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Sleep Initiation and Maintenance Disorders: HELP
Articles from UCLA
Based on 52 articles published since 2008
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These are the 52 published articles about Sleep Initiation and Maintenance Disorders that originated from UCLA during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Polysomnographic characteristics in nonmalignant chronic pain populations: A review of controlled studies. 2016

Bjurstrom, Martin F / Irwin, Michael R. ·Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA. Electronic address: mfbjurstrom@ucla.edu. · Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA. ·Sleep Med Rev · Pubmed #26140866.

ABSTRACT: Sleep and pain are critical homeostatic systems that interact in a bidirectional manner. Complaints of sleep disturbance are ubiquitous among patients with chronic pain disorders, and conversely, patients with persistent insomnia symptoms commonly report suffering from chronic pain. Sleep deprivation paradigms demonstrate that partial or complete sleep loss induce hyperalgesia, possibly due to shared mechanistic pathways including neuroanatomic and molecular substrates. Further, chronic pain conditions and sleep disturbances are intertwined through comorbidities, which together cause detrimental psychological and physical consequences. This critical review examines 29 polysomnography studies to evaluate whether nonmalignant chronic pain patients, as compared to controls, show differences in objective measures of sleep continuity and sleep architecture. Whereas these controlled studies did not reveal a consistent pattern of objective sleep disturbances, alterations of sleep continuity were commonly reported. Alterations of sleep architecture such as increases in light sleep or decreases in slow-wave sleep were less commonly reported and findings were mixed and also inconsistent. Methodological flaws were identified, which complicated interpretation and limited conclusions; hence, recommendations for future research are suggested. Knowledge of abnormalities in the sleep process has implications for understanding the pathophysiology of chronic pain conditions, which might also direct the development of novel intervention strategies.

2 Review Sleep in caregivers: what we know and what we need to learn. 2015

McCurry, Susan M / Song, Yeonsu / Martin, Jennifer L. ·aUniversity of Washington, Seattle, Washington bGeriatric Research, Education, and Clinical Center, Department of Veterans Affairs Greater Los Angeles Healthcare System cDavid Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA. ·Curr Opin Psychiatry · Pubmed #26397027.

ABSTRACT: PURPOSE OF REVIEW: The number of informal caregivers providing assistance to adults is increasing commensurate with our aging society. Sleep disturbances are prevalent in caregivers and associated with negative physical, medical, and functional outcomes. Here, we describe the predisposing, precipitating, and perpetuating factors contributing to the development of sleep problems in caregivers, and discuss three understudied caregiving populations that have clinical importance and unique circumstances influencing sleep quality and health. RECENT FINDINGS: There is clear evidence supporting the interaction between sleep loss, caregiving stress, and vulnerability to chronic disease. Telehealth and telemedicine sleep interventions for caregivers combined with assistive technologies targeting care-receivers have potential to be more individualized, affordable, and widely accessible than traditional in-person insomnia treatment approaches. Limited data exist describing the etiology and treatment of sleep problems in caregivers of veterans, medical patients newly discharged from the hospital, and developmentally disabled adults. SUMMARY: There is a growing literature describing the general determinants of sleep disturbances in caregivers, the health consequences of these disturbances, and intervention strategies for treating them. Identifying effective sleep treatments suited to more specialized caregiving situations and increasing intervention access will help caregivers continue to provide quality care while protecting their own health and well-being.

3 Review Sleep problems in the elderly. 2015

Rodriguez, Juan Carlos / Dzierzewski, Joseph M / Alessi, Cathy A. ·Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (IE), North Hills, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 405 Hilgard Avenue, CA 90095, USA; Department of Medicine, Pontificia Universidad Catolica de: Ave, Libertador Bernardo O'Higgins 340, Santiago, Chile. Electronic address: juan.rodrigueztapia@va.gov. · Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (IE), North Hills, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 405 Hilgard Avenue, CA 90095, USA. ·Med Clin North Am · Pubmed #25700593.

ABSTRACT: Epidemiologic studies have shown that approximately 50% of older adults have sleep problems, many of which carry deleterious consequences that affect physical and mental health and also social functioning. However, sleep problems in late life are often unrecognized, and are inadequately treated in clinical practice. This article focuses on the diagnosis and treatment of the 2 most common sleep problems in older patients: sleep apnea and insomnia.

4 Review Managing the risks of ADHD treatments. 2014

Schneider, Benjamin N / Enenbach, Michael. ·Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Suite 68-251A, Los Angeles, CA, 90024, USA, bschneider@mednet.ucla.edu. ·Curr Psychiatry Rep · Pubmed #25135779.

ABSTRACT: Pharmacotherapy of attention deficit-hyperactivity disorder (ADHD) is a well-established and effective treatment modality. However, ADHD medications are not without side effects. Understanding the prevalence of adverse events and effective management of risks associated with stimulants and other medications used to treat ADHD is central to broad applicability and effective treatment. This review discusses the literature on the prevalence of adverse events and management strategies employed. We searched online MEDLINE/PubMed and Cochrane databases for articles using several keywords relating to adverse events associated with ADHD medication management. We discuss the relevant data on the significance and prevalence of side effects and adverse events, highlight recent updates in the field, and suggest approaches to clinical management.

