Robert G. Priest

Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample.

Abstract Objectives: To determine the prevalence of snoring, breathing pauses during sleep, and obstructive sleep apnoea syndrome and determine the relation between these events and sociodemographic variables, other health problems, driving accidents, and consumption of healthcare resources. Design: Telephone interview survey directed by a previously validated computerised system (Sleep-Eval). Setting: United Kingdom. Subjects: 2894 women and 2078 men aged 15-100 years who formed a representative sample of the non-institutionalised population. Main outcome measures: Interview responses. Results: Forty per cent of the population reported snoring regularly and 3.8% reported breathing pauses during sleep. Regular snoring was significantly associated with male sex, age 25 or more, obesity, daytime sleepiness or naps, night time awakenings, consuming large amounts of caffeine, and smoking. Breathing pauses during sleep were significantly associated with obstructive airways or thyroid disease, male sex, age 35-44 years, consumption of anxiety reducing drugs, complaints of non-restorative sleep, and consultation with a doctor in the past year. The two breathing symptoms were also significantly associated with drowsiness while driving. Based on minimal criteria of the International Classification of Sleep Disorders (1990), 1.9% of the sample had obstructive sleep apnoea syndrome. In the 35-64 year age group 1.5% of women (95% confidence interval 0.8% to 2.2%) and 3.5% of men (2.4% to 4.6%) had obstructive sleep apnoea syndrome. Conclusions: Disordered breathing during sleep is widely underdiagnosed in the United Kingdom. The condition is linked to increased use of medical resources and a greater risk of daytime sleepiness, which augments the risk of accidents. Doctors should ask patients and bed partners regularly about snoring and breathing pauses during sleep. Key messages Disordered breathing during sleep is related to several health problems and may have important daytime repercussions The prevalence of disordered breathing during sleep has not been well known in the United Kingdom until now Middle aged men are at higher risk of reporting snoring, breathing pauses during sleep, or obstructive apnoea syndrome Daytime sleepiness, poor sleep, obesity, and the use of healthcare resources are highly correlated with disordered breathing during sleep Obstructive sleep apnoea syndrome is widely unrecognised, and consumption of healthcare resources is higher in this specific population, raising the question of the cause of this higher consumption

Prevalence and Patterns of Problematic Sleep Among Older Adolescents

OBJECTIVE Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence. METHOD A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19-24 years of age). RESULTS Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder. CONCLUSIONS Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.

Prevalence of narcolepsy symptomatology and diagnosis in the European general population

Objective: To determine the prevalence of narcolepsy in the general population of five European countries (target population 205,890,882 inhabitants). Methods: Overall, 18,980 randomly selected subjects were interviewed (participation rate 80.4%). These subjects were representative of the general population of the UK, Germany, Italy, Portugal, and Spain. They were interviewed by telephone using the Sleep-EVAL expert system, which provided narcolepsy diagnosis according to the International Classification of Sleep Disorders (ICSD). Results: Excessive daytime sleepiness was reported by 15% of the sample, with a higher prevalence in the UK and Germany. Napping two times or more in the same day was reported by 1.6% of the sample, with a significantly higher rate in Germany. Cataplexy (episodes of loss of muscle function related to a strong emotion), a cardinal symptom of narcolepsy, was found in 1.6% of the sample. An ICSD narcolepsy diagnosis was found in 0.047% of the sample: The narcolepsy was severe for 0.026% of the sample and moderate in 0.021%. Conclusion: This is the first epidemiologic study that estimates the prevalence of narcolepsy in the general population of these five European countries. The disorder affects 47 individuals/100,000 inhabitants.

How age and daytime activities are related to insomnia in the general population: Consequences for older people

OBJECTIVES: To determine the role of activity status and social life satisfaction on the report of insomnia symptoms and sleeping habits.

Psychotropic medication consumption patterns in the UK general population.

The prevalence of psychotropic medication consumption was assessed in the UK by surveying a representative sample of 4972 non-institutionalized individuals 15 years of age or older (participation rate, 79.6%). A questionnaire was administered over the telephone with the help of the Sleep-Eval Expert System. Topics covered included: type and name of medication, indication, dosage, duration of intake, and medical specialty of prescriber. Also collected were data pertaining to sociodemographics, physical illnesses, and DSM-IV mental disorders. Overall, 3.5% [95% CI: 3-4] of the sample reported current use of psychotropic medication. Consumption was higher among women [4.6% (3.8-5.4)] than men [2.3% (1.7-2.9)], and among the elderly (> or = 65 years of age). The distribution of psychotropics was: hypnotics 1.5%, antidepressants 1.1%, and anxiolytics 0.8%. The median duration of psychotropic intake was 52 weeks. General practitioners were the most common prescribers of psychotropics (over 80% for each class of drug). Nearly half the antidepressant users were diagnosed by the system with a DSM-IV anxiety disorder, and one-fifth the anxiolytic users with a depressive disorder. A marked improvement in sleep quality was reported by half the subjects using a psychotropic for sleep-enhancing purposes. Psychotropic users were more likely than non-users to report episodes of memory loss, vertigo, or anomia. Psychotropic medication consumption is lower and patterns of psychotropic prescription differ in the UK compared with other European and North American countries. Results suggest that physicians may not be sufficiently trained to deal with the overlap between general practice and psychiatry.

Relaxation and imagery in the treatment of breast cancer.

