Controlled data on predictors of subjective sleep quality in patients with memory complaints are sparse. To improve the amount of comprehensive data on this topic, we assessed factors associated with ...subjective sleep quality in patients from our memory clinic and healthy individuals.
Between February 2012 and August 2014 patients with mild cognitive impairment (MCI) and subjective cognitive decline (SCD) from our memory clinic and healthy controls were recruited. Apart from a detailed neuropsychological assessment, the subjective sleep quality, daytime sleepiness and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory (BDI-II).
One hundred fifty eight consecutive patients (132 (84%) MCI patients and 26 (16%) SCD patients) and 75 healthy controls were included in the study. Pairwise comparison of PSQI scores showed that non-amnestic MCI (naMCI) patients (5.4 ± 3.5) had significantly higher PSQI scores than controls (4.3 ± 2.8, p = .003) Pairwise comparison of PSQI subscores showed that naMCI patients (1.1 ± 0.4) had significantly more "sleep disturbances" than controls (0.9 ± 0.5, p = .003). Amnestic MCI (aMCI) (0.8 ± 1.2, p = .006) and naMCI patients (0.7 ± 1.2, p = .002) used "sleep medication" significantly more often than controls (0.1 ± 0.6) Both, aMCI (11.5 ± 8.6, p < .001) and naMCI (11.5 ± 8.6, p < .001) patients showed significantly higher BDI-II scores than healthy controls (6.1 ± 5.3). Linear regression analysis showed that the subjective sleep quality was predicted by depressive symptoms in aMCI (p < .0001) and naMCI (p < .0001) patients as well as controls (p < .0001). This means, that more depressive symptoms worsened subjective sleep quality. In aMCI patients we also found a significant interaction between depressive symptoms and global cognitive function (p = .002).
Depressive symptoms were the main predictor of subjective sleep quality in MCI patients and controls, but not in SCD patients. Better global cognitive function ameliorated the negative effect of depressive symptoms on the subjective sleep quality in aMCI patients.
About 80% of posttraumatic stress disorder (PTSD) patients suffer from nightmares or dysphoric dreams that cause major distress and impact nighttime or daytime functioning. Lucid dreaming (LD) is a ...learnable and effective strategy to cope with nightmares and has positive effects on other sleep variables. In LDs, the dreamer is aware of the dreaming state and able to control the dream content. The aim of this study is to evaluate the effectiveness of lucid dreaming therapy (LDT) in patients suffering from PTSD. We suggest that learning a technique that enables the affected subjects to regulate the occurrence and content of nightmares autonomously increases the chance of coping with the complex symptoms of PTSD and can reduce suffering. Sleep quality (PSQI, Pittsburgh Sleep Quality Index), daytime sleepiness (ESS, Epworth Sleepiness Scale), quality of life (MQLI, Multicultural Quality of Life Index), psychological distress (SCL-90-R, Symptom Checklist 90-Revised), distress caused by traumatic events (IE-S, Impact of Events Scale), anxiety (SAS, Self-Rating Anxiety Scale), depression (SDS, Self-Rating Depression Scale), and nightmare severity were assessed in a self-rating questionnaire before and after the intervention. LDT had no effect on the investigated sleep variables. No correlation between reduction of nightmare severity and changes in PTSD-profile (IE-S) was found. Nevertheless, levels of anxiety and depression decreased significantly in the course of therapy. LDT could provide an alternate or complementary treatment option for nightmares in PTSD, specifically for symptoms of anxiety and depression.
•Sleep problems of approximately 8 % of the Austrian adult population fulfilled the ICSD-III criteria for chronic insomnia.•Individuals with chronic insomnia showed the highest level of subjective ...daytime sleepiness.•Only half of people with chronic insomnia showed active help-seeking behavior, which involved family doctors and psychologists/psychotherapists most frequently.