5 Review Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. 2013

Irwin, Michael R. ·Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, David Gefffen School of Medicine, University of California, Los Angeles, 300 UCLA Medical Plaza, Room 3130, Los Angeles, CA, 90095-7076, USA, mirwin1@ucla.edu. ·Curr Psychiatry Rep · Pubmed #24078066.

ABSTRACT: Over two-thirds of the 11.4 million cancer survivors in the United States can expect long-term survival, with many others living with cancer as a chronic disease controlled by ongoing therapy. Behavioral comorbidities often arise during treatment and persist long term to complicate survival and reduce quality of life. This review focuses on depression and insomnia with an emphasis on understanding the role of cancer-specific factors and their contribution to the prevalence of these behavioral comorbidities in cancer patients following cancer diagnosis and treatment. The clinical significance of depression and insomnia for cancer patients is further stressed by epidemiological observations that link depression and insomnia to cancer morbidity and mortality risk.

6 Review Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. 2013

Ganz, Patricia A / Yip, Cheng Har / Gralow, Julie R / Distelhorst, Sandra R / Albain, Kathy S / Andersen, Barbara L / Bevilacqua, Jose Luiz B / de Azambuja, Evandro / El Saghir, Nagi S / Kaur, Ranjit / McTiernan, Anne / Partridge, Ann H / Rowland, Julia H / Singh-Carlson, Savitri / Vargo, Mary M / Thompson, Beti / Anderson, Benjamin O. ·University of California, Los Angeles, CA, USA. ·Breast · Pubmed #24007941.

ABSTRACT: Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.

7 Review Insomnia (primary) in older people. 2011

Alessi, Cathy / Vitiello, Michael V. ·David Geffen School of Medicine at UCLA, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA. ·BMJ Clin Evid · Pubmed #22030082.

ABSTRACT: INTRODUCTION: Up to 40% of older adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include psychological factors, stress, daytime napping, and hyperarousal. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug treatments for insomnia in older people? What are the effects of drug treatments for insomnia in older people? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 34 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antidepressants, benzodiazepines, cognitive behavioural therapy (CBT), diphenhydramine, exercise programmes, timed exposure to bright light, zaleplon, zolpidem, and zopiclone.

8 Review Behavioral symptoms in patients with breast cancer and survivors. 2008

Bower, Julienne E. ·University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA. jbower@ucla.edu ·J Clin Oncol · Pubmed #18258985.

ABSTRACT: Behavioral symptoms are a common adverse effect of breast cancer diagnosis and treatment and include disturbances in energy, sleep, mood, and cognition. These symptoms cause serious disruption in patients' quality of life and may persist for years after treatment. Patients need accurate information about the occurrence of these adverse effects as well as assistance with symptom management. This review considers four of the most common behavioral sequelae of breast cancer, namely fatigue, sleep disturbance, depression, and cognitive impairment. Research on the prevalence, mechanisms, and treatment of each symptom is described, concluding with recommendations for future studies.

9 Clinical Trial Provision of ancillary medications during buprenorphine detoxification does not improve treatment outcomes. 2010

Hillhouse, Maureen / Domier, Catherine P / Chim, David / Ling, Walter. ·University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA 90025, USA. hillhous@ucla.edu ·J Addict Dis · Pubmed #20390696.

ABSTRACT: For individuals dependent on opioids, recovery efforts begin with a period of withdrawal that typically includes discomfort from symptoms, possibly precipitating a return to drug use. The study described here investigated whether the provision of ancillary medications for opioid withdrawal symptoms affected treatment outcomes in 139 participants receiving buprenorphine in a 13-day detoxification trial. Outcome measures include the number of opioid-free urine samples collected and retention in treatment. Ancillary medications were provided to 70% of participants: 59% received medication for insomnia, 45% for anxiety, 40% for bone pain, 35% for nausea, and 28% for diarrhea. Findings indicate no difference in the number of opioid-free urine samples between the group receiving ancillary medication and the group who did not, although tests of specific ancillary medications indicate that those who received diarrhea medication had fewer opioid-free urines than those who did not (P = .004). Results also indicate that participants attended fewer days of treatment if they received anxiety, nausea, or diarrhea medication compared to no medication (all P values < .05).

10 Article Are sleep continuity disturbance and fatigue prodromal symptoms of cancer development? 2018

Garland, Sheila N / Irwin, Michael R / Posner, Donn / Perlis, Michael L. ·Departments of Psychology and Oncology, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland A1B 3X9, Canada. Electronic address: sheila.garland@mun.ca. · Cousins Center for Psychoneuroimmunology at the UCLA Semel Institute for Neuroscience, and the Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza #3109, Los Angeles, CA 90095, United States. · Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, United States. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, United States. ·Med Hypotheses · Pubmed #30220346.

