A pilot to assess the feasibility and potential clinical utility of enhanced sleep management on inpatient wards in a mental health trust

AimsTo assess the feasibility and utility of introducing the following changes on to in-patient units:Structural and cultural adaptation to create a sleep friendly ward environmentA “Protected Sleep Time” between midnight and 6amRoutine screening for sleep disorders, including obstructive sleep apnoea and restless leg syndromeBackgroundInsomnia and other sleep disturbances are cause, correlate and consequence of psychiatric disorders. Routine hourly night time observations, ward noise, bright lights at night time, sleep disorders, insufficient exercise, insufficient day light exposure, too much caffeine and inappropriate psychotropic use are all causes of disturbed sleep (Horne 2018).MethodSeven wards participated in a pilot (SleepWell). These consisted of one male and two female Acute Wards (General Adult), a High Dependency Unit, a Neurorehabilitation ward, an in-patient dementia service and one rehabilitation ward. These wards were supported via an existing trust management structure and the pilot was specifically supported by two trust managers (RW and RB) and by a clinical director (PK). The expectation was that each ward would identify a sleep champion from existing staff to facilitate the changes. A “product” was developed which identified core sleep management features but, in addition, wards were not confined to these. The existing policy that all inpatients should be checked each hour over night was suspended for the pilot wards and the patients had protected sleep time (PST) if the MDT agreed that it was clinically appropriate.Quantitative and qualitative techniques were used to identify facilitators of change, impact on sleep and, outcome.ResultProtected sleep was viewed positively by all staff and approximately 50% of patients on the pilot wards were able to have PST at some point in their admission. Routine sleep disorder assessments were harder to implement and 33% of patients were screened. There were no deaths or significant events on patients due to PST. Hypnotic use on the pilot wards reduced. It is anticipated that PST where it is safe will be rolled out across all adult and old age wards in the trust.ConclusionWith support, it has been feasible to change many aspects of sleep management across a breadth of inpatient units in a large NHS trust.

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DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people with dementia and sleep disturbances: a single-blind feasibility and acceptability randomized controlled trial

International Psychogeriatrics ◽

10.1017/s1041610218000753 ◽

2018 ◽

Vol 31 (2) ◽

pp. 251-265 ◽

Cited By ~ 9

Author(s):

Gill Livingston ◽

Julie A. Barber ◽

Kirsi M. Kinnunen ◽

Lucy Webster ◽

Simon D. Kyle ◽

...

Keyword(s):

Sleep Disorders ◽

Sleep Disturbances ◽

Light Exposure ◽

Controlled Trial ◽

Intervention Group ◽

Pharmacological Therapy ◽

Post Intervention ◽

Night Time ◽

People With Dementia ◽

Single Blind

ABSTRACTBackground:40% of people with dementia have disturbed sleep but there are currently no known effective treatments. Studies of sleep hygiene and light therapy have not been powered to indicate feasibility and acceptability and have shown 40–50% retention. We tested the feasibility and acceptability of a six-session manualized evidence-based non-pharmacological therapy; Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS-START) for sleep disturbance in people with dementia.Methods:We conducted a parallel, two-armed, single-blind randomized trial and randomized 2:1 to intervention: Treatment as Usual. Eligible participants had dementia and sleep disturbances (scoring ≥4 on one Sleep Disorders Inventory item) and a family carer and were recruited from two London memory services and Join Dementia Research. Participants wore an actiwatch for two weeks pre-randomization. Trained, clinically supervised psychology graduates delivered DREAMS-START to carers randomized to intervention; covering Understanding sleep and dementia; Making a plan (incorporating actiwatch information, light exposure using a light box); Daytime activity and routine; Difficult night-time behaviors; Taking care of your own (carer's) sleep; and What works? Strategies for the future. Carers kept their manual, light box, and relaxation recordings post-intervention. Outcome assessment was masked to allocation. The co-primary outcomes were feasibility (≥50% eligible people consenting to the study) and acceptability (≥75% of intervention group attending ≥4 intervention sessions).Results:In total, 63out of 95 (66%; 95% CI: 56–76%) eligible referrals consented between 04/08/2016 and 24/03/2017; 62 (65%; 95% CI: 55–75%) were randomized, and 37 out of 42 (88%; 95% CI: 75–96%) adhered to the intervention.Conclusions:DREAM-START for sleep disorders in dementia is feasible and acceptable.

