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Sleep Initiation and Maintenance Disorders: HELP
Articles from San Francisco
Based on 62 articles published since 2008
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These are the 62 published articles about Sleep Initiation and Maintenance Disorders that originated from San Francisco during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. 2017

Sateia, Michael J / Buysse, Daniel J / Krystal, Andrew D / Neubauer, David N / Heald, Jonathan L. ·Geisel School of Medicine at Dartmouth, Hanover, NH. · University of Pittsburgh School of Medicine, Pittsburgh, PA. · University of California, San Francisco, San Francisco, CA. · Johns Hopkins University School of Medicine, Baltimore, MD. · American Academy of Sleep Medicine, Darien, IL. ·J Clin Sleep Med · Pubmed #27998379.

ABSTRACT: INTRODUCTION: The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults. METHODS: The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, and patient values and preferences. Literature reviews are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS: The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults, when such treatment is indicated. Under GRADE, a STRONG recommendation is one that clinicians should, under most circumstances, follow. A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients, but should not be construed as an indication of ineffectiveness. GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient, but rather, to the strength of evidence in published data. Downgrading the quality of evidence for these treatments is predictable in GRADE, due to the funding source for most pharmacological clinical trials and the attendant risk of publication bias; the relatively small number of eligible trials for each individual agent; and the observed heterogeneity in the data. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. We suggest that clinicians use suvorexant as a treatment for sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use eszopiclone as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use zaleplon as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use zolpidem as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use triazolam as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use temazepam as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use ramelteon as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use doxepin as a treatment for sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use tiagabine as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use diphenhydramine as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use melatonin as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use tryptophan as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use valerian as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK).

2 Editorial Guest editorial: Overcoming barriers to care for returning veterans: expanding services to college campuses. 2013

McCaslin, Shannon E / Leach, Bridget / Herbst, Ellen / Armstrong, Keith. ·Mental Health Service, SFVAMC, San Francisco, CA. ·J Rehabil Res Dev · Pubmed #24458904.

ABSTRACT: -- No abstract --

3 Review Genetic prion disease: Experience of a rapidly progressive dementia center in the United States and a review of the literature. 2017

Takada, Leonel T / Kim, Mee-Ohk / Cleveland, Ross W / Wong, Katherine / Forner, Sven A / Gala, Ignacio Illán / Fong, Jamie C / Geschwind, Michael D. ·Department of Neurology, Cognitive and Behavioral Neurology Unit, University of São Paulo, São Paulo, Brazil. · Department of Neurology, Memory and Aging Center, University of California, San Francisco, California. · Department of Pediatrics, The University of Vermont Children's Hospital, University of Vermont, Burlington, Vermont. · Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. ·Am J Med Genet B Neuropsychiatr Genet · Pubmed #27943639.

ABSTRACT: Although prion diseases are generally thought to present as rapidly progressive dementias with survival of only a few months, the phenotypic spectrum for genetic prion diseases (gPrDs) is much broader. The majority have a rapid decline with short survival, but many patients with gPrDs present as slowly progressive ataxic or parkinsonian disorders with progression over a few to several years. A few very rare mutations even present as neuropsychiatric disorders, sometimes with systemic symptoms such as gastrointestinal disorders and neuropathy, progressing over years to decades. gPrDs are caused by mutations in the prion protein gene (PRNP), and have been historically classified based on their clinicopathological features as genetic Jakob-Creutzfeldt disease (gJCD), Gerstmann-Sträussler-Scheinker (GSS), or Fatal Familial Insomnia (FFI). Mutations in PRNP can be missense, nonsense, and octapeptide repeat insertions or a deletion, and present with diverse clinical features, sensitivities of ancillary testing, and neuropathological findings. We present the UCSF gPrD cohort, including 129 symptomatic patients referred to and/or seen at UCSF between 2001 and 2016, and compare the clinical features of the gPrDs from 22 mutations identified in our cohort with data from the literature, as well as perform a literature review on most other mutations not represented in our cohort. E200K is the most common mutation worldwide, is associated with gJCD, and was the most common in the UCSF cohort. Among the GSS-associated mutations, P102L is the most commonly reported and was also the most common at UCSF. We also had several octapeptide repeat insertions (OPRI), a rare nonsense mutation (Q160X), and three novel mutations (K194E, E200G, and A224V) in our UCSF cohort. © 2016 Wiley Periodicals, Inc.