ABSTRACT: Sleep continuity disturbance (also known as insomnia) and fatigue are common complaints of individuals diagnosed with cancer. Traditionally, many have believed that sleep continuity disturbance and fatigue are caused, in large measure, by the impact of the cancer diagnosis and treatment. Recent prospective research suggests however, that sleep continuity disturbance and fatigue may actually precede a cancer diagnosis. We suggest that sleep continuity disturbance and fatigue may in fact represent prodromal symptoms of cancer. We review the current perspectives of this sequence of events and present a revised schematic that accounts for the role of biological, behavioural, and cognitive factors that contribute to the development and maintenance of sleep continuity disturbances in cancer patients. Monitoring emergent and unexplained patient-reported fatigue, sleepiness, and insomnia may serve as early warning signs of new onset cancer, providing opportunity for early detection and early intervention.

11 Article Insomnia mediates the longitudinal relationship between anxiety and depressive symptoms in a nationally representative sample of adolescents. 2018

Li, Y Irina / Starr, Lisa R / Wray-Lake, Laura. ·Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA. · Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA. ·Depress Anxiety · Pubmed #29697888.

ABSTRACT: BACKGROUND: Anxiety and depression are commonly comorbid with each other, with anxiety often temporally preceding the development of depression. Although increasingly research has begun to investigate the role of sleep problems in depression, no study has examined insomnia as a mediator in the longitudinal relationship between anxiety and subsequent depression. METHODS: The current study utilizes data from Waves I, II, and IV of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative prospective study conducted over a 14-year period (n = 20,745, 50.5% female, M age at Wave I = 16.20). Participants completed portions of the Center for Epidemiologic Studies Depression Scale at Waves I and IV to assess depressive symptoms, a six-item anxiety measure at Wave I, and three items assessing insomnia, sleep quality, and sleep duration at Wave II. RESULTS: Structural equation modeling indicated that insomnia and unrestful sleep significantly mediated the relationship between anxiety and subsequent depression. The relationship between anxiety and depression was not significantly mediated by sleep duration. CONCLUSIONS: Findings suggest that anxiety may increase risk for the development of later depression through insomnia.

12 Article Discrimination and Sleep Difficulties during Adolescence: The Mediating Roles of Loneliness and Perceived Stress. 2018

Majeno, Angelina / Tsai, Kim M / Huynh, Virginia W / McCreath, Heather / Fuligni, Andrew J. ·Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Los Angeles, CA, 90024, USA. amajeno@mednet.ucla.edu. · Department of Child and Adolescent Development, San Jose State University, San Jose, CA, USA. · Child and Adolescent Development Department, California State University Northridge, Northridge, CA, USA. · Division of Geriatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. · Department of Psychology, UCLA, Los Angeles, CA, USA. · Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA. ·J Youth Adolesc · Pubmed #29164378.

ABSTRACT: Irregular and insufficient sleep place youth at risk for adverse psychological and physical health outcomes. Recent research indicates that discrimination constitutes a type of stressor that interferes with adolescent sleep; however, the mechanisms through which discrimination affects sleep are not well understood. This study examined whether ethnic and non-ethnic (i.e., gender, age, and height/weight) discrimination were associated with adolescents' sleep duration, variability, and quality, and whether loneliness and perceived stress mediated these associations. An ethnically-diverse sample (42% Latino, 29% European American, 23% Asian) of adolescents (N = 316; M

13 Article Sleep and mood in older adults: coinciding changes in insomnia and depression symptoms. 2018

Li, Michael J / Kechter, Afton / Olmstead, Richard E / Irwin, Michael R / Black, David S. ·Department of Preventive Medicine,Keck School of Medicine,University of Southern California,Los Angeles,California,USA. · Cousins Center for Psychoneuroimmunology,Semel Institute for Neuroscience,University of California,Los Angeles,California,USA. ·Int Psychogeriatr · Pubmed #28766467.

ABSTRACT: The aim of this analysis was to test if changes in insomnia symptoms and global sleep quality are associated with coinciding changes in depressed mood among older adults. We report on results yielded from secondary analysis of longitudinal data from a clinical trial of older adults (N = 49) aged 55 to 80 years who reported at least moderate levels of sleep problems. All measures were collected at baseline and after the trial ten weeks later. We computed change scores for two separate measures of disturbed sleep, the Athens Insomnia Scale (AIS) and the Pittsburgh Sleep Quality Index (PSQI), and tested their association with change in depressed mood (Beck Depression Inventory-II; BDI-II) in two separate linear regression models adjusted for biological covariates related to sleep (sex, age, body mass index, and NF-κB as a biological marker previously correlated with insomnia and depression). Change in AIS scores was associated with change in BDI-II scores (β = 0.38, p < 0.01). Change in PSQI scores was not significantly associated with change in BDI-II scores (β = 0.17, p = 0.26). Our findings suggest that improvements over ten weeks in insomnia symptoms rather than global sleep quality coincide with improvement in depressed mood among older adults.

