- Email: [email protected]
Hyperarousal in insomnia
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Abstracts / Sleep Medicine 14S (2013) e239–e317
Materials and methods: The Helsinki Health Study baseline questionnaire survey data on 40–60-year-old City of Helsinki employees were collected in 2000–2002 (response rate 67%). These data were linked with register data on mortality until the end of 2011 (n = 188 deaths) for those with written consent for such linkages (74%; N = 6,464). Insomnia symptoms included difficulties initiating and maintaining sleep, and non-restorative sleep (none, occasional, i.e. 1–14 nights per month, and frequent, i.e. 15 + nights per month). Baseline covariates included age, sex, education, marital status, obesity, alcohol drinking, physical inactivity, and mental health. Cox regression analysis was used to calculate hazard ratios (HR) and their 95% confidence intervals (CI). Results: At baseline, 21% of women and 17% of men reported frequent insomnia symptoms. The summary measure examining any insomnia symptoms was not associated with all-cause mortality among men or women. However, difficulties in initiating sleep were strongly associated with mortality among men (HR 4.46, 95% CI 2.03–9.77). After adjusting for all covariates, the association attenuated but remained (HR 2.78, 95% CI 1.19–6.48). No associations could be confirmed among women or for difficulties maintaining sleep and non-restorative sleep. Conclusion: Difficulties initiating sleep were associated with mortality among men. Otherwise insomnia symptoms were unassociated with mortality. Studies need to examine insomnia symptoms separately, especially as they may have contrasting associations with mortality. Health care should emphasise early detection and prevention of insomnia symptoms, especially difficulties initiating sleep. Acknowledgements: Funding from the Academy of Finland, Finnish Work Environment Fund and University of Helsinki. http://dx.doi.org/10.1016/j.sleep.2013.11.579
Magnetic resonance imaging study of peripharyngeal mucosal intensity in obstructive sleep apnea patients A. Rahmawati 1, A. Chishaki 2, M. Nagao 3, K. Adachi 4, M. Nishizaka 1,5, S. Ando 5 1 Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 2 Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3 Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 4 Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 5 Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan
Introduction: Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive episodes of airway closure which usually occur in the retro-palatal region of the oropharynx. It has been known that upper airway mucosa in OSA patients is described as edematous. Recurrent injuries owing to vibration of the upper airway tissues or repetitive negative pressure may contribute to this phenomenon. On the other hand, fluid redistribution from the lower to the upper body during nocturnal recumbency could shift the fluid into neck and tissue around airway. The combination of these might contribute the occurrence or worsening of OSA by compressing the airway. Therefore, this study aims to investigate and establish simple magnetic resonance imaging (MRI) parameters, namely T2 mucous-to- masseter intensity ratio (T2MMIR), to assess the degree of tissue water content at the retro-palatal level and its relationship with sleep parameters in OSA patients. Materials and methods: Twenty-seven subjects with OSA underwent polysomnography and cervical MRI with 1.5-tesla during
wakefulness (age 55.0 ± 16.5 y, 77.8% male, with apnea-hypopnea index (AHI) 54.1 ± 27.6 and a body mass index (BMI) 29.4 ± 5.5) were included. On the axial T2-weighted images from the epipharynx to the oropharynx, the signal intensities for masseter muscle and peripharyngeal mucosa were measured. T2 mucous-to-masseter intensity ratio was calculated, and was used as an estimate of water content in the retro-palatal region. Pearson correlation analysis was performed to examine the correlation between peripharyngeal T2MMIR and polysomnography parameters. Results: T2 mucous-to-masseter intensity ratio had moderate, positive correlation with supine AHI (r = 0.388, P < 0.05), AHI (r = 0.408, P < 0.05), arousal index (r = 0.411, P < 0.05), and stage 1 sleep (r = 0.419, P < 0.05). Strong, positive correlation in the T2MMIR and REM AHI was also noted (r = 0.645, P < 0.001). Meanwhile, mean oxygen saturation had moderate, negative correlation with T2MMIR (r = 0.401, P < 0.05). Conclusion: This is the first report to establish peripharyngeal T2MMIR as one simple parameter representing peripharyngeal mucosal water contents due to inflammatory edema and/or fluid redistribution during recumbency, related to severity of OSA. This finding suggested its potential usefulness in reevaluation of change of peripharyngeal mucosa after OSA treatment to confirm its success.