Chronic insomnia is highly prevalent and associates with poor physical and mental health, leading to high societal cost. Data on insomnia from Austria, including help-seeking behaviour, are currently lacking. In 2017 we conducted an online survey in Austrian adults aged between 18 and 67 years. Chronic insomnia was defined based on the 3rd edition of the diagnostic criteria of the International Classification of Sleep Disorders (ICSD-III) using an exact and a broad definition. Daytime functioning had to be affected “much” to “very much” for the exact (chronic insomnia) and “somewhat” for the broad (chronic insomnia symptoms) definition, respectively. We evaluated the distribution of sociodemographic characteristics, sleep problems overall and stratified by help-seeking behaviour. A total of 1004 participants (50.4% female, age 42 ± 13 years) completed the survey. In 8.9 % sleep problems were classified as chronic insomnia symptoms (broad definition) and in 7.8% as chronic insomnia (exact definition). Among participants with chronic insomnia symptoms and chronic insomnia, 26% and 53% respectively, reported active help-seeking behavior for their sleep problems. In conclusion, the prevalence of chronic insomnia appears comparable to that of other European countries with a higher proportion of people with chronic insomnia symptoms not fulfilling current diagnostic criteria. The low rates of active help-seeking behavior in both groups warrant more attention to public health initiatives regarding patient education and early treatment of insomnia.
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Purpose
Sleep respiratory events are scored based on the reduction of airflow measured by a thermistor or nasal pressure cannula, together with oxygen desaturation and arousal criteria for hypopneas. ...We investigated whether automatic scoring can be performed without using the uncomfortable oronasal sensors and developed an automatic scoring system that is compatible with level III home sleep apnea testing devices.
Methods
We developed a respiratory event detection algorithm, based on SpO
2
and respiratory effort signal measured from respiratory inductance plethysmograph (uncalibrated RIPsum), that outputs the time and duration of detected events and calculates an apnea–hypopnea-index (AHI) based on total recording time. The algorithm was tested on 98 polysomnography (PSG) recordings of patients, 77 with suspected sleep apnea and 21 without. The results were compared to annotations provided by the PSG systems where PSG AHI was computed using the total sleep time. The predicted AHI was evaluated for correlation and agreement with the PSG AHI using the intra-class correlation coefficient (ICC). Severity classification was performed and evaluated using the following categories: normal (< 5), mild (5–15), moderate (15–30), and severe (
≥
30
).
Results
The ICC between predicted AHI and PSG AHI scored
r
= 0.96 (0.95–0.97,
p
< 0.001). The algorithm correctly predicted the severity for 74 recordings, overestimated 16, and underestimated 8. There was no misclassification by more than one severity level.
Conclusion
Using respiratory effort and SpO
2
, our algorithm was able to detect respiratory events with high correlation and agreement compared to full PSG-based detection.
Nine patients with idiopathic restless legs syndrome (RLS) were treated with 300 mg of gabapentin as an initial dose and an up-titration until relief of symptoms for 4 weeks. Subjective symptoms ...improved significantly. Polysomnographic data showed a reduction of periodic leg movements during sleep (PLMS) (p = 0.003) and PLMS index (p = 0.001). The authors conclude that gabapentin provides a well-tolerated and effective treatment of idiopathic RLS.
In dream research there exists a multitude of dream questionnaires and dream content analysis scales. However, many of them are either limited, not standardized or validated, or require a lot of ...effort. At the same time there are often divergent or even contradictory results in dream research, and comparability between different studies is often limited. Large sample sizes are rare but would be necessary for representative and compelling findings. For studies analyzing large samples of dreams, short and easy-to-use questionnaires would be of great assistance. As an easy-to-use questionnaire that covers all relevant dream aspects, the Dreamland Questionnaire, was developed in 1997. The questionnaire has since been revised and partially validated. In this paper, we give an overview of the questionnaire and its underlying methodology. The questionnaire is separated into three parts measuring dream quantities and dream qualities as well as lucidity. The questionnaire further encourages the dreamer to write down their dream. In different studies it has already been used to show that dreams sampled in the laboratory and dreams sampled at home differ and that emotionality in dreams differs if rated by the dreamer themselves or by external raters. The questionnaire is also available in German.
