| 1. |
- Wiklund, Tobias, 1986-
(författare)
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Insomnia Symptoms in Chronic Pain : Clinical presentation, risk and treatment
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, chronic and recurrent pain have gained interest as distinct conditions interacting both with peripheral and central parts of the nervous system as well as with the immune system. The risk of getting affected by abnormal pain modulation i.e., chronic pain is not equally distributed in the population and the search for risk factors is therefore of interest. One potential risk factor for chronic pain is insomnia symptoms i.e., difficulties falling asleep or maintaining sleep. In turn, insomnia symptoms are overrepresented in persons with chronic pain. Common current pain treatments lead to limited improvement of insomnia symptoms calling for treatments specifically directed to improve sleep. The overall aim of this thesis is therefore to investigate the distribution of insomnia severity in patients seeking specialized care for chronic pain, to investigate the role of insomnia severity as a risk factor for spreading of pre-existing pain, and to evaluate potential treatments for insomnia symptoms comorbid to chronic pain.Study I highlighted the high prevalence rates of insomnia symptoms in patients with chronic pain conditions. Roughly, insomnia was six times more common in our sample compared to the general population. We also showed that there were weak connections between insomnia symptoms and other variables (primarily psychological symptoms and pain intensity). In Study II physical exercise was more efficacious than Acceptance and Commitment Therapy-based stress management and the active control group in reducing insomnia symptoms and pain intensity short term. Improvements in physical exercise were largely maintained after twelve months but pain intensity had then also declined in the control group. No improvements in the Acceptance and Commitment Therapy-based stress management remain significant when an intention to treat principles were applied. In Study III, a dose-dependent increase in risk for spreading of pain was confirmed in subjects reporting moderate and severe insomnia symptoms. Though, there was no increase in the risk of pain spreading in subjects reporting sub-threshold insomnia symptoms (according to Insomnia Severity Index). In Study IV patients in the Internet-delivered Cognitive Behavioural Therapy for insomnia group, showed a more rapid improvement in insomnia symptoms than patients in the internet-delivered applied relaxation. The effect of Cognitive Behavioural Therapy for insomnia had declined slightly after six months and the Applied Relaxation group had continued to improve, leading to a comparable outcome on the Insomnia Severity Index at six-month follow-up.In conclusion, insomnia symptoms are common in patients seeking specialized pain care. High levels of insomnia symptoms increase the risk of spreading of pre-existing pain and this in a dose-dependent manner. Physical exercise has significant, but not clinically meaningful effects on pain intensity and insomnia symptoms. Internet-delivered Cognitive Behavioral Therapy for insomnia leads to a more rapid reduction of insomnia symptoms compared to applied relaxation, although long-term effects are uncertain
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| 2. |
- Amofah, Hege A., et al.
(författare)
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Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement
- 2016
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 15:2, s. 168-177
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Tidskriftsartikel (refereegranskat)abstract
- Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.
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| 3. |
- Baglioni, Chiara, et al.
(författare)
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The European Academy for Cognitive Behavioural Therapy for Insomnia : An initiative of the European Insomnia Network to promote implementation and dissemination of treatment
- 2020
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 29:2
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Tidskriftsartikel (refereegranskat)abstract
- Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.
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| 4. |
- Benedict, Christian, Docent, 1976-, et al.
(författare)
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Meal and Sleep Timing before and during the COVID-19 Pandemic : A Cross-Sectional Anonymous Survey Study from Sweden
- 2021
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Ingår i: Clocks & Sleep. - : MDPI AG. - 2624-5175. ; 3:2, s. 251-258
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic and related restrictions, such as stay-at-home-orders, have significantly altered daily routines and lifestyles. Given their importance for metabolic health, we herein compared sleep and meal timing parameters during vs. before the COVID-19 pandemic based on subjective recall, in an anonymous Swedish survey. Among 191 adults (mean age: 47 years; 77.5% females), we show that social jetlag, i.e., the mismatch in sleep midpoint between work and free days, was reduced by about 17 min during the pandemic compared with the pre-pandemic state (p < 0.001). Concomitantly, respondents' sleep midpoint was shifted toward morning hours during workdays (p < 0.001). A later daily eating midpoint accompanied the shift in sleep timing (p = 0.001). This effect was mainly driven by a later scheduled first meal (p < 0.001). No difference in the timing of the day's last meal was found (p = 0.814). Although our survey was limited in terms of sample size and by being cross-sectional, our results suggest that the delay in sleep timing due to the COVID-19 pandemic was accompanied by a corresponding shift in the timing of early but not late meals.