4 Review An evidence-based review of insomnia treatment in early recovery. 2014

Kaplan, Katherine A / McQuaid, John / Primich, Charles / Rosenlicht, Nicholas. ·From the Department of Psychiatry (KAK), Stanford University School of Medicine, Stanford, CA · Department of Psychiatry (JM, NR), University of California, San Francisco · and San Francisco VA Medical Center (JM, CP, NR), San Francisco, CA. ·J Addict Med · Pubmed #25369938.

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

5 Review Treatment of sleep disturbances in posttraumatic stress disorder: a review. 2012

Schoenfeld, Frank B / Deviva, Jason C / Manber, Rachel. ·San Francisco Department of Veterans Affairs (VA) Medical Center, San Francisco, CA 94121, USA. Frank.schoenfeld@va.gov ·J Rehabil Res Dev · Pubmed #23015583.

ABSTRACT: Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive-behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

6 Review Measures of sleep in rheumatologic diseases: Epworth Sleepiness Scale (ESS), Functional Outcome of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). 2011

Omachi, Theodore A. ·Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Francisco, CA 94115, USA. omachi@ucsf.edu ·Arthritis Care Res (Hoboken) · Pubmed #22588751.

ABSTRACT: -- No abstract --

7 Clinical Trial Health-related quality of life in patients with locally recurrent or metastatic breast cancer treated with etirinotecan pegol versus treatment of physician's choice: Results from the randomised phase III BEACON trial. 2017

Twelves, Chris / Cortés, Javier / O'Shaughnessy, Joyce / Awada, Ahmad / Perez, Edith A / Im, Seock-Ah / Gómez-Pardo, Patricia / Schwartzberg, Lee S / Diéras, Véronique / Yardley, Denise A / Potter, David A / Mailliez, Audrey / Moreno-Aspitia, Alvaro / Ahn, Jin-Seok / Zhao, Carol / Hoch, Ute / Tagliaferri, Mary / Hannah, Alison L / Rugo, Hope S. ·Leeds Institute of Cancer and Pathology and St James's Institute of Oncology, Leeds, UK. Electronic address: c.j.twelves@leeds.ac.uk. · Ramon y Cajal University Hospital, Madrid, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. · Baylor-Sammons Cancer Center, Texas Oncology, U.S. Oncology, Dallas, TX, USA. · Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium. · Mayo Clinic, Jacksonville, FL, USA. · Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. · Vall d'Hebron Institute of Oncology, Barcelona, Spain. · The West Clinic, Memphis, TN, USA. · Institut Curie, Paris, France. · Sarah Cannon Research Institute, Nashville, TN, USA. · University of Minnesota, Department of Medicine, Masonic Cancer Center, Minneapolis, MN, USA. · Centre Oscar Lambret, Lille, France. · Ramon y Cajal University Hospital, Madrid, Spain. · Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. · Nektar Therapeutics, San Francisco, CA, USA. · Consultant, Sebastopol, CA, USA. · University of California, San Francisco, CA, USA. ·Eur J Cancer · Pubmed #28360015.

ABSTRACT: BACKGROUND: Health-related quality of life (HRQoL) enhances understanding of treatment effects that impact clinical decision-making. Although the primary end-point was not achieved, the BEACON (BrEAst Cancer Outcomes with NKTR-102) trial established etirinotecan pegol, a long-acting topoisomerase-1 (TOP1) inhibitor, as a promising therapeutic for patients with advanced/metastatic breast cancer (MBC) achieving clinically meaningful benefits in median overall survival (OS) for patients with stable brain metastases, with liver metastases or ≥ 2 sites of metastatic disease compared to treatment of physician's choice (TPC). Reported herein are the findings from the preplanned secondary end-point of HRQoL. PATIENTS AND METHODS: HRQoL, assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) (version 3.0) supplemented by the breast cancer-specific Quality of Life Questionnaire (QLQ-BR23), was evaluated post randomisation in 733 of 852 patients with either anthracycline-, taxane- and capecitabine-pretreated locally recurrent or MBC randomised to etirinotecan pegol (n = 378; 145 mg/m RESULTS: Differences were seen favouring etirinotecan pegol up to 32 weeks for global health status (GHS) and physical functioning scales (P < 0.02); numerical improvement was reported in other functional scales. The findings from HRQoL symptom scales were consistent with adverse event profiles; etirinotecan pegol was associated with worsening gastrointestinal symptoms whereas TPC was associated with worsened dyspnoea and other systemic side-effects. Analysis of GHS and physical functioning at disease progression showed a decline in HRQoL in both treatment arms, with a mean change from baseline of -9.4 and -10.8 points, respectively. CONCLUSION: There was evidence of benefit associated with etirinotecan pegol compared with current standard of care agents in multiple HRQoL measurements, including global health status and physical functioning, despite worse gastrointestinal symptoms (e.g. diarrhoea). Patients in both arms had a decline in HRQoL at disease progression. STUDY NUMBER: NCT01492101.

