Biomedical subjects

S Ancoli-Israel

Publications and source records attributed to S Ancoli-Israel.

At least 37 records · Page 2Linked to original sources

PubMed2000

Sleep duration, illumination, and activity patterns in a population sample: effects of gender and ethnicity.

BACKGROUND: Current knowledge of the population's sleep durations emanates primarily from questionnaires and laboratory studies. Using Actillumes, we investigated whether self-reported sleep durations were indicative of a population decline in sleep duration. We also explored illumination and activity patterns. METHODS: San Diego adults (n = 273, age range: 40-64) were recruited through random telephone calls and were monitored at home while engaging in usual daily routines. RESULTS: Volunteers slept an average of 6.22 hours and received an average of 554 lux (environmental illumination). The timing of sleep, illumination, and activity occurred at 2:44, 12:57, and 13:43, respectively. Irrespective of ethnicity, age, and time reference, men received greater illumination than did women, but this gender effect was not independent of work status. Women and men exhibited a similar circadian activity profile; however, women exhibited better sleep-wake patterns. Interactions between gender and ethnicity suggested worse sleep-wake patterns among minority men. An age-related decline in activity was found, but no age trend in sleep duration or illumination patterns was observed. CONCLUSIONS: This study showed an objective population decline in sleep duration. Sociodemographic effects should be considered in analyses of sleep-wake patterns and illumination exposures.

Adult↗

PubMed2000

Insomnia in the elderly: a review for the primary care practitioner.

The elderly are known to have a high prevalence of insomnia. Causes of insomnia include: medical, psychiatric, and drug issues; circadian rhythm changes; sleep disorders; and psychosocial factors. The elderly frequently use sleeping aids. Risks associated with elderly patients' use of hypnotic drugs are attributable to concomitant comorbid conditions, use of multiple medications, altered pharmacokinetics, and increased central nervous system sensitivity to these drugs. Treatment options for insomnia include behavior modification and pharmacotherapy. The choice of hypnotics is based on matching the nature of the insomnia to the hypnotic agent. Benzodiazepine receptor agonists are common hypnotics prescribed for insomnia in the elderly. The ideal agent has rapid onset, duration of action that lasts through the night but no residual daytime effects, and no adverse effects. The longer-acting agents have been shown to result in a higher risk of falls and hip fractures in the elderly. This relationship is not apparent with short-acting agents. Zaleplon, the newest benzodiazepine receptor agonist, has the shortest half-life of available agents. Studies have demonstrated that zaleplon is effective in improving sleep latency, duration, and sleep quality in the elderly. Zaleplon does not appear to cause rebound insomnia, residual sedation, or adversely affect psychomotor function. The key for the healthcare professional is finding the appropriate treatment or treatment combination, including behavioral modification and pharmacotherapy. When hypnotics are indicated, the most appropriate short-acting agent should be considered.

Age Factors↗

PubMed2000

Sleep apnea and health-related quality of life in African-American elderly.

The relationship between health-related quality of life (HRQOL) and sleep apnea was examined in a sample of elderly African-Americans screened for snoring and daytime sleepiness. Seventy African-Americans over the age of 65 years completed a comprehensive sleep questionnaire, the Quality of Well-Being Scale (QWB), and the Medical Outcomes Study (MOS) Core Measures of HRQOL (116-item Long Version) and had sleep recorded. Those with moderate-severe sleep apnea had significantly lower Physical Component summary scores than those with no sleep apnea (p < 0.05). After controlling for medical conditions, sleep apnea was significantly related to both general physical functioning and general mental health functioning in those with mild apnea (apnea-hypopnea index [AHI] < 15), but not in those with moderate to severe apnea. There was an initial decrease in HRQOL up to an AHI level of 15, at which point HRQOL remained at a lowered level. The QWB scores of our sleep apnea sample were similar to the QWB scores found in patients with depression and chronic obstructive pulmonary disease (COPD), suggesting that sleep disturbances may impact daily living and health as much as other medical conditions.

Black or African American↗

PubMed2000

Circadian sleep, illumination, and activity patterns in women: influences of aging and time reference.

