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Introduction: Major depressive disorder is one of the most commonly diagnosed psychiatric illnesses, and it has a profound negative impact on an individual's ability to function. Up to 90% of individuals suffering from depression also report sleep and circadian disruptions. If these disruptions are not effectively resolved over the course of treatment, the likelihood of relapse into depression is greatly increased. Cognitive Behavioural Therapy for Insomnia (CBT-I) has shown promise in treating these sleep and circadian disturbances associated with depression, and may be effective as a stand-alone treatment for depression. This may be particularly relevant in cases where antidepressant medications are not ideal (e.g. due to contraindications, cost, or treatment resistance).Methods: A systematic literature review was conducted of trials investigating the use of CBT-I to treat depression in adults. Therapy included in-person CBT-I, as well as telehealth and group CBT-I.Results and Conclusions: CBT-I presents a promising treatment for depression comorbid with insomnia. In-person therapy has the most supporting evidence for its efficacy, though treatment effects may not be additive with those of antidepressant medications. Insomnia improvement due to CBT-I may mediate the improvement in depressive symptoms. There is less evidence for the use of telehealth, though a stepped-care approach is indicated based on baseline depressive severity. More research on group therapy and telehealth modalities of delivering CBT-I are required before making recommendations. [ABSTRACT FROM AUTHOR]

Prader-Willi syndrome (PWS) is a genetic disorder characterized by short stature, mental retardation, hypotonia, functionally deficient gonads, and uncontrolled appetite leading to extreme obesity at an early age. Patients with this condition require multidisciplinary medical care, which facilitates a significant improvement in quality of life. PWS is the first human disorder to be attributed to genomic imprinting. Prevalence varies in the literature, ranging from 1 in 8,000 in the Swedish population to 1 in 54,000 in the United Kingdom. Rarely, the genetic mechanism responsible for Prader-Willi syndrome can be inherited. We report a highly unique case of three siblings who share this condition. This report describes a case of two brothers and one half sister with PWS. All three siblings have sleep-related complaints. The sister died at the age of 24 years in her sleep, with the cause of death reported as obstructive sleep apnea. The outcome was positive in both of the brothers’ cases as a result of professional medical care and specific tailored recommendations implemented by their mother. A review of the relevant literature vis-à-vis sleep and PWS is provided. [ABSTRACT FROM AUTHOR]

Background: Delayed recovery in persons after mild traumatic brain injury (mTBI) is poorly understood. Community integration (CI) is endorsed by persons with neurological disorders as an important outcome. We aimed to describe CI and its associated factors in insured Ontario workers with delayed recovery following mTBI.Methods: A cross-sectional study of insured workers in the chronic phase following mTBI was performed at a rehabilitation hospital in Ontario, Canada. Sociodemographic, occupational, injury-related, clinical, and claim-related data were collected from self-reports, medical assessments, and insurers' referral files. Community Integration Questionnaire (CIQ) scores were compared using analysis of variance or Spearman's correlation tests. Stepwise multivariable linear regression models were used to evaluate the associations with CI.Results: Ninety-four workers with mTBI (45.2 ± 9.9 years old, 61.2% male) at 197 days post-injury (interquartile range, 139-416 days) were included. The CIQ total and subscale scores were similar to those reported in more severe TBI samples. The CIQ scores were moderately to strongly correlated with various sociodemographic, claim-related, and clinical variables. In the multivariable regression analysis, several covariates accounted for 36.4% of the CIQ variance in the final fully adjusted model.Discussion: This study evaluated CI in workers with mTBI, and analyzed its associated variables. Analysis revealed insomnia, head or neck pain, being married or in a relationship, time since injury, and a diagnosis of possible/probable malingering were independently associated with limited CI.Conclusions: Workers with delayed recovery from mTBI experience difficulty with CI. Insomnia is a particularly relevant covariate, explaining the greater part of its variance. To enhance participation, care should focus on clinical and non-clinical covariates. [ABSTRACT FROM AUTHOR]

Circadian phase resetting is sensitive to visual short wavelengths (450-480 nm). Selectively filtering this range of wavelengths may reduce circadian misalignment and sleep impairment during irregular light-dark schedules associated with shiftwork. We examined the effects of filtering short wavelengths (<480 nm) during night shifts on sleep and performance in nine nurses (five females and four males; mean age ± SD: 31.3 ± 4.6 yrs). Participants were randomized to receive filtered light (intervention) or standard indoor light (baseline) on night shifts. Nighttime sleep after two night shifts and daytime sleep in between two night shifts was assessed by polysomnography (PSG). In addition, salivary melatonin levels and alertness were assessed every 2 h on the first night shift of each study period and on the middle night of a run of three night shifts in each study period. Sleep and performance under baseline and intervention conditions were compared with daytime performance on the seventh day shift, and nighttime sleep following the seventh daytime shift (comparator). On the baseline night PSG, total sleep time (TST) ( p < 0.01) and sleep efficiency ( p = 0.01) were significantly decreased and intervening wake times (wake after sleep onset [WASO]) ( p = 0.04) were significantly increased in relation to the comparator night sleep. In contrast, under intervention, TST was increased by a mean of 40 min compared with baseline, WASO was reduced and sleep efficiency was increased to levels similar to the comparator night. Daytime sleep was significantly impaired under both baseline and intervention conditions. Salivary melatonin levels were significantly higher on the first ( p < 0.05) and middle ( p < 0.01) night shifts under intervention compared with baseline. Subjective sleepiness increased throughout the night under both conditions ( p < 0.01). However, reaction time and throughput on vigilance tests were similar to daytime performance under intervention but impaired under baseline on the first night shift. By the middle night shift, the difference in performance was no longer significant between day shift and either of the two night shift conditions, suggesting some adaptation to the night shift had occurred under baseline conditions. These results suggest that both daytime and nighttime sleep are adversely affected in rotating-shift workers and that filtering short wavelengths may be an approach to reduce sleep disruption and improve performance in rotating-shift workers. (Author correspondence: casper@lunenfeld.ca) [ABSTRACT FROM AUTHOR]