8 Clinical Trial Association Between Insomnia and Asthma Burden in the Severe Asthma Research Program (SARP) III. 2016

Luyster, Faith S / Strollo, Patrick J / Holguin, Fernando / Castro, Mario / Dunican, Eleanor M / Fahy, John / Gaston, Benjamin / Israel, Elliot / Jarjour, Nizar N / Mauger, David T / Moore, Wendy C / Wenzel, Sally E. ·School of Nursing, University of Pittsburgh, Pittsburgh, PA. Electronic address: luysterfs@upmc.edu. · Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA. · Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. · Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO. · Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, CA. · Division of Pediatric Allergy and Immunology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH. · Pulmonary Division, Brigham and Women's Hospital, Boston, MA. · Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine, Madison, WI. · Department of Public Health Science, The Pennsylvania State University College of Medicine, Hershey, PA. · Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. ·Chest · Pubmed #27720882.

ABSTRACT: BACKGROUND: Sleep difficulties are commonly reported by patients with asthma; however, the prevalence of insomnia and its association with disease burden and well-being is unknown. We aimed to determine the prevalence of insomnia, defined as combined sleep-specific complaints with associated daytime symptoms, among a large sample of adults with asthma, and to compare well-being, asthma control, and asthma-related health care utilization in individuals with asthma and insomnia and those without insomnia. METHODS: Baseline data from adults with physician-confirmed asthma enrolled in the Severe Asthma Research Program III was used for analyses (N = 714). Participants completed the Insomnia Severity Index (ISI), Asthma Control Test, Asthma Quality of Life Questionnaire, and Hospital Anxiety and Depression Scale. RESULTS: Insomnia (ISI ≥ 10) was identified in 263 participants (37%). Presence of insomnia was associated with higher levels of depression and anxiety symptoms and poorer quality of life. Those with insomnia had a 2.4-fold increased risk for having not well-controlled asthma and a 1.5-fold increased risk for asthma-related health care utilization in the past year compared with those without insomnia. CONCLUSIONS: Insomnia is highly prevalent in asthma and is associated with adverse outcomes. Further studies are needed to gain a better understanding of the interaction between insomnia and asthma control.

9 Clinical Conference Behavioral treatment of insomnia in early recovery. 2014

Kaplan, Katherine A / McQuaid, John / Batki, Steven L / Rosenlicht, Nicholas. ·From the Department of Psychiatry (KAK), Stanford University School of Medicine, Stanford, CA · and Department of Psychiatry (JM, SLB, NR), University of California, and San Francisco VA Medical Center, San Francisco, CA. ·J Addict Med · Pubmed #25369939.

ABSTRACT: -- No abstract --

10 Article Physical Activity Intensity is Associated with Symptom Distress in the CNICS Cohort. 2019

Webel, Allison R / Willig, Amanda L / Liu, Wei / Sattar, Abdus / Boswell, Stephen / Crane, Heidi M / Hunt, Peter / Kitahata, Mari / Matthews, W Christopher / Saag, Michael S / Lederman, Michael M / Rodriguez, Benigno. ·Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA. arw72@case.edu. · School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA. · Fenway Health, Boston, MA, USA. · School of Medicine, University of Washington, Seattle, WA, USA. · School of Medicine, University of California, San Francisco, San Francisco, CA, USA. · University of California, San Diego Medical Center, San Diego, CA, USA. · School of Medicine, Case Western Reserve University, Cleveland, OH, USA. ·AIDS Behav · Pubmed #30368620.

ABSTRACT: Symptom distress remains a challenging aspect of living with HIV. Physical activity is a promising symptom management strategy, but its effect on symptom distress has not been examined in a large, longitudinal HIV-infected cohort. We hypothesized that higher physical activity intensity would be associated with reduced symptom distress. We included 5370 people living with HIV (PLHIV) who completed patient-reported assessments of symptom distress, physical activity, alcohol and substance use, and HIV medication adherence between 2005 and 2016. The most frequent and burdensome symptoms were fatigue (reported by 56%), insomnia (50%), pain (46%), sadness (45%), and anxiety (45%), with women experiencing more symptoms and more burdensome symptoms than men. After adjusting for age, sex, race, time, HIV medication adherence, alcohol and substance use, site, and HIV RNA, greater physical activity intensity was associated with lower symptom intensity. Although individual symptoms may be a barrier to physical activity (e.g. pain), the consistent association between symptoms with physical activity suggests that more intense physical activity could mitigate symptoms experienced by PLHIV.