http://dx.doi.org/10.1016/j.sleep.2013.11.580
Hyperarousal in insomnia R. Wix Ramos 1, A. De Abreu Arvelo 1, R. Wix Ramos 2, J. Pastor Gomez 3 1 Universitary Hospital ‘‘La Princesa’’ Madrid, Spanish Sleep Society, Spain 2 Carabobo University, Venezuela 3 Universitary Hospital ‘‘La Princesa’’ Madrid, Spain
Introduction: Insomnia is a common sleep disorder in the world, studies show that has been associated with affective disorders. The hyperarousal state associated with primary insomnia is usually present throughout wakefulness and during sleep, and may be due to an increase in activity of ascending reticular activating system or a reduction in the adaptive drive to sleep. Objectives: analyse the association between insomnia and hyperarousal. Materials and methods: Retrospective study in a sleep medicine unit, 55 patients (27 men’s and 28 woman’s) age between 17 and 84 (57, 2 years old) with a primary diagnosis of insomnia without medication were included. Insomnia diagnosis was defined by ICSD2. In the polysomnography (PSG) objective insomnia was defined by: sleep onset latency longer than 30 min (sleep onset insomnia), wake after sleep onset lasting more than 30 min (sleep maintenance insomnia), total sleep time shorter than 360 min and a terminal wakefulness longer than 30 min (insomnia with too short duration or early morning awakening) or a combination of previous quantitative criteria (mixed type insomnia). The hyperarousal state was defined by index 14/hour of arousal spontaneous index in no REM sleep (ANREM). Association between depressive and anxiety symptoms was determined by a cut-off 50 in each by zung test and compare the PSG of patients who had normal zung test, insomnia severity index (ISI) 15 has defined as clinical insomnia moderate or severe. Results: Patient with comorbidity anxiety and depression (81%) were categorized and 19% without mood disorders. 28% of the patients had sleep onset insomnia, 22% sleep maintenance insomnia, 28% insomnia with too short duration or early morning aweking and 22% mixed type insomnia. Of all patients 78% had hyperarousal state, the arousal spontaneous index in no REM sleep was 28.4 per hour (0.8–71). The correlation coefficients were
Abstracts / Sleep Medicine 14S (2013) e239–e317
significant between ANREM and anxiety (P < 0.05), and not significant in depression. The ANREM was significant higher in patients with mood disorder compare with other patients (P < 0.001) and depression have a significant correlation with an increase of REM sleep. ISI found 94% of all patients had clinical insomnia moderate or severe. Conclusion: There are electrophysiological evidence of hyperarousal and anxiety in patients with primary insomnia. This suggests that the hyperarousal disorder underlying this condition affects both sleep and wake-fullness. Acknowledgement: Hospital La Princesa, Almevan, Circadin. http://dx.doi.org/10.1016/j.sleep.2013.11.581
Obstructive sleep apnea out patient screening study E. Rasul 1, A. Patel 1, A. Khan 2 1 Crozer Chester Medical Center, Temple University, United States 2 Pulmonary Consultants, Crozer Chester Medical Ctr, United States
Introduction: Obstructive sleep apnea (OSA) is increasingly being recognized as an important health care issue. Incidence and prevalence of OSA are gradually increasing worldwide. There is increasing evidence that OSA is being considered as an independent risk factor for hypertension, diabetes mellitus, cardiovascular diseases and stroke, leading to increased cardio-metabolic morbidity and mortality. Many questionnaires are available for OSA screening. Many studies done in peri-operative population showed that the STOP-BANG questionnaire (Snoring, Tiredness, Observed apnea, high blood Pressure, BMI >30, Age >50, neck Circumference, Gender male) is the simplest, with a high positive predictive value. A sleep study is advised for anyone who has 3 or more positive variables from STOP-BANG. The purpose of our study was to analyze the STOPBANG questionnaire’s validity for OSA screening in the primary care setting. Currently, there is no available screening tool for OSA in an outpatient setting. Materials and methods: Study involved a retrospective chart analysis from outpatient clinics. Patients from neurology and sleep clinic were excluded. Electronic medical record was used for patient selection. We randomly selected the first 400 patients who had 3 out of 8 variables from STOP-BANG. Results: Out of 400 selected patients, 124 (31%) had 3 variables, 180 (45%) had 4 variables, 54 (13.5%) had 5 variables, 32 (8%) had 6 variables and 10 (2.5%) had 7 variables. Neck circumference was not documented in the charts so the 8th variable was not available. Out of 400 patients with 3–7 positive STOP-BANG variables, only 25% (100/400) received a sleep study and 73% (73/100) were diagnosed with OSA. Out of 400 patients, 124 (31%) had 3 variables, 16/124 (12.9%) got the sleep study and 10/16 (62.5%) were diagnosed with sleep apnea. Similarly 180/400 (45%) had 4 variables, 26/180 (14.4%) got the sleep study and 15/26 (57.7%) were diagnosed with sleep apnea. 