Search

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This review appraises the process of development and the measurement properties of the Pittsburgh sleep quality index (PSQI), gauging its potential as a screening tool for sleep dysfunction in non-clinical and clinical samples; it also compares non-clinical and clinical populations in terms of PSQI scores. MEDLINE, Embase, PsycINFO, and HAPI databases were searched. Critical appraisal of studies of measurement properties was performed using COSMIN. Of 37 reviewed studies, 22 examined construct validity, 19 - known-group validity, 15 - internal consistency, and three - test-retest reliability. Study quality ranged from poor to excellent, with the majority designated fair. Internal consistency, based on Cronbach's alpha, was good. Discrepancies were observed in factor analytic studies. In non-clinical and clinical samples with known differences in sleep quality, the PSQI global scores and all subscale scores, with the exception of sleep disturbance, differed significantly. The best evidence synthesis for the PSQI showed strong reliability and validity, and moderate structural validity in a variety of samples, suggesting the tool fulfills its intended utility. A taxonometric analysis can contribute to better understanding of sleep dysfunction as either a dichotomous or continuous construct. [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]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Many young patients are asked to wear headgear or functional appliances during sleep as part of their orthodontic treatment. The objective of this clinical study was to assess the impact of these appliances on sleep quality. Methods: Twenty-two subjects (8 boys, 14 girls) between 10 and 15 years of age wearing either a headgear or a removable appliance for 3 to 12 months were enrolled in a sleep study. Each subject participated in 2 overnight sleep studies with and without the appliance. There was a 1-week interval after an adaptation night. The studies were performed at the Sleep Research Laboratory at Toronto Western Hospital in Canada. Each subject served as his or her own control. Twelve subjects had an extraoral headgear appliance, and 10 had intraoral functional (5 Fränkel, 5 Twin-block) appliances. No subject reported any sleep or medical disorder. The primary outcome variable was sleep efficiency. Results: Sleep efficiencies were 90.7% (SD, 7.9) and 91.6% (SD, 4.3) with and without the appliances, respectively. When sleep quality was compared with and without appliances, analysis of variance (ANOVA) showed no significant difference in sleep efficiency or other sleep variables such as sleep onset latency, rapid eye movement onset latency, rapid eye movement percentage, short-wave sleep percentage, or respiratory disturbance index. Sex and body mass index were not confounding variables. In addition, the use of extraoral or intraoral appliances did not affect sleep quality. Conclusions: In young orthodontic patients, there appears to be no difference in sleep quality with or without the overnight use of these appliances after they have been worn for a minimum of 3 months. [Copyright &y& Elsevier]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Summary: Sleepiness and fatigue are two interrelated, but distinct phenomena; observed in a number of psychiatric, medical and primary sleep disorders. Despite their different implications in terms of diagnosis and treatment, these two terms are often used interchangeably, or merged under the more general lay term of ‘tired’. Sleepiness is multidimensional and has many causes (multidetermined) and distinguished from fatigue by a presumed impairment of the normal arousal mechanism. Despite its ubiquity, no clear consensus exits as yet as to what constitutes sleepiness. Definitions of sleepiness, to date, are at best operational definitions, conceptualized so as to produce specific assessment instruments. As a result, while a number of subjective and objective measurement tools have been developed to measure sleepiness, each only captures a limited aspect of an otherwise heterogeneous entity. Fatigue is an equally complex phenomenon, its nature captured by a number of conceptualizations and definitions. Measures of fatigue have remained subjective, with a ‘gold standard’ for its measurement remaining elusive. Despite a high prevalence and high degree of morbidity, fatigue has remained a relatively under appreciated symptom, from both a clinical and research point of view. [Copyright &y& Elsevier]

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]

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]

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]

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]

Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown. Objectives This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment. Methods Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age > 18 years, N = 115) with chronic HCV infection at a tertiary hepatitis clinic. Results Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes ( B = .114, 95% CI = .054–.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection. Conclusion Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection. [ABSTRACT FROM AUTHOR]

