- Email: [email protected]
Cognitive behaviour therapy: An additive treatment in delayed sleep phase disorder
e104
Abstracts / Sleep Medicine 14S (2013) e93–e164
ment Disorders (ICSD-II). Among the many kinds of motor manifestation during sleep, rhythmic masticatory muscle activity and bruxism may occur in association with sleep disordered breathing. Authors report a case of a female patient with sleep bruxism secondary to undiagnosed sleep disordered breathing in which motor related symptoms where the reason for consultation. Materials and methods: None. Results: A female patient, aged 67, obese, come to our clinical unit for a dental appointment, referring, as the main reason for consultation, a widespread symmetrical tooth and face ache, usually felt soon after awakening in the morning. There were no signs of acute, local or systemic disease, no history of smoking or alcohol consumption nor chronic medication except anti-hypertensive one. Sleep disordered breathing was suspected after the initial clinical interview and it was also suspected that motor events could be induced by respiratory events. Sleep related breathing disorder was confirmed by an ambulatory cardio-respiratory sleep study showing an AHI of 18/h and ODI of 18/h. It was also confirmed by masseter activity register the diagnosis of sleep bruxism (MI = 10.6/h). Furthermore it was observed a persistent and regular synchrony between the final part of respiratory events and masseter activity, which was absent after the PAP therapy implementation. As the AHI and ODI improved to normal levels (0.9/h and 0.9/h) confirmed by cardiorrespiratory sleep study, patient came to a follow-up visit showing significant clinical improvement. Neither respiratory nor motor events were observed in this later study. Conclusion: Sleep bruxism can be the first and the main manifestation of sleep disordered breathing. Sleep bruxism related symptoms should therefore be adequately evaluated in a global context that should include sleep history, daytime function and sleep study.
low up (p < .001). For Group II baseline mean sleep onset was 03:10 am and sleep offset was 10:22 am. During second week of LT mean sleep onset and sleep offset were significantly advanced (p < .001) to 01:19 am and to 08:09 am, respectively. At 6-week follow-up mean sleep onset and sleep offset were 01:28 am and 09:02 am, respectively. At 6 month follow-up mean sleep onset and sleep offset were 01:22 am and 08:59 am. A continuous decrease in ISI-score was observed from 15.7 at pre-treatment to 6.4 at 6 month follow- up (p < .001). Although non-significant, between- group effect sizes were in favor of the LT + CBT group for sleep onset (Cohen’s d = 0.23 and 0.22), sleep offset (d = 0.31 and 0.61), and severity of sleep difficulties (d = 0.89 and 0.86) at 6 week and 6 month assessments respectively. Conclusion: LT improved diurnal rhythm in both groups. Although not significant, the trend suggests that CBT appear to maintain the effect of LT and slightly decrease severity in sleep difficulties, better than LT alone. Acknowledgement: This project was supported by Bror Gadelius foundation and the Swedish Sleep Research Society.
http://dx.doi.org/10.1016/j.sleep.2013.11.224
Introduction: Excessive daytime sleepiness (EDS) is a common complaint in obstructive sleep apnea (OSA) patients. OSA, the most prevalent sleep breathing disturbance, is a risk-factor for various adverse health conditions. Epidemiological data on this subject in the Georgian population are scarce. The present study is aimed at investigating self-reported daytime sleepiness and the severity of sleep apnea risk in the population of the two largest cities of Georgia – Tbilisi and Kutaisi. Materials and methods: 304 subjects from Tbilisi (mean age 37.07 + 10.73, 67.4% female) and 91 subjects from Kutaisi (39.4 + 10.8, 67.1% female) were surveyed. Participants completed Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Beck depression inventory, short form (BDI SF). The risk of sleep apnea was screened using STOP BANG questionnaire (low risk – 0–2 positive answers; intermediate risk – 3–4 positive answers; high risk – 5 or more positive answers). Socio-demographic data and self evaluation of the overall health status were also obtained. EDS was defined as an ESS score P11. Pearson chi-square tests were used to examine associations between OSA risk and sleep, health and socio-demographic variables. Group comparisons were conducted with unpaired t-test. Results: Mean ESS score in the Tbilisi sample was 6.9 ± 3.8, and 19.7% had an EDS. These parameters were lower in the Kutaisi sample – 5.64 ± 3.54, and 7.7%. The between group differences in ESS score was statistically significant (t393 = 2.8, p = 0.005). Poor sleep quality was observed in 46.1% of Tbilisi sample (mean score 5.56 ± 3.13), and 33% of Kutaisi sample (4.52 ± 2.7). The significant correlation between sleep quality and BDI score was found in both groups. 7.9% of the Tbilisi and 4.4% of the Kutaisi sample had a high risk for OSA. 26% of the Tbilisi and 25.3% of the Kutaisi sample had an intermediate risk for OSA. In the Tbilisi population EDS and OSA severity were significantly associated with health status, sleep quality, BMI, age, gender and with EDS for OSA. In the Kutaisi sample, EDS was associated with health status, sleep quality and gender,