54/400 (13.5%) had 5 variables, 28/54 (51.8%) got the sleep study and 21/28 (75%) were diagnosed with sleep apnea. 32/400 (8%) had 6 variables, 23/32 (71.8%) got the sleep study and 18/23 (78.2%) were diagnosed with sleep apnea. Lastly, 10/400 (2.5%) had 7 variables, 7/10 (70%) got the sleep study and 6/7 (85.7%) were diagnosed with sleep apnea. As mentioned earlier, the 8th variable (neck circumference) was not available in the charts so it was not included in the study. Increasing positive variables translated into more patients with confirmed sleep apnea when tested with sleep study. Conclusion: Primary care physicians should screen all high-risk patients using STOP-BANG questionnaire. STOP-BANG is an affirmative screening tool in peri-operative population and our study indicates that it can also be an efficient screening questionnaire in
e241
primary care clinics. However more studies are needed to validate it. OSA is an easily diagnosable condition but often overlooked. Early recognition and treatment of obstructive sleep apnea may prevent adverse health consequences. Acknowledgement: Ashish Rana, M.D. http://dx.doi.org/10.1016/j.sleep.2013.11.582
Headaches, sleep and academic success in adolescents T. Rebelo-Pinto 1, J. Carneiro-Pinto 2, H. Rebelo-Pinto 2, T. Paiva 1 1 Sleep Medicine Center – CENC, Lisbon, Portugal 2 FCH, UCP, Portugal
Introduction: Sleep complaints often correlate with other health and social problems. During a national study about sleep habits in adolescents, we observed a very high frequency of headaches, so the aim of this work was to analyse what could be correlated with this complaint in terms of sleep duration, daytime sleepiness, academic success, age and gender. Materials and methods: We used a specific questionnaire that included Cleveland Adolescent Sleepiness Scale (CASQ) and other variables concerning sleep related habits, sleep complaints, health complaints and demographics. Teachers from 31 schools across Portugal collected data between January and April, 2012. We used SPSS to analyse data. Results: The 6838 participants were between 12 and 22 years old, mean = 14.97(1.99); 53.3% were females. From the whole sample, 53.8% (3671) students reported having headaches regularly. Those with a headache complaint slept less hours during weekdays (p = 0.008) and more hours on weekends (p = 0.045); they also had more daytime sleepiness (p = 0.000), but showed no differences on academic success (p > 0.050). As expected girls had more headaches than boys (p = 0.000) and there were no differences across age, since all groups had high frequency of headaches (p = 0.098). Conclusion: These results suggest that in adolescents headaches are also related to sleep deprivation or sleep problems. In the future, we should pay more attention to headaches as a symptom of sleep problems and explore which factors may mediate the risk of academic failure in the presence of headaches. Furthermore, the high level of headaches in younger people across all age groups supports the need of early intervention. Acknowledgements: The Sleep-Schools Project team Sleep Medicine Center – CENC, Lisbon. http://dx.doi.org/10.1016/j.sleep.2013.11.583
A taxometric analysis of the children’s sleep habits questionnaire F. Ren 1, G. Wang 2, M. Wang 3, J. Zhang 1 1 Institute of Psychology, Chinese Academy of Sciences, China 2 East China Normal University, China 3 Central South University, China
Introduction: Sleep problems characterized by later bedtimes, insomnia and excessive daytime sleepiness occur in different populations. Sleep problems are highly prevalent, affecting approximately 20–30% of children, and they influence multiple domains of child and family functioning as proven studies using different methods. Sleep problems are connected with many psychiatric disorders, including ADHD, autism, cognitive functioning problems, and behavior problems et al. There is an old important issue in the psychopathology field as to whether the latent construct is dimensional or taxometric. This study
Abstracts / Sleep Medicine 14S (2013) e239–e317
