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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many mental and behavioural disorders during childhood and adolescence are associated with sleep difficulties. A polysomnography is seldom needed but indicated in following cases: In a general view when there is suspected obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness or suspected nocturnal seizures. Specific mental disorders with indication of polysomnography are: Diagnostic unclear and dangerous parasomnias, emotional disorders in case of differing sleep perception, Attention-deficit Hyperactivity Disorder (ADHD) and Tourette Syndrome with suspected (additional) OSAS, Restless Legs Syndrome (RLS) or Periodic Limb Movement Disorder (PLMD). Further indications are -therapy-resistant insomnia and sleep-wake-rhythm-disorders.
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PMID:[Indications for sleep laboratory studies in psychiatrically symptomatic children and adolescents]. 1598 56

Sleep disorders are common among the elderly and are associated with diminished quality of life, increased risk for development of psychiatric disorders, inappropriate use of sleep aids, and decreased daytime functioning. The most common and important sleep disorders in the elderly include insomnia, obstructive sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, and the advanced sleep phase syndrome. In this article, we summarize the current treatment strategies for each of these sleep-related disorders. Before contemplating specific treatments, the authors recommend that more conservative and nonpharmacologic therapies be attempted first because the elderly are more likely to have medication side effects or complications related to surgery. Many sleep problems can be treated by simple sleep hygiene modifications that can be implemented and adopted easily. For others, therapies that specifically consider older adults may be required. For each of the sleep disorders we provide an updated discussion of therapies beginning with diet and lifestyle, pharmacologic treatment, interventional procedures, surgery, assistive devices, physical and speech therapy, exercise, and emerging therapies with specific considerations for older adults.
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PMID:Treatment of sleep disorders in elderly patients. 1607 39

Obstructive sleep apnea (OSA) and insomnia are among the most common sleep diagnoses encountered in the sleep clinic population, however little is known about potential interactions or associations between the two disorders. This retrospective, cross-sectional study was designed to determine the prevalence of insomnia complaints in patients undergoing evaluation for OSA and to ascertain which clinical and polysomnographic features are associated with insomnia. Of 255 consecutive patients who underwent polysomnography for clinically suspected OSA, 54.9% reported a complaint of insomnia: 33.4% reported difficulty initiating sleep, 38.8% difficulty maintaining sleep, and 31.4% early morning awakenings. Insomnia complaints were noted more commonly in patients without significant sleep-disordered breathing [apnea hypopnea index (AHI)<10; 81.5%] vs those with sleep-disordered breathing (AHI> or =10; 51.8%); p=0.01. Clinical factors associated with insomnia included female gender, psychiatric diagnoses, chronic pain, the absence of regular alcohol use, restless leg symptoms, and reports of nocturnal kicking. Polysomnographic factors associated with insomnia included lower AHI and lower desaturation index (DI). In the subgroup of patients with significant sleep-disordered breathing (AHI> or =10, n=228), there was no association between insomnia complaints and AHI or DI. These results suggest that insomnia is a common complaint in patients being evaluated for OSA, but it is not strongly associated with sleep-disordered breathing and may instead reflect other coexisting factors.
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PMID:Insomnia complaints in patients evaluated for obstructive sleep apnea. 1609 54

Psychiatric disorders constitute 15.4% of the disease burden in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including posttraumatic stress disorder), substance abuse disorders, eating disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insomnia, hypersomnia, nocturnal panic, sleep paralysis, hypnagogic hallucinations, restless legs/periodic limb movements of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are summarized.
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PMID:Sleep and psychiatry. 1641 5

Sleep complaints are very common among the general population and are usually accompanied by significant medical, psychological and social disturbances (Redline S, Strohl K, Otolaryngol Clin North Am, 132:303, 1999). A higher prevalence of sleep complaints has been described in the elderly (Vgontzas AN, Kales A, Annu Rev Med, 50:387-400, 1999). It is manifested by breathing disturbances during sleep, loud snoring, difficulties maintaining sleep, fatigue, daytime sleepiness, mood effects and impairment of daily activities (Lugaresi E, Cirignotta F, Zucconi M et al., Good and poor sleepers: an epidemiological survey of the San Marino population, Raven, New York, pp 1-12, 1983; Kales A, Soldatos CR, Kales JD, Am Fam Physician, 22:101-108, 1980). It has been associated with cardiovascular, endocrine and neurocognitive manifestations. Growing interest in early diagnosis and treatment has been noted in recent years based on emerging knowledge about the potential health consequences when the disease goes untreated (Nanen AM, Dunagan DP, Fleisher A et al., Chest, 121:1741, 2002). The veteran population in the mainland has a higher tendency for obesity, high blood pressure (HBP), sleep disorders and chronic alcohol consumption (Mustafa M, Erokwu N, Ebose I, Strohl K, Sleep Breath, 9:57-63, 2005). The Hispanic veteran population has never been studied in detail for sleep disorders and related conditions. We used previously validated screening tools for sleep disturbance breathing. Two hundred and forty-five questionnaires were administered. We found a higher prevalence of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in our population compared with data from the mainland (USA). The mean age was 64 years (+/-11). Ninety seven per cent were males. The mean body mass index was 25 kg/cm(2); mean Epworth Sleepiness Scale score was 8. Thirty-four per cent met high-risk criteria for sleep apnea, 53% for insomnia, 13% for symptoms suggestive of narcolepsy and 13% for those suggestive of restless leg syndrome. There were high incidences of alcohol consumption (37.6%), diabetes (32.7%), hypercholesterolemia (31.8%), depression (31.8%), hypertension (39.6%) and post-traumatic stress disorder (PTSD) (9.8%).
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PMID:The veteran population: one at high risk for sleep-disordered breathing. 1649 17