Dopaminergic agents such as ropinirole are the drugs of first choice in treating restless legs syndrome (RLS). Recently, gabapentin, a structural analogue of gamma-aminobutyric acid, has also been ...shown to improve sensorimotor symptoms in RLS. Therefore, the tolerability and efficacy of randomized treatment with either gabapentin or ropinirole in patients with idiopathic RLS was evaluated in this 4-week open clinical trial. Patients with idiopathic RLS were treated with either 300 mg of gabapentin (n = 8) or 0.5 mg of ropinirole (n = 8) as the initial dose, and the dose was up-titrated until relief of symptoms was achieved (gabapentin mean dosage 800 +/- 397 mg, range 300-1,200 mg; ropinirole mean dosage 0.78 +/- 0.47 mg, range 0.25-1.50 mg). In both groups, International Restless Legs Syndrome Study Group questionnaire scores improved significantly (p < or = 0.018), whereas the scores of the Epworth sleepiness scale remained unchanged within normal limits. Polysomnographic data showed a reduction of periodic leg movements during sleep (PLMS; p < 0.03) and PLMS index (p < 0.02) in both groups. Side effects were only mild and mostly transient. After 6-10 months of follow-up, in most patients, RLS symptoms were still improved. We conclude that gabapentin and ropinirole provide a similarly well-tolerated and effective treatment of PLMS and sensorimotor symptoms in patients with idiopathic RLS.
Validated instruments for the analysis of dream contents are still scarce. Therefore, the aim of this study was to validate the Dreamland Questionnaire (DL-Q) by comparing its results to those of the ...Hall and van de Castle Coding System (HVDC). Twenty-two participants voluntarily filled in a written dream report as well as our DL-Q questionnaire, in total 30 dreams were collected with both measures. Written reports were analyzed with the HVDC and results of the two instruments were compared using Pearson correlations. Results showed that correlations were high for dominant characters, pleasantness of dream content, and body-related experiences. However, some DL-Q items showed low correlations and others could not be compared directly, as the HVDC did not include the same set of items. The DL-Q showed satisfactory validity and reliability as a measure of dream criteria and may serve as an effective tool for diagnosis and evaluation and facilitate future clinical and research studies. Nevertheless, some items could not be compared as part of this study and should be validated in future investigations.
To date, the only standard for the classification of sleep-EEG recordings that has found worldwide acceptance are the rules published in 1968 by Rechtschaffen and Kales. Even though several attempts ...have been made to automate the classification process, so far no method has been published that has proven its validity in a study including a sufficiently large number of controls and patients of all adult age ranges. The present paper describes the development and optimization of an automatic classification system that is based on one central EEG channel, two EOG channels and one chin EMG channel. It adheres to the decision rules for visual scoring as closely as possible and includes a structured quality control procedure by a human expert. The final system (Somnolyzer 24 x 7) consists of a raw data quality check, a feature extraction algorithm (density and intensity of sleep/wake-related patterns such as sleep spindles, delta waves, SEMs and REMs), a feature matrix plausibility check, a classifier designed as an expert system, a rule-based smoothing procedure for the start and the end of stages REM, and finally a statistical comparison to age- and sex-matched normal healthy controls (Siesta Spot Report). The expert system considers different prior probabilities of stage changes depending on the preceding sleep stage, the occurrence of a movement arousal and the position of the epoch within the NREM/REM sleep cycles. Moreover, results obtained with and without using the chin EMG signal are combined. The Siesta polysomnographic database (590 recordings in both normal healthy subjects aged 20-95 years and patients suffering from organic or nonorganic sleep disorders) was split into two halves, which were randomly assigned to a training and a validation set, respectively. The final validation revealed an overall epoch-by-epoch agreement of 80% (Cohen's kappa: 0.72) between the Somnolyzer 24 x 7 and the human expert scoring, as compared with an inter-rater reliability of 77% (Cohen's kappa: 0.68) between two human experts scoring the same dataset. Two Somnolyzer 24 x 7 analyses (including a structured quality control by two human experts) revealed an inter-rater reliability close to 1 (Cohen's kappa: 0.991), which confirmed that the variability induced by the quality control procedure, whereby approximately 1% of the epochs (in 9.5% of the recordings) are changed, can definitely be neglected. Thus, the validation study proved the high reliability and validity of the Somnolyzer 24 x 7 and demonstrated its applicability in clinical routine and sleep studies.
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