.
RESULTS: This study included 831 school children with mean age of 8.9 years. Nearly half of the subjects were boys in this study. Urban children outnumbered those from rural area. Total sleep time on weekdays was 8.3 h that increased to 9.5 h on weekends. Rural children spent more time in sleep than urban children on weekdays and weekends. A higher proportion of urban children felt sleepy during the day. Television watching before bedtime was more common in urban settings. Room sharing was more common among rural children. Nearly 65% rural parents as compared to 77.5% urban parents reported that their child was sleeping sufficient enough. Gender did not affect sleep-schedule and parent's perception regarding their child's sleep. Interaction between gender, domicile and school-type did not have any significant effect on sleep patterns.
CONCLUSION: Television watching before bedtime was more common among urban school children and they had shorter total sleep time. They had signs of sleep deprivation. Room sharing was more common among rural children. Despite longer sleep time, parents of rural children felt the need for more sleep.
Keywords: Children, Sleep-patterns, Co-sleeping, Pre-sleep behavior
Actigraphy has become a common method of measuring sleep due to its non-invasive, cost-effective nature. An actigraph (ReadibandTM) that utilizes automatic scoring algorithms has been used in the research, but is yet to be evaluated for its inter-device reliability. A total of 77 nights of sleep data from 11 healthy adult participants was collected while participants were concomitantly wearing two Readi-bandTM actigraphs attached together (ACT1 and ACT2). Sleep indices including total sleep time (TST), sleep latency (SL), sleep efficiency (SE%), wake after sleep onset (WASO), total time in bed (TTB), wake episodes per night (WE), sleep onset variance (SOV) and wake variance (WV) were assessed between the two devices using mean differences, 95% levels of agreement, intraclass correlation coefficients (ICC), typical error of measurement (TEM) and coefficient of variation (CV%) analysis. There were no significant differences between devices for any of the measured sleep variables (p > 0.05). TST, SE, SL, TTB, SOV and WV all resulted in very high ICC's ( > 0.90), with WASO and WE resulting in high ICC's between devices (0.85 and 0.80, respectively). Mean differences of - 2.1 and 0.2 min for TST and SL were associated with a low TEM between devices (9.5 and 3.8 min, respectively). SE resulted in a 0.3% mean difference between devices. The ReadibandTM is a reliable tool for researchers using multiple devices of this brand in sleep studies to assess basic measures of sleep quality and quantity in healthy adult populations.
Keywords: Actigraphy, Polysomnography, Agreement, Validity
Sleep complaints and sleep disturbances are highly prevalent in patients with psychiatric disorders. During hospitalization the patients' condition may be even worse but little is known about the subjective sleep quality in psychiatric hospitals. Thus, we have investigated subjective sleep quality and mean sleep duration in patients with different psychiatric disorders at the end of hospitalization. For a period of one year, inpatients of a psychiatric hospital with diagnosis of substance use disorder (SUD), schizophrenia (SCZ), or anxiety/depressive disorders (AND) were routinely asked to fill in an easily comprehensible sleep quality questionnaire at the end of their hospitalization. Age, gender, subjective sleep quality, and sleep duration were analyzed; sleep duration was classified according to age-specific recommendations. Data of n=309 patients (age 52.1 ± 17.9y, 56.1% women) were analyzed (n = 63 SUD, n = 50 SCZ, n = 196 AND). Mean sleep duration was 7.0 ± 2.0 h; 20.7% of patients had sleep durations below and 4.5% above age-specific recommendations. Non-restorative sleep during hospitalization was reported “almost always” in 38.2% (n = 118), and “occasionally” in 30.1% (n=93). Subjective sleep quality was significantly associated with sleep duration (rs = -0.31, P< 0.0005), but not with age, gender or diagnostic subgroup. The study showed that a great proportion of patients reported poor subjective sleep quality during hospitalization, regardless of age, gender and psychiatric diagnosis. As sleep quality was significantly associated with short sleep duration, a first step could be to take care to achieve recommended age-specific sleep durations in psychiatric hospitals.