Cognitive behaviour therapy: an additive treatment in delayed sleep phase disorder K. Danielsson 1, M. Jansson-Fröjmark 2, J. Broman 1, A. Markström 3 1 Uppsala University, Department of Neuroscience, Psychiatry, Portugal 2 Stockholm University, Department of Psychology, Portugal 3 Uppsala University, Department of Medical Sciences, Respiratory Medicine and Allergology, Portugal
Introduction: Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder and yet there are still no established treatments with enduring effects. The aim was to examine if cognitive behaviour therapy (CBT) maintain and enhance the effect of light therapy (LT) in DSPD, regarding sleep onset, sleep offset and severity of sleep difficulties. Materials and methods: Thirty-six subjects (17 women) with a mean age of 22 years (range 16–26) participated. All subjects fulfilled the criteria for DSPD according to ICSD-2. The study was a randomised controlled trial. Group I received LT for 2 weeks followed by no treatment for 4 weeks. Group II was administered LT for 2 weeks and then CBT in group once a week for 4 weeks. All patients filled out a sleep diary and the Insomnia Severity Index (ISI) at pre- treatment and at the 2 week, 6 week and 6 month assessments. Results: For Group I baseline mean sleep onset was 02:56 am and sleep offset was 10:22 am. During second week of LT mean sleep onset and sleep offset were significantly advanced (p < .001) to 01:08 am and to 08:14 am, respectively. At 6-week follow-up mean sleep onset and sleep offset were 01:57 am and 09:43 am, respectively. At 6-month follow-up mean sleep onset and sleep offset were 01:50 am and 09:40 am, respectively. A continuous decrease in ISIscore was observed from 15.7 at pre-treatment to 9.6 at 6 month fol-
http://dx.doi.org/10.1016/j.sleep.2013.11.225
Excessive daytime sleepiness and the risk for obstructive sleep apnea in Georgian population N. Oniani 1, M. Datunashvili 1, I. Saxelashvili 1, V. Ibanez 2, K. Espa-Cervena 2, N. Darchia 1 1 Ilia State University, Georgia 2 University Hospital of Geneva, Division of Neuropsychiatry, Switzerland
Abstracts / Sleep Medicine 14S (2013) e93–e164
ment Disorders (ICSD-II). Among the many kinds of motor manifestation during sleep, rhythmic masticatory muscle activity and bruxism may occur in association with sleep disordered breathing. Authors report a case of a female patient with sleep bruxism secondary to undiagnosed sleep disordered breathing in which motor related symptoms where the reason for consultation. Materials and methods: None. Results: A female patient, aged 67, obese, come to our clinical unit for a dental appointment, referring, as the main reason for consultation, a widespread symmetrical tooth and face ache, usually felt soon after awakening in the morning. There were no signs of acute, local or systemic disease, no history of smoking or alcohol consumption nor chronic medication except anti-hypertensive one. Sleep disordered breathing was suspected after the initial clinical interview and it was also suspected that motor events could be induced by respiratory events. Sleep related breathing disorder was confirmed by an ambulatory cardio-respiratory sleep study showing an AHI of 18/h and ODI of 18/h. It was also confirmed by masseter activity register the diagnosis of sleep bruxism (MI = 10.6/h). Furthermore it was observed a persistent and regular synchrony between the final part of respiratory events and masseter activity, which was absent after the PAP therapy implementation. As the AHI and ODI improved to normal levels (0.9/h and 0.9/h) confirmed by cardiorrespiratory sleep study, patient came to a follow-up visit showing significant clinical improvement. Neither respiratory nor motor events were observed in this later study. Conclusion: Sleep bruxism can be the first and the main manifestation of sleep disordered breathing. Sleep bruxism related symptoms should therefore be adequately evaluated in a global context that should include sleep history, daytime function and sleep study.
low up (p < .001). For Group II baseline mean sleep onset was 03:10 am and sleep offset was 10:22 am. During second week of LT mean sleep onset and sleep offset were significantly advanced (p < .001) to 01:19 am and to 08:09 am, respectively. At 6-week follow-up mean sleep onset and sleep offset were 01:28 am and 09:02 am, respectively. At 6 month follow-up mean sleep onset and sleep offset were 01:22 am and 08:59 am. A continuous decrease in ISI-score was observed from 15.7 at pre-treatment to 6.4 at 6 month follow- up (p < .001). Although non-significant, between- group effect sizes were in favor of the LT + CBT group for sleep onset (Cohen’s d = 0.23 and 0.22), sleep offset (d = 0.31 and 0.61), and severity of sleep difficulties (d = 0.89 and 0.86) at 6 week and 6 month assessments respectively. Conclusion: LT improved diurnal rhythm in both groups. Although not significant, the trend suggests that CBT appear to maintain the effect of LT and slightly decrease severity in sleep difficulties, better than LT alone. Acknowledgement: This project was supported by Bror Gadelius foundation and the Swedish Sleep Research Society.
