Chronic Insomnia Associated With Higher Risk of End Stage Kidney Disease and Mortality

MedicalResearch.com Interview with:
Dr. Jun Ling (Lucy) Lu, MD, CCRP
Senior Clinical Research Coordinator in the Department of Medicine

Csaba P Kovesdy MD FASN
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program

Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Around one third of the world’s population suffers from insomnia. Previous studies showed that sleep disorders affect the hypothalamic–pituitary–adrenal axis and the sympatho-adrenal system, which may cause abnormalities in several organ systems and pathways causing metabolic or cardiovascular abnormalities. However, there is inadequate evidence of an association between chronic insomnia and adverse renal outcomes.

After examining 938,473 US veterans (4.4% of them had chronic insomnia) with baseline estimated eGFR >60 ml/min/1.73m2, we found that chronic insomnia is associated with a 43% higher risk of all-cause mortality, a 2.5-fold higher incidence of eGFR ≤45ml/min/1.73m2, a 2.3-fold higher ESRD risk, and with rapid loss of kidney function.

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Insomnia Linked to Increased Risk of Stroke and Heart Attack

MedicalResearch.com Interview with:
Qiao He

Master’s degree student
China Medical University
Shenyang, China

MedicalResearch.com: What is the background for this study?

Response: Sleep is an important factor for biological recovery functions, but in modern society, more and more people have complained having sleep problems like insomnia, one of the main sleep disorders. It is reported that approximately one-third of the German general population has been suffering from insomnia symptoms. In decades, many researchers have found associations between insomnia and bad health outcomes. Insomnia seems to be a big health issue. However, the results from previous studies regarding the association of insomnia and cardiovascular or cerebrovascular events were inconsistent. Therefore, we conducted this study.
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Insomniacs May Benefit From Internet Delivered Program

MedicalResearch.com Interview with:

Lee M. Ritterband, Ph.D. Professor, Department of Psychiatry and Neurobehavioral Sciences Director, Center for Behavioral Health and Technology University of Virginia School of Medicine Ivy Foundational Translational Research Building Charlottesville, VA 22903

Dr. Lee M. Ritterband

Lee M. Ritterband, Ph.D.
Professor, Department of Psychiatry and Neurobehavioral Sciences
Director, Center for Behavioral Health and Technology
University of Virginia School of Medicine
Ivy Foundational Translational Research Building
Charlottesville, VA 22903 

MedicalResearch.com: What is the background for this study?

Response: Cognitive behavioral therapy for insomnia, a non-pharmacological intervention, is the first line recommendation for adults with chronic insomnia (see recommendations made earlier this year from the American College of Physicians). Access to CBT-I, however, is limited by numerous barriers, including a limited supply of behavioral medicine providers. One way to help improve access to this effective treatment is to develop and evaluate additional delivery methods of CBT-I, including Internet-delivered CBT-I.

This study was designed to evaluate the efficacy of an Internet-delivered CBT-I program (SHUTi: Sleep Healthy Using The Internet) over the short-term (9-weeks) and long-term (1-year).

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Treating Insomnia May Improve Blood Pressure Control

MedicalResearch.com Interview with:

Haicong Li Director and Professor, Department of Geriatrics China-Japan Friendship Hospital Beijing, China.

Dr. Haicong Li

Haicong Li
Director and Professor, Department of Geriatrics
China-Japan Friendship Hospital
Beijing, China. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Based on our clinical observations over the years, we noticed two common
phenomena:

  • One is that the occurrence of hypertension in patients with
    chronic sleep disorders tend to be higher than those with normal sleep
    conditions;
  • The other is that the blood pressure of some hypertensive
    patients cannot be lowered to normal level even with anti-hypertensive
    treatments, of which group many have sleep disorders.

So we hypothesized that the improvement of insomnia can effectively help lower the of
hypertensive patients and the combination of anti-hypertensive medication
and sedative-hypnotic drugs can achieve better therapeutic effects.
In our experiment, a total of 402 patients with a diagnosis of insomnia and
hypertension were selected and randomly divided into two groups. The
treatment group (202 cases) received standard antihypertensive treatment
with Estazolam and the control group (200 cases) received standard
antihypertensive treatment with placebo. We measured the sedentary
diastolic (SiSBP) and systolic blood pressure (SiDBP) before the treatment
and every 7 days during the experiment. To assess the sleep quality and
anxiety and depression levels of patients, we reported the scores of the
Pittsburgh Sleep Quality Index (PSQI), the Hamilton Anxiety Rating Scale
(HAMA) and the Hamilton Depression Scale-17 (HAMD 17) at the same time
points.

