Anna F. Johann

Insomnia with objective short sleep duration is associated with longer duration of insomnia in the Freiburg Insomnia Cohort compared to insomnia with normal sleep duration, but not with hypertension.

Study objectives To replicate the association between insomnia with objective short sleep duration and hypertension, type 2 diabetes and duration of insomnia. Design Retrospective case-control study. Setting Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg. Participants 328 patients with primary insomnia classified according to DSM-IV criteria (125 males, 203 females, 44.3 ± 12.2 years). Interventions N/A Measurements All participants were investigated using polysomnography, blood pressure measurements, and fasting routine laboratory. Results Insomnia patients with short sleep duration (< 6 hours) in the first night of laboratory sleep presented with a longer duration of insomnia compared to those with normal sleep duration (≥ 6 hours) in the first night of laboratory sleep. Insomnia patients who were categorised as short sleepers in either night were not more likely to suffer from hypertension (systolic blood pressure of ≥ 140 mm Hg, diastolic blood pressure of ≥ 90 mm Hg, or a previously established diagnosis). Data analysis showed that insomnia patients with objective short sleep duration were not more likely to suffer from type 2 diabetes (fasting plasma glucose level of ≥ 126 mg/dl, or a previously established diagnosis). However, the diabetes analysis was only based on a very small number of diabetes cases. As a new finding, insomnia patients who were categorised as short sleepers in either night presented with increases in liver enzyme levels. Conclusions The finding on insomnia duration supports the concept of two distinct sub-groups of insomnia, namely insomnia with, and without, objectively determined short sleep duration. However, our data challenges previous findings that insomnia patients with short sleep duration are more likely to suffer from hypertension.

Die Prävention körperlicher Erkrankungen durch eine Behandlung von Insomnien

ZusammenfassungIn den vergangenen Jahren wurde eine beachtliche Anzahl an Studien publiziert, die nahelegen, dass Insomnien ein Risikofaktor für körperliche Folgeerkrankungen sind, insbesondere für kardiovaskuläre Erkrankungen. Dies wirft die Frage auf, ob eine Behandlung von Schlafstörungen bei Patienten mit einer Insomnie als Präventionsmaßnahme für kardiovaskuläre Erkrankungen eingesetzt werden kann. Die vorliegende Arbeit liefert eine Übersicht über empirische Studien, in denen diese Fragestellung bearbeitet wurde. Eine randomisierte kontrollierte klinische Studie legt nahe, dass die kognitive Verhaltenstherapie für Insomnien zu einer Verbesserung von Laborparametern führt, die für das kardiovaskuläre Risiko bedeutsam sind. Hierbei sollte jedoch angemerkt werden, dass eine unabhängige Replikation dieses Befundes wünschenswert wäre. Zudem zeigen Register für klinische Studien, dass aktuell einige Studien zu dem Thema durchgeführt werden bzw. kürzlich abgeschlossen wurden. Falls die kognitive Verhaltenstherapie für Insomnien in Bezug auf kardiovaskuläre Erkrankungen tatsächlich präventiv wirksam ist, würde eine flächendeckende Verbreitung dieser Therapie sowohl den betroffenen Patienten helfen als auch zu einer erheblichen Reduktion der Versorgungskosten führen.AbstractIn recent years, a considerable number of studies suggesting that insomnia is a risk factor for somatic diseases, especially cardiovascular diseases have been published. This leads to the question of whether the treatment of sleep disturbances in those with insomnia can prevent future cardiovascular diseases. The current review summarises the empirical literature on this issue. The results of one randomised controlled trial suggest that cognitive behavioural treatment for insomnia leads to a reduction in well-established biomarkers of cardiovascular risk. However, it should be noted that this conclusion awaits replication in independent samples. Furthermore, clinical trials registries reveal that several studies on this issue are either currently being conducted or have just been completed. If cognitive behavioural treatment for insomnia can prevent future cardiovascular diseases, further dissemination of this treatment may both help afflicted individuals and reduce healthcare costs substantially.

Prävention psychischer Störungen durch kognitive Verhaltenstherapie bei Insomnie

The relationship between insomnia and other mental disorders is still not fully understood. Yet, symptoms of insomnia are frequently observed in patients with other mental disorders and often precede the onset of other conditions. In some cases, symptoms of insomnia persist even after the successful treatment of other mental disorders. This observation has led to the assumption that the successful treatment of insomnia may prevent the future onset of other mental disorders. Since then, a considerable number of studies have lent further credibility to that hypothesis. This article reviews recent studies that shed further light on this issue with regard to depressive disorders, anxiety disorders, post-traumatic stress disorder, schizophrenia and alcohol dependence. While no studies have investigated whether cognitive behavioral therapy for insomnia (CBT-I) can prevent the future onset of mental disorders, there is evidence of a positive effect of CBT-I on a number of disorders. There is strong evidence of a positive effect of CBT-I on depression and anxiety disorders suggesting apreventive effect of CBT-I on these. Conversely, the current evidence does not suggest that CBT-I might prevent the onset of PTSD. Finally, research regarding the impact of CBT-I on schizophrenia and alcohol dependence is still at an early stage, and firm conclusions cannot yet be drawn.

Reference Data for Polysomnography-Measured and Subjective Sleep in Healthy Adults

STUDY OBJECTIVES Reference data for sleep are needed for the interpretation of clinical sleep parameters. This analysis aimed to provide polysomnography-measured, spectral analytic and subjective reference data based on a sample of healthy adults. In addition, effects of age and sex were investigated. METHODS The sample was selected from the archival database of the Sleep Center at the University Medical Center Freiburg and consisted of 206 healthy adults aged 19 to 73 years. For an adaptation and a second examination night, polysomnography parameters, spectral analytic data, and subjective sleep estimations are presented. RESULTS With increasing age, sleep became shorter (less total sleep time, more wake time after sleep onset) and lighter (eg, more percentage of stage N1 sleep, increase in fast activity in the beta range). Sleep in females was deeper than sleep in males (eg, higher percentage of stage N3 sleep). Females had higher overall power density than males. Altogether, it is apparent that sleep parameters exhibit high standard deviations, suggesting a high variability within healthy adults and complicating the specification of reference values. CONCLUSIONS Our data suggest that the informative value of sleep reference data in healthy individuals is limited because of high interindividual and intraindividual variation within sleep variables. More research, preferably in the form of meta-analyses and/or large international databases, is needed to further investigate the relevance of such reference data for mental and physical health. In the absence of such knowledge, giving patients feedback about deviations from the norm in their sleep profile may give rise to ill-founded concerns and worry.

Verbesserung der Lebensqualität durch Akzeptanz und CommitmentTherapie

Bei Insomnie ist die Akzeptanz- und Commitment-Therapie (ACT) möglicherweise eine geeignete Behandlungsmethode, vor allem zur Verbesserung der schlafbezogenen Lebensqualität. Eine Pilotstudie erbrachte erste Hinweise auf die Wirksamkeit bei Patienten mit schwerer chronischer Insomnie, die auf eine störungsspezifische kognitive Verhaltenstherapie nicht respondiert hatten.