Keywords: Sleep quality, Sleep duration, Psychiatric disorders, Hospitalization
Sleepiness is the condition where for some reason fails to go into a sleep state and will have difficulty in remaining awake even while carrying out activities. Sleep restriction occurs when an individual fails to get enough sleep due to high work demands. The mechanism between sleep restriction and underlying brain physiology deficits is not well assumed. The objective of the present study was to investigate the mental attention (P300) and reaction time [visual (VRT) and auditory (ART)] among night watchmen, at subsequent; first (1st) day, fourth (4th) day and seventh (7th) day of restricted sleep period. After exclusion and inclusion criteria, the study was performed among 50 watchmen (age = 18-35 years) (n = 50) after providing written informed consent and divided into two group. Group I-(Normal sleep) (n=28) working in day time and used to have normal sleep in night ( ≥ 8 h); Group II-(Restricted sleep) (n=22) - working in night time and used to have less sleep in night ( ≤ 3 h). Statistical significance between the different groups was determined by the independent student ‘t’ test and the significance level was fixed at p ≤ 0.05. We observed that among all normal and restricted sleep watchmen there was not any significant variation in Karolinska Sleepiness Scale (KSS) score, VRT and ART, along with latency and amplitude of P300 on 1st day of restricted sleep. However at subsequent on 4th day and 7th day of restricted sleep, there was significant increase in (KSS)score, and prolongation of VRT and ART as well as alteration in latency and amplitude of P300 wave in restricted sleep watchmen when compare to normal sleep watchmen. The present finding concludes that loss of sleep has major impact in dynamic change in mental attention and reaction time among watchmen employed in night shift. Professional regulations and work schedules should integrate sleep schedules before and during the work period as an essential dimension for their healthy life.
Keywords: Attention, P300, Reaction time, Sleep restriction
Many observations have demonstrated that the hypothalamic neuroendocrine change determines the chronological sequence of aging in mammals. However, it remains uncertain on the mechanism to account for the hypothalamic aging manifestations. In this article, it is pointed out that, as constantly exposed to sunshine and oxygen, the skin would undergo both telomere-shortening and oxidative senescent processes. The senescent alterations of skin, such as attenuation in electrodermal activities, would in turn reduce the emotional responses and memories. Whereas previously I demonstrated that the slow wave sleep just functioned to adjust the emotional balance disrupted by accumulated emotional memories, especially capable of ameliorating the symptoms of depressed patients. Therefore, the reduction in emotional responses and memories from skin senescence would reduce the requirement for slow wave sleep in many senescent observations. The decrement in slow wave sleep would in further cause functional but not chronological degeneration of suprachiasmatic nucleus rather than paraventricular nucleus in hypothalamus. In these respects, from skin senescence to slow wave sleep, there forms a new degenerative aging pathway able to account for the hypothalamic chronological sequence of aging, specifically addressed to the suprachiasmatic nucleus.
Keywords: Skin aging, Electrodermal activity, Depression, Emotional memory, Slow wave sleep, Suprachiasmatic nucleus
INTRODUCTION: The aim of the study was to propose the Clinical Inventory of Sleep Quality (CISQ), and compared it with the Pittsburgh sleep quality index (PSQI).
METHODS: We studied 400 subjects with the CISQ. Cronbach’s alpha coefficient was calculated to measure the reliability, and to determine the concurrent validity, a Canonical correlation analysis was performed. At next, we used an exploratory and confirmatory Factorial analysis with Varimax rotation for validity construct calculation.
RESULTS: Cronbach alpha coefficient of the scale was significantly strong (α=0.81). Canonic correlation was=0.93, suggesting that data proved that the CISQ and PSQI are measuring identical subject. Confirmatory Factorial analysis model grouped items of the scale in four factors: 1. Daytime symptoms, 2. Nocturnal symptoms, 3. Sleep disordered breathing symptoms, and 4. Sleep-related movement disorders symptoms. We proposed five categories to score CISQ in a range of 0-52 points, as follows: Good quality of sleep, Mild bad sleep quality, Moderate bad sleep quality, Severe bad sleep quality, and Profound bad sleep quality.
CONCLUSION: CISQ is a promising tool to measure sleep quality and deserve more research to confirm its utility.
Keywords: Sleep quality, Pittsburgh sleep quality index, Reliability, Validity
INTRODUCTION: Mandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients.
OBJECTIVE: The aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP)
METHOD: We performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results.
