Hsi-Chung Chen

Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review

QUESTION Does an exercise training program improve the quality of sleep in middle-aged and older adults with sleep problems? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults aged over 40 years with sleep problems. INTERVENTION A formal exercise training program consisting of either aerobic or resistance exercise. OUTCOME MEASURES Self-reported sleep quality or polysomnography. RESULTS Six trials were eligible for inclusion and provided data on 305 participants (241 female). Each of the studies examined an exercise training program that consisted of either moderate intensity aerobic exercise or high intensity resistance exercise. The duration of most of the training programs was between 10 and 16 weeks. All of the studies used the self-reported Pittsburgh Sleep Quality Index to assess sleep quality. Compared to the control group, the participants who were randomised to an exercise program had a better global Pittsburgh Sleep Quality Index score, with a standardised mean difference (SMD) of 0.47 (95% CI 0.08 to 0.86). The exercise group also had significantly reduced sleep latency (SMD 0.58, 95% CI 0.08 to 1.08), and medication use (SMD 0.44, 95% CI 0.14 to 0.74). However, the groups did not differ significantly in sleep duration, sleep efficiency, sleep disturbance, or daytime functioning. CONCLUSION Participation in an exercise training program has moderately positive effects on sleep quality in middle-aged and older adults. Physical exercise could be an alternative or complementary approach to existing therapies for sleep problems.

Validity of the five-item brief symptom rating scale among subjects admitted for general health screening

BACKGROUND AND PURPOSE Hospital-based general health screening plays an important role in the early detection of mental disorders. The present study examined the validity of the 5-item Brief Symptom Rating Scale (BSRS-5) in subjects admitted for a 2-day general health screening program. METHODS A cross-sectional survey with a modified 2-phase design was conducted at a medical center in Taipei. A total of 283 consecutive subjects who received health screening in a 1-month period completed the BSRS-5 in the first phase. There were 172 (60.8%) males and 111 (39.2%) females with a mean age of 54.4+/-12.0 years. 115 subjects received a standard psychiatric interview with the Mini International Neuropsychiatric Interview-Plus in the second phase. RESULTS In this hospital-based sample, the internal consistency (Cronbach alpha) coefficient for the BSRS-5 was 0.84 and the area under the receiver-operating characteristic curve was 0.91 [95% confidence interval (CI), 0.86-0.95]. The optimal cut-off point was 5/6. The rate of accurate classification was 82.2% (82.6% sensitivity, 81.8% specificity, 81.9% positive predictive value, 82.5% negative predictive value). The estimated prevalence of minor psychiatric morbidity in this sample was 27.2% (95% CI, 22.2-32.4%). CONCLUSION The BSRS-5 is an effective screening instrument for the identification of psychiatric morbidity in hospital-based health screening settings.

Risk predictors for hypnosedative-related complex sleep behaviors: a retrospective, cross-sectional pilot study.

OBJECTIVE To explore the risk predictors for complex sleep-related behaviors (CSBs) in subjects with a DSM-IV-diagnosed depressive disorder, anxiety disorder, adjustment disorder, somatoform disorder, or sleep disorder taking hypnosedative drugs. METHOD One hundred twenty-five subjects using hypnosedatives were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan from May 2006 to July 2006. All subjects completed a questionnaire that included demographic data, current and childhood sleep habits, and CSBs after taking hypnosedatives. Complex sleep-related behaviors were defined as somnambulism with object manipulation, sleep-related eating, and other amnestic sleep-related behaviors. Demographic and clinical variables were compared in those with CSBs and those without. Then multiple logistic regression analyses were performed in order to identify significant risk predictors for CSBs. RESULTS Of the 125 subjects, 19 (15.2%) reported CSBs, all of whom took zolpidem. Among a total of 67 subjects taking zolpidem, those with CSBs were significantly more likely to be younger (P = .023), to be female (P = .011), to take a higher dose of zolpidem (> 10 mg/d; P < .001), and to not go to sleep immediately after taking zolpidem (P = .047). Multiple logistic regression analyses showed that a higher dose of zolpidem (> 10 mg/d) was the only significant predictor of CSBs (OR = 13.1; 95% CI, 2.6-65.9; P = .002). CONCLUSIONS This pilot study suggests that a higher dosage of zolpidem (> 10 mg/d) is the key risk predictor for CSBs.

Gender differences in the relationship between depression and cardiac autonomic function among community elderly

The mechanism underlying the differential effect of depression on morbidity and mortality in men and women remains unknown. This survey was designed to examine gender effects on the relationship between depressive symptoms and cardiac autonomic function among community dwelling elderly.