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Sleep, inflammation, and disease

10.1093/oso/9780198778240.003.0012 ◽

2018 ◽

Author(s):

Michelle A. Miller

Keyword(s):

Sleep Disorders ◽

Lupus Erythematosus ◽

Sleep Disturbances ◽

Subsequent Development ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Obstructive Sleep ◽

Fundamental Requirement ◽

Clear Clinical Benefit ◽

Pro Inflammatory Cytokines

Sleep is a fundamental requirement for living individuals. Sleep disturbances and sleep disorders have extensive effects on the immune system, affecting one’s susceptibility to, and ability to fight off, infections—both bacterial and viral—and the subsequent development of different diseases. This is mediated by the increase in pro-inflammatory cytokines associated with sleep loss and disruption. A number of common conditions, such as obesity, cardiovascular disease, metabolic syndrome, obstructive sleep apnoea syndrome, rheumatoid arthritis, and systemic lupus erythematosus, all share pro-inflammatory mechanisms and the presence of sleep disturbances. Early identification of sleep disorders, and the associated adverse inflammatory and metabolic risk factors, in affected individuals would have a clear clinical benefit.

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Narcolepsy: still sleepy on CPAP

10.1093/med/9780199657742.003.0011 ◽

2017 ◽

Author(s):

Dave Walder ◽

Paul Reading

Keyword(s):

Sleep Disorders ◽

Sleep Disorder ◽

Neurological Disorder ◽

Treatment Options ◽

Sleep Apnoea ◽

Daytime Somnolence ◽

Night Time ◽

Sleep Studies ◽

Obstructive Sleep ◽

Normal Sleep

Sleep disorders are an increasingly common reason for referral to the respiratory clinic, and our understanding of the different aetiologies is increasing. The commonest sleep disorder is sleep apnoea, but other sleep disorders can cause similar symptoms. Narcolepsy is a neurological disorder that affects the brain’s ability to regulate the normal sleep-wake cycle and often presents with similar symptoms to obstructive sleep apnoea, daytime hypersomnolence, and disturbed night-time sleeping but is largely underdiagnosed. This chapter discusses a patient who presented with symptoms of daytime somnolence and witnessed apnoeas and details the investigations required for a diagnosis of narcolepsy. It covers the more specialized sleep studies required for a clinical diagnosis and the treatment options available for patients with this condition.

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The association between beta-blocker therapy and daytime sleepiness in obstructive sleep apnoea

Sleep and Biological Rhythms ◽

10.1007/s41105-021-00330-z ◽

2021 ◽

Author(s):

Martina Meszaros ◽

Alexander G. Mathioudakis ◽

Maria Xanthoudaki ◽

Victoria Sircu ◽

Evangelia Nena ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Beta Blocker ◽

Daytime Sleepiness ◽

Beta Blockers ◽

Multivariate Logistic Regression Analysis ◽

Sleep Time ◽

Sleep Apnoea ◽

Sensitivity Analyses ◽

Obstructive Sleep ◽

Cardinal Symptom

AbstractDaytime sleepiness is a cardinal symptom of obstructive sleep apnoea (OSA) and a well-recognised side effect of beta-blockers, therefore patients with OSA under this treatment may have worse sleepiness. However, the interaction between daytime sleepiness and beta-blockers use has not been thoroughly investigated in patients with OSA before. We analysed the data of 2183 individuals (1852 patients with OSA and 331 snorer controls) from 3 countries (Greece, Hungary and Moldova). Medical history, including medication usage and the Epworth Sleepiness Scale (ESS) were recorded. Patients and controls were divided into somnolent (ESS ≥ 11) and non-somnolent (ESS < 11) groups, and the association between-blocker use with the somnolent group was investigated with multivariate logistic regression analysis adjusted for confounders. Sensitivity analyses were performed in each cohort, in the severity subgroups, in patients who did not take statins and in those who had polysomnography as a diagnostic test. There was no relationship between beta-blocker usage and the somnolent OSA (p = 0.24) or control (p = 0.64) groups. These results were similar in sensitivity analyses (all p > 0.05). ESS was related to BMI (ρ = 0.25), total sleep time (ρ = 0.07), AHI (ρ = 0.32), oxygen desaturation index (ρ = 0.33) and minimum oxygen saturation (ρ = – 0.32, all p < 0.05) in OSA, and was higher in patients with hypertension, diabetes and cerebro/cardiovascular disease and those who took statins (all p < 0.05). In general, beta-blockers are not associated with increased daytime sleepiness in OSA. Thus, the diagnosis of OSA should not discourage initiation of beta-blocker treatment, if it is clinically indicated.

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Triglyceride-Glucose Index in Non-Diabetic, Non-Obese Patients with Obstructive Sleep Apnoea

Journal of Clinical Medicine ◽

10.3390/jcm10091932 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1932

Author(s):

Andras Bikov ◽

Stefan M. Frent ◽

Martina Meszaros ◽

Laszlo Kunos ◽

Alexander G. Mathioudakis ◽

...