11 Article Insomnia symptoms and their association with workplace productivity: cross-sectional and pre-post intervention analyses from a large multinational manufacturing company. 2018

Espie, Colin A / Pawlecki, Brent / Waterfield, Dickon / Fitton, Kit / Radocchia, Michael / Luik, Annemarie I. ·Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, USA. Electronic address: colin.espie@ndcn.ox.ac.uk. · The Goodyear Tire & Rubber Company, Akron, OH, USA. · Big Health Inc, San Francisco, USA. · Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, USA. ·Sleep Health · Pubmed #29776626.

ABSTRACT: BACKGROUND: Symptoms of insomnia are common and might impact work productivity. We investigated the relationship between insomnia symptoms and workplace productivity in a global manufacturing company. METHODS: Within an uncontrolled, cross-sectional study, employees from a US-based company were invited to participate in an online evaluation comprising the Sleep Condition Indicator (SCI) measuring symptoms of insomnia (high score indicating better sleep), 2 items of the Work Productivity and Impairment Index (WPAI) measuring 'presenteeism' and 'absenteeism' (high score indicating loss of work productivity) and 1 item of the Perceived Stress Scale (PSS) from January 2015 onwards. Pre-post, within-subject data were collected to preliminary test effects of 'sleep tips' and digital cognitive behavioral therapy (dCBT). RESULTS: In 2798 employees [72% male; mean age 46.3(SD11.8) yrs] sleep was poorest in plant staff [SCI = 3.70(2.73)], then retail staff [4.34(3.02)], then office staff [4.95(2.83): overall F(2,2786) = 43.7, P < .0001]. More insomnia symptoms were associated with WPAI presenteeism (r = -.489, P < .0001; R CONCLUSION: Symptoms of insomnia are associated with poor work productivity. Additionally, targeted insomnia interventions may offer potential to improve sleep and work productivity.

12 Article Poor sleep quality and insufficient sleep of a collegiate student-athlete population. 2018

Mah, Cheri D / Kezirian, Eric J / Marcello, Brandon M / Dement, William C. ·Stanford Sleep Disorders Clinic and Research Laboratory, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, USA; School of Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: cherimah@stanfordalumni.org. · USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. · Department of Athletics, Stanford University, Stanford, CA, USA. · Stanford Sleep Disorders Clinic and Research Laboratory, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, USA. ·Sleep Health · Pubmed #29776619.

ABSTRACT: OBJECTIVE: Poor and inadequate sleep negatively impact cognitive and physical functioning and may also affect sports performance. The study aim is to examine sleep quality, sleep duration, and daytime sleepiness in collegiate student-athletes across a wide range of sports. DESIGN: Questionnaire. SETTING: University setting. PARTICIPANTS: 628 athletes across 29 varsity teams at Stanford University. MEASUREMENTS: Athletes completed a questionnaire inquiring about sleep quality via a modified Pittsburgh Sleep Quality Index (PSQI), sleep duration, and daytime sleepiness via Epworth Sleepiness Scale. Sleep quality on campus and while traveling for competition was rated on a 10-point scale. RESULTS: Collegiate athletes were classified as poor sleepers (PSQI 5.38 ± 2.45), and 42.4% of athletes experience poor sleep quality (reporting PSQI global scores >5). Athletes reported lower sleep quality on campus than when traveling for competition (7.1 vs 7.6, P< .001). Inadequate sleep was demonstrated by 39.1% of athletes that regularly obtain <7 hours of sleep on weekdays. Fifty-one percent of athletes reported high levels of daytime sleepiness with Epworth scores ≥10. Teen student-athletes in the first and second year of college reported the highest mean levels of daytime sleepiness. Greater total sleep time was associated with daytime functioning including lower frequency of difficulty waking up for practice or class (P< .001) and lower frequency of trouble staying awake during daily activities (P< .001). CONCLUSIONS: Collegiate athletes frequently experience poor sleep quality, regularly obtain insufficient sleep, and commonly exhibit daytime sleepiness.