At the conclusion of the experiment, PSQI, HAMA, and HAMD17
scores were significantly lower than those of the control group (P<0.001).
The insomnia treatment efficacy of Estazolam in the treatment group was
67.3%, significantly higher than that (14.0%) of the control group (P <
0.001). The blood pressure of the treatment group showed significant improvement
throughout the experiment. By Day 28, the decrease of SiSBP and SiDBP in
the treatment group was significantly greater than that of the control group
(SiSBP: 10.5±3.9 vs. 3.4±2.5; DiSBP: 8.1±3.6 vs. 2.7±2.1, mmHg, P<0.001)
and the compliance rate of goal BP (<140/90 mmHg) was 74.8% with
Estazolam, compared to 50.5% with placebo (P<0.001).

Thus, our findings indicated that the improvement of insomnia can significantly help lower the blood pressure in hypertensive patients.

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Emotional Lability and Insomnia Linked

Markus Jansson-Fröjmark PhD Associate professor, clinical psychologist Department of Psychology Stockholm University
MedicalResearch.com Interview with:
Markus Jansson-Fröjmark PhD

Associate professor, clinical psychologist
Department of Psychology
Stockholm University

 

Medical Research: What is the background for this study? What are the main findings?

Response: There is ample evidence suggesting that how people regulate their emotions might influence several types of psychopathology, including anxiety and mood disorders. The purpose of our longitudinal investigation was therefore to examine the association between emotion regulation and how insomnia develops over time. Our main finding was that people whose ability to regulate their emotions had diminished were more likely to develop insomnia and that it was more likely to be persistent. A reduced ability to regulate emotions was associated with an 11% increased risk of developing a new bout of insomnia or reporting persistent insomnia. For anyone that has to deal with insomnia on a daily basis, they may find that is can effect a large part of their lives. Sleep is important for even, as it allows us all to function properly throughout the day. When it comes to Insomnia, there is medication out there that people can take that may help them with this issue. A popular method of treatment is through the use of medical marijuana. If this is something that you have been planning on trying, you would need to obtain your medical marijuana card in Cincinnati (if you live in this city) before you could start receiving product. Hopefully this will help with your insomnia and provide you with a better quality of sleep.

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Cognitive Behavioral Therapy May Help Many Patients With Insomnia

Jason Ong, Ph.D., CBSM Associate Professor, Department of Behavioral Sciences Director, Behavioral Sleep Medicine Training Program Rush University Medical CenterMedicalResearch.com Interview with:
Jason Ong, Ph.D., CBSM
Associate Professor, Department of Behavioral Sciences
Director, Behavioral Sleep Medicine Training Program
Rush University Medical Center

Medical Research: What is the background for this study? What are the main findings?

Response: Insomnia is a very common sleep problem that was previously thought to be related to another medical or psychiatric condition.  Evidence now supports the notion that insomnia can emerge as a disorder distinct from the comorbid condition.  In this study, we evaluated the effectiveness of cognitive behavioral therapy for insomnia (CBT-I), the most widely used nonpharmacologic treatment for insomnia, in the context of medical and psychiatric comorbidities.

We conducted a systematic review and meta-analysis of 37 studies and found that 36% of patients who received cognitive behavioral therapy for insomnia were in remission at post-treatment compared to 17% who received a control or comparison condition.  CBT-I had medium to large effects for improving sleep quality and reducing the amount of time awake in bed.  Positive findings were also found on the comorbid condition, with greater improvements in psychiatric conditions compared to medical conditions.

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Cognitive Therapy May Be Safe and Effective For Chronic Insomnia

MedicalResearch.com Interview with:
Dr David Cunnington
Sleep Physician & Director
Melbourne Sleep Disorders Centre
East Melbourne Australia

Medical Research: What is the background for this study? What are the main findings?

Response: Insomnia is a very common problem with 15-20% of adults having chronic insomnia, that is, trouble getting to sleep or staying asleep most days for  3 months or more. The most commonly used treatment is sleeping pills or hypnotics, however, they don’t address the underlying disorder, and come with potential side effects. Also, sleeping tablets just mask the symptoms, and as soon as tablets are stopped, symptoms recur. People with chronic insomnia think and behave differently around sleep, which perpetuates their symptoms. The key to improving symptoms in the long run is addressing thoughts and behaviours around sleep, which is what cognitive behaviour therapy does.

Our study showed that cognitive behaviour therapy reduced the time taken to get to sleep by 20 minutes and reduced the amount of time spent awake after falling asleep by nearly 30 minutes. These effects were maintained out to 12 months after treatment. These reductions in time taken to get to sleep and time spent awake are similar to those reported in clinical trials of hypnotics.  Continue reading

Links Between Alcohol, Insomnia and Suicide Risk Explored

Michael Nadorff, PhD, Assistant professor Mississippi State University Starkville, Miss.MedicalResearch.com Interview with:
Michael Nadorff, PhD, Assistant professor
Mississippi State University
Starkville, Miss.