RESULTS: SNP show significant changes with use of MAD (p < 0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points).
CONCLUSION: Our data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.
Keywords: Obstructive sleep apnea, Mandibular advancement device, Polysomnography
Sleep is well known to have a significant impact on learning and memory. Specifically, studies adopting an experimentally induced sleep loss protocol in healthy individuals have provided evidence that the consolidation of spatial memories, as acquired through navigating and orienteering in spatial surroundings, is negatively affected by total sleep loss. Here, we used both objective and subjective measures to characterize individuals' quality of sleep, and grouped participants into either a poor (insomnia-like) or normal (control) sleep quality group. We asked participants to solve a wayfinding task in a virtual environment, and scored their performance by measuring the time spent to reach a target location and the number of wayfinding errors made while navigating. We found that participants with poor sleep quality were slower and more error-prone than controls in solving the task. These findings provide novel evidence that pre-existing sleep deficiencies in otherwise healthy individuals affects negatively the ability to learn novel routes, and suggest that sleep quality should be accounted for among healthy individuals performing experimental spatial orientation tasks in virtual environments.
Keywords: Cognitive performance, Declarative memory, Insomnia, Navigation, Sleep quality
PURPOSE: We sought explore the effects of doxorubicin on sleep patterns and locomotor activity. To investigate these effects, two groups were formed: a control group and a Doxorubicin (DOXO) group.
METHODS: Sixteen rats were randomly assigned to either the control or DOXO groups. The sleep patterns were examined by polysomnographic recording and locomotor activity was evaluated in an open-field test.
RESULTS: In the light period, the total sleep time and slow wave sleep were decreased, while the wake after sleep onset and arousal were increased in the DOXO group compared with the control group (p < 0.05). In the dark period, the total sleep time, arousal, and slow wave sleep were increased, while the wake after sleep onset was decreased in the DOXO group compared with the control group (p < 0.05). Moreover, DOXO induced a decrease of crossing and rearing numbers when compared control group (p < 0.05).
CONCLUSIONS: Therefore, our results suggest that doxorubicin induces sleep pattern impairments and reduction of locomotor activity.
Keywords: Sleep, Locomotor activity, Doxorubicin, Rats
OBJECTIVES: Effects of daily caffeine consumption on open-field behaviours, serum corticosterone and brain antioxidant levels were investigated after six hours of total sleep-deprivation in prepubertal mice. We tested the hypothesis that daily caffeine consumption may significantly alter behaviour, stress and antioxidative response of prepubertal mice to an acute episode of total sleep-deprivation.
METHODS: Prepubertal Swiss mice of both sexes were assigned to two main groups of 120 each (subdivided into 6 groups of 10 each, based on sex), and administered vehicle or graded oral doses of caffeine (10, 20, 40, 80 and 120 mg/kg/day) for 14 days. On day 14, a main group was subjected to 6 h of total sleep-deprivation by ‘gentle-handling’. Open-field behaviours were then assessed in both groups, after which animals were euthanized, and levels of corticosterone, superoxide dismutase and glutathione peroxidase assayed.
RESULTS: Horizontal locomotion, rearing and grooming increased significantly, compared to control, with sleep-deprived (SD) mice showing stronger caffeine-driven responses at higher doses; and SD female mice showing sustained response to caffeine, compared to respective males. Plasma corticosterone increased with increasing doses of caffeine in both non sleep-deprived (NSD) and SD mice; although SD mice had higher corticosterone levels. Sleep-deprivation and/or higher doses of caffeine were associated with derangements in brain antioxidant levels.
CONCLUSION: Repeated caffeine consumption and/or acute sleep-deprivation led to significant changes in pattern of open-field behaviour and stress/antioxidant response in mice. Responses seen in the study are probably due to modulatory effects of caffeine on the total body response to stressful stimuli.
Keywords: Sleep-deprivation, Caffeine, Sex, Open-field arena, Stress hormones, Antioxidant
INTRODUCTION: Obstructive sleep apnea syndrome (OSA) is diagnosed through polysomnography (PSG) or respiratory polygraphy (RP). Self-administered home-based RP using devices with data transmission could facilitate diagnosis in distant populations. The purpose of this work was to describe a telemedicine initiative using RP in four satellite outpatient care clinics (OCC) of Buenos Aires Hospital Británico Central (HBC). Materials and methods: OCC technicians were trained both in the use of RP. Raw signals were sent to HBC via intranet software for scoring and final report.