http://dx.doi.org/10.1016/j.sleep.2013.11.224
Introduction: Excessive daytime sleepiness (EDS) is a common complaint in obstructive sleep apnea (OSA) patients. OSA, the most prevalent sleep breathing disturbance, is a risk-factor for various adverse health conditions. Epidemiological data on this subject in the Georgian population are scarce. The present study is aimed at investigating self-reported daytime sleepiness and the severity of sleep apnea risk in the population of the two largest cities of Georgia – Tbilisi and Kutaisi. Materials and methods: 304 subjects from Tbilisi (mean age 37.07 + 10.73, 67.4% female) and 91 subjects from Kutaisi (39.4 + 10.8, 67.1% female) were surveyed. Participants completed Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Beck depression inventory, short form (BDI SF). The risk of sleep apnea was screened using STOP BANG questionnaire (low risk – 0–2 positive answers; intermediate risk – 3–4 positive answers; high risk – 5 or more positive answers). Socio-demographic data and self evaluation of the overall health status were also obtained. EDS was defined as an ESS score P11. Pearson chi-square tests were used to examine associations between OSA risk and sleep, health and socio-demographic variables. Group comparisons were conducted with unpaired t-test. Results: Mean ESS score in the Tbilisi sample was 6.9 ± 3.8, and 19.7% had an EDS. These parameters were lower in the Kutaisi sample – 5.64 ± 3.54, and 7.7%. The between group differences in ESS score was statistically significant (t393 = 2.8, p = 0.005). Poor sleep quality was observed in 46.1% of Tbilisi sample (mean score 5.56 ± 3.13), and 33% of Kutaisi sample (4.52 ± 2.7). The significant correlation between sleep quality and BDI score was found in both groups. 7.9% of the Tbilisi and 4.4% of the Kutaisi sample had a high risk for OSA. 26% of the Tbilisi and 25.3% of the Kutaisi sample had an intermediate risk for OSA. In the Tbilisi population EDS and OSA severity were significantly associated with health status, sleep quality, BMI, age, gender and with EDS for OSA. In the Kutaisi sample, EDS was associated with health status, sleep quality and gender,
Cognitive behaviour therapy: an additive treatment in delayed sleep phase disorder K. Danielsson 1, M. Jansson-Fröjmark 2, J. Broman 1, A. Markström 3 1 Uppsala University, Department of Neuroscience, Psychiatry, Portugal 2 Stockholm University, Department of Psychology, Portugal 3 Uppsala University, Department of Medical Sciences, Respiratory Medicine and Allergology, Portugal
Introduction: Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder and yet there are still no established treatments with enduring effects. The aim was to examine if cognitive behaviour therapy (CBT) maintain and enhance the effect of light therapy (LT) in DSPD, regarding sleep onset, sleep offset and severity of sleep difficulties. Materials and methods: Thirty-six subjects (17 women) with a mean age of 22 years (range 16–26) participated. All subjects fulfilled the criteria for DSPD according to ICSD-2. The study was a randomised controlled trial. Group I received LT for 2 weeks followed by no treatment for 4 weeks. Group II was administered LT for 2 weeks and then CBT in group once a week for 4 weeks. All patients filled out a sleep diary and the Insomnia Severity Index (ISI) at pre- treatment and at the 2 week, 6 week and 6 month assessments. Results: For Group I baseline mean sleep onset was 02:56 am and sleep offset was 10:22 am. During second week of LT mean sleep onset and sleep offset were significantly advanced (p < .001) to 01:08 am and to 08:14 am, respectively. At 6-week follow-up mean sleep onset and sleep offset were 01:57 am and 09:43 am, respectively. At 6-month follow-up mean sleep onset and sleep offset were 01:50 am and 09:40 am, respectively. A continuous decrease in ISIscore was observed from 15.7 at pre-treatment to 9.6 at 6 month fol-
http://dx.doi.org/10.1016/j.sleep.2013.11.225
Excessive daytime sleepiness and the risk for obstructive sleep apnea in Georgian population N. Oniani 1, M. Datunashvili 1, I. Saxelashvili 1, V. Ibanez 2, K. Espa-Cervena 2, N. Darchia 1 1 Ilia State University, Georgia 2 University Hospital of Geneva, Division of Neuropsychiatry, Switzerland