Factors associated with fear of falling among community-dwelling older adults in the Shih-Pai Study in Taiwan

Background Fear of falling is an important risk indicator for adverse health related outcomes in older adults. However, factors associated with fear of falling among community-dwelling older adults are not well-explored. Objectives To explore the quality of life and associated factors in fear of falling among older people in the Shih-Pai area in Taiwan. Methods This community-based survey recruited three thousand eight hundred and twenty-four older adults aged ≥ 65 years. The measurements included a structured questionnaire, including quality of life by using Short-Form 36, and information of fear of falling, fall history, demographics, medical conditions, insomnia, sleep quality, depression and subjective health through face-to-face interviews. Results A total of 53.4% of participants reported a fear of falling. The rate of fear of falling was higher in female subjects. Subjects with fear of falling had lower Short Form-36 scores both for men and women. Falls in the previous year, older age, insomnia, depression and worse subjective health were correlates of fear of falling for both sexes. Male-specific associations with fear of falling were the accessibility of medical help in an emergency, diabetes mellitus and stroke. In parallel, cardiovascular diseases were a female-specific correlate for fear of falling. Conclusions Fear of falling is prevalent among community-dwelling older adults. It is seems that there are gender differences in fear of falling with respect to the prevalence and associated factors in older adults. Gender differences should be considered when planning prevention and intervention strategies for fear of falling among older people.

Investigation of associations between NR1D1, RORA and RORB genes and bipolar disorder.

Several genes that are involved in the regulation of circadian rhythms are implicated in the susceptibility to bipolar disorder (BD). The current study aimed to investigate the relationships between genetic variants in NR1D1 RORA, and RORB genes and BD in the Han Chinese population. We conducted a case-control genetic association study with two samples of BD patients and healthy controls. Sample I consisted of 280 BD patients and 200 controls. Sample II consisted of 448 BD patients and 1770 healthy controls. 27 single nucleotide polymorphisms in the NR1D1, RORA, and RORB genes were genotyped using GoldenGate VeraCode assays in sample I, and 492 markers in the three genes were genotyped using Affymetrix Genome-Wide CHB Array in sample II. Single marker and gene-based association analyses were performed using PLINK. A combined p-value for the joining effects of all markers within a gene was calculated using the rank truncated product method. Multifactor dimensionality reduction (MDR) method was also applied to test gene-gene interactions in sample I. All markers were in Hardy-Weinberg equilibrium (P>0.001). In sample I, the associations with BD were observed for rs4774388 in RORA (OR = 1.53, empirical p-value, P = 0.024), and rs1327836 in RORB (OR = 1.75, P = 0.003). In Sample II, there were 45 SNPs showed associations with BD, and the most significant marker in RORA was rs11639084 (OR = 0.69, P = 0.002), and in RORB was rs17611535 (OR = 3.15, P = 0.027). A combined p-value of 1.6×10−6, 0.7, and 1.0 was obtained for RORA, RORB and NR1D1, respectively, indicting a strong association for RORA with the risk of developing BD. A four way interaction was found among markers in NR1D1, RORA, and RORB with the testing accuracy 53.25% and a cross-validation consistency of 8 out of 10. In sample II, 45 markers had empirical p-values less than 0.05. The most significant markers in RORA and RORB genes were rs11639084 (OR = 0.69, P = 0.002), and rs17611535 (OR = 3.15, P = 0.027), respectively. Gene-based association was significant for RORA gene (P = 0.0007). Our results support for the involvement of RORs genes in the risk of developing BD. Investigation of the functional properties of genes in the circadian pathway may further enhance our understanding about the pathogenesis of bipolar illness.

The Relationships Among Sleep Quality and Chronotype, Emotional Disturbance, and Insomnia Vulnerability in Shift Nurses

Background:Shift work is a prominent feature of most nursing jobs. Although chronotype, emotional disturbance, and insomnia vulnerability are important factors for patients with insomnia in general, their effects on shift nurses are unknown. Purpose:This study explores the relationships between the sleep quality of shift nurses and the variables of chronotype, emotional disturbance, and insomnia vulnerability. Methods:A survey was conducted with 398 shift nurses in a medical center. Chronotype, emotional disturbance, insomnia vulnerability, and sleep quality were evaluated using the Smith Morningness–Eveningness Questionnaire, the Brief Symptom Rating Scale, the Ford Insomnia Response to Stress Test, and the Pittsburgh Sleep Quality Index, respectively. Results:On the Pittsburgh Sleep Quality Index, 70.1% of the participants scored higher than 5. Multiple regression analysis revealed that, together with night shift work (b [SE] = 1.05 [0.35], p = .003), higher levels of emotional disturbance (b [SE] = 0.30 [0.05], p < .001) and higher insomnia vulnerability (b [SE] = 0.18 [0.03], p < .001) were predictors of poor sleep quality and that chronotype was not a predictor of poor sleep quality. The multiple mediator model indicated that emotional disturbance significantly mediated an indirect effect of evening chronotype preference on poor subjective sleep quality (one subscale of the Pittsburgh Sleep Quality Index). Conclusions/Implications for Practice:In addition to shift patterns, emotional disturbance and high insomnia vulnerability are factors that may be used to identify shift nurses who face a higher risk of sleep disturbance. Because evening chronotype may indirectly influence subjective sleep quality through the pathway of emotional disturbance, further research into the mechanism that underlies this pathway is warranted.