RESULTS: During a 24-month 499 RP were performed in 499 patients: 303 men (60.7%) with the following characteristics (mean and standard deviation): valid time for manual analysis: 392.8 min ( ± 100.1), AHI: 17.05 ( ± 16.49 and percentile 25-75 [Pt]: 5-23) ev/hour, ODI (criterion 3%): 18.05 ( ± 16.48 and Pt 25-75: 6-25) ev/hour, and time below 90% (T <90): 17.9% (±23.4 and Pt 25-75: 1-23). The distribution of diagnoses (absolute value and percentage) was: normal (66/13%), snoring (70/14%), mild (167/33.5%), moderate (110/22%), and severe (86/17.2%). Continuous positive airway pressure (CPAP) was indicated for 191 patients (38.6%). Twenty recordings (4%) were considered invalid and the RP had to be repeated.
Keywords: Respiratory polygraphy, OSA, Telemedicine
A cross-sectional population-based survey, the National FINRISK 2012 Study, designed to monitor chronic diseases and their risk factors in Finland. A random sample of 10,000 adults aged 25-74 years, and of them, 64% (n=6424) participated the study. Participants subjectively reported the total durations for sleep and naps (n=6238), sleep quality (n=5878), bedtimes and wake-up times separately for working days and weekends yielding the amount of sleep debt (n=5878), and the seasonal variation in sleep duration (n=4852). The participants were asked whether they were diagnosed or treated for common chronic diseases in the past 12 months. Logistic regression models were adopted to analysis and adjusted for a range of covariates as potential confounding factors. Total sleep duration and nap duration prolonged in depression and other mental disorder (p < .001 for all). Seasonal variation in sleep duration was associated with depression (p=.014), hypertension (p=.018) and angina pectoris (p=.024). Participants with gallstones, cardiac insufficiency, depression, or degenerative arthritis had poor sleep quality (odds ratios of 1.6-6.3, p=.001 or less for each). Those with degenerative arthritis had sleep debt less (p < .05) and those with angina pectoris more (p < .05) than individuals without these medical conditions. Depression is significantly associated with sleep problems, albeit no sleep debt. Cardiovascular diseases, degenerative arthritis, and gallstones had significant associations with one or more sleep problems. There is therefore a need for more successful management of sleep problems in chronic diseases to improve the quality of life, to reduce treatment relapses, and to increase health and longevity in a population.
Keywords: Population survey, Cardiovascular, Depression, Sleep debt, Sleep duration, Sleep quality
BACKGROUND AND OBJECTIVE: Among substances that have a significant effect on sleep are stimulants, including amphetamines. As there are few studies assessing sleep quality in methamphetamine withdrawal this study aims to evaluate changes in sleep quality of methamphetamine dependent patients during early remission period by controlling depression and anxiety as confounding variables.
METHODS: This study was conducted in Mashhad, Iran. Ninety amphetamine dependent patients, who were admitted in residential centers during 2012-2014 and met our inclusion criteria, were chosen by purposive nonprobability sampling method. Sleep quality was assessed by Pittsburg sleep questionnaire, in the first, second, and after the fourth week of abstinence. Additionally all participants were assessed by Beck Depression Inventory-2 and Beck Anxiety Inventory for controlling depressive and anxiety symptoms.
RESULTS: The prevalence of improper quality of sleep was very high (97.8%) within the first week of withdrawal, but it reduced considerably four weeks after abstinence (52.2%), which was statistically significant (P=0.00). The variations of depression and anxiety levels within four weeks after quitting methamphetamine, have low impact on variation of patients' sleep quality (adjusted R2 < 0.5). Furthermore, the effectiveness of these two intervening variables on patients' quality of sleep was dwindled over time after abstinence.
CONCLUSIONS: This study showed that the patients' quality of sleep improved significantly four weeks after abstinence and its variation was independent from variations in anxiety and depressive symptoms.
Keywords: Sleep quality, Amphetamine, Abstinence, Depression, Anxiety