Patterns of sleep, illumination, and activity of women of different ages were continuously monitored in their natural environments with a wrist activity monitor. Partial correlation analyses were performed to determine relationships between age and sleep and several circadian rhythm measures including the amplitudes, mesors, and timings of sleep, of illumination, and of activity. We found no age-related decline in actigraphic sleep duration. Age was not a significant correlate of circadian rhythm parameters of sleep. Moreover, no age effects were found on daily illumination exposure or on the circadian timing of illumination and activity patterns. However, the level and amplitude of the circadian activity rhythm showed a gradual decline with aging, independent of the time reference (i.e., Daylight Saving Time versus Standard Time) when recordings were obtained. As expected, significant associations were observed between local time reference and the level and timing of peak of illumination patterns. However, changes in local time reference were not significantly and consistently associated with actigraphic sleep or activity measures.

Activity Cycles↗

PubMed2000

Assessment and treatment of sleep disturbances in older adults.

Sleep disturbances are common in older adults. These disturbances are often secondary to medical illness and/or medication use or are due to specific problems such as sleep disordered breathing, periodic limb movements in sleep and circadian rhythm disturbances. The prevalence of sleep disordered breathing and periodic limb movement in sleep increases with age. The circadian rhythm tends to advance with age, causing older people to awaken early in the morning. Insomnia is often caused by pain associated with medical illness. Insomnia can also be caused by stimulating medications. In institutionalized elderly, sleep becomes even more disturbed and fragmented than in community-dwelling older adults. Accurate assessment and diagnosis is crucial since effective treatment strategies are available for these sleep disturbances. The effect, prevalence and treatment of each of these conditions is reviewed.

Aged↗

PubMed2000

Does caffeine confound relationships among adrenergic tone, blood pressure and sleep apnoea?

The purpose of this study was to determine whether caffeine consumption confounds the relationship among adrenergic tone, as measured by urinary norepinephrine (NE), blood pressure (BP) and obstructive sleep apnoea (OSA). Data were analysed using correlation and regression analysis, analysis of covariance and t-tests. Subjects included normotensives and hypertensives with and without OSA: 38 men, 23 women, aged 30-60 y; 100-150% of ideal body weight; without other major illness. Patients were studied using polysomnography, caffeine consumption was assessed, 24-h urinary NE levels were examined and ambulatory BP was recorded. Patients with OSA (N=27) reported significantly greater caffeine consumption than those without OSA (N=34) (295 vs. 103 mg, P=0.010), but caffeine was not significantly correlated with their ambulatory BP. In contrast, NE excretion correlated with caffeine consumption (r=0.24, P=0.041), apnoea severity (r=0.65, P < 0.001) and BP (r=0.34, P < 0.005). Significant OSA-NE and BP-NE relationships remained even after controlling for caffeine consumption. Patients with OSA consumed nearly three times the amount of caffeine as patients without OSA. While caffeine partially explains the increased adrenergic tone in patients with OSA and the relationship between BP and NE, it does not appear to contribute significantly to the relationship between OSA and elevated BP.

Adult↗

PubMed2000

Illumination levels in nursing home patients: effects on sleep and activity rhythms.

Studies examining levels of illumination in adult populations have demonstrated that the level and amount of light exposure are lower in the elderly compared with younger adults, particularly in institutionalized patients with dementia. Although insufficient light exposure has been implied as a cause of sleep fragmentation, evidence for such a relationship is scant. Sixty-six institutionalized elderly had their activity and light exposure monitored for a 3-day period. Mean and median light levels, minutes spent over 1000 and over 2000 lux, percent sleep and wake, and number of naps were computed for daytime intervals, defined as 07.00-18.59. Percentages of sleep and wake, number of awakenings and mean duration of wake periods were computed for night-time intervals, defined as 22.00-05.59. Mesor, amplitude and acrophase of activity and of light were determined by cosinor analysis. A mixed linear model was used to assess the effects of daytime Actillume measures on subsequent night-time measures, and vice versa. Spearman correlations were computed, and multiple regression analyses were carried out with light variables and dementia level as predictors and sleep-wake and activity measures as dependent variables. The median light level was 54 lux and a median of only 10.5 min were spent over 1000 lux. Higher light levels predicted fewer night-time awakenings, and severe dementia predicted more daytime sleep and lower mean activity. Increased bright light exposure predicted later activity acrophase. There was an association between the acrophases of light and of activity, with maximum illumination preceding peak activity. These results suggest that daytime light exposure has an impact on both night-time sleep consolidation and timing of peak activity level.

Aged↗

PubMed2000

Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease.

