Eileen P. Sloan

Nocturnal and daytime panic attacks—comparison of sleep architecture, heart rate variability, and response to sodium lactate challenge

BACKGROUND The purpose of this study was to determine if nocturnal panic patients have greater autonomic dysregulation than patients with daytime panic. METHODS Three groups were studied: patients who suffer from panic attacks during sleep (n = 12), those who suffer from daytime panic attacks only (n = 12), and control subjects (n = 12). Each subject underwent 24-hour holter monitoring for heart rate variability (HRV), an overnight sleep recording, and sodium lactate challenge during wakefulness. RESULTS There was a marked subjective response to the sodium lactate challenge in the panic disorder (PD) patients but not in control subjects. Each group showed changes in HRV in response to sodium lactate challenge. The decrease in HRV measures was more marked in PD patients as a whole than in control subjects. During non-rapid eye movement (REM) sleep the value for total power (TP) was significantly higher in the nocturnal panic patients. The PD patients as a whole had higher values for TP and low-frequency (LF) power during REM sleep than control subjects. There were no significant differences between the two PD groups in sleep architecture. The PD patients as a whole had lower sleep efficiency and less stage 4 sleep than control subjects. CONCLUSIONS These findings indicate that there are substantial differences between PD and control subjects in autonomic regulation and that there are small differences between patients with daytime panic attacks and those with sleep-related panic attacks.

The relationship between sleep and postpartum mental disorders: A systematic review

BACKGROUND Postpartum mental disorders (e.g., anxiety, depression, psychosis) are serious conditions that affect approximately 10-15% of women after childbirth, and up to 40% of women at risk for these disorders. Research reveals an association between poor sleep quality/quantity and symptoms of anxiety, depression and psychosis. The aim of this systematic review was to evaluate the available evidence for the relationship between sleep and postpartum mental disorders. METHODS Searches included MEDLINE, EMBASE, and EBM Reviews - Cochrane Central Register of Controlled Trials, PsycINFO and EBSCOHost CINAHL through June 30, 2014. Manual searching was performed on reference lists of included articles. Published primary research in any language was included. RESULTS There were 3187 unique titles/abstracts and 44 full-text articles reviewed. Thirty-one studies were included. Evidence was found for the impact of self-reported poor sleep during pregnancy and the postpartum on the development of postpartum depression, with not enough evidence for either postpartum anxiety or psychosis. The evidence for objectively assessed sleep and the development of postpartum disorders was mixed. Among the 31 studies included, 1 was strong, 13 were moderate and 17 were weak. LIMITATIONS Research design, method of assessment, timing of assessment, recruitment strategies, representative adequacy of the samples and inclusion/exclusion criteria all varied widely. Many studies did not use tools validated for the perinatal population and had small sample sizes without power analysis. CONCLUSIONS Sleep interventions represent a potential low-cost, non-pharmacological prevention and treatment strategy for postpartum mental illness. Further high-quality research is needed on this topic area.

Insecure attachment is associated with the α-EEG anomaly during sleep

BackgroundThe α-EEG anomaly during sleep, originally associated with chronic pain, is noted in several psychiatric and medical conditions and is also present in some normal subjects. The exact significance of the α-EEG anomaly is uncertain, but it has been suggested to be a nonspecific response to a variety of noxious stimuli. We propose that attachment insecurity, which is often associated with a state of hypervigilance during wakefulness, may be associated with the α-EEG anomaly during sleep.MethodsThirty one consecutive patients referred to a Sleep Disorders Clinic for clinical assessment of sleep complaints underwent standard polysomnographic recording. The degree of alpha activity in polysomnographs was scored visually according to standard criteria. Attachment insecurity was measured with the Experience in Close Relationships – Revised questionnaire.ResultsAttachment anxiety was significantly associated with the proportion of sleep in which α waves were present (df = 1, F = 5.01, p = 0.03). The relationship between the α-EEG anomaly and attachment anxiety was not explained by the distribution of sleep and mood diagnoses, medications, anxiety symptoms or depression symptoms.ConclusionInterpersonal style in close relationships may be related to sleep physiology. Further research to determine the nature of the relationship between attachment, sleep and other factors that are related to each of these, such as a history of personal adversity, is warranted.

Obstructive sleep apnea in a consecutive series of obese women

The prevalence of obstructive sleep apnea (OSA) in women who were being seen for obesity assessment, rather than for assessment of sleep disturbance, was assessed. A consecutive series of referrals to an eating disorders clinic (n = 40) were studied in the sleep laboratory. Their body mass index (BMI) ranged from 29.4 to 66.9 kg/m2. Overnight polysomnograms were carried out, with respiration and oxygen saturation being monitored. Four women (10%), 1 postmenopausal and 3 premenopausal, had significant OSA. They tended to have a higher percentage of body fat and higher BMIs than the nonapnea group. These findings indicate that the prevalence of OSA is higher in the general population of obese women than is generally thought. They highlight the need for professionals who work with obese women to consider the possibility that some of the complaints of fatigue and tiredness may be a result of OSA.