Chronic posttraumatic sleep disturbance may include sleep-disordered breathing (SDB), but this disorder of sleep respiration is usually not suspected in trauma survivors. Sleep breathing signs and symptoms were studied in 178 adults-all with SDB-including typical sleep clinic patients (N = 89) reporting classic snoring and sleepiness and crime victims (N = 89) with insomnia and posttraumatic stress. Significant differences (p < 0.0001) were common between groups. Sleep breathing complaints, loud snoring, marked obesity, and obstructive sleep apnea were prevalent in sleep clinic patients; crime victims reported more insomnia, nightmares, poor sleep quality, leg jerks, cognitive-affective symptoms, psychotropic medication usage, and less snoring but more upper airway resistance syndrome. Both groups reported high rates of fatigue or sleepiness, nocturia, morning dry mouth, and morning headaches. Awareness of these clinical features might enhance detection of SDB among trauma survivors.
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PMID:Signs and symptoms of sleep-disordered breathing in trauma survivors: a matched comparison with classic sleep apnea patients. 1677 61

At the request of Canadian health ministries, we reviewed recommendations in guidelines prepared by professional bodies on the referral of individuals to sleep laboratories. Searching electronic databases and the Internet, we found 37 guidelines that covered 18 applications of sleep laboratory investigation including obstructive sleep apnea, other respiratory disorders, obstructive sleep apnea and other conditions in children, sudden infant death syndrome, treatment for snoring, insomnia, depression with insomnia, narcolepsy, restless legs syndrome/periodic limb movement disorder, parasomnias and circadian rhythm disorders. We identified recommendations on referral of patients for sleep studies and assessed the quality and relevance of evidence cited in support of these. Of 81 recommendations, 46 were supported by evidence from primary investigations. Only six cases cited evidence from well-conducted, prospective controlled studies. Evidence was highly relevant in 18 cases, of some relevance in 22 and of little or no relevance in six. No evidence was provided in support of 31 recommendations, and in four cases the guideline had identified an absence of available evidence. Although the publications from professional bodies that were reviewed contain much detailed information, evidence supporting many recommendations is limited. There is a need for further, good quality, studies of many sleep laboratory applications.
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PMID:Recommendations and supporting evidence in guidelines for referral of patients to sleep laboratories. 1680 6

Clinical practice points were drawn from a review of sleep and headache disorders published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Sleep as well as psychiatric disorders tend to become prevalent in more complex and severe headache patterns and regulation of sleep and mood may favorably impact headache threshold; (2) Specific headache patterns, irrespective of headache diagnosis, are suggestive of a potential sleep disorder (eg, "awakening" or morning headache, chronic daily headache); (3) Sleep disorders most implicated with headache include obstructive sleep apnea, primary insomnia, and circadian phase abnormalities, and treatment of such sleep disorders may improve or resolve headache; (4) Inexpensive screening tools (eg, sleep history interview, headache/sleep diary, validated questionnaires, prediction equations) aid identification of patients warranting polysomnography; and (5) Pharmacologic and behavioral therapies are effective in the regulation of sleep and are compatible with usual headache care.
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PMID:Sleep and headache disorders: clinical recommendations for headache management. 1703 94

Review of epidemiological and clinical studies suggests that sleep disorders are disproportionately observed in specific headache diagnoses (eg, migraine, tension-type, cluster) and other nonspecific headache patterns (ie, chronic daily headache, "awakening" or morning headache). Interestingly, the sleep disorders associated with headache are of varied types, including obstructive sleep apnea (OSA), periodic limb movement disorder, circadian rhythm disorder, insomnia, and hypersomnia. Headache, particularly morning headache and chronic headache, may be consequent to, or aggravated by, a sleep disorder, and management of the sleep disorder may improve or resolve the headache. Sleep-disordered breathing is the best example of this relationship. Insomnia is the sleep disorder most often cited by clinical headache populations. Depression and anxiety are comorbid with both headache and sleep disorders (especially insomnia) and consideration of the full headache-sleep-affective symptom constellation may yield opportunities to maximize treatment. This paper reviews the comorbidity of headache and sleep disorders (including coexisting psychiatric symptoms where available). Clinical implications for headache evaluation are presented. Sleep screening strategies conducive to headache practice are described. Consideration of the spectrum of sleep-disordered breathing is encouraged in the headache population, including awareness of potential upper airway resistance syndrome in headache patients lacking traditional risk factors for OSA. Pharmacologic and behavioral sleep regulation strategies are offered that are also compatible with treatment of primary headache.
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PMID:Headache and sleep disorders: review and clinical implications for headache management. 1704 Mar 32

Sleep disorders arise by an interaction between the environment and the genetic makeup of the individual but the relative contribution of nature and nurture varies with diseases. At one extreme are the disorders with simple Mendelian patterns of inheritance such as familial advanced sleep phase syndrome, and at the other extreme are diseases such as insomnia, which can be associated with a multitude of medical and psychiatric conditions. In this article, we review data on the relative contribution of genetic and environmental factors in the pathogenesis of various sleep disorders. The understanding of many of these disorders has been advanced by the study of sleep and circadian rhythms in model laboratory organisms. We summarize this model system research and how it relates to human sleep disorders. The current challenge in this field is the identification of susceptibility genetic loci for complex diseases such as obstructive sleep apnea. We anticipate such identification will increase our ability to assess risk for disease before symptom onset and by doing so will shift the focus from treatment to prevention of disease.
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PMID:Genetic basis for sleep regulation and sleep disorders. 1704 48


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