14 Article Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures. 2017

Fung, Constance H / Vaughan, Camille P / Markland, Alayne D / Huang, Alison J / Mitchell, Michael N / Bliwise, Donald L / Ancoli-Israel, Sonia / Redline, Susan / Alessi, Cathy A / Stone, Katie. ·Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California. · Department of Medicine, University of California Los Angeles, Los Angeles, California. · Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama. · Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. · Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Medicine, University of California San Francisco, San Francisco, California. · Sleep Program, Emory University School of Medicine, Atlanta, Georgia. · Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California. · Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts. · California Pacific Medical Center, San Francisco, California. ·J Am Geriatr Soc · Pubmed #28914959.

ABSTRACT: OBJECTIVES: (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING: Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS: Community-dwelling women aged ≥80 years. MEASUREMENTS: Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS: Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R CONCLUSIONS: Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.

15 Article Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial. 2017

Irwin, Michael R / Olmstead, Richard / Carrillo, Carmen / Sadeghi, Nina / Nicassio, Perry / Ganz, Patricia A / Bower, Julienne E. ·All authors: University of California Los Angeles, Los Angeles, CA. ·J Clin Oncol · Pubmed #28489508.

ABSTRACT: Purpose Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer. Patients and Methods This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response-that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index-at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression. Results Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months ( P = .02) and at months 3 ( P = .02) and 6 ( P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups. Conclusion CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia.

16 Article A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial. 2017

Martin, Jennifer L / Song, Yeonsu / Hughes, Jaime / Jouldjian, Stella / Dzierzewski, Joseph M / Fung, Constance H / Rodriguez Tapia, Juan Carlos / Mitchell, Michael N / Alessi, Cathy A. ·Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA. · David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. · University of North Carolina, Chapel Hill, NC. · Health Services Research & Development, Durham VA Medical Center, Durham, NC. · Department of Psychology, Virginia Commonwealth University, Richmond, VA. · Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile. ·Sleep · Pubmed #28482053.

ABSTRACT: Study Objective: To test the effectiveness of a 4-week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4-week information-only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double-blind, randomized, clinical trial. Methods: Forty-two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in-person sleep and health assessments at baseline, post-treatment and 4-months follow-up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post-treatment and 4-months follow-up, with baseline values as covariates. Results: SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post-treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4-month follow-up (all p's < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4-month follow-up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post-treatment or 4-month follow-up. Conclusions: A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.

17 Article Prospective Longitudinal Study of Predictors of Postpartum-Onset Depression in Women With a History of Major Depressive Disorder. 2017

Suri, Rita / Stowe, Zachary N / Cohen, Lee S / Newport, D Jeffrey / Burt, Vivien K / Aquino-Elias, Ana R / Knight, Bettina T / Mintz, Jim / Altshuler, Lori L. ·760 Westwood Plaza, Ste 28-251, Los Angeles, CA 90095-7057. rsuri03@gmail.com. · Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, California, USA. · Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, California, USA. · Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. · Perinatal and Reproductive Psychiatry Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, University of Miami Miller School of Medicine, Florida, USA. · Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas, USA. ·J Clin Psychiatry · Pubmed #28297589.

ABSTRACT: OBJECTIVE: Risk factors for postpartum depression in euthymic pregnant women with histories of major depressive disorder (MDD) were evaluated. METHODS: From April 2003 to March 2009, 343 pregnant women with a history of Structured Clinical Interview for DSM-IV (SCID)-diagnosed major depressive disorder were prospectively assessed from the third trimester into the postpartum period using the SCID mood module and 17-item Hamilton Depression Rating Scale (HDRS). Data from 300 subjects who completed at least 2 mood module assessments (1 within 60 days before and the other within 60 days after delivery) were analyzed for predictive associations between variables assessed in the third trimester and the development of a postpartum depression. RESULTS: The majority of women were euthymic in pregnancy by SCID criteria. Women with third trimester SCID-diagnosed depression (n = 45) versus euthymia (n = 255) had a significantly higher risk for having depression after delivery (24% vs 11%, P = .013). For pregnant euthymic women, third trimester total HDRS scores significantly predicted postpartum depression (P < .0001); specifically, scores on 3 HDRS items alone-work activities, early insomnia, and suicidality-significantly predicted postpartum depression. Antidepressant use in the third trimester in euthymic women did not confer protection against the onset of postpartum depression. CONCLUSIONS: Among women with a history of MDD who are euthymic in the third trimester, 3 HDRS items-work activities, early insomnia, and suicidality-may be useful as screening items for clinicians working with pregnant women with histories of MDD to identify a group at risk for developing postpartum depression. Additionally, in euthymic women with a history of MDD, antidepressant use in the third trimester may not reduce the risk of developing postpartum depression.

18 Article Gender and Regional Differences in Sleep Quality and Insomnia: A General Population-based Study in Hunan Province of China. 2017

Tang, Jinsong / Liao, Yanhui / Kelly, Brian C / Xie, Liqin / Xiang, Yu-Tao / Qi, Chang / Pan, Chen / Hao, Wei / Liu, Tieqiao / Zhang, Fengyu / Chen, Xiaogang. ·Department of Psychiatry &Mental Health Institute of the Second Xiangya Hospital, Central South University. National Clinical Research Center on Mental Disorders &National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, 139 Renmin (M) Rd, Changsha, Hunan 410011, P. R. China. · Department of Psychiatry and Biobehavioral Sciences, UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA. · Department of Sociology &Center for Research on Young People's Health (CRYPH), Purdue University, 700 W State Street, West Lafayette, IN 47907, USA. · Changsha Social Work College, 22 Xiangzhang Rd, Yuhua, Changsha, Hunan, 410116, P. R. China. · Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Avenida da Universidade, 3/F, Building E12, Macau SAR, Taipa, P. R. China. · Clinical Psychology Department, the Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China. ·Sci Rep · Pubmed #28262807.