Abstract: Objective: Pediatric obstructive sleep apnea (OSA) is a prevalent but under-diagnosed disease. The importance of screening for OSA in every child has been recently re-emphasized by the American Academy of Pediatrics Guidelines. Although several screening questionnaires are available for pediatric OSA, they are either complicated to use or not sensitive enough, and therefore OSA is seldom screened in primary care settings. Here, we validated a previously developed short (6-item) hierarchically-based screening questionnaire tool for pediatric OSA. Methods: Parents of 85 children referred for a sleep study at a pediatric community-based sleep clinic completed the questionnaire and their children underwent an overnight PSG. Receiver operator curve analyses and other predictive scales were assessed. Results: The 6-item questionnaire exhibited favorable sensitivity and fair specificity for diagnosis of OSA, which varied depending on the apnea–hypopnea index used for OSA definition. Conclusions: A 6-item questionnaire is a sensitive and easy-to-use screening tool for pediatric OSA in a pediatric sleep clinic setting. [Copyright &y& Elsevier]

This review provides a qualitative assessment of all known scientific studies on the impact of alcohol ingestion on nocturnal sleep in healthy volunteer's. At all dosages, alcohol causes a reduction in sleep onset latency, a more consolidated first half sleep and an increase in sleep disruption in the second half of sleep. The effects on rapid eye movement (REM) sleep in the first half of sleep appear to be dose related with low and moderate doses showing no clear trend on REM sleep in the first half of the night whereas at high doses, REM sleep reduction in the first part of sleep is significant. Total night REM sleep percentage is decreased in the majority of studies at moderate and high doses with no clear trend apparent at low doses. The onset of the first REM sleep period is significantly delayed at all doses and appears to be the most recognizable effect of alcohol on REM sleep followed by the reduction in total night REM sleep. The majority of studies, across dose, age and gender, confirm an increase in slow wave sleep (SWS) in the first half of the night relative to baseline values. The impact of alcohol on SWS in the first half of night appears to be more robust than the effect on REM sleep and does not appear to be an epiphenomenon REM sleep reduction. Total night SWS is increased at high alcohol doses across gender and age groups. [ABSTRACT FROM AUTHOR]

Abstract: Objective: There are no psychometric measures to evaluate the critical construct of alertness. We, therefore, developed two questionnaires to measure alertness, the Toronto Hospital Alertness Test (THAT) and the ZOGIM-A, and evaluated their psychometric properties. Methods: We examined the correspondence between scores on the THAT and the ZOGIM-A in a sample of sleep clinic outpatients (n=96) with Maintenance of Wakefulness Test (MWT) results after an overnight sleep study, physiological sleep parameters, measures of subjective sleepiness, and two psychosocial variables (psychological well-being and emotional distress). Test–retest reliability was estimated based on responses from an independent sample of 295 sleep clinic outpatients who completed the instruments before and after an overnight sleep study. Results: High values were observed for both the THAT (r tt=.79) and the ZOGIM-A (r tt=.70). Internal consistency reliability (coefficient alpha) was also high: .96 for THAT and .83 for ZOGIM-A. Although neither of the new scales correlated significantly with measures derived from the MWT or nocturnal physiological measures, the two alertness scales did correlate significantly and as hypothesized with subjective measures of sleepiness and other psychosocial measures. Conclusions: These results support the perspective that subjective alertness cannot be reduced to the absence of sleepiness and corroborate the psychometric adequacy of the THAT and the ZOGIM-A as unique indices of alertness that complement objective data obtained via MWT and physiological indices of sleep architecture. [Copyright &y& Elsevier]

Sleep-related complaints affect 50–80% of patients on dialysis. Sleep disorders impair quality of life significantly. Increasing evidence suggests that sleep disruption has a profound impact both on an individual and on a societal level. The etiology of sleep disorders is often multifactorial: biologicsocialand psychological factors play a role. This is especially true for insomniawhich is the most common sleep disorder in different populationsincluding patients on dialysis. Biochemical and metabolic changeslifestyle factorsdepressionanxietyand other underlying sleep disorders can all have an effect on the development and persistence of sleep disruptionleading to chronic insomnia. Insomnia is defined as difficulty initiating or maintaining sleepor having nonrestorative sleep. It is also associated with daytime consequencessuch as sleepiness and fatigueand impaired daytime functioning. In most casesthe diagnosis of insomnia is based on the patient's historybut in some patients objective assessment of sleep pattern may be necessary. Optimally the treatment of insomnia involves the combination of both pharmacologic and nonpharmacologic approaches. In some cases acute insomnia resolves spontaneouslybut if left untreatedit may lead to chronic sleep problems. The treatment of chronic insomnia is often challenging. There are only a few studies specifically addressing the management of this sleep disorder in patients with chronic renal disease. Considering the polypharmacy and altered metabolism in this patient populationtreatment trials are clearly needed. This article reviews the diagnosis of sleep disorders with a focus on insomnia in patients on dialysis. [ABSTRACT FROM AUTHOR]