Materials and methods: The Helsinki Health Study baseline questionnaire survey data on 40–60-year-old City of Helsinki employees were collected in 2000–2002 (response rate 67%). These data were linked with register data on mortality until the end of 2011 (n = 188 deaths) for those with written consent for such linkages (74%; N = 6,464). Insomnia symptoms included difficulties initiating and maintaining sleep, and non-restorative sleep (none, occasional, i.e. 1–14 nights per month, and frequent, i.e. 15 + nights per month). Baseline covariates included age, sex, education, marital status, obesity, alcohol drinking, physical inactivity, and mental health. Cox regression analysis was used to calculate hazard ratios (HR) and their 95% confidence intervals (CI). Results: At baseline, 21% of women and 17% of men reported frequent insomnia symptoms. The summary measure examining any insomnia symptoms was not associated with all-cause mortality among men or women. However, difficulties in initiating sleep were strongly associated with mortality among men (HR 4.46, 95% CI 2.03–9.77). After adjusting for all covariates, the association attenuated but remained (HR 2.78, 95% CI 1.19–6.48). No associations could be confirmed among women or for difficulties maintaining sleep and non-restorative sleep. Conclusion: Difficulties initiating sleep were associated with mortality among men. Otherwise insomnia symptoms were unassociated with mortality. Studies need to examine insomnia symptoms separately, especially as they may have contrasting associations with mortality. Health care should emphasise early detection and prevention of insomnia symptoms, especially difficulties initiating sleep. Acknowledgements: Funding from the Academy of Finland, Finnish Work Environment Fund and University of Helsinki. http://dx.doi.org/10.1016/j.sleep.2013.11.579
Magnetic resonance imaging study of peripharyngeal mucosal intensity in obstructive sleep apnea patients A. Rahmawati 1, A. Chishaki 2, M. Nagao 3, K. Adachi 4, M. Nishizaka 1,5, S. Ando 5 1 Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 2 Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3 Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 4 Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 5 Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan
Introduction: Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive episodes of airway closure which usually occur in the retro-palatal region of the oropharynx. It has been known that upper airway mucosa in OSA patients is described as edematous. Recurrent injuries owing to vibration of the upper airway tissues or repetitive negative pressure may contribute to this phenomenon. On the other hand, fluid redistribution from the lower to the upper body during nocturnal recumbency could shift the fluid into neck and tissue around airway. The combination of these might contribute the occurrence or worsening of OSA by compressing the airway. Therefore, this study aims to investigate and establish simple magnetic resonance imaging (MRI) parameters, namely T2 mucous-to- masseter intensity ratio (T2MMIR), to assess the degree of tissue water content at the retro-palatal level and its relationship with sleep parameters in OSA patients. Materials and methods: Twenty-seven subjects with OSA underwent polysomnography and cervical MRI with 1.5-tesla during
wakefulness (age 55.0 ± 16.5 y, 77.8% male, with apnea-hypopnea index (AHI) 54.1 ± 27.6 and a body mass index (BMI) 29.4 ± 5.5) were included. On the axial T2-weighted images from the epipharynx to the oropharynx, the signal intensities for masseter muscle and peripharyngeal mucosa were measured. T2 mucous-to-masseter intensity ratio was calculated, and was used as an estimate of water content in the retro-palatal region. Pearson correlation analysis was performed to examine the correlation between peripharyngeal T2MMIR and polysomnography parameters. Results: T2 mucous-to-masseter intensity ratio had moderate, positive correlation with supine AHI (r = 0.388, P < 0.05), AHI (r = 0.408, P < 0.05), arousal index (r = 0.411, P < 0.05), and stage 1 sleep (r = 0.419, P < 0.05). Strong, positive correlation in the T2MMIR and REM AHI was also noted (r = 0.645, P < 0.001). Meanwhile, mean oxygen saturation had moderate, negative correlation with T2MMIR (r = 0.401, P < 0.05). Conclusion: This is the first report to establish peripharyngeal T2MMIR as one simple parameter representing peripharyngeal mucosal water contents due to inflammatory edema and/or fluid redistribution during recumbency, related to severity of OSA. This finding suggested its potential usefulness in reevaluation of change of peripharyngeal mucosa after OSA treatment to confirm its success.