Keyword(s):

Insulin Resistance ◽

Oxygen Saturation ◽

Obstructive Sleep Apnoea ◽

Sleep Time ◽

Sleep Apnoea ◽

Obese Patients ◽

Triglyceride Glucose Index ◽

Cigarette Pack ◽

Obstructive Sleep ◽

And Control

Obstructive sleep apnoea (OSA) is associated with increased insulin resistance. Triglyceride-glucose index (TyG) is a simple marker of insulin resistance; however, it has been investigated only by two studies in OSA. The aim of this study was to evaluate TyG in non-diabetic, non-obese patients with OSA. A total of 132 patients with OSA and 49 non-OSA control subjects were included. Following a diagnostic sleep test, fasting blood was taken for the analysis of the lipid profile and glucose concentrations. TyG was calculated as ln(triglyceride [mg/dL] × glucose [mg/dL]/2). Comparison analyses between OSA and control groups were adjusted for age, gender, body mass index (BMI) and smoking. TyG was higher in men (p < 0.01) and in ever-smokers (p = 0.02) and it was related to BMI (ρ = 0.33), cigarette pack-years (ρ = 0.17), apnoea–hypopnoea index (ρ = 0.38), oxygen desaturation index (ρ = 0.40), percentage of total sleep time spent with oxygen saturation below 90% (ρ = 0.34), and minimal oxygen saturation (ρ = −0.29; all p < 0.05). TyG values were significantly higher in OSA (p = 0.02) following adjustment for covariates. OSA is independently associated with higher TyG values which are related to disease severity in non-obese, non-diabetic subjects. However, the value of TyG in clinical practice should be evaluated in follow-up studies in patients with OSA.

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New forehead device in positional obstructive sleep apnoea: a randomised clinical trial

Thorax ◽

10.1136/thoraxjnl-2020-216167 ◽

2021 ◽

pp. thoraxjnl-2020-216167

Author(s):

Laura Hidalgo Armas ◽

Sandra Ingles ◽

Rafaela Vaca ◽

Jose Cordero-Guevara ◽

Joaquin Duran Carro ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Supine Position ◽

Total Sleep Time ◽

Controlled Trial ◽

Randomised Clinical Trial ◽

Sleep Time ◽

Sleep Apnoea ◽

Active Device ◽

Link Type ◽

Obstructive Sleep

RationaleApproximately 60% of the patients with obstructive sleep apnoea suffer from a positional effect, and approximately 25% of these patients present events only in the supine position.ObjectiveTo validate a new positional vibrating device and evaluate its efficacy in reducing the Apnoea–Hypopnoea Index and the total sleep time in the supine position without disturbing sleep.MethodsA total of 128 patients were recruited for this multicentre, prospective, parallel, randomised controlled trial and were distributed in three arms (general recommendations, inactive and active device). Full overnight polysomnography was performed at baseline and at 12 weeks. Anthropometric variables and sleep and quality of life questionnaires were collected at 4, 8 and 12 weeks.ResultsThe Apnoea-Hypopnoea Index decreased from 30.6 per hour to 20.4 per hour (p<0.001) in the active device (AD) group. In this group the reduction was 2.3-fold and 3.3-fold than the ones in the general recommendations (GR) and inactive device (ID) groups, respectively (p=0.014). Sleep time in supine position decreased 17.7%±26.3% in GR group (p<0.001), 13.0%±22.4% with ID group (p<0.001) and 21.0%±25.6% in the AD group (p<0.001). Furthermore, total sleep time increased significantly only in the AD group (22.1±57.5 min, p=0.016), with an increased percentage of time in the N3 (deep sleep) and N3+REM (rapid eye movement) stages, without sleep fragmentation.ConclusionThe device was effective in reducing the Apnoea–Hypopnoea Index and time spent in the supine position also in improving sleep architecture. Therefore, the device could be a good option for the management of patients with positional obstructive sleep apnoea.Trial registration detailsThe trial was registered at www.clinicaltrials.gov (NCT03336515).

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Integrative Sleep Medicine

10.1093/med/9780190885403.001.0001 ◽

2021 ◽

Keyword(s):

Circadian Rhythm ◽

Sleep Disorders ◽

Health Care Providers ◽

Sleep Disturbances ◽

Well Being ◽

Sleep Medicine ◽

Whole Body ◽

Care Providers ◽

Obstructive Sleep ◽

The Many

Sleep is one of the key underpinnings of human health, yet sleep disturbances and impaired sleep are rampant in modern life. Healthy sleep is a whole-body process impacted by circadian rhythm, daily activities, and emotional well-being, among others. When properly aligned, these work in concert to produce restorative and refreshing sleep. When not in balance, however, sleep disorders result. Yet too often, the approach to treatment of sleep disorders is compartmentalized, failing to recognize all of the complex interactions that are involved. This text offers a comprehensive approach to sleep and sleep disorders by delineating the many factors that interplay into healthy sleep. Health care providers can learn how to better manage their patients with sleep disorders by integrating complementary and conventional approaches. Using an evidence-based approach throughout, this book describes the basics of normal sleep then delves into the foundations of integrative sleep medicine, including the circadian rhythm, mind/body-sleep connection, light, dreaming, the gastrointestinal system, and botanicals/supplements. Specific sleep issues and disorders are then addressed from an integrative perspective, including insomnia, obstructive sleep apnea, sleep related movement disorders, and parasomnias.

