Markku T. Hyyppä

Quality of sleep and chronic illnesses

The association between sleep complaints and chronic illnesses was investigated in several patient groups, including type-2 diabetics, patients with recent myocardial infarction, chronic paraplegia, affective disorders or rheumatic (musculoskeletal) disorders. Sleeping habits and complaints were investigated by questionnaire. All diagnoses were established by the rehabilitation team of the Rehabilitation Research Centre (RRC). The prevalence of difficulty in initiating sleep (DIS) and difficulty in maintaining sleep (DMS) was slightly higher in the myocardial infarction group than in their respective matched control group, whereas patients with paraplegia or an affective disorder suffered markedly from various sleep disorders. Patients with rheumatic illness reported sleep disorders significantly less often than patients with affective disorder, though on admission both groups complained of similar somatic symptoms and poor sleep. Organic disease per se does not explain the prevalence of sleep disorders in patients with chronic illnesses. Psychological and social factors seem to contribute significantly to the prediction of sleep disorders in patients with chronic illnesses.

Does simvastatin affect mood and steroid hormone levels in hypercholesterolemic men? A randomized double-blind trial

Epidemiological and clinical studies have suggested that powerful cholesterol lowering may have adverse effects on mood and psychological well-being. Inhibition of cholesterol biosynthesis by simvastatin (a hydroxymethyl glutaryl coenzyme A reductase inhibitor) may also reduce steroid hormone biosynthesis. To explore if mood changes are related with steroid hormone levels, we designed a randomized double-blind placebo-controlled crossover trial. The separate and combined effects of a Mediterranean-type diet intervention and treatment with simvastatin 20 mg/day PO for 12 weeks were studied in 120 hypercholesterolemic but otherwise healthy middle-aged men. Psychological functioning was assessed with questionnaires, and steroid hormone levels in blood were assayed radioimmunologically before and after the treatments. Simvastatin resulted in a statistically significant increase of depression and somatization without changes in the anxiety, hostility or aggression scores. Mood changes seemed to be unrelated with the statistically significant but clinically insignificant decline in serum testosterone levels and unrelated with the increase in serum dehydroepiandrosterone levels.

Quality of sleep during economic recession in Finland: a longitudinal cohort study.

To assess the association between the economic recession of the 1990s in Finland and sleep behaviour, a longitudinal study was conducted in an adult Finnish population cohort. Baseline data were obtained by means of reports on sleep behaviour, health-related behaviour, health status, and objective laboratory tests in 1983-1987. The second screening conducted in 1992-1995, i.e. during economic recession, repeated data collection by postal questionnaires. The prevalences of various sleep symptoms including insomnia, daytime tiredness, fatigue, parasomnias and the use of hypnotics remained similar in the same age cohorts during economic recession. Alcohol consumption and snoring increased among the middle-aged (30-49 years), though snoring shows the greatest individual stability among various sleep symptoms. Despite some baseline differences in the sleep/health behaviour frequencies, the changes were independent of gender and socioeconomic class. The prevalences over eight years of insomnia and snoring show fair chronicity, whereas daytime tiredness and fatigue seem to be less chronic. Middle-aged participants who were stably employed at the initial screening but became unemployed during economic recession were studied separately. Prospectively unemployed persons suffered more from insomnia and used more hypnotics than the continuously employed. We conclude that the sleep quality of the general Finnish population has not drastically deteriorated during severe economic recession except among unemployed blue-collar workers.

Nocturnal breathing abnormalities in acromegaly after adenomectomy

objective The Incidence of sleep apnoea Is Increased In acromegaly. The aim of the study was to determine the occurrence of nocturnal breathing abnormalities and upper airway morphology In acromegalic patients some years after adenomectomy

Upper airway obstruction in hypothyroidism

Abstract. Objectives. To determine the occurrence and frequency of nocturnal upper airway obstruction in hypothyroidism.