Anxiety and depression mediate the health-related quality of life differently in patients with cardiovascular disease and stroke-preliminary report of the Yilan study: a population-based community health survey.

Background Cardiovascular disease and stroke have emerged as substantial and growing health challenges to populations around the world. Besides for the survival and medical prognosis, how to improve the health-related quality of life (HRQoL) might also become one of the goals of treatment programs. There are multiple factors that influence HRQol, including comorbidity, mental function and lifestyle. However, substantial research and investigation have still not clarified these underlying pathways, which merit further attention. The purpose of this study was to determine how psychological factors affect the link between cardiovascular disease and stroke with HRQoL. Methods and Result A total of 1,285 elder subjects at least 65 years of age (47.2% male) were enrolled. The mental function and HRQol of each patient was then measured using the Hospital Anxiety and Depression Scale and Short Form-12. After multiple regression analysis, anxiety, depression, cardiovascular disease, stroke, education level and age were shown to be associated with both mental component score (MCS) and physical component score (PCS). In the mediation analysis using the SPSS macro provided by Preacher and Hayes, cardiovascular disease and stroke affected HRQoL via anxiety and depression, respectively. Conclusions These results suggest that cardiovascular disease and stroke have negative impacts on patient MCS and PCS through different underlying pathways. Cardiovascular disease influences the HRQoL both directly and indirectly with the mediation of anxiety, and stroke influences the HRQoL by way of depression. These findings support the proposition that different combinations of both physical and psychological support are necessary to best manage these diseases.

Poor Sleep Quality is Independently Associated with Physical Disability in Older Adults

STUDY OBJECTIVE We aimed to evaluate the association between sleep quality and physical disability in community-dwelling older adults. METHODS There were 213 community-dwelling adults (76 men and 137 women) aged 65 years and above participated into this investigation. The Groningen Activity Restriction Scale and the Pittsburgh Sleep Quality Index were utilized to evaluate physical disability and subjective sleep quality, respectively. Global functional capacity was measured by the 6-minute walk test (6MWT). The Mini Mental State Examination and the Chinese Geriatric Depression Screening Scale were used to evaluate cognitive function and depression. RESULTS Univariate analysis revealed a correlation between physical disability and poor sleep quality, older age, 2 or more comorbidities, depression, functional capacity, and poor cognitive function. However, in the multivariate analyses, depression failed to show significant association with physical disability. In contrast, an independent association was observed between poor sleep quality and physical disability (OR = 2.03; 95% CI: 1.02-4.05). CONCLUSIONS In community-dwelling older adults, subjective poor sleep was significantly associated with physical disability, even after controlling for the effects of other established risk factors.

The Relationship of Sleep Duration with Obesity and Sarcopenia in Community-Dwelling Older Adults

Background: Numerous studies have reported the relationship between sleep duration and obesity in elderly adults; however, little is known about the relationship of sleep duration and sarcopenia. Objective: We examined the relationship of sleep duration with obesity and sarcopenia in community-dwelling older adults. Methods: A total of 488 community-dwelling adults (224 men and 264 women) aged ≥65 years were included in the analysis. Self-reported sleep duration and anthropometric data were collected. Skeletal muscle mass was estimated using the predicted equation from a bioelectrical impedance analysis measurement. Obesity and sarcopenia were defined according to the body mass index and the skeletal muscle mass index, respectively. Results: The association between sleep duration and sarcopenia exhibited a U shape in older adults. Compared to adults with 6-8 h of sleep, adults with <6 h of sleep had a nearly 3-fold increased likelihood of sarcopenia (odds ratio, OR: 2.76, 95% confidence interval, CI: 1.28-5.96), while adults with ≥8 h of sleep had a nearly 2-fold increased risk of sarcopenia (OR: 1.89, 95% CI: 1.01-3.54). Older adults with a sleep duration <6 h were more prone to obesity (OR: 2.15, 95% CI: 1.08−4.30). After gender stratification, the association between obesity and short sleep duration was more robust in women. Conclusion: There were significant associations of sleep duration with either obesity or sarcopenia in community-dwelling older adults. Gender differences in these associations were also observed.