Objective: To describe a distinct parasomnia involving sexual behaviour, which we have named sexsomnia.Method: We have used a case series as a basis for the description of sexsomina.Results: Eleven patients with distinct behaviours of the sexual nature during sleep are described. The features in common with other nonrapid eye movement arousal parasomnias, such as sleepwalking are documented. Some patients had simply been referred to a tertiary sleep clinic for investigation of unrelated sleep problems. A small number had been involved in medicolegal issues. Sexsomnia has some distinct features that separate it from sleepwalking. The automatic arousal is more prominent, motor activities are relatively restricted and specific, and some form of dream mentation is often present.Conclusions: A significant number of patients with this unusual parasomnia behaviour were identified only after specific questions were asked, suggesting that the behaviour is more common than previously thought. [ABSTRACT FROM AUTHOR]

Development and initial validation of the FACES of fatigue and sleepiness adjective checklist. An initial item pool of 65 adjectives, descriptive of fatigue, sleepiness and related deprivation states, was developed and administered to 372 individuals referred by their family physicians for psychiatric investigation and treatment of severe insomnia. Participants attended one of six Canadian university-affiliated sleep clinics where they completed a psychiatric assessment and a 766-item questionnaire, including a number of standard indices of sleep-related behavior and symptoms, medical history, sleep hygiene, psychosocial well-being and psychopathology. Principal-components and item analyses were undertaken to refine the initial 65-item pool to a smaller 50-item set, consisting of five subscales: Fatigue, Anergy, Consciousness, Energized and Sleepiness. Coefficient alpha was calculated and indicated high internal consistency reliability for all subscales. Convergent and discriminant validity were also evaluated by calculating correlations between FACES subscales and a number of independent indices. The resulting five-scale FACES questionnaire appears to offer a promising self-report instrument for the measurement of fatigue and related subjective experiences. [Copyright &y& Elsevier]

Objective: To attempt, for the first time, to apply a positive and differential diagnosis process in the general population during interviews using DSM-IV classification to ascertain the profile and occurrence of concomitant mental disorders.Method: A representative sample of 1832 individuals aged 15 years or older living in the metropolitan area of Toronto were interviewed by means of telephone interviews. The participation rate was 72.8%.Results: Overall, 13.2% (n = 242) of the sample had either a mood disorder (n = 127; 6.9%) or an anxiety disorder (n = 170; 9.3%) at the time of their interview. The prevalence was higher among women (16.5%) than among men (9.7%), with an odds ratio of 1.8. The comorbidity of mood and anxiety disorders was found in 3% (n = 55) of the sample. Less than one-third of respondents with a mood and/or anxiety disorder were being treated by a physician for a mental disorder. However, these individuals were greater consumers of health care services. Most of them consulted a physician an average of 5 times in the past year. Individuals on medication diagnosed with a mood and an anxiety disorder consulted a physician an average of 12 times in the past year. Only 13% of them were treated with antidepressants and under 9% with anxiolytics.Conclusions: More than 70% of subjects with a mood disorder also complained of insomnia. With the differential process, 12% of the subjects manifesting a full-fledged anxiety disorder were diagnosed with only a mood disorder because the anxiety occurred only in the course of the mood disorder. About two-thirds of the subjects diagnosed in this study were undiagnosed and untreated by their physician. [ABSTRACT FROM AUTHOR]

The prevalence of obstructive sleep apnea (OSA) in women who were being seen for obesity assessment, rather than for assessment of sleep disturbance, was assessed. A consecutive series of referrals to an eating disorders clinic (n = 40) were studied in the sleep laboratory. Their body mass index (BMI) ranged from 29.4 to 66.9 kg/m². Overnight polysomnograms were carried out, with respiration and oxygen saturation being monitored. Four women (10%), 1 postmenopausal and 3 premenopausal, had significant OSA. They tended to have a higher percentage of body fat and higher BMIs than the nonapnea group. These findings indicate that the prevalence of OSA is higher in the general population of obese women than is generally thought. They highlight the need for professionals who work with obese women to consider the possibility that some of the complaints of fatigue and tiredness may be a result of OSA. [ABSTRACT FROM AUTHOR]

We have reviewed studies reporting biochemical abnormalities consequent upon anorexia nervosa (AN). Hitherto, these reports have lacked any coherent synthesis in the account of how such abnormalities arise. The paper firstly addresses electrolyte imbalances, changes in underlying physiology, and the clinical consequences if such abnormalities are not recognized. Mechanisms contributing to changes in renal function are discussed. The use of alternative energy sources for the Krebs' cycle is considered in the context of catabolic processes occurring in the AN subject. Liver function, and protein and fat metabolism are considered in this context. Comparisons with the catabolism of starvation and the processes found in dietary-deficient forms of malnutrition are made. The AN subject has many features in common with the state of marasmus. The implications of chronic dietary abnormalities in activating rarely exploited metabolic pathways are considered and well recognized findings, for example hypercarotinemia, are explained through such processes. Evidence for specific trace element and vitamin deficiencies are also reviewed. [ABSTRACT FROM AUTHOR]

Discusses the impact and epidemiology of sleep disorders in Great Britain. Development of specialized facilities for treating sleep disorders; Effect of sleep disruption and sleep disorders on individual people and society; Relationship of insomnia with anxiety and depression.