http://dx.doi.org/10.1016/j.sleep.2013.11.580
Hyperarousal in insomnia R. Wix Ramos 1, A. De Abreu Arvelo 1, R. Wix Ramos 2, J. Pastor Gomez 3 1 Universitary Hospital ‘‘La Princesa’’ Madrid, Spanish Sleep Society, Spain 2 Carabobo University, Venezuela 3 Universitary Hospital ‘‘La Princesa’’ Madrid, Spain
Introduction: Insomnia is a common sleep disorder in the world, studies show that has been associated with affective disorders. The hyperarousal state associated with primary insomnia is usually present throughout wakefulness and during sleep, and may be due to an increase in activity of ascending reticular activating system or a reduction in the adaptive drive to sleep. Objectives: analyse the association between insomnia and hyperarousal. Materials and methods: Retrospective study in a sleep medicine unit, 55 patients (27 men’s and 28 woman’s) age between 17 and 84 (57, 2 years old) with a primary diagnosis of insomnia without medication were included. Insomnia diagnosis was defined by ICSD2. In the polysomnography (PSG) objective insomnia was defined by: sleep onset latency longer than 30 min (sleep onset insomnia), wake after sleep onset lasting more than 30 min (sleep maintenance insomnia), total sleep time shorter than 360 min and a terminal wakefulness longer than 30 min (insomnia with too short duration or early morning awakening) or a combination of previous quantitative criteria (mixed type insomnia). The hyperarousal state was defined by index 14/hour of arousal spontaneous index in no REM sleep (ANREM). Association between depressive and anxiety symptoms was determined by a cut-off 50 in each by zung test and compare the PSG of patients who had normal zung test, insomnia severity index (ISI) 15 has defined as clinical insomnia moderate or severe. Results: Patient with comorbidity anxiety and depression (81%) were categorized and 19% without mood disorders. 28% of the patients had sleep onset insomnia, 22% sleep maintenance insomnia, 28% insomnia with too short duration or early morning aweking and 22% mixed type insomnia. Of all patients 78% had hyperarousal state, the arousal spontaneous index in no REM sleep was 28.4 per hour (0.8–71). The correlation coefficients were
Abstracts / Sleep Medicine 14S (2013) e239–e317
significant between ANREM and anxiety (P < 0.05), and not significant in depression. The ANREM was significant higher in patients with mood disorder compare with other patients (P < 0.001) and depression have a significant correlation with an increase of REM sleep. ISI found 94% of all patients had clinical insomnia moderate or severe. Conclusion: There are electrophysiological evidence of hyperarousal and anxiety in patients with primary insomnia. This suggests that the hyperarousal disorder underlying this condition affects both sleep and wake-fullness. Acknowledgement: Hospital La Princesa, Almevan, Circadin. http://dx.doi.org/10.1016/j.sleep.2013.11.581
Obstructive sleep apnea out patient screening study E. Rasul 1, A. Patel 1, A. Khan 2 1 Crozer Chester Medical Center, Temple University, United States 2 Pulmonary Consultants, Crozer Chester Medical Ctr, United States
Introduction: Obstructive sleep apnea (OSA) is increasingly being recognized as an important health care issue. Incidence and prevalence of OSA are gradually increasing worldwide. There is increasing evidence that OSA is being considered as an independent risk factor for hypertension, diabetes mellitus, cardiovascular diseases and stroke, leading to increased cardio-metabolic morbidity and mortality. Many questionnaires are available for OSA screening. Many studies done in peri-operative population showed that the STOP-BANG questionnaire (Snoring, Tiredness, Observed apnea, high blood Pressure, BMI >30, Age >50, neck Circumference, Gender male) is the simplest, with a high positive predictive value. A sleep study is advised for anyone who has 3 or more positive variables from STOP-BANG. The purpose of our study was to analyze the STOPBANG questionnaire’s validity for OSA screening in the primary care setting. Currently, there is no available screening tool for OSA in an outpatient setting. Materials and methods: Study involved a retrospective chart analysis from outpatient clinics. Patients from neurology and sleep clinic were excluded. Electronic medical record was used for patient selection. We randomly selected the first 400 patients who had 3 out of 8 variables from STOP-BANG. Results: Out of 400 selected patients, 124 (31%) had 3 variables, 180 (45%) had 4 variables, 54 (13.5%) had 5 variables, 32 (8%) had 6 variables and 10 (2.5%) had 7 variables. Neck circumference was not documented in the charts so the 8th variable was not available. Out of 400 patients with 3–7 positive STOP-BANG variables, only 25% (100/400) received a sleep study and 73% (73/100) were diagnosed with OSA. Out of 400 patients, 124 (31%) had 3 variables, 16/124 (12.9%) got the sleep study and 10/16 (62.5%) were diagnosed with sleep apnea. Similarly 180/400 (45%) had 4 variables, 26/180 (14.4%) got the sleep study and 15/26 (57.7%) were diagnosed with sleep apnea. 