Ana I. Sánchez

CPAP and behavioral therapies in patients with obstructive sleep apnea: Effects on daytime sleepiness, mood, and cognitive function

Obstructive sleep apnea (OSA) is a disorder characterized by repeated episodes of complete (apneas) or partial (hypopneas) cessations of breathing while sleeping. While continuous positive airway pressure (CPAP) treatment is commonly chosen to treat OSA, various conservative behavioral therapies are also used, particularly in patients unable to tolerate or benefit from CPAP or who have mild OSA. The principal purpose of these behavioral measures is to reduce risk factors which may underlie or exacerbate the disorder (e.g., weight reduction, smoking cessation, reduction/elimination of alcohol consumption, change in sleeping posture and sleep hygiene). Numerous studies have been conducted to evaluate the efficacy and/or effectiveness of CPAP in treating a wide range of OSA symptomatology. The present study consists of an exhaustive bibliographic search in Medline, PsycINFO, and Cochrane Review (1994-2007) databases and selection of works which have evaluated the efficacy and/or effectiveness of CPAP vis-a-vis daytime sleepiness, depression and cognitive functioning in OSA patients. The selected studies include randomized clinical trials in which CPAP was compared with more conservative measures, sham CPAP and oral placebos. The most important studies which evaluate the efficacy of behavioral treatments for OSA are also reviewed and the most remarkable results are presented. Various conclusions derived from the studies are discussed.

When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self-efficacy and sleep quality.

OBJECTIVES Fibromyalgia (FM) is a chronic pain syndrome associated with adverse symptoms of cognitive, behavioural, and emotional dysfunction. Accumulating evidence supports the notion that sleep dysfunction, which affects almost all FM patients, has a reciprocal influence on pain. Yet, little is known about the relationship between sleep and other FM symptoms. The present study analysed the role of sleep dysfunction as a mediator of the impact of pain intensity on anxiety, depression, and daily functioning, comparing them with the mediating role of self-efficacy. DESIGN A cross-sectional design was used. METHODS A sample of 104 women with FM and 86 healthy control women completed a semi-structured interview and self-reported measures of pain, sleep quality, anxiety, depression, and daily functioning. Multiple mediation models were proposed and a bootstrapping approach was used to test these models. RESULTS Women diagnosed with FM had more dysfunctional scores on the variables examined than control participants, and there were significant relationships between all the variables examined in the mediation models for the FM group. The mediation analyses suggested that sleep quality and self-efficacy significantly mediated the relationship between pain and emotional distress. Additionally, self-efficacy was a significant mediator and sleep quality a likely mediator that was marginally significant in the relationship between pain and functioning. CONCLUSIONS Sleep dysfunction is importantly related to FM symptoms and deserves more attention in both research and clinical practice. Our results suggest that, in addition to the usual treatment of FM, improving sleep could optimize the current management of the syndrome.

The effects of continuous positive air pressure treatment on anxiety and depression levels in apnea patients

Abstract Various studies have focused on understanding how the continuous positive air pressure (CPAP) treatment improves the emotional state of obstructive sleep apnea patients, as well as factors that determine improvement. Yet the results are contradictory. The objective of the present study was to evaluate the changes in depression levels, anxiety state and anxiety trait levels of patients with obstructive sleep apnea after 1 month and again after 3 months of CPAP treatment. The sample consisted of 51 obstructive sleep apnea patients. The Beck Depression Inventory (BDI) standardized spanish version was used to assess depressive symptoms. The State‐Trait Anxiety Inventory (STAI) was used to assess two elements of the response to anxiety: anxiety‐state and anxiety‐trait. The results indicate that there exist statistically significant differences in depression levels after 1 month and after 3 months of treatment (P < 0.05). In specific, a drop in depression symptomatology was observed in both experimental conditions. With respect to anxiety state‐trait levels, the obtained results show statistically significant differences in anxiety‐trait levels after 1 month and after 3 months of treatment (P < 0.05) and in anxiety state after 3 months of treatment (P < 0.01). Both variables experienced a decrease after CPAP treatment.

Differential structural and functional changes in penile and coronary arteries from obese Zucker rats.

