It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older ...people.
This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons.
We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485.
The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty.
Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.
Is it more about mood than about sleep? Sandlund, C.; Norell-Clarke, Annika
JOURNAL OF SLEEP RESEARCH,
2020, Volume:
29
Journal Article, Conference Proceeding
Peer reviewed
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Patients with multimorbidity, having two or more chronic diseases, suffer frequently from undiagnosed common mental health problems and are an increasing challenge in primary care. There is a call to ...improve care delivery to address all these patients' needs at the same time. The aim of this study was to identify general practitioners' experiences of managing patients with multimorbidity and common mental health problems in primary care.
We conducted five focus group interviews with 28 physicians (3-8 participants in each group) in 5 primary care practices in and outside of Stockholm, Sweden. We used a semi-structured interview guide, and we analysed the data using reflexive thematic analysis. The methodological orientation of the study was inductive, latent constructivism.
We generated two themes from the data: Unmet patient needs and fragmented care send patients and physicians off balance and Dancing with the patient individually and together with others leads to confident and satisfied patients and physicians. The two themes are related as general practitioners expressed a need to shift from disease-specific fragmentation to relational continuity, teamwork, and flexibility to meet the needs of patients with multimorbidity and common mental health problems.
These findings can provide guidance in developing future interventions for patients with multimorbidity and common mental health problems in primary care in general, and in Sweden in particular.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Summary
Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep ...disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision‐making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk–benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross‐sectional design, including 788 participants with RLS (65% females, mean SD age 70.8 11.4 years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS‐related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome‐6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Tegaserod (Zelnorm®) is a potent 5‐hydroxytryptamine
4
(5‐HT
4
) receptor agonist with clinical efficacy in disorders associated with reduced gastrointestinal motility and transit. The present study ...investigated the interaction of tegaserod with 5‐HT
2
receptors, and compared its potency in this respect to its 5‐HT
4
receptor agonist activity.
Tegaserod had significant binding affinity for human recombinant 5‐HT
2A
, 5‐HT
2B
and 5‐HT
2C
receptors (p
K
i
=7.5, 8.4 and 7.0, respectively). The 5‐HT
2B
receptor‐binding affinity of tegaserod was identical to that at human recombinant 5‐HT
4(c)
receptors (mean p
K
i
=8.4) in human embryonic kidney‐293 (HEK‐293) cells stably transfected with the human 5‐HT
4(c)
receptor.
Tegaserod (0.1–3
μ
M
) inhibited 5‐HT‐mediated contraction of the rat isolated stomach fundus potently (p
A
2
=8.3), consistent with 5‐HT
2B
receptor antagonist activity. Tegaserod produced, with similar potency, an elevation of adenosine 3′,5′ cyclic monophosphate in HEK‐293 cells stably transfected with the human 5‐HT
4(c)
receptor (mean pEC
50
=8.6), as well as 5‐HT
4
receptor‐mediated relaxation of the rat isolated oesophagus (mean pEC
50
=8.2) and contraction of the guinea‐pig isolated colon (mean pEC
50
=8.3).
Following subcutaneous administration, tegaserod (0.3 or 1 mg kg
−1
) inhibited contractions of the stomach fundus in anaesthetized rats in response to intravenous dosing of
α
‐methyl 5‐HT (0.03 mg kg
−1
) and BW 723C86 (0.3 mg kg
−1
), selective 5‐HT
2B
receptor agonists. At similar doses, tegaserod (1 and 3 mg kg
−1
subcutaneously) evoked a 5‐HT
4
receptor‐mediated increase in colonic transit in conscious guinea‐pigs.
The data from this study indicate that tegaserod antagonizes 5‐HT
2B
receptors at concentrations similar to those that activate 5‐HT
4
receptors. It remains to be determined whether this 5‐HT
2B
receptor antagonist activity of tegaserod contributes to its clinical profile.
