The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES

Background/Objective. Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. Methods. Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. Results. Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. Conclusion. Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.

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Sleep disorders in children with attention-deficit/hyperactivity disorder

Paediatrica Indonesiana ◽

10.14238/pi1.1.2018.46-50 ◽

2018 ◽

Vol 1 (1) ◽

pp. 48

Author(s):

Medina Permatawati ◽

Agung Triono ◽

Mei Neni Sitaresmi

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Sleep Disorders ◽

Sleep Disorder ◽

Attention Deficit ◽

Sleep Disturbances ◽

Sleep Hygiene ◽

Poor Sleep ◽

Cross Sectional ◽

Children With Adhd ◽

Hyperactivity Disorder

Background Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral abnormality that commonly occurs among children. Sleep disorders are comorbid with ADHD. Sleep disorders in Indonesian children with ADHD have not been widely studied.Objective To understand the proportion and factors that influence sleep disorders in children with ADHD. Methods This cross-sectional study involved 54 children aged 3-14 years who had been diagnosed with ADHD by a pediatric growth and development consultant using DSM-5 criteria. The subjects were consecutively selected from March to August 2017 at the Child Development Polyclinic, Dr. Sardjito Hospital, Yogyakarta. Sleep data were collected using the Sleep Disturbances Scale for Children (SDSC) and the Children’s Sleep Hygiene Scale (CSHS).Results Of the 54 children with ADHD (46 males and 8 females), 35 (64.8%) experienced sleep disorders. The majority (26 subjects, 48.1%) had the disorder of initiating and maintaining sleep. Children with the combined (inattention and hyperactive-impulsive) type of ADHD experienced significantly greater sleep disturbance compared to the inattention type or hyperactive-impulsive type (OR=3.750; 95% CI 1.133 to 12.41; P=0.027). Poor sleep hygiene was also significantly associated with more severe sleep disorders (r=-0.383, P=0.004).Conclusion The proportion of sleep disorder in children with ADHD is relatively high, with the majority having a disorder of initiating and maintaining sleep. Children with combined type ADHD experience a higher amount of sleep disorder than those with either the inattention or hyperactive-impulsive types of ADHD. Children with poor sleep hygiene have significantly more severe sleep disorders.

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0827 The Association Among Diagnosed and Suspected Sleep Disorders and Pain

SLEEP ◽

10.1093/sleep/zsaa056.823 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A315-A315

Author(s):

S Ravyts ◽

J Dzierzewski

Keyword(s):

Sleep Apnea ◽

Pain Intensity ◽

Sleep Disorders ◽

Sleep Disorder ◽

Severity Index ◽

Future Research ◽

Poor Sleep ◽

Pain Scores ◽

Pain Outcomes ◽

Average Pain

Abstract Introduction Poor sleep has increasingly been linked to adverse pain outcomes. Yet, the complex interplay between sleep apnea, insomnia, or comorbid sleep apnea and insomnia (COMISA), and pain are less well understood. The purpose of the present study was twofold: 1) assess pain intensity in individuals with diagnoses of insomnia, sleep apnea, and COMISA, and 2) examine pain intensity in individuals who are at a high risk for having either sleep apnea, insomnia, or both sleep disorders. Methods Participants included 3401 adults (mean age= 42.77, male= 45.6%) who participated in an online study investigating sleep across the lifespan. Sleep apnea and insomnia diagnoses were self-reported while participant risk profiles for these disorders were assessed via the Insomnia Severity Index and the STOP-BANG questionnaire respectively. Average pain intensity over the last two weeks was rated from 0 (no pain) to 100 (very severe). Results Participants with self-reported comorbid sleep disorders reported higher pain scores than individuals with one or no sleep disorder (F(2,3398) = 71.61, p < .001). Among individuals with no previously diagnosed sleep disorder, participants with more insomnia symptoms reported greater pain intensity (F(3,3100) = 201.64, p < .001), as did those with higher scores on the STOP-BANG (F(2,3125) = 46.79, p < .001). Participants with suspected comorbid sleep disorders reported higher pain scores than individuals with either sleep apnea or no sleep disorder, but not insomnia (F(3,2887) = 110.15, p < .001). Conclusion Results suggest that individuals with known sleep disorders report high levels of pain particularly in the context of comorbid sleep apnea and insomnia. Additionally, individuals with suspected, but untreated, sleep disorders also report increased pain. Future research should examine whether treating one of more sleep disorders can improve pain outcomes. Support This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).