Erectile dysfunction frequently coexists with coronary artery disease and has been proposed as a potential marker for silent coronary artery disease in type 2 diabetes. In the present study, we comparatively assessed the structural and functional changes of both penile arteries (PAs) and coronary arteries (CAs) from a prediabetic animal model. PAs and CAs from 17- to 18-wk-old obese Zucker rats (OZRs) and from their control counterparts [lean Zucker rats (LZRs)] were mounted in microvascular myographs to evaluate vascular function, and stained arteries were subjected to morphometric analysis. Endothelial nitric oxide (NO) synthase (eNOS) protein expression was also assessed. The internal diameter was reduced and the wall-to-lumen ratio was increased in PAs from OZRs, but structure was preserved in CAs. ACh-elicited relaxations were severely impaired in PAs but not in CAs from OZRs, although eNOS expression was unaltered. Contractions to norepinephrine and 5-HT were significantly enhanced in both PAs and CAs, respectively, from OZRs. Blockade of NOS abolished endothelium-dependent relaxations in PAs and CAs and potentiated norepinephrine and 5-HT contractions in arteries from LZRs but not from OZRs. The vasodilator response to the phosphodiesterase 5 inhibitor sildenafil was reduced in both PAs and CAs from OZRs. Pretreatment with SOD reduced the enhanced vasoconstriction in both PAs and CAs from OZRs but did not restore ACh-induced relaxations in PAs. In conclusion, the present results demonstrate vascular inward remodeling in PAs and a differential impairment of endothelial relaxant responses in PAs and CAs from insulin-resistant OZRs. Enhanced superoxide production and reduced basal NO activity seem to underlie the augmented vasoconstriction in both PAs and CAs. The severity of the structural and functional abnormalities in PAs might anticipate the vascular dysfunction of the more preserved coronary vascular bed.

Attentional deficits in fibromyalgia and its relationships with pain, emotional distress and sleep dysfunction complaints.

Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.

Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial.

This pilot, randomized controlled trial analyzed the effects of a cognitive behavioral therapy (CBT, n = 20) for insomnia vs a sleep hygiene (SH, n = 20) program on the three attentional networks (alertness, orienting, and executive function) and other additional outcome measures (sleep, pain, depression, anxiety, and daily functioning) of fibromyalgia patients. The CBT group showed significant improvement in alertness (F(1, 28) = 11.84, p = .0018), executive functioning (F(1, 28) = 15.76, p = .00059), sleep quality ( F(1, 38) = 6.33, p = .016), and a trend to improvement in daily functioning (p > .06), as compared with the SH group. The improvement in executive functioning was significantly related to the changes in sleep (r = 0.40, p = .026). A CBT for insomnia represents a useful intervention in fibromyalgia patients not only regarding sleep disturbance but also attentional dysfunction and probably daily functioning.

Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial

Sleep disturbances play an important role in the exacerbation of pain and other troubling symptoms reported by patients with fibromyalgia (FM). The objective of this trial was to analyze the efficacy of a cognitive-behavioral therapy for insomnia (CBT-I) versus a sleep hygiene (SH) education program at improving sleep and other clinical manifestations in FM. Sixty-four FM women with insomnia were randomly assigned to the CBT-I or the SH groups, and 59 completed the treatments (30 in the CBT-I group and 29 in the SH group). Participants completed several self-report questionnaires at pre-, post-treatment and follow-ups. The CBT-I group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM.

The relationship between the fear-avoidance model of pain and personality traits in fibromyalgia patients.

This study examined the relationship between several cognitive-affective factors of the fear-avoidance model of pain, the big five model of personality, and functional impairment in fibromyalgia (FM). Seventy-four FM patients completed the NEO Five-Factor Inventory, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale-20, the Pain VigilanceandAwareness Questionnaire, and the Impairment and Functioning Inventory. Results indicated that the cognitive-affective factors of pain are differentially associated with personality traits. Neuroticism and conscientiousness were significant predictors of pain catastrophizing, and neuroticism, openness, and agreeableness were significant predictors of pain anxiety. Personality traits did not contribute significantly to vigilance to pain. The effect of neuroticism upon pain anxiety was mediated by pain catastrophizing, and neuroticism showed a trend to moderate the relationship between impairment and pain anxiety. Results support the fear-avoidance model of pain. Implications of the findings for the understanding and management of FM are discussed.

Effect of 38 h of total sleep deprivation on the waking EEG in women: sex differences

38 h of sleep deprivation in women resulted in decreased alpha, increased theta and increased intrahemispheric correlation during rest and increased theta and reaction time during task. F3-O1 coherent activity was selectively decreased consistent with the role of sleep for recovery of frontal functions. Sleep deprivation effects were milder in women than in men, however, recovery was not complete suggesting that women need more sleep than men to recover.

Relationships Between Physical Symptoms, Emotional Distress, and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

ABSTRACT Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.