British Journal of Pharmacology
(2004)
143
, 549–560. doi:
10.1038/sj.bjp.0705929
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Tegaserod (Zelnorm®) is a potent 5‐hydroxytryptamine4 (5‐HT4) receptor agonist with clinical efficacy in disorders associated with reduced gastrointestinal motility and transit. The present study ...investigated the interaction of tegaserod with 5‐HT2 receptors, and compared its potency in this respect to its 5‐HT4 receptor agonist activity.
Tegaserod had significant binding affinity for human recombinant 5‐HT2A, 5‐HT2B and 5‐HT2C receptors (pKi=7.5, 8.4 and 7.0, respectively). The 5‐HT2B receptor‐binding affinity of tegaserod was identical to that at human recombinant 5‐HT4(c) receptors (mean pKi=8.4) in human embryonic kidney‐293 (HEK‐293) cells stably transfected with the human 5‐HT4(c) receptor.
Tegaserod (0.1–3 μM) inhibited 5‐HT‐mediated contraction of the rat isolated stomach fundus potently (pA2=8.3), consistent with 5‐HT2B receptor antagonist activity. Tegaserod produced, with similar potency, an elevation of adenosine 3′,5′ cyclic monophosphate in HEK‐293 cells stably transfected with the human 5‐HT4(c) receptor (mean pEC50=8.6), as well as 5‐HT4 receptor‐mediated relaxation of the rat isolated oesophagus (mean pEC50=8.2) and contraction of the guinea‐pig isolated colon (mean pEC50=8.3).
Following subcutaneous administration, tegaserod (0.3 or 1 mg kg−1) inhibited contractions of the stomach fundus in anaesthetized rats in response to intravenous dosing of α‐methyl 5‐HT (0.03 mg kg−1) and BW 723C86 (0.3 mg kg−1), selective 5‐HT2B receptor agonists. At similar doses, tegaserod (1 and 3 mg kg−1 subcutaneously) evoked a 5‐HT4 receptor‐mediated increase in colonic transit in conscious guinea‐pigs.
The data from this study indicate that tegaserod antagonizes 5‐HT2B receptors at concentrations similar to those that activate 5‐HT4 receptors. It remains to be determined whether this 5‐HT2B receptor antagonist activity of tegaserod contributes to its clinical profile.
British Journal of Pharmacology (2004) 143, 549–560. doi:10.1038/sj.bjp.0705929
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
•There was a considerable need for treatment of sleeping difficulties in the Swedish population.•The factor most strongly associated with this need was difficulty initiating sleep.•Other important ...factors were nonrestorative sleep, mental health disorders, and fatigue.•Nearly one-third of those who felt that they needed treatment did not consult healthcare providers.•More than one third with insomnia disorder reported no need for treatment.
This study aims to investigate factors associated with the self-reported need for treatment of sleeping difficulties in the general population.
This study consisted of a cross-sectional telephone survey of 1550 people randomly selected from the total population of Sweden. The survey, conducted by the Swedish national statistics agency, Statistics Sweden, was completed by 1115 people aged 18–85 years. Participants were asked about sleep patterns, daytime symptoms, physical and mental health disorders, use of prescribed hypnotics, help-seeking behaviors, and sociodemographic characteristics. They were also asked whether they thought they needed treatment for sleeping difficulties.
A total of 12.5% of the participants reported a need for treatment because of sleeping difficulties. Significantly more women than men reported such a need (OR 1.46, 95% CI 1.02–2.10). Additionally, in univariate analyses, older age (age 60–69), sick leave, retirement, and unemployment were associated with a self-reported need for treatment, as were several sleep complaints, daytime symptoms, and physical and mental health disorders. A logistic regression model showed that difficulty initiating sleep (OR 6.29, 95% CI 3.67–10.78) was the factor most strongly associated with a self-reported need for treatment for sleeping difficulties. Other important factors were nonrestorative sleep (OR 3.70, 95% CI 2.05–6.69), mental health disorders (OR 3.01, 95% CI 1.59–5.67), and fatigue (OR 2.95, 95% CI 1.53–5.68).
There was considerable self-reported need for treatment for sleeping difficulties in the population. Difficulty initiating sleep was the factor most strongly associated with this need, followed by nonrestorative sleep, mental health disorders, and fatigue.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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