Agitation is a common problem in institutionalized patients with Alzheimer's disease (AD). "Sundowning," or agitation that occurs primarily in the evening, is estimated to occur in 10-25% of nursing home patients. The current study examined circadian patterns of agitation in 85 patients with AD living in nursing homes in the San Diego, California, area. Agitation was assessed using behavioral ratings collected every 15 minutes over 3 days, and activity and light exposure data were collected continuously using Actillume recorders. A five-parameter extension of the traditional cosine function was used to describe the circadian rhythms. The mean acrophase for agitation was 14:38, although there was considerable variability in the agitation rhythms displayed by the patients. Agitation rhythms were more robust than activity rhythms. Surprisingly, only 2 patients (2.4%) were "sundowners." In general, patients were exposed to very low levels of illumination, with higher illumination during the night being associated with less robust agitation rhythms with higher rhythm minima (i.e., some agitation present throughout the day and night). Seasonality was examined; however, there were no consistent seasonal patterns found. This is the largest study to date to examine agitation rhythms using behavioral observations over multiple 24 h periods. The results suggest that, although sundowning is uncommon, agitation appears to have a strong circadian component in most patients that is related to light exposure, sleep, and medication use. Further research into the understanding of agitation rhythms is needed to examine the potential effects of interventions targeting sleep and circadian rhythms.

Activity Cycles↗

PubMed2000

Reliability of nocturnal blood pressure dipping.

BACKGROUND: Increasing evidence documents the fact that individuals whose blood pressure drops or 'dips' relatively little at night have a higher risk of numerous cardiovascular illnesses. OBJECTIVE: To examine the reliability of various measures of nocturnal blood pressure dipping. METHODS: This study examined 17 individuals with ambulatory blood pressure monitoring on three 24 h recordings while they pursued a schedule similar to that of in-patients on a clinical research unit. Nocturnal dipping of blood pressure was scored three ways: as the drop in blood pressure between 10 p.m. and 6 a.m. ('clocktime'), as the drop in blood pressure tailored to each individual's reported bedtime ('bedtime'), and as the drop in blood pressure accompanying polysomnographically verified sleep ('sleeptime'). RESULTS: Adequate reliability was obtained for all three measures of dipping. There was, in general, a significant correlation across testing occasions (P<0.05). The correlation coefficient ranged from 0.5 to 0.8, depending on which criterion of dipping was selected and whether the endpoint was systolic blood pressure, diastolic blood pressure, or mean arterial blood pressure. CONCLUSIONS: The reliability of systolic blood pressure dipping was somewhat lower than that of diastolic or mean arterial blood pressure dipping. Dipping appears to be a reliable construct. While no one definition of dipping was demonstrably better than another, the most sensible definition of dipping would allow some adjustment for defining 'night' on the basis of each individual's idiosyncratic bed time.

Adult↗

PubMed1999

Night-to-night arousal variability and interscorer reliability of arousal measurements.

STUDY OBJECTIVES: Measurement of arousals from sleep is clinically important, however, their definition is not well standardized, and little data exist on reliability. The purpose of this study is to determine factors that affect arousal scoring reliability and night-to-night arousal variability. DESIGN: The night-to-night arousal variability and interscorer reliability was assessed in 20 subjects with and without obstructive sleep apnea undergoing attended polysomnography during two consecutive nights. Five definitions of arousal were studied, assessing duration of electroencephalographic (EEG) frequency changes, increases in electromyographic (EMG) activity and leg movement, association with respiratory events, as well as the American Sleep Disorders Association (ASDA) definition of arousals. SETTING: NA. PATIENTS: NA. INTERVENTIONS: NA. RESULTS: Interscorer reliability varied with the definition of arousal and ranged from an Intraclass correlation (ICC) of 0.19 to 0.92. Arousals that included increases in EMG activity or leg movement had the greatest reliability, especially when associated with respiratory events (ICC 0.76 to 0.92). The ASDA arousal definition had high interscorer reliability (ICC 0.84). Reliability was lowest for arousals consisting of EEG changes lasting <3 seconds (ICC 0.19 to 0.37). The within subjects night-to-night arousal variability was low for all arousal definitions CONCLUSION: In a heterogeneous population, interscorer arousal reliability is enhanced by increases in EMG activity, leg movements, and respiratory events and decreased by short duration EEG arousals. The arousal index night-to-night variability was low for all definitions.

Arousal↗

PubMed1999

Sleep-disordered breathing and periodic limb movements in sleep in older patients with schizophrenia.