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616 Restless sleep and other comorbidities in children with attention deficit hyperactivity disorder

SLEEP ◽

10.1093/sleep/zsab072.614 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A242-A242

Author(s):

Vidhi Kapoor ◽

Raffaele Ferri ◽

Mark Stein ◽

Chris Ruth ◽

Jennifer Reed ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disorders ◽

Sleep Disorder ◽

Sleep Disturbances ◽

Psychiatric Comorbidities ◽

Children With Adhd ◽

Hyperactivity Disorder ◽

Obstructive Sleep ◽

Pediatric Sleep Medicine

Abstract Introduction The etiology of restless sleep has recently been identified as secondary to various medical and sleep conditions. Parents of children with ADHD complain of restless sleep and sleep disturbances in their children. We aimed to assess restless sleep causes in our patient population with ADHD and establish the prevalence of restless sleep disorder (RSD), as recently defined. Methods A retrospective study of children with ADHD who underwent polysomnography was carried out. Diagnostic and descriptive information collected for each patient included age, sex, polysomnographic parameters, sleep disorders, psychiatric comorbidities, and medications. Results Sixty-six PSGs were reviewed. The mean age of children was 11.6 (±3.6 SD) years; 17 were female and 49 were male. Parents of 54 (81.1%) children had concerns of restlessness during sleep; 47 (71.2%) children had obstructive sleep apnea, 17 (25.8%) had PLMS ≥5/hour, 13 (19.7%) had RLS, 6 (9.1%) had RSD, 27 (41%) had depression or anxiety, 5 (7.6%) had insomnia. Conclusion In a pediatric sleep medicine referred group of patients with ADHD, who are known to have significant sleep and psychiatric comorbidities, obstructive sleep apnea, RLS, and RSD were found to be the most prevalent sleep disorders, whereas depression and anxiety were the most common psychiatric disorders. Complaint of secondary restless sleep seems to be common, while primary restless sleep disorder was seen in approximately 9% of children. The results of this study aid pediatricians and child psychiatrists in screening children with ADHD for associated sleep disorders. Support (if any):

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Sleep disorders in children with attention-deficit/hyperactivity disorder

Paediatrica Indonesiana ◽

10.14238/pi58.1.2018.48-52 ◽

2018 ◽

Vol 58 (1) ◽

pp. 48 ◽

Cited By ~ 1

Author(s):

Medina Permatawati ◽

Agung Triono ◽

Mei Neni Sitaresmi

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Sleep Disorders ◽

Sleep Disorder ◽

Attention Deficit ◽

Sleep Disturbances ◽

Sleep Hygiene ◽

Poor Sleep ◽

Cross Sectional ◽

Children With Adhd ◽

Hyperactivity Disorder

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There Are Not Enough Sheep

Psychological and Psychiatric Issues in Patients with Chronic Pain ◽

10.1093/med/9780197544631.003.0014 ◽

2021 ◽

pp. 117-126

Author(s):

Daniel M. Doleys ◽

Nicholas D. Doleys

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Sleep Apnea ◽

Sleep Disturbance ◽

Pain Intensity ◽

Sleep Disorders ◽

Physical Factor ◽

Pain Clinic ◽

Poor Sleep ◽

Potential Impact

It is difficult to overemphasize the potential impact of sleep and sleep disorders on chronic pain. Indeed, there are data indicating that sleep disturbance mat be a significant causal factor in the development and maintenance of chronic pain. One would think that daytime pain would predict degree of sleep. But, in fact, it is the opposite; sleep is better predictor of daytime pain intensity. The factor associated with poor sleep are many and varied. Ruling out sleep apnea should be a priority. The availability of in-home studies simplifies the assessment/screening, and may engender greater cooperation. Sleep apnea contributes to hypogonadism, which, in turn, impact a number of physical factor that influence mood, function, and pain. There is a number of approaches that can be implemented in the primary care and pain clinic setting to address the problem of sleep disorders in the patient with chronic pain.

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Evaluation of Subjective Sleep Disturbances in Cancer Patients: A Cross-Sectional Study in a Radiotherapy Department

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.648896 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jun Wang ◽

Bei-Yun Zhou ◽

Chen-Lu Lian ◽

Ping Zhou ◽

Hui-Juan Lin ◽

...