SLEEP MOVEMENTS AND POOR SLEEP IN PATIENTS WITH NON-SPECIFIC SOMATIC COMPLAINTS - I. NO FIRST-NIGHT EFFECT IN POOR AND GOOD SLEEPERS

To evaluate the possible first-night effect on the nocturnal motor activity 25 poor sleepers and 12 good sleepers slept on the Static Charge Sensitive Bed (SCSB) during two consecutive nights. The frequency of body movements in poor sleepers was almost two times higher than in good sleepers. The method itself was reproducible across two nights. There were no statistically significant and systemic level differences between the nights in the movements in bed (MIB). The difference t-test did not either reveal group differences in the magnitude or direction of changes from night to night. Results are consistent with the view that the level of motor activity is one of the determinants of sleep quality. No first-night effect exists in terms of psychomotor activity.

COUPLE THERAPY IMPROVES MENTAL WELL-BEING IN CHRONIC LOW BACK PAIN PATIENTS. A CONTROLLED, FIVE YEAR FOLLOW-UP STUDY

Fifty-six chronic low back pain (CLBP) patients participated in a controlled, prospective 5-yr follow-up study evaluating the long-term effects of five-session couple therapy. Twenty-eight patients were included both in the treatment group and in the control group. Outcome measures were self-reported psychological distress, marital satisfaction, health locus of control, pain and disability as well as clinical examinations. The reliability of the outcome measures was statistically analysed and found acceptable. At the 5-yr follow-up assessments, psychological distress was found to be decreased in the treatment group and increased in controls. The difference between the groups was significant. No difference was found in the other self-reported or clinical outcome measures. We conclude that couple therapy has a prolonged beneficial effect on the mental well-being of CLBP patients.

Sleep movements and poor sleep in patients with non-specific somatic complaints — II. Affective disorders and sleep quality

Nocturnal motor activity of 67 poor sleepers referred to the Rehabilitation Research Centre (RRC) and of 16 healthy subjects were recorded to distinguish poor sleepers without affective disorders from those with affective disorders. All subjects slept on the static charge sensitive bed (SCSB) in a single room of the patient dormitory. All subjects filled out a sleep questionnaire about their subjective sleep quality. After comprehensive rehabilitation consultations the poor sleepers were divided into two subgroups: those with and those without affective disorders. Complaints about insomnia and sleep disorders distinguished poor sleepers from healthy controls but the subgroups of poor sleepers did not differ in the estimation of the quality of sleep. However, when the distribution of body movements through the night was considered, the dynamic of nocturnal motor activity typified poor sleepers with affective symptoms.

Self-perceived fatigue and cortisol secretion in a community sample.

The possible relation of cortisol secretion to self-perceived fatigue was examined in an adult community sample. Serum cortisol levels measured after the dexamethasone suppression test (DST) did not predict fatigue whereas depression assessed by the Beck Depression Inventory (BDI) and current medical treatment were significant and independent predictors. Confounding variables such as age, gender, body mass and social status were not predictive of fatigue. Of putative hypothalamic-pituitary-adrenal abnormalities hypersecretion of cortisol does not typify subjects with self-perceived fatigue.

Neurotransmission and the experience of low back pain; no association between csf monoamine metabolites and pain

&NA; We have investigated the possible associations between the demographic, clinical and psychological characteristics of 80 patients with low back pain and the CSF levels of 5‐hydroxyindoleacetic acid (5‐HIAA), homovanillic acid (HVA) and 3methoxy‐4‐hydroxyphenylglycol (MHPG), the principal central nervous system metabolites of serotonin, dopamine and noradrenaline, and of tryptophan, the amino acid precursor of serotonin. Neither the clinical measures nor the psychological characteristics were significantly correlated with the CSF neurochemistry. Therefore the hypothesis about an intimate relationship between monoaminergic neurotransmission and the experience of chronic low back pain was not confirmed. Among the other factors studied, body height contributed most to the variance in both 5‐HIAA and HVA concentrations; the levels of MHPG increased with age.