Examines the sleeping pattern and problems of elderly people. Prevalence of sleep problems and use of hypnotic problems; Changes in sleep architecture and physiology; Improvement of daytime alertness through correction of sleep deficiency. INSETS: Causes of nocturnal agitation;ANY QUESTIONS.

Examines the sleep problems in patients with medical illness in Great Britain. Factors affecting the sleep problems of patients; Comparison of features in chronic fatigue syndrome and fibromyalgia; Reasons for occurrence of sleep disruption in patients; Treatment of sleep disorders in psychotherapy patients.

Examines the pathogenesis, diagnosis and treatment of bronchial asthma during the night. Circadian changes affecting bronchial hyper-reactivity; Symptoms of asthma during the night and early morning; Recognition of inhaled corticosteroids as a treatment of choice.

Examines the physiological effect of psychotropic drugs on human health. Association between sleep and non-psychotropic drugs; Importance of pharmacokinetic profiles of any drugs; Evaluation of the pharmacological action of the drug.

Examines the nature of parasomnias. Interaction between biological and psychological factors; Consideration of the different stages of sleeping; Differences between nightmares and night terrors.

Focuses on the diagnosis and management of sleep-related complaints. Sources of information about the patterns and habits of sleep; Causes of the non-restorative quality of sleep; Factors contributing to the development of insomnia.

The article focuses on two cases of sleep disorders presenting as common pediatric problems. The first case involves an 11-year-old boy with severe inattention problems, an inability to concentrate and restlessness. The second case involves a 17-year-old boy who keeps falling asleep suddenly and waking up in a state of confusion. Information is provided on several sleep disorders, including restless legs syndrome and narcolepsy.

Presents a case study on hysterical conversion disorder or pseudo-narcolepsy. Symptoms of narcolepsy; History of excessive daytime sleepiness, hallucinations, cataplectic attacks and migraine; Response to methylphenidate; Impact of patient's disclosure about her sexual relation on her symptoms; Explanations for the sleep symptoms of patients.

Focuses on the medical problems during sleep. Interaction between sleep and general medicine; Prevalence of ischemic heart disease nocturnal symptoms; Forms of hypertension during sleep.

Focuses on the use of continuous positive airway pressure to treat sleep apnea. Factors influencing rise of symptoms of the disease; Scope of presentations of the disorder; Association between nocturnal seizures and sleep apnea. INSET: Untitled.

Focuses on the association of dreams with illness and diseases in man. Contribution of Freud and Jung in the dream theory; Effect of drugs on the quality and extent of dreaming; Use of polysomnography in detecting dreams.

Depression is a significant public health issue, made worse by the absence of response to antidepressant medications by many patients. Given the high degree of overlap between sleep and circadian complaints and depression, chronotherapies are a promising avenue for novel, effective, and fast-acting treatments for depression. A critical literature review was conducted of bright light therapy (BLT) as a treatment for unipolar depression. Additionally, a separate critical literature review was also conducted of several promising, non-pharmacological, combination chronotherapeutic treatments, including BLT, sleep deprivation/wake therapy, and sleep phase advance. Results of BLT as a treatment for depression are encouraging, especially when used as an adjunct to antidepressant medications. It may also be desirable in special populations, such as geriatric and perinatal patients. Overall, results from combination chronotherapies are encouraging, though none has strong empirical support. Combining chronotherapies is an avenue of treatment which should be further explored. [ABSTRACT FROM AUTHOR]

Comments on the study which explained dreaming and rapid eye movement (REM) sleep mechanisms. Claims of the author of the study that different brain mechanisms control dreaming and REM sleep separately; Physiological evidence presented to support the claim that dreaming is generated by a forebrain mechanism; Details on the activation-synthesis model and its explanation of dream imagery as a product of passive forebrain synthesis of brainstem impulses.

Objective/background/aim: Insomnia has not been explored as it relates to recovery after mild traumatic brain injury (mTBI). We aimed to evaluate the prevalence of insomnia among Ontario workers with delayed recovery from mTBI, and its relationship with sociodemographic, TBI- and claim-related, behavioral, and clinical factors.Patients/methods: This was a cross-sectional study carried out over a period of 24 months in a large rehabilitation hospital in Ontario. To assess the prevalence of insomnia, we used the Insomnia Severity Index (ISI). Data were collected from standardized questionnaires, insurer records, and clinical assessment at the time of recruitment. Bivariate associations were calculated using the Spearman's correlation coefficient or analysis of variance. We established stepwise multivariate linear regression models of factors associated with insomnia. Additional analyses, including the assessment of the internal consistency of the ISI, were performed.Results: Of the 94 participants diagnosed with mTBI, clinical insomnia was reported by 69.2%. The mean age was 45.20 ± 9.94 years; 61.2% were men. No sex-related differences were observed in insomnia prevalence or severity. Insomnia was significantly associated with certain sociodemographic, claim-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 53% of the insomnia variance. The internal consistency of the ISI, as measured by Cronbach's α, was 0.86.Conclusions: Insomnia is common in persons with delayed recovery from mTBI, and is significantly associated with potentially modifiable clinical and nonclinical variables. Care of persons with brain injury requires greater attention with regard to the diagnosis and management of insomnia and associated disorders. [ABSTRACT FROM AUTHOR]