13 Article Poor nighttime sleep is positively associated with dyskinesia in Parkinson's disease patients. 2018

Mao, Cheng-Jie / Yang, Ya-Ping / Chen, Ju-Ping / Wang, Fen / Chen, Jing / Zhang, Jin-Ru / Zhang, Hui-Jun / Zhuang, Sheng / Xiong, Yi-Tong / Gu, Chen-Chen / Yuan, Wen / Huang, Juan-Ying / Fay, Alexander / Zhong, Chong-Ke / Liu, Chun-Feng. ·Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China. · Department of Neurology, Changshu Traditional Chinese Medicine Hospital, East Huanghe Road, Changshu 215000, China. · Institute of Neuroscience, Soochow University, Suzhou 215123 China. · Department of Neurology, UCSF School of Medicine, Medical Center, San Francisco, California CA94143, United States. · Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou 215123, China. · Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123 China. Electronic address: liuchunfeng@suda.edu.cn. ·Parkinsonism Relat Disord · Pubmed #29305084.

ABSTRACT: BACKGROUND: Dyskinesia is a troublesome complication of long-term dopaminergic medications in Parkinson's disease (PD) patients. Many factors are reported to be associated with dyskinesia in PD. OBJECTIVE: To investigate the association between sleep quality and dyskinesia in patients with PD. METHODS: Four hundred twenty-five patients with PD were enrolled in this study. Demographic information was collected. Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (H-Y) stage scale were also performed. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were applied to evaluate daytime sleepiness and overall nighttime sleep quality, respectively, in PD patients. RESULTS: Patients with dyskinesia tended to have a longer duration of disease, higher daily levodopa-equivalent dose (LED), H-Y stage, UPDRS II and PSQI score, and a higher percentage of levodopa treatment than those without dyskinesia. After adjusting for age, sex, age at onset of PD, disease duration, UPDRS I, UPDRS II, UPDRS III, cigarette smoking, use of different antiparkinsonian drugs, phenotype, daily LED, and restless leg syndrome (RLS), PSQI score was still associated with dyskinesia, with corresponding ORs 1.111 (95% CI, 1.004-1.229) as a continuous variable, and 2.469 (95% CI, 1.051-5.800) as a categorical variable, respectively. Further analysis of PSQI components showed that subjective sleep quality and sleep latency were associated with dyskinesia in PD patients. CONCLUSIONS: Our data showed that poor nighttime sleep is positively associated with dyskinesia in PD patients. Attention to the management of nighttime sleep quality may be beneficial to dyskinesia in patients with PD.

14 Article Effects of daily maladaptive coping on nightly sleep in mothers. 2018

Felder, Jennifer N / Epel, Elissa S / Coccia, Michael / Puterman, Eli / Prather, Aric A. ·a Department of Psychiatry , University of California , San Francisco , CA , USA. · b School of Kinesiology, University of British Columbia , Vancouver , Canada. ·Psychol Health · Pubmed #28391720.

ABSTRACT: OBJECTIVE: We examined effects of daily rumination and suppression in response to stressors on objective and subjective sleep among mothers. DESIGN: Participants were 183 mothers, including chronically stressed mothers of children with an autism spectrum disorder (M-ASD; n = 92) and age-matched mothers of neurotypical children (M-NT; n = 91). In an intensive longitudinal design, participants provided reports of daily rumination and suppression, nightly objective actigraphy-defined sleep and nightly subjective sleep quality for seven consecutive days at baseline, 9 months and 18 months. MAIN OUTCOME MEASURES: Total sleep time, sleep fragmentation, sleep onset latency, and subjective sleep quality. RESULTS: Among M-NT with above average depressive symptoms, higher daily rumination was associated with shorter total sleep time. Rumination was associated with more sleep fragmentation among M-NT at the trend level. Rumination was not associated with sleep onset latency among M-NT, or with any sleep outcomes among M-ASD. Suppression was not associated with any sleep outcomes. CONCLUSION: We provide novel evidence of the effect of rumination on objectively measured sleep duration among M-NT. Coping was not related to sleep among M-ASD. Given the prevalence of poor sleep among mothers, future work should examine modifiable factors perpetuating sleep disturbance.

15 Article Poor Sleep Quality, Psychological Distress, and the Buffering Effect of Mindfulness Training During Pregnancy. 2018

Felder, Jennifer N / Laraia, Barbara / Coleman-Phox, Kimberly / Bush, Nicole / Suresh, Madhuvanthi / Thomas, Melanie / Adler, Nancy / Epel, Elissa / Prather, Aric A. ·a Department of Psychiatry , University of California , San Francisco , California. · b Community Health Science , University of California , Berkeley , California. · c Center for Health and Community , University of California , San Francisco , California. · d Department of Pediatrics , University of California , San Francisco , California. ·Behav Sleep Med · Pubmed #28060531.