Keyword(s):

Logistic Regression ◽

Sleep Quality ◽

Sleep Disturbance ◽

Sleep Disorders ◽

Cancer Patients ◽

Sleep Disturbances ◽

Cancer Type ◽

Multivariate Logistic Regression ◽

Subjective Sleep ◽

Radiotherapy Department

Background: The factors associated with sleep disturbances in cancer patients remains unclear. This study aimed to explore the prevalence of sleep disorders and predictors associated with sleep disturbance in cancer patients from a radiotherapy department.Methods: Patients with cancers were recruited before the start of radiotherapy from our institution between January 2019 and February 2020. Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality. Descriptive statistics, Chi-square test, and multivariate logistic regression analysis were used to conduct statistical analysis.Results: A total of 330 eligible patients were included. Of them, 38.3% (n = 127) had the globe PSQI score >7, indicating that they suffered from sleep disorders. Patients with lung cancer (45.2%) were more likely to suffer from sleep disturbance, followed by cervical cancer (43.8%), nasopharyngeal carcinoma (41.7%), esophageal cancer (41.5%), breast cancer (37.7%), and colorectal cancer (30%). With regard to the PSQI components, the mean sleep duration was 8 h, 20.3% (n = 67) of them reported poor subjective sleep quality, 6.1% (n = 20) needed medication to improve sleep, and 53.6% (n = 177) suffered daytime dysfunction. Multivariate logistic regression models showed body mass index (BMI) ≥ 20 kg/m2 [odds ratio (OR) 0.599, 95% confidence interval (CI) 0.329–0.948, P = 0.031] and the receipt of surgery (OR 0.507, 95% CI 0.258–0.996, P = 0.048) were the significant favorable predictors for sleep disturbance, while age, gender, marital status, education level, comorbidity, metastasis status, diagnostic status, and cancer type were not significantly associated with sleep disturbance.Conclusions: Approximately 40% of the cancer patients suffer from sleep disturbance before the start of radiotherapy. Patients with BMI ≥ 20 kg/m2 and receiving surgery are less likely to develop sleep disturbance in comparison with others.

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0785 Associations Between Circadian Preference And Sleep-related Thoughts: Data From The 2015 Sleep In America Poll

SLEEP ◽

10.1093/sleep/zsaa056.781 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A298-A299

Author(s):

B Jeon ◽

F S Luyster ◽

E R Chasens

Keyword(s):

Sleep Disturbance ◽

Sleep Duration ◽

Sleep Disturbances ◽

Secondary Analysis ◽

Logistic Models ◽

Poor Sleep ◽

Sleep Habits ◽

Circadian Preference ◽

Physical Consequences ◽

The Impact

Abstract Introduction Evening types of sleep tend to have poorer sleep quality and sleep habits than morning types. Maladaptive beliefs or thoughts about sleep can affect one’s sleep and may differ between evening and morning types. We examined the association between the circadian preference and sleep-related thoughts in U.S adults. Methods A secondary analysis used survey data from the 2015 National Sleep Foundation’s Sleep in America Poll. Questions included normal bedtime and wake-up time for week/work days and weekend/non-work days. Circadian preference was determined by midpoint of sleep calculated as midpoint of sleep on weekends corrected for average nightly sleep duration. Participants were excluded if their sleep midpoint was from noon to midnight. Midpoint of sleep was divided into two groups using median split (“earlier” vs. “later”). Sleep-related thoughts were “worry about getting a good sleep”, “overwhelming thoughts about getting enough sleep”, “motivation to get sleep”, and “concern about serious physical consequences due to poor sleep”; responded often/always or extremely to somewhat for these items were coded as maladaptive. Logistic regression analysis controlling for socio-demographics, sleep duration, and sleep disturbance (PROMIS Scale; higher scores = greater sleep disturbance) was conducted to examine the relationships between midpoint of sleep and sleep-related thoughts. Results The sample (N = 1011) was primarily White (73.6%), male (50.9%), college educated (62.2%), married/partnered (67.6%) with a mean age of 51.65 ± 17.05 years. Mean midpoint of sleep in “earlier” type was 2:33AM and 5:29AM in “later” type. “Later” type had shorter sleep duration on weekdays and longer sleep duration on weekends than “earlier” type (p < .01), but average sleep duration was similar between two types. “Later” type had more “worry” and “overwhelming thoughts” (p < .05) about sleep. In logistic models, midpoint of sleep was significant only for “concern” (p = .02). Conclusion In this study, late chronotype was associated with increased sleep disturbances and greater variability in sleep duration. The relationship between the timing of sleep and thoughts about the impact of impaired sleep remains unclear and an area for further study with objective measures. Support

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Sleep and Sleep Disorders in Tourette Syndrome: What is Known and What is Still Unknown

Current Drug Therapy ◽

10.2174/1574885514666191121142555 ◽

2020 ◽

Vol 15 (2) ◽

pp. 124-131 ◽

Cited By ~ 1

Author(s):

Arie Oksenberg

Keyword(s):