ABSTRACT: Insomnia and the inability to sleep affect people's health and well-being. However, its systematic estimates of prevalence and distribution in the general population in China are still lacking. A population-based cluster sampling survey was conducted in the rural and urban areas of Hunan, China. Subjects (n = 26,851) were sampled from the general population, with a follow-up using the Pittsburgh Sleep Quality Index (PSQI) for interview to assess quality of sleep and Insomnia (PSQI score >5). While the overall prevalence of insomnia was 26.6%, and little difference was found between males (26.3%) and females (27.0%); the mean PSQI score was 4.26 (±2.67), and significant higher in females (4.32 ± 2.70) than males (4.21 ± 2.64, p = 0.003). Individuals in the rural areas tended to report a higher PSQI score (4.45 ± 2.81) than urban residents did (4.18 ± 2.60) (p < 0.001) and the estimates of prevalence of insomnia was 29.4% in the rural areas, significant higher than 25.5% in the urban areas (p < 0.001). Multiple logistic regression analysis showed that female gender, older age, higher level of education, being unmarried, living in the rural area, cigarette smoking and alcohol drinking were associated with insomnia. Our study may provide important information for general and mental health research.

19 Article Association of sleep disturbance and sexual function in postmenopausal women. 2017

Kling, Juliana M / Manson, JoAnn E / Naughton, Michelle J / Temkit, M'hamed / Sullivan, Shannon D / Gower, Emily W / Hale, Lauren / Weitlauf, Julie C / Nowakowski, Sara / Crandall, Carolyn J. ·1Division of Women's Health, Mayo Clinic, Scottsdale, AZ 2Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 3Division of Population Sciences, Department of Internal Medicine, Ohio State University, Columbus, OH 4Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ 5Division of Endocrinology, Medstar Washington Hospital Center and Georgetown University, Washington, DC 6Department of Epidemiology and Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 7Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY 8Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 9Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 10Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 11Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. ·Menopause · Pubmed #28141665.

ABSTRACT: OBJECTIVE: Sleep disturbance and sexual dysfunction are common in menopause; however, the nature of their association is unclear. The present study aimed to determine whether sleep characteristics were associated with sexual activity and sexual satisfaction. METHODS: Sexual function in the last year and sleep characteristics (past 4 wk) were assessed by self-report at baseline for 93,668 women age 50 to 79 years enrolled in the Women's Health Initiative (WHI) Observational Study (OS). Insomnia was measured using the validated WHI Insomnia Rating Scale. Sleep-disordered breathing (SDB) risk was assessed using questions adapted from the Berlin Questionnaire. Using multivariate logistic regression, we examined cross-sectional associations between sleep measures and two indicators of sexual function: partnered sexual activity and sexual satisfaction within the last year. RESULTS: Fifty-six percent overall reported being somewhat or very satisfied with their current sexual activity, and 52% reported partnered sexual activity within the last year. Insomnia prevalence was 31%. After multivariable adjustment, higher insomnia scores were associated with lower odds of sexual satisfaction (yes/no) (odds ratio [OR] 0.92, 95% CI, 0.87-0.96). Short sleep duration (<7-8 h) was associated with lower odds of partnered sexual activity (yes/no) (≤5 h, OR 0.88, 95% CI, 0.80-0.96) and less sexual satisfaction (≤5 h, OR 0.88, 95% CI, 0.81-0.95). CONCLUSIONS: Shorter sleep durations and higher insomnia scores were associated with decreased sexual function, even after adjustment for potential confounders, suggesting the importance of sufficient, high-quality sleep for sexual function. Longitudinal investigation of sleep and its impact on sexual function postmenopause will clarify this relationship.

20 Article Estimated Prevalence of Insomnia among Women Veterans: Results of a Postal Survey. 2017

Martin, Jennifer L / Schweizer, C Amanda / Hughes, Jaime M / Fung, Constance H / Dzierzewski, Joseph M / Washington, Donna L / Kramer, B Josea / Jouldjian, Stella / Mitchell, Michael N / Josephson, Karen R / Alessi, Cathy A. ·VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California. Electronic address: Jennifer.Martin@va.gov. · VA Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California. · Durham VA Healthcare System, Center for Health Services Research in Primary Care, Durham, North Carolina. · VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California. · Virginia Commonwealth University, Department of Psychology, Richmond, Virginia. · David Geffen School of Medicine at the University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California. · VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California. ·Womens Health Issues · Pubmed #28110799.