ABSTRACT: OBJECTIVE/BACKGROUND: Poor sleep quality is common in pregnancy and associated with increased psychological distress, which has adverse consequences for families. Emerging theory suggests that mindfulness-based interventions may help reduce cognitive and emotional reactivity to stressful events. The current study examines the effects of a mindfulness-based intervention on the relationship between poor sleep quality and increased depression symptom severity and perceived stress during pregnancy. Additionally, we explored the prevalence of poor sleep quality in this unique sample and the impact of intervention on sleep quality. PARTICIPANTS: Participants were 215 ethnically diverse, overweight and obese, predominantly low-income pregnant women drawn from a study examining the impact of an 8-week mindfulness-based program (Mindful Moms Training; MMT) to reduce excessive gestational weight gain, stress, and depression compared to treatment as usual (TAU). METHODS: Participants reported global sleep quality, depressive symptoms, and perceived stress at baseline and postintervention. RESULTS: Most participants (63%) were categorized as poor sleepers at baseline. MMT participants did not experience significantly greater improvement in sleep quality compared to TAU participants. Baseline poor global sleep quality predicted increased depression symptom severity for all participants. Baseline poor global sleep quality predicted increased perceived stress for the TAU group only; this association was not evident in the MMT group. CONCLUSIONS: Poor sleep quality is prevalent in overweight and obese predominantly low-income pregnant women. Poor sleep quality was associated with worsening psychological distress, but mindfulness training significantly attenuated the influence of poor sleep on perceived stress.

16 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.

17 Article Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium. 2017

Evans, Joanna L / Nadler, Jacob W / Preud'homme, Xavier A / Fang, Eric / Daughtry, Rommie L / Chapman, Joseph B / Attarian, David / Wellman, Samuel / Krystal, Andrew D. ·Duke University School of Medicine, Durham, NC, USA. · University of Rochester Medical Center, Rochester, NY, USA. · Duke-NUS Graduate Medical School, Singapore. · Duke University School of Medicine, Durham, NC, USA; University of California San Francisco, San Francisco, CA, USA. Electronic address: andrew.krystal@ucsf.edu. ·Clin Neurophysiol · Pubmed #28618293.

ABSTRACT: OBJECTIVE: Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. METHODS: Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2). RESULTS: Diminished total sleep time (r=-0.68; p<0.05) and longer latency to sleep onset (r=0.67; p<0.05) on the first night in the hospital were associated with greater POD2 delirium severity. Patients experiencing delirium slept 2.4h less and took 2h longer to fall asleep. Greater waking EEG delta power (r=0.84; p<0.05) on POD1 and less non-REM sleep EEG delta power (r=-0.72; p<0.05) on night 2 also predicted POD2 delirium severity. CONCLUSIONS: Loss of sleep on night1 post-surgery is an early predictor of subsequent delirium. EEG Delta Power alterations in waking and sleep appear to be later indicators of impending delirium. Further work is needed to evaluate reproducibility/generalizability and assess whether sleep loss contributes to causing delirium. SIGNIFICANCE: This first study to prospectively collect continuous EEG data for an extended period prior to delirium onset identified EEG-derived indices that predict subsequent delirium that could aid in developing and targeting therapies.

18 Article Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans. 2017

Miller, Mary Beth / DiBello, Angelo M / Carey, Kate B / Borsari, Brian / Pedersen, Eric R. ·Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA. Electronic address: millerme04@gmail.com. · Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA. Electronic address: angelo_dibello@brown.edu. · Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA. Electronic address: kate_carey@brown.edu. · Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, 505 Parnassus Ave., San Francisco, CA 94143, USA. Electronic address: brian.borsari@va.gov. · RAND Corporation, 1776 Main St., Santa Monica, CA 90407, USA. Electronic address: ericp@rand.org. ·Drug Alcohol Depend · Pubmed #28618286.

ABSTRACT: PURPOSE: Prior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans. PROCEDURES: Veterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity. MAIN FINDINGS: Insomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity. CONCLUSIONS: Symptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD.