54/400 (13.5%) had 5 variables, 28/54 (51.8%) got the sleep study and 21/28 (75%) were diagnosed with sleep apnea. 32/400 (8%) had 6 variables, 23/32 (71.8%) got the sleep study and 18/23 (78.2%) were diagnosed with sleep apnea. Lastly, 10/400 (2.5%) had 7 variables, 7/10 (70%) got the sleep study and 6/7 (85.7%) were diagnosed with sleep apnea. As mentioned earlier, the 8th variable (neck circumference) was not available in the charts so it was not included in the study. Increasing positive variables translated into more patients with confirmed sleep apnea when tested with sleep study. Conclusion: Primary care physicians should screen all high-risk patients using STOP-BANG questionnaire. STOP-BANG is an affirmative screening tool in peri-operative population and our study indicates that it can also be an efficient screening questionnaire in
e241
primary care clinics. However more studies are needed to validate it. OSA is an easily diagnosable condition but often overlooked. Early recognition and treatment of obstructive sleep apnea may prevent adverse health consequences. Acknowledgement: Ashish Rana, M.D. http://dx.doi.org/10.1016/j.sleep.2013.11.582
Headaches, sleep and academic success in adolescents T. Rebelo-Pinto 1, J. Carneiro-Pinto 2, H. Rebelo-Pinto 2, T. Paiva 1 1 Sleep Medicine Center – CENC, Lisbon, Portugal 2 FCH, UCP, Portugal
Introduction: Sleep complaints often correlate with other health and social problems. During a national study about sleep habits in adolescents, we observed a very high frequency of headaches, so the aim of this work was to analyse what could be correlated with this complaint in terms of sleep duration, daytime sleepiness, academic success, age and gender. Materials and methods: We used a specific questionnaire that included Cleveland Adolescent Sleepiness Scale (CASQ) and other variables concerning sleep related habits, sleep complaints, health complaints and demographics. Teachers from 31 schools across Portugal collected data between January and April, 2012. We used SPSS to analyse data. Results: The 6838 participants were between 12 and 22 years old, mean = 14.97(1.99); 53.3% were females. From the whole sample, 53.8% (3671) students reported having headaches regularly. Those with a headache complaint slept less hours during weekdays (p = 0.008) and more hours on weekends (p = 0.045); they also had more daytime sleepiness (p = 0.000), but showed no differences on academic success (p > 0.050). As expected girls had more headaches than boys (p = 0.000) and there were no differences across age, since all groups had high frequency of headaches (p = 0.098). Conclusion: These results suggest that in adolescents headaches are also related to sleep deprivation or sleep problems. In the future, we should pay more attention to headaches as a symptom of sleep problems and explore which factors may mediate the risk of academic failure in the presence of headaches. Furthermore, the high level of headaches in younger people across all age groups supports the need of early intervention. Acknowledgements: The Sleep-Schools Project team Sleep Medicine Center – CENC, Lisbon. http://dx.doi.org/10.1016/j.sleep.2013.11.583
A taxometric analysis of the children’s sleep habits questionnaire F. Ren 1, G. Wang 2, M. Wang 3, J. Zhang 1 1 Institute of Psychology, Chinese Academy of Sciences, China 2 East China Normal University, China 3 Central South University, China
Introduction: Sleep problems characterized by later bedtimes, insomnia and excessive daytime sleepiness occur in different populations. Sleep problems are highly prevalent, affecting approximately 20–30% of children, and they influence multiple domains of child and family functioning as proven studies using different methods. Sleep problems are connected with many psychiatric disorders, including ADHD, autism, cognitive functioning problems, and behavior problems et al. There is an old important issue in the psychopathology field as to whether the latent construct is dimensional or taxometric. This study