| 1. |
- Araghi, Marzieh Hosseini, et al.
(författare)
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Effectiveness of Lifestyle Interventions on Obstructive Sleep Apnea (OSA) : Systematic Review and Meta-Analysis
- 2013
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 36:10, s. 1553-1562
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Forskningsöversikt (refereegranskat)abstract
- Background: Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined. Objectives: To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4). Methods: A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data. Results: Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I-2 = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]). Conclusions: Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.
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| 2. |
- Blom, Kerstin, et al.
(författare)
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Internet Treatment Addressing either Insomnia or Depression, for Patients with both Diagnoses : A Randomized Trial
- 2015
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 38:2, s. 267-277
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression. Design: A 9-w randomized controlled trial with 6- and 12-mo follow-up. Setting: Internet Psychiatry Clinic, Stockholm, Sweden. Participants: Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists. Interventions: Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression. Measurements and Results: Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Asberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups. Conclusions: In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment.
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| 3. |
- Blom, Kerstin, et al.
(författare)
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Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses
- 2017
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 40:8
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Tidskriftsartikel (refereegranskat)abstract
- This 3-year follow-up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty-three participants were randomized to either treatment, in the form of Internet-delivered therapist-guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3-year follow-up. After 3 years, reductions on depression severity were similar in both groups (between-group effect size, d = 0.33, p =.45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p <.05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co-occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression.
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| 4. |
- Blom, Kerstin, et al.
(författare)
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Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet Treatment for Insomnia
- 2016
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 39:6, s. 1267-1274
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: To investigate the long-term effects of therapist-guided Internet-based insomnia treatment on insomnia severity and sleep medication use, compared with active control. Methods: This study was an 8 week randomized controlled trial with follow-up posttreatment and at 6, 12, and 36 months, set at the Internet Psychiatry Clinic, Stockholm, Sweden. Participants were 148 media-recruited nondepressed adults with insomnia. Interventions were Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) or active control treatment (ICBT-ctrl). Primary outcome was insomnia severity, measured with the Insomnia Severity Index. Secondary outcomes were sleep medication use and use of other treatments. Results: The large pretreatment to posttreatment improvements in insomnia severity of the ICBT-i group were maintained during follow-up. ICBT-ctrl exhibited significantly less improvement posttreatment (between-Cohen d = 0.85), but after 12 and 36 months, there was no longer a significant difference. The within-group effect sizes from pretreatment to the 36-months follow-up were 1.6 (ICBT-i) and 1.7 (ICBT-ctrl), and 74% of the interviewed participants no longer had insomnia diagnosis after 36 mo. ICBT-ctrl used significantly more sleep medication (P = 0.017) and underwent significantly more other insomnia treatments (P < 0.001) during the follow-up period. Conclusions: The large improvements in the ICBT-i group were maintained after 36 months, corroborating that CBT for insomnia has long-term effects. After 36 months, the groups did not differ in insomnia severity, but ICBT-ctrl had used more sleep medication and undergone more other additional insomnia treatments during the follow-up period.
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| 5. |
- Bothelius, Kristoffer, 1973-, et al.
(författare)
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Measuring Acceptance of Sleep Difficulties : The Development of the Sleep Problem Acceptance Questionnaire
- 2015
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 38:11, s. 1815-1822
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: Acceptance may be an important therapeutic process in sleep medicine, but valid psychometric instruments measuring acceptance related to sleep difficulties are lacking. The purpose of this study was to develop a measure of acceptance in insomnia, and to examine its factor structure as well as construct validity. Design: In a cross-sectional design, a principal component analysis for item reduction was conducted on a first sample (A) and a confirmatory factor analysis on a second sample (B). Construct validity was tested on a combined sample (C). Setting: Questionnaire items were derived from a measure of acceptance in chronic pain, and data were gathered through screening or available from pretreatment assessments in four insomnia treatment trials, administered online, via bibliotherapy and in primary care. Participants: Adults with insomnia: 372 in sample A and 215 in sample B. Sample C (n = 820) included sample A and B with another 233 participants added. Measures: Construct validity was assessed through relations with established acceptance and sleep scales. Results: The principal component analysis presented a two-factor solution with eight items, explaining 65.9% of the total variance. The confirmatory factor analysis supported the solution. Acceptance of sleep problems was more closely related to subjective symptoms and consequences of insomnia than to diary description of sleep, or to acceptance of general private events. Conclusions: The Sleep Problem Acceptance Questionnaire (SPAQ), containing the subscales "Activity Engagement" and "Willingness", is a valid tool to assess acceptance of insomnia.
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| 6. |
- Davidson, Per, et al.