19 Article Sleep Disturbances and Risk of Hospitalization and Inpatient Days Among Older Women. 2017

Paudel, Misti L / Taylor, Brent C / Vo, Tien N / Kats, Allyson M / Schousboe, John T / Lui, Li-Yung / McCulloch, Charles E / Langsetmo, Lisa / Ancoli-Israel, Sonia / Redline, Susan / Yaffe, Kristine / Stone, Katie L / Hillier, Teresa A / Ensrud, Kristine E / Anonymous5480900. ·Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. · Department of Medicine, University of Minnesota, Minneapolis, MN. · Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN. · Park Nicollet Clinic, St. Louis Park, MN. · Division of Health Policy and Management, University of Minnesota, Minneapolis, MN. · California Pacific Medical Center Research Institute, San Francisco, CA. · Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. · Departments of Psychiatry and Medicine, University of California-San Diego, La Jolla, CA. · Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, CA. · Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, OR. ·Sleep · Pubmed #28329356.

ABSTRACT: Study Objectives: Determine the associations of sleep disturbances with hospitalization risk among older women. Methods: One thousand eight hundred and twenty-seven women (mean age 83.6 years) participating in Study of Osteoporotic Fractures Year 16 (Y16) examination (2002-2004) linked with Medicare and/or HMO claims. At Y16 examination, sleep/wake parameters were measured by actigraphy (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], and wake after sleep onset [WASO]) and subjective sleep measures (sleep quality [Pittsburgh Sleep Quality Index] and daytime sleepiness [Epworth Sleepiness Scale]) were assessed by questionnaire. Measures except TST were dichotomized based on clinical thresholds. Incident hospitalizations were determined from claims data. Results: Nine hundred and seventy-six women (53%) had ≥1 hospitalization in the 3 years after the Year 16 examination. Reduced SE (odds ratio [OR] = 2.39, 95% confidence interval [CI] 1.69-3.39), prolonged SL (OR = 1.41, 95% CI 1.11-1.78), greater WASO (OR = 1.57, 95% CI 1.28-1.93), shorter TST (OR = 1.98, 95% CI 1.42-2.77) and poorer sleep quality (OR = 1.33, 95% CI 1.07-1.65) were each associated with a higher age and site-adjusted odds of hospitalization; associations were attenuated after multivariable adjustment for traditional prognostic factors with the OR for reduced SE (OR = 1.60, 95% CI 1.08-2.38) and shorter TST (OR = 1.63, 95% CI 1.12-2.37) remaining significant. Among women who were hospitalized, greater WASO (rate ratio [RR] = 1.20, 95% CI 1.04-1.37) and poorer sleep quality (RR = 1.18, 95% CI 1.02-1.35) were each associated with a greater age and site-adjusted RR of inpatient days, but associations did not persist after multivariate adjustment. Conclusions: Older women with sleep disturbances have an increased risk of hospitalization partially attributable to demographics, poorer health status, and comorbidities.

20 Article Symptom Presentation and Prescription of Sleep Medications for Veterans With Posttraumatic Stress Disorder. 2017

Greenbaum, Mark A / Neylan, Thomas C / Rosen, Craig S. ·*Department of Veterans Affairs (DVA), PTSD Methods and Evaluation Core, VISN 21 Sierra Pacific MIRECC; National Center for PTSD, DVA Palo Alto Healthcare System, Menlo Park Division; †DVA, PTSD Research Core, VISN 21 Sierra Pacific MIRECC; DVA San Francisco Healthcare System; ‡University of California at San Francisco Medical School; §DVA Affairs Palo Alto Healthcare System and HSR&D Center for Implementation to Innovation, Menlo Park; and ∥Stanford University Department of Psychology and Behavioral Sciences, CA. ·J Nerv Ment Dis · Pubmed #28106623.

ABSTRACT: This study tested whether sleep medications prescribed to veterans diagnosed with posttraumatic stress disorder (PTSD) are being targeted to patients who report more severe insomnia or nightmares. Secondary analysis of survey and pharmacy data was conducted in samples of veterans from two periods: from 2006 to 2008 and from 2009 to 2013. Logistic regression tested associations between self-reported insomnia and nightmare severity, and being prescribed trazodone, prazosin, zolpidem, and benzodiazepines, controlling for PTSD severity and other covariates. In both samples, insomnia severity independently predicted trazodone receipt, and nightmare severity independently predicted prazosin receipt. In the later study, insomnia severity predicted receipt of zolpidem. Veterans in the later sample were more likely to receive trazodone, prazosin, and non-benzodiazepine hypnotics, and less likely to receive benzodiazepines than those in the earlier sample. Further research is needed to evaluate and optimize pharmacological and psychosocial treatments for sleep problems among veterans with PTSD.