OBJECTIVE--To see whether stress could be alleviated in patients being treated for early breast cancer. DESIGN--Controlled randomised trial lasting six weeks. SETTING--Outpatient radiotherapy department in a teaching hospital. PATIENTS--One hundred fifty four women with breast cancer stage I or II after first session of six week course of radiotherapy, of whom 15 dropped out before end of study. INTERVENTION--Patients saw one of two researchers once a week for six weeks. Controls were encouraged to talk about themselves; relaxation group was taught concentration on individual muscle groups; relaxation and imagery group was also taught to imagine peaceful scene of own choice to enhance relaxation. Relaxation and relaxation plus imagery groups were given tape recording repeating instructions and told to practise at least 15 minutes a day. END POINT--Improvement of mood and of depression and anxiety on self rating scales. MEASUREMENTS AND MAIN RESULTS--Initial scores for profile of mood states and Leeds general scales for depression and anxiety were the same in all groups. At six weeks total mood disturbance score was significantly less in the intervention groups, women in the combined intervention group being more relaxed than those receiving relaxation training only; mood in the control group was worse. Women aged 55 and over benefited most. There was no difference in Leeds scores among the groups. CONCLUSIONS--Patients with early breast cancer benefit from relaxation training.

The prevalence of depressive disorders in the united kingdom

BACKGROUND The prevalence of major psychiatric disorders in the general population is difficult to pinpoint owing to widely divergent estimates yielded by studies employing different criteria, methods, and instruments. Depressive disorders, which represent a sizable mental health care expense for the public purse, are no exception to the rule. METHODS The prevalence of depressive disorders was assessed in a representative sample (n = 4972) of the U.K. general population in 1994. Interviews were performed over the telephone by lay interviewers using an expert system that tailored the questionnaire to each individual based on prior responses. Diagnoses and symptoms lists were based on the DSM-IV. RESULTS Five percent (95% confidence interval = 4.4-5.6%) of the sample was diagnosed by the system with a depressive disorder at the time of the interview, with the rate slightly higher for women (5.9%) than men (4.2%). Unemployed, separated, divorced, and widowed individuals were found to be at higher risk for depression. Depressive subjects were seen almost exclusively by general practitioners (only 3.4% by psychiatrists). Only 12.5% of them consulted their physician seeking mental health treatment, and 15.9% reported being hospitalized in the past 12 months. CONCLUSIONS The study indicates that mental health problems in the community are seriously underdetected by general practitioners, and that these professionals are highly reluctant to refer patients with depressive disorders to the appropriate specialist.

Is sleep-disordered breathing an independent risk factor for hypertension in the general population (13,057 subjects)?

UNLABELLED OBJECTIVES Sleep-disordered breathing has been hypothesized to have a close relationship with hypertension but previous studies have reported mixed results. This is an important health issue that requires further clarification because of the potential impact on the prevention and control of hypertension. METHODS The relationship between hypertension and three forms of sleep-disordered breathing (chronic snoring, breathing pauses and obstructive sleep apnea syndrome (OSAS)) was assessed using representative samples of the non-institutionalized population of the UK, Germany and Italy (159 million inhabitants). The samples were comprised of 13,057 individuals aged 15-100 years who were interviewed about their sleeping habits and their sleep symptoms over the telephone using the Sleep-EVAL system. RESULTS OSAS was found in 1.9% (95% CI: 1.2% to 2.3%) of the UK sample, 1.8% (95% CI: 1.4% to 2.2%) of the German sample and 1.1% (95% CI: 0.8% to 1.4%) of the Italian sample. OSAS was an independent risk factor (odds ratio (OR): 9.7) for hypertension after controlling for possible confounding effects of age, gender, obesity, smoking, alcohol consumption, life stress, and, heart and renal disease. CONCLUSIONS Results from three of the most populated countries in Western Europe indicate that OSAS is an independent risk factor for hypertension. Snoring and breathing pauses during sleep appeared to be non-significant predictive factors.

The place of confusional arousals in sleep and mental disorders - Findings in a general population sample of 13,057 subjects

Confusional arousals, or sleep drunkenness, occur upon awakening and remain unstudied in the general population. We selected a representative sample from the United Kingdom, Germany, and Italy (N = 13,057) and conducted telephone interviews. Confusional arousals were reported by 2.9% of the sample: 1% (95% confidence interval: .8 to 1.2%) of the sample also presented with memory deficits (53.9%), disorientation in time and/or space (71%), or slow mentation and speech (54.4%), and 1.9% (1.7% to 2.1%) reported confusional arousals without associated features. Younger subjects (< 35 years) and shift or night workers were at higher risk of reporting confusional arousals. These arousals were strongly associated with the presence of a mental disorder with odds ratios ranging from 2.4 to 13.5. Bipolar and anxiety disorders were the most frequently associated mental disorders. Furthermore, subjects with Obstructive Sleep Apnea Syndrome (OSAS), hypnagogic or hypnopompic hallucinations, violent or injurious behaviors, insomnia, and hypersomnia are more likely to suffer from confusional arousals. Confusional arousals appears to occur quite frequently in the general population, affecting mostly younger subjects regardless of their gender. Physicians should be aware of the frequent associations between confusional arousals, mental disorders, and OSAS. Furthermore, the high occurrence of confusional arousals in shift or night workers may increase the likelihood of inappropriate response by employees sleeping at work.

PSYCHOMETRIC ANTE-NATAL PREDICTORS OF POST-NATAL DEPRESSED MOOD

One hundred and nine women were studied during the course of pregnancy in an attempt to predict which of them would later rate themselves as suffering from depressed mood up to twelve months post-natally. The psychometric measures used comprised the Zung Self-Rating Scale to measure depression, the DSSI/SAD sub-scale to measure anxiety and the Hostility and Direction of Hostility Questionnaire. Post-natal depression observed up to twelve months post-partum was positively associated with first trimester ante-natal scores on all three measures. The HDHQ and the DSSI/SAD measures were good predictors of depression at six weeks post-partum and both correlated significantly at six and nine months post-partum, whereas the Zung measure predicted depression at nine and twelve months as well as at six weeks post-partum. Parity was significantly associated with severe depression at six months post-partum.