ABSTRACT: OBJECTIVES: Insomnia is a significant public health concern known to particularly impact women and the veteran population; however, rates of insomnia disorder among women veterans are not known. METHOD: Women veterans who had received health care at VA Greater Los Angeles Healthcare System between 2008 and 2010 and resided within 25 miles of the facility were sent a postal survey assessing sleep, demographics, and other related patient characteristics. RESULTS: A total of 660 women (43.1% of potential responders) returned the postal survey and provided sufficient information for insomnia diagnosis. On average, women reported 6.2 hours of sleep per night. The prevalence of insomnia, determined according to diagnostic criteria from the International Classification of Sleep Disorders-2, was 52.3%. Women with insomnia reported more severely disturbed sleep, and more pain, menopausal symptoms, stress/worries, and nightmares compared with women without insomnia. There was a quadratic relationship between age and insomnia with women in their mid-40s, most likely to have insomnia. CONCLUSIONS: This survey study found that insomnia symptoms were endorsed by more than one-half of the women veterans in this sample of VA users, highlighting the critical need for enhanced clinical identification and intervention. Further research is needed to establish national rates of insomnia among women veterans and to improve access to evidence-based treatment of insomnia disorder.

21 Article Longitudinal changes in menopausal symptoms comparing women randomized to low-dose oral conjugated estrogens or transdermal estradiol plus micronized progesterone versus placebo: the Kronos Early Estrogen Prevention Study. 2017

Santoro, Nanette / Allshouse, Amanda / Neal-Perry, Genevieve / Pal, Lubna / Lobo, Rogerio A / Naftolin, Frederick / Black, Dennis M / Brinton, Eliot A / Budoff, Matthew J / Cedars, Marcelle I / Dowling, N Maritza / Dunn, Mary / Gleason, Carey E / Hodis, Howard N / Isaac, Barbara / Magnani, Maureen / Manson, JoAnn E / Miller, Virginia M / Taylor, Hugh S / Wharton, Whitney / Wolff, Erin / Zepeda, Viola / Harman, S Mitchell. ·1Department of Obstetrics & Gynecology 2Department of Biostatistics, University of Colorado School of Medicine, Aurora, CO 3Department of Obstetrics, Gynecology & Women's Health and Neurosciences, Albert Einstein College of Medicine, Bronx, NY 4Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, CT 5Department of Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 6Department of Obstetrics & Gynecology, New York University School of Medicine, New York, NY 7Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, CA 8Utah Foundation for Biomedical Research, Salt Lake City, UT 9Department of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA, Torrance, CA 10Department of Obstetrics & Gynecology, University of California at San Francisco, San Francisco, CA 11Departments of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI 12Kronos Longevity Research Institute, Phoenix, AZ 13Department of Medicine and Public Health, University of Wisconsin, Madison, WI 14Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA 15Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 16Departments of Surgery and Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 17Department of Neurology, Emory University, Atlanta, GA 18Department of Reproductive Biology and Medicine, National Institutes of Health, Bethesda, MD 19Department of Medicine, Endocrine Division, Phoenix VA Health Care System, Phoenix, AZ. ·Menopause · Pubmed #27779568.

ABSTRACT: OBJECTIVE: The objective of the present study was to compare the efficacy of two forms of menopausal hormone therapy in alleviating vasomotor symptoms, insomnia, and irritability in early postmenopausal women during 4 years. METHODS: A total of 727 women, aged 42 to 58, within 3 years of their final menstrual period, were randomized to receive oral conjugated estrogens (o-CEE) 0.45 mg (n = 230) or transdermal estradiol (t-E2) 50 μg (n = 225; both with micronized progesterone 200 mg for 12 d each mo), or placebos (PBOs; n = 275). Menopausal symptoms were recorded at screening and at 6, 12, 24, 36, and 48 months postrandomization. Differences in proportions of women with symptoms at baseline and at each follow-up time point were compared by treatment arm using exact χ tests in an intent-to-treat analysis. Differences in treatment effect by race/ethnicity and body mass index were tested using generalized linear mixed effects modeling. RESULTS: Moderate to severe hot flashes (from 44% at baseline to 28.3% for PBO, 7.4% for t-E2, and 4.2% for o-CEE) and night sweats (from 35% at baseline to 19% for PBO, 5.3% for t-E2, and 4.7% for o-CEE) were reduced significantly by 6 months in women randomized to either active hormone compared with PBO (P < 0.001 for both symptoms), with no significant differences between the active treatment arms. Insomnia and irritability decreased from baseline to 6 months postrandomization in all groups. There was an intermittent reduction in insomnia in both active treatment arms versus PBO, with o-CEE being more effective than PBO at 36 and 48 months (P = 0.002 and 0.05) and t-E2 being more effective than PBO at 48 months (P = 0.004). Neither hormone treatment significantly affected irritability compared with PBO. Symptom relief for active treatment versus PBO was not significantly modified by body mass index or race/ethnicity. CONCLUSIONS: Recently postmenopausal women had similar and substantial reductions in hot flashes and night sweats with lower-than-conventional doses of oral or transdermal estrogen. These reductions were sustained during 4 years. Insomnia was intermittently reduced compared with PBO for both hormone regimens.