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Comparison of Hospital-Based and Home-Based Obstructive Sleep Apnoea Severity Measurements with a Single-Lead Electrocardiogram Patch

Sensors ◽

10.3390/s21238097 ◽

2021 ◽

Vol 21 (23) ◽

pp. 8097

Author(s):

Wen-Te Liu ◽

Shang-Yang Lin ◽

Cheng-Yu Tsai ◽

Yi-Shin Liu ◽

Wen-Hua Hsu ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Sleep Time ◽

Sleep Apnoea ◽

Health Concern ◽

Lower Percentage ◽

Short Sleep Duration ◽

Patch Type ◽

Home Based ◽

Obstructive Sleep ◽

Supine Sleep

Obstructive sleep apnoea (OSA) is a global health concern, and polysomnography (PSG) is the gold standard for assessing OSA severity. However, the sleep parameters of home-based and in-laboratory PSG vary because of environmental factors, and the magnitude of these discrepancies remains unclear. We enrolled 125 Taiwanese patients who underwent PSG while wearing a single-lead electrocardiogram patch (RootiRx). After the PSG, all participants were instructed to continue wearing the RootiRx over three subsequent nights. Scores on OSA indices—namely, the apnoea–hypopnea index, chest effort index (CEI), cyclic variation of heart rate index (CVHRI), and combined CVHRI and CEI (Rx index), were determined. The patients were divided into three groups based on PSG-determined OSA severity. The variables (various severity groups and environmental measurements) were subjected to mean comparisons, and their correlations were examined by Pearson’s correlation coefficient. The hospital-based CVHRI, CEI, and Rx index differed significantly among the severity groups. All three groups exhibited a significantly lower percentage of supine sleep time in the home-based assessment, compared with the hospital-based assessment. The percentage of supine sleep time (∆Supine%) exhibited a significant but weak to moderate positive correlation with each of the OSA indices. A significant but weak-to-moderate correlation between the ∆Supine% and ∆Rx index was still observed among the patients with high sleep efficiency (≥80%), who could reduce the effect of short sleep duration, leading to underestimation of the patients’ OSA severity. The high supine percentage of sleep may cause OSA indices’ overestimation in the hospital-based examination. Sleep recording at home with patch-type wearable devices may aid in accurate OSA diagnosis.

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Sleep disorders in migraine

Medical Council ◽

10.21518/2079-701x-2021-2-111-120 ◽

2021 ◽

pp. 111-120

Author(s):

N. V. Vashchenko ◽

A. I. Kozhev ◽

Ju. E. Azimovа

Keyword(s):

Combination Therapy ◽

Sleep Disorders ◽

Sleep Disturbances ◽

Mutual Influence ◽

Integrated Approach ◽

Epidemiological Studies ◽

Exact Nature ◽

Obstructive Sleep ◽

Underlying Mechanisms

Migraine and sleep disorders are common in the general population, may be associated with each other and often significantly reduce patients’ quality of life. Clinicians and epidemiological studies have long acknowledged a link between these conditions. However, the exact nature of this relationship, its underlying mechanisms and patterns are complex and not fully understood. This publication brings together the latest data on the relationship between migraine and sleep disorders: the biochemical and functional-anatomical background, the mutual influence of these conditions on each other and the typical sleep disturbances in migraine patients (such as insomnia, obstructive sleep apnea, parasomnia, snoring, excessive daytime sleepiness). The paper discusses the hypotheses of pathogenetic relationships based on the studies of the central nervous system’s anatomical and physiological features in people with migraine and sleep disorders. The available data should encourage physicians to evaluate sleep quality in migraineurs and use combination therapy systematically. The therapy of insomnia is reviewed: both nonpharmacological and pharmacological therapies are discussed; the advantages of an integrated approach are discussed, and a brief overview of each group of medications is offered.Lastly, a case study of a patient with chronic migraine and insomnia treated with Doxylamine in combination therapy is presented. Treatment with Doxylamine significantly reduced the incidence of insomnia, probably thereby positively influencing the course of migraine as well.

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