J. Catesby Ware

Sleep and psychopathology.

Abstract This article examines the relationship between sleep disturbance and psychopathology. Epidemiological, cross-sectional, and longitudinal data suggest a high rate of comorbidity between sleep disturbance and psychopathology, particularly between insomnia, anxiety, and depression. Between 50% and 80% of psychiatric patients complain of sleep disturbances during the acute phase of their illness. Conversely, among treatment-seeking individuals with a primary complaint of insomnia and randomly selected community samples, approximately one third display a concurrent psychopathology, one third exhibit psychological symptoms that do not necessarily exceed the threshold for a psychiatric disorder, and another third present insomnia as a functionally autonomous disorder. There is a positive relationship between severity of sleep disturbances and concurrent psychopathology, but unequivocal evidence of a cause-and-effect relationship is still lacking. However, longitudinal data suggest that anxiety and stressful life events often precede acute sleep difficulties, whereas persistent insomnia may be a risk factor for subsequent development of depression. Implications for the prevention and treatment of coexisting sleep disturbance and psychopathology are discussed.

Symptoms of gastro‐oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients

Background :u2002Studies suggest obstructive sleep apnea syndrome (OSAS) frequently manifests in patients with gastroesophageal reflux disease (GERD) and that there may be a causal relationship.

Medical Resident Driving Simulator Performance Following a Night on Call

This study compared driving simulation performance after night call and after being off call in 22 medical residents and 1 medical student in a prospective within-subjects counterbalanced design. The results demonstrated an unexpected interaction between call and sex wherein men performed more poorly after night call than women as measured by lane variance and crash frequency. Secondary measures, including caffeine, actigraphy, and subjective total sleep time, did not differ between men and women. Collectively, results of this study and others suggest that medical residents are at risk when driving after a night on call and support the need for resident education to address sleep needs, consequences of sleep disruption, postcall recovery sleep, and countermeasures that may reduce residents driving risks.

Marital satisfaction of wives of untreated sleep apneic men.

OBJECTIVESnThe purpose of this study was to assess marital satisfaction of the wives of untreated sleep apnea patients.nnnDESIGN AND METHODSnA prospective study was carried out that compared the marital satisfaction of wives of men with sleep apnea to the marital satisfaction of wives of men presenting to a primary care physicians office. The study examined three patient groups: 26 wives of men with severe sleep apnea, 19 wives of men with mild sleep apnea, and 19 controls from a primary care physicians office. Those with other significant medical disorders were excluded. Marital satisfaction using the Dyadic Adjustment Scale and a sleep behaviors questionnaire was compared between the patient groups.nnnRESULTSnWives of severe and mild apneic men were similar to controls on marital satisfaction but differed significantly in satisfaction with husbands sleep behaviors.nnnCONCLUSIONSnAlthough the presence of sleep apnea in married men has little effect on their wives overall marital satisfaction, it did affect whether they slept together or apart. For these patients, the choice to sleep apart may have benefited rather than impaired marital satisfaction.

Effects of clomiphene citrate on episodic luteinizing hormone secretion throughout the menstrual cycle

Pituitary luteinizing hormone secretory dynamics (pulse frequency and amplitude) were evaluated in eight normal women administered clomiphene citrate or placebo. After 5 days of treatment clomiphene citrate was found to increase mean luteinizing hormone secretion by increasing the amount of pituitary luteinizing hormone released per pulse. No change in pituitary luteinizing hormone interpulse interval was found in the follicular phase of the cycle, although a faster pulse frequency in the luteal phase was found after clomiphene citrate when compared with placebo. No differences were found in the luteal phase (pulse frequency, amplitude, and mean luteinizing hormone level) after clomiphene citrate versus placebo in the volunteers. These data suggest that the principal mechanism of action of clomiphene citrate is an increase in the concentration of hypothalamic gonadotropin releasing hormone into the hypothalamic-pituitary portal circulation, with a resultant increase in pituitary luteinizing hormone secretion.

Are We Ignoring the Clouds on the Horizon While Looking for Sharks?: Commentary on “Longitudinal Study of Maternal Report of Sleep Problems in Children With Prenatal Exposure to Cocaine and Other Drugs”

For adults, cocaine increases wakefulness and suppresses REM sleep. Sleep disturbance and REM sleep rebound occur with cocaine withdrawal. Although objectively measured sleep parameters may deteriorate during abstinence, patients report that sleep quality remains unchanged or improves (Schierenbeck, Riemann, Berger, & Hornyak, 2008). However, little is known about the effects on sleep of prenatal cocaine exposure (PCE). Dr. Kristin C. Stone reduces this deficiency with a remarkable study that examines sleep of infants and children with PCE. Her study may be the first examining sleep as a primary variable that followed a group of PCE infants well into childhood. She and colleagues carefully navigated a course in uncharted waters, avoiding an enormous number of obstacles that would have sunk lesser researchers or kept them in port. We do know that the electroencephalogram is sensitive to the neurotoxic effects of PCE at 1 year (Sher, Richardson, & Day, 2000). Although objective measures of sleep are important, the bottom line for the sleep of infants and children comes from the caregiver. Poor behavioral sleep rather than an electroencephalogram triggers visits to the pediatrician; triggers caregiver aggravation and frustration; and, in some cases, triggers mistreatment of the sleepless child. Dr. Stone’s study “Longitudinal Study of Maternal Report of Sleep Problems in Children With Prenatal Exposure to Cocaine and Other Drugs” appears in this issue of Behavioral Sleep Medicine (BSM). The prospective longitudinal study compared a large number of children of (a) mothers claiming no drug use, (b) mothers reporting cocaine use, and (c) mothers reporting