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| 5. |
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| 6. |
- Berezin, Linor, et al.
(författare)
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Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID
- 2024
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Ingår i: Journal of Clinical Sleep Medicine (JCSM). - : American Academy of Sleep Medicine. - 1550-9389 .- 1550-9397. ; 20:1, s. 111-119
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk for developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher amongst those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration.METHODS: Using data from 13,461 respondents from 16 countries who participated in the 2021 survey based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID.RESULTS: Of 2,508 individuals who had COVID-19, 61% reported at least one Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8-fold higher for average-length sleepers (6-9h/night) with pre-existing medical conditions compared to those without pre-existing medical conditions [aOR 1.84 (1.18-2.90), P=0.008]. The risk of Long COVID was 3-fold higher for short sleepers with pre-existing medical conditions [aOR 2.95 (1.04-8.4), P=0.043] and not significantly higher for long sleepers with pre-existing conditions [aOR 2.11 (0.93-4.77), P=0.073] compared to average-length sleepers without pre-existing conditions.CONCLUSIONS: Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at-risk patients.
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| 7. |
- Bjorvatn, Bjørn, et al.
(författare)
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Shift workers are at increased risk of severe COVID-19 compared with day workers : Results from the international COVID sleep study (ICOSS) of 7141 workers.
- 2023
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Ingår i: Chronobiology International. - : Taylor & Francis. - 0742-0528 .- 1525-6073. ; 40:2, s. 114-122
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Tidskriftsartikel (refereegranskat)abstract
- The present study had two main aims. First, to investigate whether shift/night workers had a higher prevalence and severity of COVID-19 compared with day workers. Second, to investigate whether people regularly working in face-to-face settings during the pandemic exhibited a higher prevalence and severity of COVID-19 compared with those having no need to be in close contact with others at work. Data consisted of 7141 workers from 15 countries and four continents who participated in the International COVID Sleep Study-II (ICOSS-II) between May and December 2021. The associations between work status and a positive COVID-19 test and several indications of disease severity were tested with chi-square tests and logistic regressions adjusted for relevant confounders. In addition, statistical analyses were conducted for the associations between face-to-face work and COVID-19 status. Results showed that shift/night work was not associated with an increased risk of COVID-19 compared to day work. Still, shift/night workers reported higher odds for moderate to life-threatening COVID-19 (adjusted odds ratio (aOR) = 2.71, 95%-confidence interval = 1.23-5.95) and need for hospital care (aOR = 5.66, 1.89-16.95). Face-to-face work was associated with an increased risk of COVID-19 (aOR = 1.55, 1.12-2.14) but not with higher disease severity. In conclusion, shift/night work was not associated with an increased risk of COVID-19, but when infected, shift/night workers reported more severe disease. Impaired sleep and circadian disruption commonly seen among shift/night workers may be mediating factors. Working face-to-face increased the risk of COVID-19, likely due to increased exposure to the virus. However, face-to-face work was not associated with increased disease severity.
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| 8. |
- Bjorvatn, Bjørn, et al.