Background Pediatric obstructive sleep apnea (OSA) is a prevalent but under-diagnosed disease. The importance of screening for OSA has been emphasized in the recently published guidelines for the diagnosis and management of childhood OSA. Several pediatric OSA questionnaires are available, but are complicated to use or not sensitive enough for screening. Methods In this study we developed an 8-item (IF SLEEPY) screening tool for pediatric OSA. One hundred and fifty children referred for evaluation at a pediatric sleep clinic and their parents completed the questionnaire and had a polysomnography. Two further questionnaires were developed: I SLEEPY and I’M SLEEPY versions. The questionnaires’ scores were compared to the apnea hypopnea index (AHI) and the validity of each questionnaire was evaluated. Results The I’M SLEEPY version was found to have the highest sensitivity (82%) and a modest specificity (50%) for OSA diagnosis. Conclusion I’M SLEEPY is a sensitive and easy-to-use screening tool for pediatric OSA. It is intended to be used by the primary physician in every suspected case of OSA. Larger studies are needed in the primary care setting for the validation of this tool. [ABSTRACT FROM AUTHOR]

The human eye serves distinctly dual roles in image forming (IF) and non-image-forming (NIF) responses when exposed to light. Whereas IF responses mediate vision, the NIF responses affect various molecular, neuroendocrine, and neurobehavioral variables. NIF responses can have acute and circadian phase-shifting effects on physiological variables. Both the acute and phase-shifting effects induced by photic stimuli demonstrate short-wavelength sensitivity peaking ≈450-480 nm. In the current study, we examined the molecular, neuroendocrine, and neurobehavioral effects of completely filtering (0% transmission) all short wavelengths <480 nm and all short wavelengths <460 nm or partially filtering (∼30% transmission) <480 nm from polychromatic white light exposure between 2000 and 0800 in healthy individuals. Filtering short wavelengths <480 nm prevented nocturnal light-induced suppression of melatonin secretion, increased cortisol secretion, and disrupted peripheral clock gene expression. Furthermore, subjective alertness, mood, and errors on an objective vigilance task were significantly less impaired at 0800 by filtering wavelengths <480 nm compared with unfiltered nocturnal light exposure. These changes were not associated with significantly increased sleepiness or fatigue compared with unfiltered light exposure. The changes in molecular, endocrine, and neurobehavioral processes were not significantly improved by completely filtering <460 nm or partially filtering <480 nm compared with unfiltered nocturnal light exposure. Repeated light-dark cycle alterations as in rotating nightshifts can disrupt circadian rhythms and induce health disorders. The current data suggest that spectral modulation may provide an effective method of regulating the effects of light on physiological processes. [ABSTRACT FROM AUTHOR]

Abstract: Sleepiness and fatigue are terms commonly used in clinical practice and research. At times sleepiness and fatigue are used interchangeably; however, each of them has distinct implications for diagnosis and treatment. The objective of this article is to review the psychometric properties of the measurements of sleepiness and fatigue. Although there are objective and subject measures to evaluate sleepiness, only rating scales are available to assess fatigue. Further research should be directed toward exploring the potential mechanisms underlying the measurements of sleepiness and fatigue. Establishing objective assessing instruments to evaluate fatigue and clarifying the relationship between objective and subjective assessments of sleepiness are crucially needed. [Copyright &y& Elsevier]

Abstract: Background: Depression is a common problem in patients with Delayed Sleep Phase Syndrome (DSPS). This study used a randomized, double-blind, crossover, placebo-controlled approach to test the hypothesis that exogenous melatonin (5mg) can attenuate depressive symptomatology in DSPS patients. Methods: Twenty patients with an established diagnosis of DSPS were dichotomized into DSPS with depressive symptoms (Group I; n =8) and without depressive symptoms (Group II; n =12) based on structured clinical interviews and a score greater than 17 on Center for Epidemiologic Studies Depression Scale (CES-D). Both groups received melatonin and placebo treatment for 4weeks with a 1-week washout period in between. Participants underwent a clinical interview and psychometric evaluation to assess depression, and overnight polysomnographic sleep studies were carried out at baseline and at the end of melatonin and placebo treatments. Furthermore, melatonin secretion rhythm as a circadian phase marker was assessed by measuring urinary 6-sulphatoxymelatonin levels. Results: Melatonin treatment significantly reduced depression scores in the depressed patients as measured by the CES-D and Hamilton Depression Rating Scale – 17. Melatonin treatment improved sleep continuity in both groups compared to placebo and baseline conditions. Group I individuals showed marked alterations in melatonin rhythms compared to Group II individuals. Conclusion: Exogenous melatonin treatment may be an effective treatment modality for individuals with circadian rhythm sleep disorders and associated comorbid depressive symptomatology. [Copyright &y& Elsevier]

Women constitute about half the work force, and women shift workers warrant special attention given the different physiological needs of women, their reproductive status, and the added burden of family responsibilities. There is increasing evidence that women have greater difficulty adjusting to shift work compared to their male counterparts and that sleep problems may in large part account for this difficulty. The purpose of this article is to review the existing literature to highlight the differential negative impact of shift work on sleep and other health issues in women and as part of a needs assessment to promote research in female shift workers by developing and prioritizing research questions in this field. The literature suggests that women shift workers report poor sleep quality and experience reproductive disturbances, an increased risk of breast cancer, and a greater risk of metabolic and cardiovascular disorders. [ABSTRACT FROM AUTHOR]