Viewing the fetus following termination of pregnancy for fetal anomaly.

OBJECTIVES To determine what evidence exists to support the practice of viewing the deceased fetus by women terminating pregnancy for fetal anomalies. DATA SOURCES Electronic databases searched (1966-2007) were Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Dissertation Abstracts Index. STUDY SELECTION Literature was reviewed that either directly or parenthetically dealt with the emotional effects on women of viewing the fetus post termination of pregnancy for fetal anomalies. DATA EXTRACTION No randomized or controlled trials were found. The main conclusion of each article was noted. DATA SYNTHESIS Topical focus is on viewing of the fetus by women following termination of pregnancy for fetal anomalies. Thematic emphasis is on the beneficial and detrimental aspects of fetal viewing assumed by obstetric nurses and physicians and by mental health practitioners. CONCLUSIONS Despite an absence of empirical evidence, most articles concluded that viewing of the fetus by women post termination of pregnancy for fetal anomalies is beneficial and should be promoted. Concerns are expressed that health professionals may be inadvertently encouraging women and their partners to see the fetus because of their own or their institutions particular beliefs and practices. Health professionals must remain mindful of their underlying motives and stay open to respecting the decision of women who conclude that viewing is not appropriate for them.

Circadian Rhythms and Psychiatric Disorders in the Elderly

This article reviews changes in circadian rhythms that have been reported to occur in the elderly psychiatric population. Data relating to circadian changes in normal aging are included where relevant. Information was obtained from: (1) a computerized MEDLINE search from 1975 to May 1996; (2) a review of bibliographies of papers obtained through the computerized search; and (3) texts on chronobiology. We could not locate any information relating to circadian rhythms and mania, anxiety, or paranoid disorders in old age. Disruption to the sleep/wake cycle, temperature, melatonin, and motor activity rhythms have been reported in dementia and depression, and disruption to some neuroendocrine and cardiovascular rhythms are reported in dementia. Disruption to circadian rhythmicity has implications for the management of dementia patients: for example, the sleep/wake and behavioral disturbances, and for the long-term management of mood disorders. A number of circadian markers have not been studied and several patient groups have received no research attention to date.

Characteristics of obstetrical inpatients referred to a consultation-liaison psychiatry service in a tertiary-level university hospital.

A review of psychiatric consult notes of 96 obstetric inpatients referred to a Consultation-Liaison (C-L) psychiatry service in a tertiary-level university general hospital was carried out in order to compare the characteristics of such a service in a North American setting with similar services in other parts of the world. Data extracted from consult notes included: reason for referral, current diagnosis (DSM-IV-R), psychiatric history, obstetrical history, recommended treatment approaches, current psychotropic medications, current gestational age or number of days postpartum, patient age, and partnership status. In addition, obstetrical referrals were calculated as a percentage of hospital-wide referrals to C-L psychiatry. The most prominent findings include: (1) a high C-L psychiatry referral rate from obstetrics as a percentage of total C-L referrals within the study hospital; (2) past psychiatric history alone as a prevalent reason for referral; (3) adverse reproductive event (past and/or current) as a common reason for referral. These findings differ markedly in certain ways from comparable studies and may reflect both the hospital’s large high-risk pregnancy service that represents an at-risk group for mental health issues, and the focus on educational collaboration with obstetrical staff regarding risk factors for, and consequences of, perinatal mental illness. Inpatient perinatal C-L psychiatric services require creative approaches to the accurate identification and treatment of women at risk for antenatal and postpartum mental illness due to psychiatric history and/or reproductive crises.

Sleep and Sleep Disorders in Women

Reproductive and hormonal status influences sleep and sleep-related problems in women. Women tend to be larks (morning-types) rather than owls and they may have a higher sleep need than men. Across the entire adult female life span, changing hormone profiles, sociological and psychological factors may all play a role in the greater female predisposition for insomnia. There is also a growing recognition of gender differences in symptom reporting, for example, in sleep-related breathing disorders. Furthermore, changes in hormone concentration or sensitivity to estrogen and progesterone in particular may underlie many of the symptoms experienced by women. Ideally, fluctuations in hormone levels and their influence on the body and brain are delicately balanced so as not to disrupt sleep. However, there are periods when sleep is adversely affected, such as sleep disturbance caused by pain at menstruation, physical changes particularly in the last trimester of pregnancy, or menopausal hot flashes. In addition, gynecologic conditions and a higher incidence of some medical disorders in women (such as obesity and depression) are associated with increased risk of certain sleep disorders. Possible gender differences in such factors as need for sleep, perception, and symptom reporting should also be considered. In this chapter, we outline normal changes in sleep across a woman’s adult life, gynecologic conditions associated with sleep disorders, and sleep disorders that may manifest at certain times.