Els Tobback

Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients

OBJECTIVE To evaluate whether a 3-factor model of the Pittsburgh Sleep Quality Index (PSQI) scale would fit the constellation of sleep disturbances in patients with a diagnosis of chronic fatigue syndrome (CFS). METHODS Consecutive CFS patients filled out the PSQI. Scores from this self-report questionnaire were examined with exploratory and confirmatory factor analysis (CFA). RESULTS 413 CFS patients were included for analysis in this study. CFA showed that the 7 PSQI component scores clustered into the 3 factors reported by Cole et al. (2006), i.e. Sleep Efficiency, Perceived Sleep Quality and Daily Disturbances. In contrast with the single-factor and all 2-factor models, all factor loadings were significant, and all goodness-of-fit values were acceptable. CONCLUSION In CFS, the PSQI operates as a 3-factor scoring model as initially seen in healthy and depressed older adults. The separation into 3 discrete factors suggests the limited usefulness of the global PSQI as a single factor for the assessment of subjective sleep quality, as also evidenced by a low Cronbachs alpha (0.64) in this patient sample.

Sleep in the chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a disabling condition characterized by severe fatigue lasting for more than six months and the presence of at least four out of eight minor criteria. Sleep disturbance presenting as unrefreshing or nonrestorative sleep is one of these criteria and is very common in CFS patients. Biologically disturbed sleep is a known cause of fatigue and could play a role in the pathogenesis of CFS. However, the nature of presumed sleep impairment in CFS remains unclear. Whilst complaints of NRS persist over time, there is no demonstrable neurophysiological correlate to substantiate a basic deficit in sleep function in CFS. Polysomnographic findings have not shown to be significantly different between subjects with CFS and normal controls. Discrepancies between subjectively poor and objectively normal sleep suggest a role for psychosocial factors negatively affecting perception of sleep quality. Primary sleep disorders are often detected in patients who otherwise qualify for a CFS diagnosis. These disorders could contribute to the presence of daytime dysfunctioning. There is currently insufficient evidence to indicate that treatment of primary sleep disorders sufficiently improves the fatigue associated with CFS. Therefore, primary sleep disorders may be a comorbid rather than an exclusionary condition with respect to CFS.

Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome

OBJECTIVE To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS). METHODS Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders. RESULTS Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder. CONCLUSIONS A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.

The role of basic psychological need satisfaction, sleep, and mindfulness in the health-related quality of life of people living with HIV

Research has not yet examined the relationship between psychological need satisfaction, sleep, mindfulness, and health-related quality of life in people living with HIV. This cross-sectional study (N = 101; 84% male; mean age = 45.48, SD = 12.75) found need satisfaction to relate positively to physical and mental health. Sleep quality fully mediated the association with physical health and partially mediated the association with mental health. Furthermore, mindfulness related to higher sleep quality through higher need satisfaction. Findings underscore the role of need satisfaction in determining health-related quality of life and sleep quality in people living with HIV and suggest that mindfulness may facilitate need satisfaction.

Behavioural hyperventilation as a novel clinical condition associated with central sleep apnoea: A report of three cases

Central sleep apnoea (CSA) is a disorder characterised by repetitive episodes of decreased ventilation due to complete or partial reduction in the central neural outflow to the respiratory muscles. Hyperventilation plays a prime role in the pathogenesis of CSA. Chronic heart failure and dwelling at high altitude are classical conditions in which CSA is induced by hyperventilation. Hyperventilation syndrome (HVS) is a prevalent behavioural condition in which minute ventilation exceeds metabolic demands, resulting in haemodynamic and chemical changes that produce characteristic dysphoric symptoms. HVS is frequently caused by anxiety disorders and panic attacks. Until now, medical literature has focussed primarily on daytime symptoms of behavioural hyperventilation. It is currently unknown how this condition may affect sleep. Three cases are reported in which behavioural hyperventilation was associated with occurrence of significant central sleep apnoea, which was not present during normal tidal breathing in steady sleep. Therefore, behavioural hyperventilation should be added to the list of known clinical conditions associated with CSA.

Sleep, training load and performance in elite female gymnasts

Abstract Training load (TL) and recovery should be in optimal balance to obtain maximal performance gains. We aimed to study sleep as a recovery technique and its relationship with TL and performance in elite athletes. Twenty-six elite female artistic gymnasts were divided into an under 13 (n = 6), an under 14 (n = 6), a junior (n = 7; 14–15y) and a senior (=World Championship (WC) competitors, n = 7; ≥16y) category. Sleep, through sleep logs, and training parameters, using the session Rate of Perceived Exertion (sRPE) scale, were monitored to calculate total sleep time (TST), sleep efficiency (SE), TL, monotony and strain. Performance of WC competitors was evaluated through coach and WC qualification ranking. For the entire group, TST (effect sizes (ES) = −1.12, confidence intervals (CI) = −60:−47, P < .05) and SE (ES = −0.13, CI = −1.40:−0.10, P = .022) were shorter during week than weekend nights. TST and SE were highest in youngest gymnasts (P < .05). TL was lowest in under 13 and senior gymnasts (P < .05), while TL, monotony and strain were highest in junior gymnasts (P < .05). A negative regression was found between TST and TL the day after, while higher TL also led to lower TST the following night (P < .001). For the WC competitors, TST the night before the qualifications was shorter than the mean TST of the WC period (ES = −0.95, CI = −170:24, P = .030). TST correlated with coach ranking (r = −0.857, P = .014). Higher TL correlated with worse WC (r = 0.829, P = .042) and coach (r = 0.893, P = .007) ranking. This research in elite gymnasts indicated associations between decreased TST, augmented TL and inferior performance. Optimizing sleep and TL may therefore represent strategies to enhance performance.