The objective of the study was to provide further information related to newly described parasomnia variant, Sexual Behaviour in Sleep (SBS, sexsomnia). Previous studies dealt with selected population, typically middle-aged males, featuring extensive medico-legal exposure. At the same time, an anecdotal evidence suggested higher involvement of younger population, and skew towards balance between genders comparable to those seen in other non-Rapid Eye Movement (NREM) sleep parasomnias. The epidemiological information regarding this condition is still virtually non-existent. In order to sample this difficult-to-reach population, a 28-item Internet survey was posted on the sexsomnia reference site and the link was also sent to prospective respondents (mostly registered visitors to this site). The respondents were able to complete the survey anonymously, which resulted in a need for the screening of bogus and duplicate results. At the end, a total of 219 validated responses were collected and analysed. The results showed greater representation of females (31% of the total number), and wider age distribution (mean age of 30.4 years). The respondents typically reported multiple sexsomnia episodes, in most cases precipitated by body contact, stress and fatigue. Relatively small number of respondents reported involvement of legal authorities (8.6% of males and 3% of females) and participation of minors in their sexsomnia (6% of the total sample). In spite of known limitations of such surveys, the study provided much needed insight into this complex nocturnal behaviour. It confirmed the anecdotal evidence about the gender and age distribution, and provided information on some key features, such as precipitating factors, type of behaviour, medication use, personal medical history and medico-legal aspects. [ABSTRACT FROM AUTHOR]

Sleep complaints are very common in patients with end-stage renal disease (ESRD) and contribute to their impaired quality of life. Both obstructive and central sleep apnea syndromes are reported more often in patients on dialysis than in the general population. Impaired daytime functioning, sleepiness, and fatigue, as well as cognitive problems, are well known in patients with sleep apnea. Increasing evidence supports the pathophysiological role of sleep apnea in cardiovascular disorders, which are the leading cause of death in ESRD patients. Uremic factors may be involved in the pathogenesis of sleep apnea in this patient population and optimal dialysis may reduce disease severity. Furthermore, treatment with continuous positive airway pressure may improve quality of life and may help to manage hypertension in these patients. Secondary restless legs syndrome is highly prevalent in patients on maintenance dialysis. The pathophysiology of the disorder may also involve uremia-related factors, iron deficiency, and anemia, but genetic and lifestyle factors might also play a role. The treatment of restless legs syndrome involves various pharmacologic approaches and might be challenging in severe cases. In this article we review the diagnosis and treatment of sleep apnea and restless legs syndrome, with a focus on dialysis patients. We also briefly review current data regarding sleep problems after transplantation, since these studies may indirectly shed light on the possible pathophysiological role of uremia or dialysis in the etiology of sleep disorders. Considering the importance of sleep disorders, more awareness among professionals involved in the care of patients on dialysis is necessary. Appropriate management of sleep disorders could improve the quality of life and possibly even impact upon survival of renal patients. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiological data describing the prevalence of sleep complaints in Hungary and its region are lacking; furthermore, limited information is available on health care use by individuals with sleep complaints. We assessed the prevalence of sleep complaints, insomnia in particular, in a nationally representative sample of the Hungarian population and assessed health care utilization by insomniacs.Methods: Cross-sectional study, enrolling a nationally representative sample (N=12,643) of the adult Hungarian population. A battery of questionnaires was administered during a home interview. The Athens Insomnia Scale (AIS), additional questions on sleep behavior, as well as questions on current medical therapy for somatic and mental disorders were included in the battery of questionnaires administered. Psychosocial and demographic characteristics were also tabulated.Results: Forty-seven percent of the sample reported at least one complaint related to sleep. Based on the AIS we report a 9% prevalence of insomnia in the total sample. Sleep deprivation was highly prevalent in the younger and middle-aged groups. The frequency of sleep problems increased with age. Individuals diagnosed with insomnia reported more frequent utilization of health services, including sick leave, emergency visits and hospitalization, than those without insomnia.Conclusion: Sleep complaints and sleep deprivation are frequent problems in the Hungarian population and are associated with increased health care utilization. The prevalence of insomnia in our sample was similar to what has been previously reported from other countries. The high prevalence of sleep-deprived individuals warrants further attention. Interventions that effectively improve insomnia may also reduce health care utilization by the affected individuals. [Copyright &y& Elsevier]

