A population-based 2-year longitudinal study of insomnia disorder in a Chinese population in Hong Kong

There is a paucity of literature examining the longitudinal course of insomnia using standardized diagnostic criteria. This study aims to evaluate the persistence, remission, relapse, and incidence rates of insomnia symptoms and insomnia disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th edition (DSM-IV and DSM-5). A total of 398 community dwellers were interviewed annually over two years using the Brief Insomnia Questionnaire, a validated questionnaire for deriving insomnia diagnoses. Normal sleepers were defined according to the DSM-5 quantitative criteria as having insomnia symptoms at most twice per week. Estimates were weighted against population age and sex distribution. Persistence for two consecutive years was 26.3, 26.4, and 23.0% for insomnia symptoms, DSM-IV, and DSM-5 insomnia disorders; remission rate was 55.8, 22.9, and 26.1%, relapse rate was 21.8, 1.3, and 0%, while incidence rate was 62.4, 19.6, and 4.5%. The common trajectories for DSM-IV insomnia disorder were to remain the same (26.4%), followed by a change to insomnia symptoms at the second year (25.7%), and at the third year (17.3%). For DSM-5 insomnia disorder, a change to insomnia symptoms at the second year was the commonest (28.3%), followed by continuing the same (23.0%), and a change to insomnia symptoms at the third year (14.0%). Over a two-year naturalistic follow-up, persistence of insomnia disorder was roughly 25%. Changes from insomnia disorder to insomnia symptoms were common; however, remission only occurred in about 25%, highlighting the chronic course of insomnia, perhaps due to a lack of treatment, under-treatment, or resistance to treatment. Incidence of insomnia symptoms was 62.4%, suggesting a high risk of developing insomnia in the general population.     

Insomnia and eating expectancies among college students: the role of emotion dysregulation

There is limited understanding of the relation between insomnia and aspects of eating among college students though available data suggest salient clinical relationships. The present study explored a potential transdiagnostic mechanism in the relation between insomnia symptoms and eating expectancies. Participants were a racially/ethnically diverse sample of 1589 college students (80.4% females; Mage = 22.2 years, SD = 5.27) from an urban university. Primary analysis included three regression-based models of eating expectancies. Insomnia symptoms served as the predictor, and emotion dysregulation served as the indirect (mediator) variable in all models. Results indicated that insomnia symptoms yielded a significant indirect effect through emotion dysregulation on expectancies of eating to help manage negative affect, alleviate boredom, and lead to feeling out of control. Students experiencing insomnia symptoms may be at higher risk for experiencing dysregulated emotions and consequently maladaptive eating expectancies compared to good sleepers.     

Relationship between sleep disturbance,depression and anxiety in the 12 months following a cardiac event

We aimed to assess the prevalence of sleep disturbance in a cardiac patient population over a 12-month period and assess its relationship with treatment adherence, self-efficacy, anxiety and depression. A total of 134 patients consecutively admitted to two Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%) were interviewed at six weeks and four and 12 months. Sleep disturbance was measured using a recode of the Beck Depression Inventory (v.2) item 16. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Sleep disturbance was highly prevalent (69%) at 6 weeks but was not associated with 12-month psychological outcomes. Path analysis revealed that sleep disturbance at 4 months was, however, associated with reduced treatment adherence and self-efficacy, and higher anxiety and depression scores at 12 months. The high prevalence of sleep disturbance in this study and its association with psychological outcomes may have adverse prognostic implications and possibly impede cardiac rehabilitation efforts.     

Sleep and Immunity: Cytokine Pathways Linking Sleep and Health Outcomes

ABSTRACT— The functions of sleep are enigmatic but are beginning to be delineated. Sleep has been long thought to be important for health, and poor sleep is prospectively associated with worsened health outcomes. Yet the mechanisms accounting for this are only partially understood. In this review, we suggest that the immune system plays a role in the relationship between sleep and health and that sleep processes and immunity show bidirectional interactions, as evidenced in both animal and human studies. Immunological signaling molecules, termed cytokines, are important in coordinating brain–immune system communication, and particular cytokines such as tumor necrosis factor, interleukin-1, and interleukin-6 play a crucial role in sleep regulation. Elevated levels of these cytokines are also associated with a number of chronic diseases and may provide a pathway linking poor sleep with health outcomes.     