Sleep Disorders ◽

Sleep Disorder ◽

Tourette Syndrome ◽

Sleep Disturbances ◽

Sleep Problems ◽

Life Quality ◽

Sleep Stages ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Impaired Sleep

Background: Most of the patients with Tourette Syndrome (TS) present additional comorbidities. Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD) are the most common. Sleep Disorder has been suggested also as common comorbidity. Objective: To review the literature on sleep characteristics and sleep disorder in patients with Tourette Syndrome (TS), with emphasis on the contribution of specific co-morbidities to the severity of impaired sleep and life quality of the patients. Results: In general, sleep problems are not frequent at the age when tics appear which are estimated to affect about 10 % of these children. In severe cases, tics appear in all sleep stages. In a large study, the prevalence of sleep problems was 17.8% but was 12 % in “TS-only” (9.4% in children and 7.5 in adults) compared to 22% in children and 18% in adults with TS+ADHD. Unfortunately, in most of the studies, the characteristics of these “sleep problems” are not defined. In spite of the scarcity of data, the two main sleep disorders in TS patients are insomnia and parasomnias. Although much more data is needed, many TS subjects are sleep deprived (which exacerbate the tics) and may suffer from excessive daytime sleepiness, which negatively affects normal functioning. Conclusions: Although the literature is not conclusive, children and adolescents with TS appear to suffer more from sleep disturbances and sleep disorders than age-matched controls. Not all patients have tics during sleep, but in severe cases, tics may appear in all sleep stages. It is clear that when patients present both TS and ADHD, (a very common condition), the sleep difficulties are related mainly to ADHD. Much more research is warranted in all aspects of sleep and sleep disorders in TS.

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Sleep Disorders and Depression

10.1093/oxfordhb/9780199797004.013.012 ◽

2014 ◽

Cited By ~ 1

Author(s):

Colleen E. Carney ◽

Taryn G. Moss

Keyword(s):

Sleep Disorders ◽

Sleep Disorder ◽

Clinical Management ◽

Sleep Disturbances ◽

Sleep Problems ◽

Clinical Care ◽

Major Depressive ◽

Bidirectional Relationship ◽

Assessment And Treatment ◽

Almost All

Major depressive disorder (MDD) commonly occurs with several sleep disorders, including hypersomnia, breathing or limb-related sleep disturbances, and most notably chronic insomnia. A bidirectional relationship exists between sleep and mood problems, and both issues often warrant timely clinical management. However, there are several assessment- and treatment-related complexities that complicate the clinical management of such patients. For example, there are several overlapping symptoms for MDD and both insomnia and hypersomnia, and the two sleep conditions are both listed as possible symptoms in the diagnostic criteria for MDD. This has led to a well-documented problem of underrecognizing and undertreating these significant disorders in the context of MDD. Moreover, certain effective depression treatments can actually worsen the coexisting sleep disorder. Understanding and treating both disorders (i.e., MDD and the co-occurring sleep disorder) is imperative for effective clinical care. Almost all (i.e., up to 90%) of those with depression report sleep problems. This chapter provides an overview of the etiologic, assessment, and treatment issues inherent in this very large, highly prevalent group.

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The Association of Sleep Disorder, Obesity Status, and Diabetes Mellitus among US Adults—The NHANES 2009-2010 Survey Results

International Journal of Endocrinology ◽

10.1155/2013/234129 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Jian Liu ◽

John Hay ◽

Brent E. Faught

Keyword(s):

Sleep Disturbance ◽

Sleep Disorders ◽

Sleep Disorder ◽

Sleep Problems ◽

Tolerance Test ◽

Oral Glucose ◽

Logistic Regression Models ◽

Obesity Status ◽

Overnight Fasting ◽

The Impact

To examine the association between sleep disorders, obesity status, and the risk of diabetes in adults, a total of 3668 individuals aged 40+ years from the NHANES 2009-2010 without missing information on sleep-related questions, measurements related to diabetes, and BMI were included in this analysis. Subjects were categorized into three sleep groups based on two sleep questions: (a) no sleep problems; (b) sleep disturbance; and (c) sleep disorder. Diabetes was defined as having one of a diagnosis from a physician; an overnight fasting glucose > 125 mg/dL; Glycohemoglobin > 6.4%; or an oral glucose tolerance test > 199 mg/dL. Overall, 19% of subjects were diabetics, 37% were obese, and 32% had either sleep disturbance or sleep disorder. Using multiple logistic regression models adjusting for covariates without including BMI, the odds ratios (OR, (95% CI)) of diabetes were 1.40 (1.06, 1.84) and 2.04 (1.40, 2.95) for those with sleep disturbance and with sleep disorder, respectively. When further adjusting for BMI, the ORs were similar for those with sleep disturbance 1.36 (1.06, 1.73) but greatly attenuated for those with sleep disorders (1.38 [0.95, 2.00]). In conclusion, the impact of sleep disorders on diabetes may be explained through the individuals’ obesity status.

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