Objective: Solriamfetol (formerly JZP-110), a dopamine/norepinephrine reuptake inhibitor, is approved in the US to improve wakefulness in adults with excessive daytime sleepiness associated with narcolepsy (75-150 mg/d) or obstructive sleep apnea (37.5-150 mg/d). In a randomized, double-blind, placebo-controlled trial in participants with narcolepsy, effects of solriamfetol on functional status, health-related quality of life (HRQoL), and work productivity were evaluated.Methods: Participants with narcolepsy (N = 239) were randomized to solriamfetol 75, 150, or 300 mg, or placebo for 12 weeks. Outcome measures included the Functional Outcomes of Sleep Questionnaire short version (FOSQ-10), 36-Item Short Form Health Survey version 2 (SF-36v2), and Work Productivity and Activity Impairment questionnaire for Specific Health Problem (WPAI:SHP). A mixed-effects model with repeated measures was used for comparisons vs placebo.Results: At week 12, solriamfetol increased FOSQ-10 total score, with greatest mean difference from placebo (95% CI) at 300 mg (1.45 [0.31, 2.59]). On SF-36v2, improvements vs placebo were observed in physical component summary scores (300 mg: 2.22 [0.04, 4.41]) and subscales of role physical, general health, and vitality. On WPAI:SHP, solriamfetol 150 mg reduced overall work impairment vs placebo (-15.5 [-29.52, -1.47]), and 150 and 300 mg reduced activity impairment vs placebo (-10.05 [-19.48, -0.62] and -13.49 [-23.19, -3.78], respectively). Most treatment-emergent adverse events (TEAEs) were mild or moderate in severity. Common TEAEs were headache, nausea, decreased appetite, nasopharyngitis, dry mouth, and anxiety.Conclusions: Solriamfetol improved measures of functional status, HRQoL, and work productivity, particularly at the 150- and 300-mg doses. Most TEAEs were mild to moderate.Trial Registration: ClinicalTrials.gov identifier NCT02348593, EudraCT number 2014-005487-15. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a major predictor of adverse outcomes in mild traumatic brain injury (mTBI), including concussion; although insomnia symptoms may be due to various sleep disorders, those related to circadian rhythm sleep–wake disorders (CRSWDs) require specific assessment and treatment. The objective of the current study was to determine the prevalence of CRSWD in a sample of treatment-seeking people with chronic insomnia symptoms after an mTBI. Methods: Participants aged 17–65 years who had experienced an mTBI and reported chronic insomnia were recruited from diverse community clinics in Ontario 3–24 months after their injury to participate in this cross-sectional observational study. Potential participants were screened by both telephone and intake interview. Exclusion criteria were alcohol or substance use disorders, preexisting brain disorder or previous neurosurgery, recent travel across more than 2 time zones or shift work. Assessments included a clinical interview, questionnaires, 2 weeks of actigraphy and a sleep diary, and a dim-light melatonin onset test. The main outcome measure was the proportion of patients with CRSWDs. Results: Of the 50 participants (32 [64%] female; median age 39.5 yr), 13 (26% [standard deviation 12%]) had an CRSWD. The most common circadian diagnosis was delayed sleep–wake phase disorder (10 participants [20%]). Interpretation: The prevalence of CRSWDs may be exceptionally high among people with chronic insomnia symptoms following mTBI. Proper detection and treatment of CRSWDs in this population is essential to facilitate recovery. The findings emphasize the relevance of a diagnostic circadian assessment in patients with mTBI presenting with chronic insomnia symptoms. [ABSTRACT FROM AUTHOR]

Objective: To assess the evolution of narcolepsy symptoms in first-, second, and third-degree relatives and to compare multiplex and simplex families.Methods: A total of 4045 family members and 362 narcoleptic individuals were entered in the study; with 3255 family members interviewed twice, five to seven years apart. A control group (n = 178) composed of spouses or housemates was also interviewed twice. Family members were divided according to their blood relationship with the probands and further divided into multiplex (ie, more than one narcolepsy cases) and simplex (only one narcolepsy case) families. Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy probands were evaluated and diagnosed by a Sleep Specialist in a Sleep Clinic Center.Results: A total of 1123 family members from 72 families were identified as members of multiplex families while the rest of the sample were a part of simplex families (n = 2132). Multiplex families had higher incidence and chronicity of hypersomnolence than the simplex family members and the control group. For cataplexy-like symptoms, only prevalence at the time of the first assessment distinguished multiplex (5.5%) and simplex (2.9%) families. Prevalence of sleep paralysis was higher among the first- and second-degree relatives coming from multiplex families, while incidence was the highest among second- and third-degree relatives. Hypnagogic hallucinations had similar prevalence between multiplex and simplex families but the incidence and chronicity were significantly higher among multiplex families. For each symptom, predictive factors were also determined in simplex and multiplex families.Conclusions: Our results show that individuals coming from multiplex families are at greater risks of a broad range of narcolepsy symptoms compared to simplex families. [ABSTRACT FROM AUTHOR]

Summary: Untreated obstructive sleep apnea in children is associated with significant medical and psychological morbidities. Polysomnographic testing is the gold‐standard method for diagnosis of obstructive sleep apnea. However, laboratory‐based polysomnography is expensive and associated with a substantial healthcare burden. Thus, a simple valid tool to accurately identify those at high risk of obstructive sleep apnea is essential. We performed a retrospective cross‐sectional study of children referred to the Youthdale Child and Adolescent Sleep Clinic. Data were collected from questionnaires and sleep studies reports of 395 children. A comparison between two screening tools for paediatric obstructive sleep apnea – a six‐item (parent‐response) and an eight‐item IF‐SLEEPY/IM‐SLEEPY scales – was performed. The results showed that 42% of the children (n = 164) were diagnosed with obstructive sleep apnea. The six‐item scale (score ≥3) exhibited a sensitivity of 17% and a specificity of 95% for diagnosing obstructive sleep apnea. The eight‐item IF‐SLEEPY scale displayed 82% sensitivity and 28% specificity. The IM‐SLEEPY scale exhibited 79% sensitivity and 32% specificity. In children ≥7 years old, the IF‐SLEEPY (parent‐response) had a sensitivity of 82% and specificity of 28% compared with the child‐response (66% and 37%, respectively). Logistic regression analysis revealed that age (odds ratio = 0.78), IF‐SLEEPY/IM‐SLEEPY score ≥3 (odds ratio = 1.78) and a score ≥2.72 on the six‐item scale (odds ratio = 4.54) were predictors of obstructive sleep apnea. This study suggests that the eight‐item scale is a better screening tool for paediatric obstructive sleep apnea, with a higher sensitivity and simple yes/no responses that are easy to complete and to score. [ABSTRACT FROM AUTHOR]