BACKGROUND: Since the prevalence of both sleep-disordered breathing (SDB) and periodic limb movements in sleep (PLMS) increase with age, we explored whether older schizophrenia patients would have a high incidence of SDB and PLMS. Correlations between sleep and clinical variables were also examined. METHODS: Fifty-two patients (mean age = 59.6 years, SD = 8.9) had their sleep/wake, respiration, and leg movements recorded using a modified Medilog/Respitrace portable recording system plus oximetry. A battery of clinical, psychosocial, and motor disturbance variables were collected by research center staff. RESULTS: Forty-eight percent of these patients had at least 10 respiratory events per hour of sleep. These patients reported more symptoms of daytime sleepiness than patients with fewer than 10 events per hour. The relatively high prevalence of SDB in this group may contribute to overall sleep disturbances, and does not appear to be a result of high body mass index. Only 14% of the patients had at least five limb movements per hour of sleep, suggesting the prevalence of PLMS is much lower than expected in this age group. The number of leg jerks was inversely related to symptoms of tardive dyskinesia. CONCLUSIONS: The disturbance of sleep in these patients may be due, in part, to SDB, but is unlikely due to PLMS.

Age Factors↗

PubMed1999

Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I.

The National Sleep Foundation in conjunction with the Gallup Organization conducted telephone interviews with a sample of Americans (N = 1000) to examine the prevalence and nature of difficulty with sleep. Consistent with other national studies, about one-third of Americans reported some type of sleep problem. Approximately one in four reported occasional insomnia while 9% reported that their sleep difficulty occurred on a regular nightly basis. The problem most frequently reported by insomniacs was waking up in the morning feeling drowsy or tired, followed by waking up in the middle of the night, difficulty going back to sleep after waking up and difficulty falling asleep initially. Importantly, insomniacs rarely visited a physician to discuss their sleep problem and four out of ten insomniacs self-medicated with either over-the-counter medications or with alcohol. Two-thirds of the insomniacs reported that they did not have an understanding of available treatments for insomnia.

Adolescent↗

PubMed1999

Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. II.

The daytime consequences and correlates of insomnia were examined in the National Sleep Foundation and the Gallup Organization survey of 1,000 randomly selected Americans. Respondents were grouped as having occasional insomnia, chronic insomnia or no insomnia. There were dramatic differences in reported waking behaviors and psychosocial measures by insomniacs compared to those who do not report sleep difficulty. These problems include impaired concentration, impaired memory, decreased ability to accomplish daily tasks and decreased enjoyment of interpersonal relationships. Importantly, most of these variables showed an increasing degree of impairment with greater frequency of sleep disturbance. These findings suggest that insomnia negatively impacts aspects of waking function related to quality of life.

Accidents, Traffic↗

PubMed1999

Insomnia in primary care patients.

STUDY OBJECTIVES: To determine the prevalence and characteristics of insomnia in primary care patients, to examine patients' help-seeking behavior, and to compare the frequency of insomnia in primary care patients to the general population. METHODS: 286 patients from primary care clinics in San Diego, California (n = 96), and in Haleiwa and Honolulu, Hawaii (n = 190) participated. Sleep study questionnaires were distributed by front desk receptionists to all patients over 18 years of age upon arrival at the clinic for an appointment with the physician. Completed questionnaires were collected at the clinic or returned by mail. Comparisons were made by using nonparametric statistics. A logistic regression analysis using backward elimination was done to develop a model showing predictors of who would consult with the physician about a sleep problem. RESULTS: The prevalence of insomnia in primary care patients was 69%, with 50% reporting occasional insomnia and 19% reporting chronic insomnia. As expected, patients with chronic insomnia had the most severe sleep complaints as well as the poorest daytime functioning, and exhibited the most help-seeking behaviors. The four predictors of discussing insomnia with a physician were how patients felt physically, number of years of insomnia, age, and income. CONCLUSIONS: The primary care population has a higher prevalence of insomnia than the general population, probably because of concomitant psychiatric and medical illnesses. Although many of the characteristics of the sleep complaints are easily detected, most patients with insomnia are not treated effectively.

Adolescent↗

PubMed1999

Psychological correlates of sleep apnea.

