Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sleep is important for health and quality of life at all ages, and poor sleep interacts with many medical conditions. Somatic and psychiatric diseases, and unfavourable habits and life-style factors, increase the propensity to insomnia in older persons. As health deteriorates with age, sleep becomes poorer. Heart disease and stroke, cancer, painful conditions, breathing disorders and nocturnal polyuria syndrome often disturb sleep. Dementia and depression, which are often associated with sleep disturbances, are also more prevalent in the elderly. Moreover, true age-related sleep deterioration occurs after the age of 75 years. Attempts to improve sleep should first and foremost be focused on elimination of somatic and psychiatric symptoms as far as possible, and on modification of lifestyle factors that may affect sleep quality. For short term treatment, hypnotics are appropriate; for longer periods, nonpharmacological methods, for example light therapy or behavioural modification techniques, should be considered, as many hypnotic drugs are less suitable for long term use. However, there are situations when sleep medication must continue for long periods, especially in elderly patients with severe diseases and poor quality of life. In these patients, careful individualisation of therapy is appropriate.
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PMID:Sleep disorders in the elderly. 1008 63

Fatigue is a highly prevalent condition among cancer patients. Although most cancer patients report that fatigue is a major obstacle to maintaining normal daily activities and quality of life, it is seldom assessed and treated in clinical practice. Few studies have explored its epidemiology, possible etiologies, or management. Cancer-related fatigue, which recently was accepted as a diagnosis in the International Classification of Diseases 10th Revision-Clinical Modification, reduces physical, psychological, and social functioning and results in significant distress for patients and caregivers. Adequate evaluation of fatigue must do more than simply assess severity. The assessment should clarify other characteristics, determine the degree to which fatigue interferes with the activities of daily living, and identify potential causes, including the underlying disease, disease treatments, intercurrent systemic disorders, psychological disorders, and other conditions. Possible primary therapies include modification of the patient's drug regimen, correction of metabolic abnormalities, and pharmacologic treatments for anemia (e.g., epoetin alfa), depression, or insomnia. Other symptomatic interventions include specific drug treatments, exercise, modification of activity and rest patterns, cognitive therapies, sleep hygiene approaches, and nutritional support. Pharmacologic approaches, which are supported by limited studies and growing clinical experience, include psychostimulant drugs, corticosteroids, and possibly other therapies. Although additional research is needed to further identify the causes and corresponding treatment of fatigue, practitioners should routinely assess and treat patients who may benefit from currently identified interventions, because fatigue can profoundly undermine the quality of life of patients with cancer.
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PMID:Cancer-related fatigue: guidelines for evaluation and management. 1033 65

Although the initial phase of illness is recognized as important in the overall process of adjustment after a diagnosis of breast cancer, little is known about pretreatment patterns of symptom distress. Seventy-four women ages 25 to 79 years and newly diagnosed with breast cancer were studied to determine physical, cognitive, and affective distress in the pretreatment period. Severity of distress was assessed about 11 days before primary surgery using the Symptom Distress Scale (SDS), Attentional Function Index (AFI), and Profile of Mood States (POMS). Higher levels of distress (SDS) were related to a triad of symptoms, insomnia, fatigue, and loss of concentration. Also, lowered effectiveness in cognitive function (AFI) and significant disturbances in mood state (POMS) were observed. Overall, a greater number of symptoms was associated with lowered cognitive function (r = -0.47; p < 0.01) and greater mood disturbance (r = 0.65; p < 0.01). Younger women younger than 55 years of age (n = 25) reported significantly (p = 0.02) greater overall symptom distress (SDS) than older women (n = 49). Interestingly, severity of distress did not differ in groups anticipating breast-conserving surgery (n = 35) instead of mastectomy (n = 39). The findings showed a discernible pattern of symptom distress before any treatment in women newly diagnosed with breast cancer, indicating a need for early intervention to promote the initial process of adjustment.
Cancer Nurs 1999 Jun
PMID:Pretreatment symptom distress in women newly diagnosed with breast cancer. 1037 79