Background Fatigue is common after traumatic brain injury (TBI). Its risk factors, natural history and consequences are uncertain. Best-evidence synthesis was used to address the gaps. Methods Five databases were searched for relevant peer-reviewed studies. Of the 33 articles appraised, 22 longitudinal studies were selected. Results were reported separately based on their timing of baseline assessment. Results All studies document changes in fatigue frequency and severity with time, irrespective of setting or TBI severity. There is limited evidence for certain clinical and psychosocial variables as predictors of fatigue severity at follow-up. Early fatigue severity predicted persistent post-concussive symptoms and Glasgow outcome score at follow-up. Conclusions Fatigue is present before and immediately following injury, and can persist long term. The variation in findings supports the idea of fatigue in TBI as a nonhomogeneous entity, with different factors influencing the course of new onset or chronic fatigue. To decrease the heterogeneity, we emphasize the need for agreement on a core set of relevant fatigue predictors, definitions and outcome criteria. PROSPERO registry number: CRD42013004262. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether a 30-degree head-up sleeping position decreases nocturnal intraocular pressure (IOP) compared with lying flat in patients with glaucoma. Design: Prospective, nonrandomized comparative case series. Participants: Seventeen eyes of 17 patients with glaucoma with controlled IOP and new disc hemorrhage. Methods: Patients with a new disc hemorrhage despite well-controlled IOP were evaluated in a sleep laboratory on 2 separate nights, the first night lying flat and the second night in a 30-degree head-up position. Intraocular pressure and blood pressure (BP) were measured every 2 hours from 6 pm to 8 am. For the 6 pm, 8 pm, 10 pm, and 8 am measurements (awake period) the subjects were sitting for both nights. For the midnight, 2 am, 4 am, and 6 am measurements (sleep period), the subjects were supine for the first night and 30 degrees head up for the second night. Main Outcome Measure: Difference in IOP during the sleep period (midnight to 6 am) between lying flat and 30-degree head-up positions. Results: Seventeen eyes of 17 patients were included. There were no significant differences (P=0.68) between the 2 study visits in IOP during the awake period (6 pm, 8 pm, 10 pm, and 8 am) when patients were sitting upright. During the sleep period (midnight to 6 am) the mean IOP was 3.2 mmHg lower in the 30-degree head-up position compared with the flat position (P=0.03; 95% confidence interval, 0.25–6.1 mmHg). Sixteen of 17 patients (94.1%) had lower IOP in the 30-degree head-up position. The reduction in IOP in the 30-degree head-up position was 20% or more in 35% of patients (6/17). There were no differences in BP or ocular perfusion pressure between the 2 positions. Conclusions: The 30-degree head-up sleeping position lowers IOP compared with the flat position. Although this effect varies between individual patients, mean IOP was 20% lower in one third of patients in this series. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract: Objective: Our objective was to examine a novel standardized assessment methodology of detecting impaired driving performance due to drowsiness in a normative cohort. Methods: Thirty-one healthy subjects with no significant sleep, medical, and psychiatric pathology were assessed in a driving simulation paradigm. Thirty-minute simulations were repeated at two-hourly intervals (i.e., at 1000, 1200, 1400, and 1600 h). Convergent data sources included drivers'' subjective ratings of sleepiness and alertness, electroencephalogram-verified microsleep (MS) episodes, and a variety of real-time driving simulator performance measures such as speed, lane tracking, reaction time (RT), and off-road events (crashes). Results: Significant diurnal fluctuations were noted on objective measures of RT, velocity, tracking, and MS events, indicating the highest risk of impairment in the afternoon. By contrast, subjective ratings of sleepiness and alertness did not demonstrate significant circadian variation. The mean incidence of MS episodes and crash risk correlated highly (r=.748). Conclusions: This prospective study demonstrates the relevance of multiple convergent measures for comprehensive assessment. The divergence of subjective and objective assays of impairment implies that healthy individuals may not have full insights into neurophysiologically mediated performance deficits. These results will serve as normative comparators to patients presenting with daytime somnolence and may allow a more accurate prediction of potential crash risk than noninteractive daytime polysomnogram tests such as the mean sleep latency test or the maintenance of wakefulness test. [Copyright &y& Elsevier]