Relationships were examined between psychological and sleep variables in individuals with sleep apnea (n=72, 24 with hypertension; Respiratory Disturbance Index=15) and without sleep apnea (n=40, 16 with hypertension; respiratory disturbance index<15). Subjects were 32-64 years old, 100-150% of ideal weight, with no other major illness. For subjects with sleep apnea, depression, anger, and total mood disturbance correlated positively with deep sleep, rapid eye movement sleep, and/or hypoxemia. For subjects without sleep apnea, vigor correlated positively with sleep quantity and negatively with hypoxemia. When age, body mass, and hypertension were controlled, results changed little for subjects without sleep apnea; for subjects with sleep apnea, depression and total mood disturbance no longer correlated with sleep measures. Although various psychological measures correlate with sleep variables in sleep apnea subjects, many are explained by controlling age, body mass, and hypertension. Anger and vigor, however, remain associated with sleep variables.

Adult↗

PubMed1999

Relationship of arousals from sleep to sympathetic nervous system activity and BP in obstructive sleep apnea.

STUDY OBJECTIVE: Obstructive sleep apnea (OSA) patients have a high frequency of arousals. We hypothesized that arousals significantly influence tonic sympathetic nervous system function. DESIGN: We examined the association of 11 variables measuring sympathetic activity, including plasma norepinephrine (NE), urinary NE, and BP measurements, with movement and cortical arousals. PATIENTS: Sixty-seven subjects with various degrees of hypertension and OSA were evaluated. All patients were free from antihypertensive medications. RESULTS: The age (range, 35 to 60 years), weight (range, 100 to 150% of ideal body weight), and diet of the subjects were similar. The movement arousal index was correlated with daytime baseline plasma NE (BNE), daytime urine NE, mean daytime diastolic BP, and systolic BP during rapid eye movement sleep (r = 0.39 to 0.53; p < or = 0.002). Cortical arousals did not correlate with any of the variables. A multiple regression procedure was performed to examine how well movement arousals predicted those variables with significant correlations. The respiratory disturbance index (RDI) and nighttime pulse oxyhemoglobin saturation were included in the regression equation due to their close association with movement arousals. Movement arousals independently predicted BNE (t [48] = 2.06; p < 0.05). No other variable independently predicted any of the measurements of sympathetic activity. CONCLUSIONS: These findings suggest that movement arousals may influence daytime sympathetic tone independently of RDI and nighttime saturation.

Adult↗

PubMed1999

Effect of continuous positive airway pressure vs placebo continuous positive airway pressure on sleep quality in obstructive sleep apnea.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) therapy has become the treatment of choice for obstructive sleep apnea (OSA). However, the efficacy of CPAP therapy has not been evaluated against a suitable control. We investigated the effectiveness of CPAP therapy in improving sleep quality in patients with OSA. We hypothesized that CPAP improves sleep quality. PATIENTS: Forty-eight CPAP-naive OSA patients were evaluated. None were receiving antihypertensive medications, and none had major medical illnesses. DESIGN: Patients were randomized to receive either CPAP or placebo CPAP (CPAP at an ineffective pressure) for 7 days in a double-blind fashion. Forty-one patients completed the protocol. Sleep quality variables, arousals, sleep arterial oxygen saturation (SaO(2)), and respiratory disturbance index (RDI) were assessed at baseline, after 1 day of treatment, and after 7 days of treatment. Repeated measures analysis of variance was used to evaluate the effects of treatment, time, and the interaction of the two. RESULTS: As expected, CPAP lowered RDI and number of arousals, and increased SaO(2) over time (p = 0.001). Contrary to expectations, both CPAP and placebo CPAP had comparable effects on sleep quality as assessed by sleep architecture, sleep efficiency, total sleep time, and wake after sleep onset time. CONCLUSIONS: This study confirms the effectiveness of CPAP in lowering the number of arousals and the RDI, and in raising SaO(2). However, our data suggest that short-term CPAP is no different than placebo in improving sleep architecture. Further evaluation of the effectiveness of CPAP using a suitable placebo CPAP in prospective randomized studies is needed

Adult↗

PubMed1999

Sleep in the elderly.

Older adults frequently experience difficulties with sleep that can be caused by specific sleep disorders (such as sleep-disordered breathing or periodic limb movements in sleep) and circadian rhythm disturbances. These all can be effectively treated. Medical illnesses and medications also can have a negative affect on sleep and effective management of these can significantly improve sleep in older adults. Sleep in institutionalized older adults is even more disturbed than sleep of community-dwelling older people and special considerations can be made to improve the quality of sleep in institutional settings.

Aged↗