To determine incidence and remission rates of insomnia in older adults and associated risk factors. Three-year longitudinal study, 1982-198--East Boston, MA; New Haven, CT; Iowa and Washington counties, IA. Participants were 6,899 men and women aged 65 years and older. Self-reported difficulty falling asleep or early morning arousal (insomnia), along with physician diagnosis of heart disease, stroke, cancer, diabetes, or hip-fracture, self-report of physical disability, depressive symptomatology, perceived health status, and use of medications ascertained at both baseline and three-year follow-up. Nearly 15% of the 4,956 participants without symptoms of insomnia at baseline reported chronic difficulty falling asleep or early morning arousal at follow-up, suggesting an annual incidence rate of approximately 5%. Incident insomnia was associated with depressed mood, respiratory symptoms, fair to poor perceived health, and physical disability. In multivariate analyses, these risk factors explained the higher incidence of insomnia among those with medical conditions such as heart disease, stroke, and diabetes. Other factors associated with an increased risk of insomnia included use of prescribed sedatives, and widowhood. Only 7% of the incident cases of insomnia occurred in the absence of associated risk factors. Of the nearly 2,000 survivors with chronic insomnia at baseline, almost half no longer reported symptoms upon follow-up and were more likely to report improved self-perceived health compared to those who continued to report symptoms. Chronic disease, depressed mood, physical disability, poor perceived health, widowhood, and use of sedatives are associated with development and remission of insomnia symptoms. Because the vast majority of incident cases of insomnia were among persons with one or more of these risk factors, these data do not support a model of incident insomnia caused by the aging process per se.
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PMID:Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years. 1039 9

Vital exhaustion, defined as a combination of fatigue, lack of energy, feelings of hopelessness, loss of libido, and increased irritability, has been proposed as a risk indicator for the development of coronary heart disease (CHD). It is unclear if the association between vital exhaustion and CHD is independent of sleep behavior, depression, and physical activity. We ascertained sense of exhaustion among 5,053 male college alumni who were free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease by asking, "How often do you experience sense of exhaustion (except after exercise)?" on a health survey in 1980. Eight hundred fifteen men died during 12 years of follow-up, 25% due to CHD. After adjustment for age, body mass index, smoking status, and history of physician-diagnosed diabetes and hypertension, frequent sense of exhaustion was associated with a twofold increase in CHD mortality (rate ratio 2.07; 95% confidence interval 1.08 to 3.96). After additional adjustment for insomnia, sleep duration, use of sleeping pills and tranquilizers, physical activity, history of physician-diagnosed depression, and alcohol intake, the rate ratio was not appreciably altered; however, the association now was of borderline significance (rate ratio 2.06; 95% confidence interval: 0.98 to 4.36) because there were only 10 deaths from CHD among men who were frequently exhausted. In a prospective observational study, frequent sense of exhaustion appeared to be independently associated with increased risk of CHD mortality in men.
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PMID:Sense of exhaustion and coronary heart disease among college alumni. 1060 12

Tamoxifen (TAM) is used in the treatment of breast cancer and decreases the incidence of breast cancer when given to healthy women for different therapeutic purposes. This expansion of its use calls for further studies of its own potential side effects and those in combination with other prescription drugs. Diazepam (DP) is one such drug normally administered to patients who are under cancer treatment and those who suffer from insomnia. The present study examines the effect of individual and simultaneous administration of TAM and DP at therapeutic dose level of 0.8 mg/Kg/day of TAM and 0.3 mg/Kg/day of DP to normal female Wistar rats for a period of 12 weeks. The drugs were administered orally by mixing it in pellet made by wheat dough. There was no significant change in the terminal body weight and liver weights of animals. The ovary weights in TAM + DP treated animals were significantly decreased. The serum succinate dehydrogenase (SDH) levels were significantly lower in TAM, DP and TAM + DP treated rats and comparatively were lowest in TAM and TAM + DP treated animal groups. Serum glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT), acid and alkaline phosphatase (ACP & ALP) levels were significantly higher in the three treated groups, but comparatively lower in TAM + DP treated animals when compared to TAM or DP alone treated rats. There was marked increase in liver triglyceride and cholesterol levels in the three treated groups but remarkable decrease in liver glycogen. Total serum cholesterol levels were significantly high in DP and TAM + DP treated rats and total serum triglyceride levels were significantly high only in TAM treated rats. As a whole it can be concluded that DP does not enhance TAM toxicity on simultaneous administration, but on its own when administered individually brings about perturbation in lipid storage and metabolism.
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PMID:A toxicity study of simultaneous administration of Tamoxifen and Diazepam to female Wistar rats. 1066 14

Fatigue is one of the most frequent symptoms in cancer patients. However, the precise causes of this fatigue are still unknown, and this situation makes it difficult to combat the problem. The present study was conducted to investigate factors correlated with fatigue in disease-free breast cancer patients. A group of 134 randomly selected ambulatory breast cancer patients who had undergone successful surgical treatment participated. They completed the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale, the Mental Adjustment to Cancer Scale, and an ad hoc questionnaire detailing physical symptoms, social support, and demographic variables at home and returned them by mail the following day. Multiple regression analysis revealed that fatigue was significantly correlated with dyspnea, insufficient sleep, and depression, and that these three variables accounted for a total of 46% of variance in fatigue. Factors concerned with the cancer and treatment, such as disease stage, lymph node metastasis, number of days since operation, past intravenous chemotherapy, radiotherapy, current use of fluoropyrimidine compounds, and current use of tamoxifen citrate were not correlated with fatigue. The results suggest that fatigue in this population is determined by current physical and psychological distress rather than by the cancer itself and prior cancer treatments, and that the management of dyspnea, insomnia, and depression might be important in reducing fatigue in this population.
Support Care Cancer 2000 May
PMID:Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. 1078 63