Intraorganizational Communication and Job Satisfaction Among Flemish Hospital Nurses: An Exploratory Multicenter Study

Intraorganizational communication affects job satisfaction and turnover. The goal of this study was to explore relationships between communication and job satisfaction, intention to leave, and burnout among Flemish hospital nurses. A multicenter questionnaire study was conducted in three hospitals using the Communication Satisfaction Questionnaire, the Turnover Intention subscale of the Questionnaire on the Experience and Evaluation of Work, and the Maslach Burnout Inventory. A visual analog scale measured job satisfaction. The mean job satisfaction score was 7.49/10 (±1.43). Almost 7% of nurse participants (93/1,355) reported a high intent to leave, and 2.9% of the respondents (41/1,454) had a score indicative of burnout. All dimensions of communication were associated with job satisfaction. A low score on any dimension of communication satisfaction, except “Relationship With Employees,” was associated with higher intent to leave and burnout. Study findings support the need for management interventions to enhance efficient communication and ensure high-quality care and patient safety.

Polysomnographic and multiple sleep latency testing data in a large sample of patients with chronic fatigue syndrome and their relationship with subjective scores

ABSTRACT Background: Despite the majority of patients with chronic fatigue syndrome (CFS) complaining about sleep disturbances and/or non-refreshing sleep, abnormalities in objective sleep parameters have not consistently been identified in this population. Purpose: To assess objective parameters of sleep and sleepiness in a large sample of patients with CFS and their relationship with the subjective dimensions of mental and physical health, sleep quality, daytime sleepiness and fatigue. Methods: Objective sleep parameters were derived from polysomnography (PSG) and multiple sleep latency testing (MSLT). Subjective scores for mental and physical health, sleep quality, daytime sleepiness and fatigue were based on validated, self-report questionnaires. Hierarchical multiple regression analysis was performed to predict sleepiness, global quality of sleep and fatigue. Results: PSG in 184 CFS patients indicated decreased total sleep time and sleep efficiency as well as increased sleep latency and waking after sleep onset. Only a few modest but significant correlations (r’s < .30) were found between objective parameters of sleep and sleepiness and subjective scores for health, sleep quality and fatigue. Conclusions: Objective sleep parameters indicated poor sleep in CFS, suggesting an insomnia phenotype, but with only modest associations to subjective scores of mental and physical health, sleep quality, daytime sleepiness and fatigue.

A multidisciplinary network for the care of abnormal fatigue and chronic fatigue syndrome in the provinces of East and West Flanders in Belgium

Abstract The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated by the Belgian Health Care Knowledge Centre on the endpoint of socio-professional reintegration. Subsequently, the federal health authorities asked for the elaboration of a new and innovative model of stepped care, aiming at improved integration of diagnosis and treatment into primary care and between levels of health care for patients with CFS. The reference centre of the University Hospital Ghent took the initiative of recruiting partners in the Belgian provinces of East and West Flanders to guarantee the care for patients with medically unexplained symptoms, in particular abnormal fatigue and CFS. A new and innovative care model, in which general practitioners play a central role, emphasizes the importance of early recognition of the patient ‘at risk’, correct diagnosis and timely referral. Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity, to safeguard opportunities for significant health improvement as well as to enhance successful socio-professional reintegration. This approach covers both the large sample of patients developing somatic complaints without obvious disease in an early phase as well as the more limited group of patients with chronic illness, including CFS. Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter. A biopsychosocial model underlies the proposed path of care.

Comparison of subjective sleep and fatigue in breast- and bottle-feeding mothers

OBJECTIVES Artificial milk supplementation remains a popular practice in spite of the well documented and indisputable advantages of breast feeding for both mother and child. However, the association between maternal sleep, fatigue and feeding method is understudied and remains unclear. The aim of this study is to investigate whether perceived sleep and fatigue differ between breast- and bottle feeding post partum women. In addition, the relationship between subjective sleep characteristics and fatigue is examined. METHODS Post partum women (four to 16 weeks) filled out a socio-demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS). FINDINGS Sixty-one within the past week exclusively breast- and 44 exclusively bottle-feeding mothers were included. The first group showed better subjective sleep quality, but lower habitual sleep efficiency as measured by the PSQI. Global PSQI, as well as subjective fatigue and global CIS, did not differ between the two groups. Significant positive correlations were found between global CIS and the number of night feeds and global PSQI. However, only global PSQI significantly predicted global CIS in relation to the number of night feeds. CONCLUSIONS Within a general pattern of deteriorated sleep quality, breast-feeding women showed better subjective sleep quality, but lower habitual sleep efficiency, between four and fourteen weeks after childbirth. However, the PSQI component scores compensated for each other, resulting in absence of any difference in global PSQI sleep quality between the two groups. Global PSQI significantly predicted global CIS, resulting in an absence of any difference in post partum fatigue according to feeding method. IMPLICATIONS FOR PRACTICE Midwives and nurses should, together with the parents, continue to focus on exploring ways to improve maternal sleep quality and to reduce postnatal fatigue.