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 Associations of Subjective Sleep Quality and Daytime Sleepiness With Cognitive Impairment in Adults and Elders With Heart Failure. 2017

Byun, Eeeseung / Kim, Jinyoung / Riegel, Barbara. ·a Department of Family Health Care Nursing , University of California San Francisco School of Nursing , San Francisco , California. · b School of Nursing , University of Pennsylvania , Philadelphia , Pennsylvania. · c Biobehavioral Health Sciences Department, School of Nursing , University of Pennsylvania, Philadelphia , Pennsylvania. ·Behav Sleep Med · Pubmed #27116617.

ABSTRACT: This study examined the association of subjective nighttime sleep quality and daytime sleepiness with cognitive impairment in 105 adults (< 60 years old) and 167 elders (≥ 60 years old) with heart failure. Nighttime sleep quality and daytime sleepiness were measured by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Cognitive impairment was assessed using a neuropsychological battery measuring attention, memory, and processing speed. Multivariate logistic regression was used. In adults, daytime sleepiness was associated with cognitive impairment, whereas poor nighttime sleep quality was associated with cognitive impairment in elders. Age may play an important role in how sleep impacts cognition in persons with heart failure. Improving nighttime sleep quality and daytime sleepiness in this population may improve cognition.

23 Article Insomnia in patients admitted to psychiatric hospital departments 2016

Antomás Osés, J / Gárriz Murillo, C / Huarte del Barrio, S / Cambra, K / Ibáñez, B. ·Centro San Francisco Javier. elfariultra@gmail.com. ·An Sist Sanit Navar · Pubmed #28032875.

ABSTRACT: Background. The aim of this study is to estimate the prevalence of insomnia in patients requiring admittance to short-stay hospital psychiatric units. Methodology. A descriptive observational study was designed with the participation of 16 units for brief adult psychiatric hospitalization in Spain. The Athens Insomnia Scale was the instrument used. Results. Four hundred and twenty-five patients were included, with an average value on the global score of the Athens Insomnia Scale of 8.56 (SD: 5.78). The item that obtained the highest average score concerned the presence of waking up during the night, followed by that concerning the time needed to fall asleep. The estimated prevalence of insomnia is 53% (CI 95%). Conclusions. Insomnia is a problem with a high prevalence in psychiatric hospitalization units. The greatest difficulties are found in inducing sleep and staying asleep.

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 Incorporating development of a patient-reported outcome instrument in a clinical drug development program: examples from a heart failure program. 2016

Wiklund, Ingela / Anatchkova, Milena / Oko-Osi, Hafiz / von Maltzahn, Robyn / Chau, Dina / Malik, Fady I / Patrick, Donald L / Spertus, John / Teerlink, John R. ·Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK. ingela.wiklund@evidera.com. · Evidera, Bethesda, MD, USA. · Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK. · Amgen Inc., Thousand Oaks, USA. · Cytokinetics, Inc., San Francisco, CA, USA. · University of Washington, Seattle, WA, USA. · University of Missouri, Kansas City, KS, USA. · San Francisco Veterans Affairs Medical Center and University of California San Francisco School of Medicine, San Francisco, CA, USA. ·Health Qual Life Outcomes · Pubmed #27629389.

ABSTRACT: BACKGROUND: Patient-reported outcome (PRO) measures can be used to support label claims if they adhere to US Food & Drug Administration guidance. The process of developing a new PRO measure is expensive and time-consuming. We report the results of qualitative studies to develop new PRO measures for use in clinical trials of omecamtiv mecarbil (a selective, small molecule activator of cardiac myosin) for patients with heart failure (HF), as well as the lessons learned from the development process. METHODS: Concept elicitation focus groups and individual interviews were conducted with patients with HF to identify concepts for the instrument. Cognitive interviews with HF patients were used to confirm that no essential concepts were missing and to assess patient comprehension of the instrument and items. RESULTS: During concept elicitation, the most frequently reported HF symptoms were shortness of breath, tiredness, fluid retention, fatigue, dizziness/light-headedness, swelling, weight fluctuation, and trouble sleeping. Two measures were developed based on the concepts: the Heart Failure Symptom Diary (HF-SD) and the Heart Failure Impact Scale (HFIS). Findings from cognitive interviews suggested that the items in the HF-SD and HFIS were relevant and well understood by patients. Multiple iterations of concept elicitation and cognitive interviews were needed based on FDA request for a broader patient population in the qualitative study. Lessons learned from the omecamtiv mecarbil PRO/clinical development program are discussed, including challenges of qualitative studies, patient recruitment, expected and actual timelines, cost, and engagement with various stakeholders. CONCLUSION: Development of a new PRO measure to support a label claim requires significant investment and early planning, as demonstrated by the omecamtiv mecarbil program.

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