22 Article Epigenetic Aging and Immune Senescence in Women With Insomnia Symptoms: Findings From the Women's Health Initiative Study. 2017

Carroll, Judith E / Irwin, Michael R / Levine, Morgan / Seeman, Teresa E / Absher, Devin / Assimes, Themistocles / Horvath, Steve. ·Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles. Electronic address: jcarroll@mednet.ucla.edu. · Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles. · Department of Human Genetics, Los Angeles. · Department of Geriatrics, David Geffen School of Medicine, Los Angeles. · HudsonAlpha Institute for Biotechnology, Huntsville, Alabama. · Department of Medicine, Stanford University, Palo Alto, California. · Department of Human Genetics, Los Angeles; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles. ·Biol Psychiatry · Pubmed #27702440.

ABSTRACT: BACKGROUND: Insomnia symptoms are associated with vulnerability to age-related morbidity and mortality. Cross-sectional data suggest that accelerated biological aging may be a mechanism through which sleep influences risk. A novel method for determining age acceleration using epigenetic methylation to DNA has demonstrated predictive utility as an epigenetic clock and prognostic of age-related morbidity and mortality. METHODS: We examined the association of epigenetic age and immune cell aging with sleep in the Women's Health Initiative study (N = 2078; mean 64.5 ± 7.1 years of age) with assessment of insomnia symptoms (restlessness, difficulty falling asleep, waking at night, trouble getting back to sleep, and early awakenings), sleep duration (short sleep 5 hours or less; long sleep greater than 8 hours), epigenetic age, naive T cell (CD8+CD45RA+CCR7+), and late differentiated T cells (CD8+CD28-CD45RA-). RESULTS: Insomnia symptoms were related to advanced epigenetic age (β ± SE = 1.02 ± 0.37, p = .005) after adjustments for covariates. Insomnia symptoms were also associated with more late differentiated T cells (β ± SE = 0.59 ± 0.21, p = .006), but not with naive T cells. Self-reported short and long sleep duration were unrelated to epigenetic age. Short sleep, but not long sleep, was associated with fewer naive T cells (p < .005) and neither was related to late differentiated T cells. CONCLUSIONS: Symptoms of insomnia were associated with increased epigenetic age of blood tissue and were associated with higher counts of late differentiated CD8+ T cells. Short sleep was unrelated to epigenetic age and late differentiated cell counts, but was related to a decline in naive T cells. In this large population-based study of women in the United States, insomnia symptoms are implicated in accelerated aging.

23 Article Acceptability of Medication and Nonmedication Treatment for Insomnia Among Female Veterans: Effects of Age, Insomnia Severity, and Psychiatric Symptoms. 2016

Culver, Najwa C / Song, Yeonsu / Kate McGowan, Sarah / Fung, Constance H / Mitchell, Michael N / Rodriguez, Juan Carlos / Dzierzewski, Joseph M / Josephson, Karen R / Jouldjian, Stella / Washington, Donna L / Yano, Elizabeth M / Schweizer, C Amanda / Alessi, Cathy A / Martin, Jennifer L. ·Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System. Electronic address: najwa.culver@va.gov. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Medicine, Pontificia Universidad Catolica de Chile. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Psychology, Virginia Commonwealth University, Virginia. · David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California. · VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California. ·Clin Ther · Pubmed #28314434.

ABSTRACT: PURPOSE: Female veterans are at high risk for sleep problems, and there is a need to provide effective treatment for this population who experience insomnia. This study's primary goal was to compare the acceptability of medication versus nonmedication treatments for insomnia among female veterans. In addition, we examined the role of patient age, severity of sleep disturbance, and psychiatric symptoms on acceptability of each treatment approach and on the differences in acceptability between these approaches. METHODS: A large nationwide postal survey was sent to a random sample of 4000 female veterans who had received health care at a Veterans Administration (VA) facility in the previous 6 months (May 29, 2012-November 28, 2012). A total of 1559 completed surveys were returned. Survey items used for the current analyses included: demographic characteristics, sleep quality, psychiatric symptoms, military service experience, and acceptability of medication and nonmedication treatments for insomnia. For analysis, only ratings of "very acceptable" were used to indicate an interest in the treatment approach (vs ratings of "not at all acceptable," "a little acceptable," "somewhat acceptable," and "no opinion/don׳t know"). FINDINGS: In the final sample of 1538 women with complete data, 57.7% rated nonmedication treatment as very acceptable while only 33.5% rated medication treatment as very acceptable. This difference was statistically significant for the group as a whole and when examining subgroups of patients based on age, sleep quality, psychiatric symptoms, and military experience. The percentage of respondents rating medication treatment as very acceptable was higher for women who were younger, had more severe sleep disturbances, had more psychiatric symptoms, who were not combat exposed, and who had experienced military sexual trauma. By contrast, the percentage of respondents rating nonmedication treatment as very acceptable differed only by age (younger women were more likely to find nonmedication treatment acceptable) and difficulty falling asleep. IMPLICATIONS: Female veterans are more likely to find nonmedication insomnia treatment acceptable compared with medication treatment. Thus, it is important to match these patients with effective behavioral interventions such as cognitive behavioral therapy for insomnia. Efforts to educate providers about these preferences and about the efficacy of cognitive behavioral therapy for insomnia may serve to connect female veterans who have insomnia to the treatment they prefer. These findings also suggest that older female veterans may be less likely to find either approach as acceptable as their younger counterparts.