(1) In the United States melatonin is just a dietary supplement, but in Europe its status varies from country to country and also over time. It is illegal in some European member states but tolerated or authorised as a drug or dietary product elsewhere. Melatonin, a hormone secreted by the pineal gland, has been on the front cover of magazines throughout the world for its claimed effects on ageing, cancer and many other health problems, opening up a vast potential market. (2) Only its use in jet lag, sleep disorders and advanced cancer has been tested clinically (albeit scantily). (3) Melatonin seems to alleviate jet lag symptoms, but that could be linked to its moderate hypnotic effect. (4) The use of melatonin to treat major insomnia cannot be envisaged until its long-term safety has been proven. With this proviso, and if efficacy is confirmed in sufficiently large comparative trials, melatonin could prove useful for treating major sleep disorders in some patients, especially blind people and those with severe neurological disabilities. (5) According to open trials conducted by a single team, melatonin, alone or combined with interleukin-2, could slightly lengthen the survival of patients with some advanced cancers, but even partial tumour remissions are rare. (6) All other "indications" are based on simplistic hypotheses or purely commercial considerations.
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PMID:Melatonin: interesting, but not miraculous. 1084 53

The purpose of this study was to evaluate the effects of two alternative chemotherapy regimes on the quality of life (QoL) of patients with advanced breast cancer. In a multicentre trial, 283 patients were randomised to receive either docetaxel (T) or sequential methotrexate and 5-fluorouracil (MF). QoL was assessed at baseline and before each treatment using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). Initial compliance in the QoL study was 96% and the overall compliance 82%. QoL data were available for 245 patients (T 130 and 115 MF). Both treatment groups showed some improvement in emotional functioning during treatment, with a significant difference favouring the MF group at treatment cycles 5 and 6. In the T group, the scores on the other functional scales remained stable throughout the first six cycles. There were significant differences favouring the MF group on the social functioning scale at treatment cycle 6 and on the Global QoL scale at treatment cycles 5 and 6. On most symptom and single-item scales there were no statistically significant differences between the groups. However, at baseline, the T patients reported more appetite loss, at treatment cycles 2-4, the MF patients reported more nausea/vomiting, and at treatment cycle 6, the T patients reported more symptoms of fatigue, dyspnoea and insomnia. There were no statistically significant differences between the groups in the mean change scores of the functional and symptom scales. Interindividual variance was, however, larger in the T group. Differences in QoL between the two treatment groups were minor. Hence, given the expectancy of comparable QoL outcomes, the choice of treatment should be made on the basis of the expected clinical effect.
Eur J Cancer 2000 Jul
PMID:Quality of life in patients with metastatic breast cancer receiving either docetaxel or sequential methotrexate and 5-fluorouracil. A multicentre randomised phase III trial by the Scandinavian breast group. 1089 55

The aim of the project was to identify clinical and quality of life (QL) factors that together predict survival and response to chemotherapy in advanced breast cancer. Potential prognostic factors were studied in 187 women with baseline QL data from a trial of paclitaxel versus doxorubicin as first-line chemotherapy. Demographic and clinical factors studied were age, performance status, dominant site of disease and preceding disease-free interval (DFI). Factors from the EORTC QLQ-C30 were all function scales, fatigue, nausea/vomiting, pain, dyspnoea, insomnia, loss of appetite and global QL. The proportional hazards regression model with stratification for treatment, and the logistic regression model adjusting for treatment arm were used for univariate and multivariate analyses of survival and response to treatment, respectively. For survival, multiple sites of visceral disease, pain, global QL and fatigue were significant prognostic factors in the univariate analysis. The final multivariate model predicted poor survival with multiple sites of visceral disease (P=0.003), DFI </=2 years (P=0.026) and pain (P=0.003). For response, age, dyspnoea, fatigue and global QL were significant predictive factors in the univariate analysis. The final multivariate model for response selected DFI (P=0.009), multiple sites of visceral disease (P=0.037) and dyspnoea (P=<0.001) using forward selection, but model instability was indicated by the inclusion of fatigue and emotional function in the final model when backward selection was used. In addition to known clinical factors, patient-assessed QL variables appear to be prognostic for survival and response to chemotherapy in women with advanced breast cancer. However, identification of prognostic factors from responses to questionnaires may be unstable, and their reliability and clinical utility should be tested prospectively.
Eur J Cancer 2000 Aug
PMID:Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. 1093 Jul 97


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