(författare)
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The Association Between Shift Work and Immunological Biomarkers in Nurses
- 2020
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Ingår i: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Shift work is associated with several negative health effects. The underlying pathophysiological mechanisms are unclear, but low-grade inflammation has been suggested to play a role. This project aimed to determine whether levels of immunological biomarkers differ depending on work schedule, self-reported sleep duration, self-reported sleep quality, and presence of shift work disorder (study 1). Furthermore, we aimed to determine whether these biomarkers differ after a night of sleep vs. at the end of a night or a day shift (study 2).Methods: In study 1, 390 nurses provided blood samples after a night of sleep with the dried blood spot method. In study 2, a subset of 55 nurses also provided blood samples after a day shift and after a night shift. The following biomarkers were measured: interleukin-1alpha, interleukin-1beta, interleukin-4, interleukin-6, interleukin-8, interleukin-10, interleukin-13, monocyte chemoattractant protein-1, interferon-gamma, and tumor necrosis factor-alpha. Multiple linear regressions with adjustment for age, sex and body mass index (study 1) and ANOVAs with repeated measures (study 2) were conducted.Results: In study 1, neither work schedule, number of night shifts, number of quick returns (<11 h between consecutive shifts), sleep duration, poor sleep quality, nor shift work disorder were systematically associated with most of these biomarkers. Compared with day only work, day-evening work was associated with higher levels of IL-1alpha and IL-13, quick returns were associated with higher levels of IL-1beta and MCP-1, short sleep duration (<6 h) was associated with lower levels of IL-1beta and higher levels of TNF-alpha, and long sleep duration (8+ h) was associated with higher levels of IL-13. In study 2, IL-1beta levels were higher (large effect size) both after a day shift (14% increase) and a night shift (75% increase) compared with levels after a night of sleep. Similarly, TNF-alpha levels were higher (moderate-large effect size) after a day shift (50% increase) compared to after a night of sleep. In contrast, MCP-1 levels were lower (large effect size) both after a day shift (22% decrease) and a night shift (12% decrease) compared with after a night of sleep.Conclusions: We found some indications that shift work influenced immunological biomarkers. The results should be interpreted with caution due to limitations, e.g., related to the sampling procedure and to low levels of biomarkers in the blood samples.
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| 9. |
- Bolstad, Courtney J, et al.
(författare)
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Nightmare frequency is a risk factor for suicidal ideation during the COVID-19 pandemic.
- 2024
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Ingår i: Journal of Sleep Research. - : WILEY. - 0962-1105 .- 1365-2869. ; , s. e14165-
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Tidskriftsartikel (refereegranskat)abstract
- The association between nightmare frequency (NMF) and suicidal ideation (SI) is well known, yet the impact of the COVID-19 pandemic on this relation is inconsistent. This study aimed to investigate changes in NMF, SI, and their association during the COVID-19 pandemic. Data were collected in 16 countries using a harmonised questionnaire. The sample included 9328 individuals (4848 women; age M[SD] = 46.85 [17.75] years), and 17.60% reported previous COVID-19. Overall, SI was significantly 2% lower during the pandemic vs. before, and this was consistent across genders and ages. Most countries/regions demonstrated decreases in SI during this pandemic, with Austria (-9.57%), Sweden (-6.18%), and Bulgaria (-5.14%) exhibiting significant declines in SI, but Italy (1.45%) and Portugal (2.45%) demonstrated non-significant increases. Suicidal ideation was more common in participants with long-COVID (21.10%) vs. short-COVID (12.40%), though SI did not vary by COVID-19 history. Nightmare frequency increased by 4.50% during the pandemic and was significantly higher in those with previous COVID-19 (14.50% vs. 10.70%), during infection (23.00% vs. 8.10%), and in those with long-COVID (18.00% vs. 8.50%). The relation between NMF and SI was not significantly stronger during the pandemic than prior (rs = 0.18 vs. 0.14; z = 2.80). Frequent nightmares during the pandemic increased the likelihood of reporting SI (OR = 1.57, 95% CI 1.20-2.05), while frequent dream recall during the pandemic served a protective effect (OR = 0.74, 95% CI 0.59-0.94). These findings have important implications for identifying those at risk of suicide and may offer a potential pathway for suicide prevention.
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| 10. |
- Chen, Si-Jing, et al.
(författare)
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The association of insomnia with long COVID : An international collaborative study (ICOSS-II)
- 2023
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 112, s. 216-222
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection.METHODS: Data were collected cross-sectionally (May-Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18-99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety.RESULTS: COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07-1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50-2.66).CONCLUSIONS: The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.
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