Objective: Parasomnias are common in childhood but there is no established treatment for parasomnias. The aim of this study was to (1) report on the outcome of using L-tryptophan to manage parasomnias in children and (2) examine sleep architecture and subjective psychological/sleep symptoms in children with parasomnia.Method: A retrospective analysis was conducted of charts of children (3-18 years old) who underwent polysomnographic testing and were diagnosed with primary parasomnia. Study patients were either prescribed L-tryptophan (daily dose range: 500-4500 mg, mean dose of 2400 mg) to manage their parasomnias or administered no treatment whereby parents/guardians declined treatment. Questionnaires assessing sleep and psychosocial symptoms were administered at the initial clinical consultation and a follow-up parasomnia outcome questionnaire was administered over the phone to parents/guardians.Results: One hundred and sixty-five children (106 boys, 59 girls) received a sleep diagnosis of primary parasomnia. A significantly (p < 0.001) higher proportion (84%) of children taking L-tryptophan experienced improvements in their parasomnia symptoms compared with those (47%) who chose not to use L-tryptophan. Polysomnography revealed that children with parasomnias had an altered sleep architecture based on age-related normative values. Children with a diagnosis of parasomnia were also subjectively more fatigued and endorsed more depressive symptoms.Conclusions: This study finds that parasomnias in children are not benign and that treatment with L-tryptophan provides a favorable outcome. Children diagnosed with parasomnia had altered sleep architecture, were more fatigued, and endorsed depressive symptoms. This study supports the need to diagnose and treat parasomnias in children. [ABSTRACT FROM AUTHOR]

Introduction. Obstructive sleep apnea (OSA) is common and usually underdetected in patients with cardiac arrhythmia. Ambulatory sleep testing may provide an alternative method for detection of OSA under realistic conditions compared to in-laboratory polysomnography. We aimed to (1) determine the sleep architecture in arrhythmia patients; (2) detect differences in sleep parameters between patients with and without OSA; and (3) compare the results of two consecutive nights of unattended ambulatory sleep testing. Methods. Consecutive patients with unknown OSA status were recruited from arrhythmia clinics. Patients underwent two consecutive nights of self-applied in-home sleep testing replete with electroencephalogram (EEG) recording. Results. One hundred patients were recruited. The mean age was 64±13 years (70% males). OSA (AHI ≥ 5/h) was detected in 85% of patients. In the total sample, the sleep efficiency was reduced, and sleep onset latency was longer compared to a reference population of the same age. In patients with OSA, the sleep efficiency and the percentage of slow wave sleep were reduced; however, the arousal and periodic limb movement indices were increased compared to patients without OSA. The two nights of the ambulatory sleep testing showed consistent results with an excellent test-retest reliability for the AHI (ICC = 0.813). REM latency was shorter during the second night of sleep recording (p=0.02). There were no other significant differences in the sleep architecture, respiratory indices, and other sleep parameters between the first and the second night of the ambulatory sleep recording. Conclusions. There is no significant difference in the respiratory parameters obtained during two consecutive nights of ambulatory sleep testing. Ambulatory studies incorporating EEG may provide a reliable, convenient, and economically efficient method for sleep assessment and there appears to be no significant night-to-night variability. [ABSTRACT FROM AUTHOR]

Objective and Background: Sleep stage disruption in persons with mild traumatic brain injury (mTBI) has received little research attention. We examined deviations in sleep stage distribution in persons with mTBI relative to population age- and sex-specific normative data and the relationships between such deviations and brain injury-related, medical/psychiatric, and extrinsic factors.Patients and Methods: We conducted a cross-sectional polysomnographic investigation in 40 participants diagnosed with mTBI (mean age 47.54 ± 11.30 years; 56% males).Measurements: At the time of investigation, participants underwent comprehensive clinical and neuroimaging examinations and one full-night polysomnographic study. We used the 2012 American Academy of Sleep Medicine recommendations for recording, scoring, and summarizing sleep stages. We compared participants' sleep stage data with normative data stratified by age and sex to yield z-scores for deviations from available population norms and then employed stepwise multiple regression analyses to determine the factors associated with the identified significant deviations.Results: In patients with mTBI, the mean duration of nocturnal wakefulness was higher and consolidated sleep stage N2 and REM were lower than normal (p < 0.0001, p = 0.018, and p = 0.010, respectively). In multivariate regression analysis, several covariates accounted for the variance in the relative changes in sleep stage duration. No sex differences were observed in the mean proportion of non-REM or REM sleep.Conclusions: We observed longer relative nocturnal wakefulness and shorter relative N2 and REM sleep in patients with mTBI, and these outcomes were associated with potentially modifiable variables. Addressing disruptions in sleep architecture in patients with mTBI could improve their health status. [ABSTRACT FROM AUTHOR]