(författare)
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The effect of sleep on intrusive memories in daily life : a systematic review and meta-analysis of trauma film experiments
- 2023
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 46:2
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Tidskriftsartikel (refereegranskat)abstract
- Study objectives: To synthesize the literature on the effect of sleep versus wake on the frequency and distress of intrusive memories in everyday life after watching film clips with distressing content as a proxy for traumatic experiences.Methods: We conducted a systematic review by searching PubMed and PsychInfo. The last search was conducted on January 31 st 2022. We included experimental studies comparing sleep and wake groups on intrusions using ecological diary methods, whereas studies lacking a wake control condition or relying solely on intrusion-triggering tasks or retrospective questionnaires were excluded. Meta-analyses were performed to evaluate the results. Risks of biases were assessed following the Cochrane guidelines.Results: Across 7 effect sizes from 6 independent studies, sleep (n = 192), as compared to wake (n=175), significantly reduced the number of intrusive memories (Hedges' g = -0.26, p = .04, 95% CI [-0.50, -0.01]), but not the distress associated with them (Hedges' g = -0.14, p = .25, 95% CI [-0.38, 0.10]).Conclusions: Although the results suggest that sleep reduces the number of intrusions, there is a strong need for high-powered pre-registered studies to confirm this effect. Risks of biases in the reviewed work include the selection of the reported results, measurement of the outcome, and failure to adhere to the intervention. Limits with the current meta-analysis include the few number of studies, only including English-language studies, and the fact that it was not pre-registered.
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| 7. |
- Lancee, Jaap, et al.
(författare)
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Guided Online or Face-to-Face Cognitive Behavioral Treatment for Insomnia : A Randomized Wait-List Controlled Trial
- 2016
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 39:1, s. 183-191
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: To compare the efficacy of guided online and individual face-to-face cognitive behavioral treatment for insomnia (CBT-I) to a wait-list condition. Methods: A randomized controlled trial comparing three conditions: guided online; face-to-face; wait-list. Posttest measurements were administered to all conditions, along with 3-and 6-mo follow-up assessments to the online and face-to-face conditions. Ninety media-recruited participants meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for insomnia were randomly allocated to either guided online CBT-I (n = 30), individual face-to-face CBT-I (n = 30), or wait-list (n = 30). Results: At post-assessment, the online (Cohen d = 1.2) and face-to-face (Cohen d = 2.3) intervention groups showed significantly larger treatment effects than the wait-list group on insomnia severity (insomnia severity index). Large treatment effects were also found for the sleep diary estimates (except for total sleep time), and anxiety and depression measures (for depression only in the face-to-face condition). Face-to-face treatment yielded a statistically larger treatment effect (Cohen d = 0.9) on insomnia severity than the online condition at all time points. In addition, a moderate differential effect size favoring face-to-face treatment emerged at the 3-and 6-mo follow-up on all sleep diary estimates. Face-to-face treatment further outperformed online treatment on depression and anxiety outcomes. Conclusions: These data show superior performance of face-to-face treatment relative to online treatment. Yet, our results also suggest that online treatment may offer a potentially cost-effective alternative to and complement face-to-face treatment.
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| 8. |
- Söderström, Marie, et al.
(författare)
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Sleep and sleepiness in young individuals with high burnout scores
- 2004
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 27:7, s. 1369-1377
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: Burnout is a growing health problem in Western society. This study aimed to investigate sleep in subjects scoring high on burnout but still at work. The purpose was also to study the diurnal pattern of sleepiness, as well as ratings of work stress and mood in groups with different burnout scores.Design: Sleep was recorded in 2 groups (high vs low on burnout) during 2 nights; 1 before a workday and 1 before a day off, in a balanced order. Sleepiness ratings as well as daytime diary ratings were analyzed for the workday and the day off after the sleep recordings.Setting: The polysomnographic recordings were made in the subjects' home.Participants: Twenty-four healthy individuals (14 women and 10 men) between the ages of 24 and 43 years participated.Interventions: N/A.Measurements and Results: A higher frequency of arousals during sleep (Workday: high burnout = 12 +/- 1 per hour, low burnout = 8 +/- 1 per hour; Day off: high burnout = 12 2 per hour, low burnout = 8 +/- 1 per hour), and more subjective awakening problems were found in the high-burnout group. The diurnal pattern of sleepiness indicated that the high-burnout group did not recover in the same way as did the low-burnout group on the day off. Indicators of impaired recovery were also seen within the high-burnout group as a higher degree of bringing work home and working on weekends, as well as more complaints of work interfering with leisure time.Conclusions: Young subjects with high burnout scores, but who are still working, show more arousals during sleep and an absence of reduced sleepiness during days off.
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