创伤性截瘫患者的人文关怀

截瘫是一种严重的残疾,其中大部分是由外伤导致脊髓损伤而引起的。在目前的急救护送、诊治方法和康复治疗中仍然存在很多不足。中国的人文关怀有着深厚的传统根基,已经渗透到各个领域。本文就如何应用人文关怀的精神关爱截瘫患者,更好地构建和谐社会谈几点看法。     

The impact of post-learning sleep vs. wakefulness on recognition memory for faces with different facial expressions

A beneficial effect of sleep after learning, compared to wakefulness, on memory formation has been shown in many studies using a variety of tasks. However, none of these studies has specifically addressed recognition memory for faces so far. The recognition of familiar faces, together with the extraction of emotional information from facial expression, is a fundamental cognitive skill in human everyday life, for which specific neural systems and mechanisms of processing have been developed. Here, we investigated the role of post-learning sleep for later recognition memory for neutral, happy, and angry faces. Twelve healthy subjects, after judging the emotional valence of the faces in the evening (learning phase), either slept normally in the subsequent night, with sleep recorded polysomnographically (sleep condition), or remained awake (wake condition) according to a cross-over design. Recognition testing took place in the second evening after learning, i.e. after a further night of regular sleep spent at home. Sleep after learning, compared to wakefulness, enhanced memory accuracy in recognition memory. This effect was independent of the emotional valence of facial expression. The response criterion at recognition testing did not differ between sleep and wake conditions. The amount of non rapid eye movement (NonREM) sleep during post-learning sleep correlated positively with memory accuracy at recognition testing, while time in REM sleep was associated with a speeded responding to the learned faces. Results suggest that face recognition, despite its dependence on specialized brain systems, nevertheless relies on the general neural mechanisms of sleep-associated memory consolidation.     

ERPs studies of cognitive processing during sleep

In the last few decades, several works on cognitive processing during sleep have emerged. The study of cognitive processing with event related potentials (ERPs) during sleep is a topic of great interest, since ERPs allow the study of stimulation with passive paradigms (without conscious response or behavioural response), opening multiple research possibilities during different sleep phases. We review ERPs modulated by cognitive processes during sleep: N1, Mismatch Negativity (MMN), P2, P3, N400-like, N300-N550, among others. The review shows that there are different cognitive discriminations during sleep related to the frequency, intensity, duration, saliency, novelty, proportion of appearance, meaning, and even sentential integration of stimuli. The fascinating results of cognitive processing during sleep imply serious challenges for cognitive models. The studies of ERPs, together with techniques of neuroimaging, have demonstrated the existence of cognitive processing during sleep. A fundamental question to be considered is if these cognitive phenomena are similar to processing that occurs during wakefulness. Based on this question we discussed the existence of possible mechanisms associated with sleep, as well as the specific cognitive and neurophysiologic differences of wakefulness and sleep. Much knowledge is still required to even understand the conjunction of dramatic changes in cerebral dynamics and the occurrence of cognitive processes. We propose some insights based on ERPs research for further construction of theoretical models for integrating both cognitive processing and specific brain sleep dynamics.     

Safe to sleep: Community-based caregiver training

Annually, thousands of infant deaths are classified as sudden unexpected infant deaths (SUIDs). In an effort to reduce the risk of SUIDs, the American Academy of Pediatrics has made a number of recommendations to educate caregivers, childcare providers, and healthcare professionals on safe infant sleep practices. The purpose of the current study was to extend the literature on safe infant sleep practices by teaching caregivers to arrange safe infant sleep environments using a mannequin and common infant items. We partnered with community-based agencies to evaluate the effectiveness of behavioral skills training delivered in a single training session as part of the ongoing pre- or postnatal care these agencies provided. Following training, all participants demonstrated a substantial change in responding and returned favorable social validity ratings. We discuss these outcomes in light of previous studies, limitations, and future directions.