24 Article Differences in the Association of Nocturia and Functional Outcomes of Sleep by Age and Gender: A Cross-sectional, Population-based Study. 2016

Vaughan, Camille P / Fung, Constance H / Huang, Alison J / Johnson, Theodore M / Markland, Alayne D. ·Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama; Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia; Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. Electronic address: camille.vaughan@emory.edu. · Department of Medicine, University of California Los Angeles, North Hills, California; Department of Veterans Affairs Greater Los Angeles Geriatric Research, Education, and Clinical Center, North Hills, California. · Department of Medicine, University of California San Francisco, San Francisco, California. · Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama; Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia; Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. · Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama; Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia; Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. ·Clin Ther · Pubmed #27751673.

ABSTRACT: PURPOSE: Nocturia is associated with poor sleep quality; however, little is known about the relationship between nocturia and sleep quality across different workforce-relevant age groups of adults. This has implications for developing new treatment strategies that are well tolerated across populations. METHODS: We conducted a cross-sectional study involving merged data from the 2005-2006 and 2007-2008 waves of the National Health and Nutrition Examination Survey. Participants responded to validated questions on nocturia frequency and sleep from the Functional Outcomes of Sleep Questionnaire General Productivity subscale (FOSQ-gp, range 1-4). Analyses included multivariable linear regression with stratification by gender to examine associations between nocturia frequency (higher worse) and the FOSQ-gp scores (lower scores indicating worse daytime function related to sleep disturbance). FINDINGS: Of 10,512 adults aged ≥20 years who completed the survey, 9148 (87%) had complete nocturia and FOSQ-gp data. The population age-adjusted prevalence of nocturia at least twice nightly was 21.1% among men and 26.6% among women (P < 0.001), and nocturia increased with age (P < 0.001). Compared with those with no or 1 episode of nocturia, those with nocturia at least twice nightly reported lower mean FOSQ-gp scores (3.65; 95% CI, 3.61-3.69 vs 3.19; 95% CI, 3.09-3.31 for men and 3.52; 95% CI, 3.48-3.56 vs 3.09; 95% CI, 3.02-3.16 for women). Older adults (aged >65 years) with greater nocturia frequency reported worse FOSQ-gp scores compared with younger adults with similar nocturia frequency (P < 0.001 among men and women). IMPLICATIONS: In a population-based sample of community-dwelling men and women, the association between nocturia and worsened functional outcomes of sleep was greater among adults older than 65 years-a group more vulnerable to drug side effects, and in whom nocturia is typically multifactorial. Additionally, these analyses found that the association between nocturia and functional outcomes of sleep is stronger with increasing age among men. Effective treatment strategies that are well tolerated by older adults, such as multicomponent treatments that simultaneously address the combined effects of lower urinary tract and sleep dysfunction, are needed.

25 Article Sleep Duration and Quality in Relation to Autonomic Nervous System Measures: The Multi-Ethnic Study of Atherosclerosis (MESA). 2016

Castro-Diehl, Cecilia / Diez Roux, Ana V / Redline, Susan / Seeman, Teresa / McKinley, Paula / Sloan, Richard / Shea, Steven. ·Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY. · Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. · Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA. · Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Department of Medicine/Geriatrics, University of California, Los Angeles, CA. · Division of Behavioral Medicine, Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY. ·Sleep · Pubmed #27568797.

ABSTRACT: STUDY OBJECTIVES: Short sleep duration and poor sleep quality are associated with adverse cardiovascular outcomes. Potential pathophysiological mechanisms include sleep-associated alterations in the autonomic nervous system. The objective of this study was to examine the associations of shorter sleep duration and poorer sleep quality with markers of autonomic tone: heart rate (HR), high-frequency HR variability (HF-HRV) and salivary amylase. METHODS: Cross-sectional analysis of data from actigraphy-based measures of sleep duration and efficiency and responses to a challenge protocol obtained from 527 adult participants in the Multi-Ethnic Study of Atherosclerosis. RESULTS: Participants who slept fewer than 6 h per night (compared to those who slept 7 h or more per night) had higher baseline HR (fully adjusted model 0.05 log beats/min, 95% confidence interval [CI] 0.01, 0.09) and greater HR orthostatic reactivity (fully adjusted model 0.02 log beats/min, 95% CI 0.002, 0.023). Participants who slept 6 to less than 7 h/night (compared to those who slept 7 h or more per night) had lower baseline HF-HRV (fully adjusted model -0.31 log msec CONCLUSIONS: Short sleep duration, low sleep efficiency, and insomnia combined with short sleep duration were associated with markers of autonomic tone that indicate lower levels of cardiac parasympathetic (vagal) tone and/or higher levels of sympathetic tone.

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