Medical Research: What is the background for this study? What are the main findings?

Dr. Nadorff: A growing literature has found that insomnia symptoms are associated with suicidal behavior, and several studies suggest that this relation may be independent of several different forms of psychopathology.  However, little research has examined the role sleep disorders, such as insomnia, play in explaining why known risk factors, such as alcohol use, are associated with suicidal behavior.  In our study, we examined whether insomnia symptoms explained a significant portion of the relation between alcohol symptoms and suicide risk.  We found that for both men and women insomnia symptoms explained a significant amount of the variance in the relation between alcohol use and suicide risk.
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Insomnia Major Contributor To Fatal Falls and Motor Vehicle Accidents

Lars Laugsand, MD, PhD, Postdoctoral fellow Department of Public Health Norwegian University of Science in Technology Trondheim, Norway.MedicalResearch.com Interview with:
Lars Laugsand, MD, PhD, Postdoctoral fellow

Department of Public Health
Norwegian University of Science in Technology
Trondheim, Norway.

Medical Research: What is the background for this study?

Dr. Laugsand: Very few prospective studies have assessed the association of insomnia symptoms and risk for injuries.

Medical Research: What are the main findings?

Dr. Laugsand: We found that increasing number of insomnia symptoms was strongly associated with higher risk for both overall unintentional fatal injuries and fatal motor-vehicle injuries in a dose-dependent manner. Those who reported to suffer from all major insomnia symptoms were at considerably higher risk than those who had no symptoms or only a few symptoms. Among the different insomnia symptoms, difficulties falling asleep appeared to have the strongest and most robust association with fatal injuries.
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Insomnia Symptoms May Not Reflect Objective Sleep Measurements

MedicalResearch.com Interview with:
Jen-Hao Chen, Ph.D.
Assistant Professor, Department of Health Sciences
University of Missouri, Columbia, MO 65211

Medical Research: What are the main findings of the study?

Dr. Chen: In this study, we mapped four commonly-reported insomnia symptoms (feeling rested when waking up, having trouble falling asleep, waking up during the night, waking up too early and not being able to fall asleep again) to direct assessment of sleep characteristics in the general population of U.S. older adults. While we know older adults frequently complain about their sleep, we know little about how these complain reflect older adults’ actual sleep outcomes.

Using innovative actigraphy data of 727 older adults aged 62-91 from the National Social Life, Health and Aging Project, we found that two of these four common report of insomnia symptoms did not match specific objective sleep characteristics as these questions intends to index. The question of feeling rested was not related to any objective sleep characteristic. The question of difficulty falling asleep was not related to the objective measure of time to fall sleep but was related to other objective sleep characteristics. For waking up during the night question, high frequency was associated with more wake time after sleep onset and numbers of wake bout (but was also related to other objective sleep characteristics). For waking up too earlier question, answer of this question was related to earlier wake up time. But again, other objective sleep characteristics also predicted frequency of waking up earlier.

In sum, many of the relationships and non-relationships found in this study were unexpected. Findings suggested that these widely used questions did not related to older adults’ sleep outcomes as exactly as the wording suggested. Thus, while older adults’ report of these questions are related to objective sleep characteristics in some ways, insomnia symptoms and objective sleep characteristics did not complete match each other as expected.

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Sleep Difficulties Linked To Shrinking Brain

Dr. Claire Sexton Ph.D. University of OxfordMedicalResearch.com Interview with:
Dr. Claire Sexton Ph.D.
University of Oxford

Medical Research: What are the main findings of the study?

Dr. Sexton: We found that sleep difficulties (which can include trouble falling asleep, waking up during the night, or waking up too early) were associated with an increased rate of decline in brain volumes over 3-5 years.

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Poor Sleep Linked To Missed Work Days

Tea Lallukka, PhD Finnish Institute of Occupational Health & University of Helsinki, Hjelt Institute, Department of Public Health University of Helsinki, FinlandMedicalResearch.com Interview with:
Tea Lallukka, PhD
Finnish Institute of Occupational Health &
University of Helsinki, Hjelt Institute, Department of Public Health
University of Helsinki, Finland


Medical Research: What are the main findings of the study?

Dr. Lallukka: Our study used nationally representative survey data linked with
register data on medically certified sickness absence among working
-aged Finnish women and men. We showed consistent associations between
insomnia symptoms, sleep duration, and being tired and sickness
absence. The follow-up lasted around 7 years.
Sickness absence days were derived from comprehensive registers from
the Social Insurance Institution of Finland. The associations were
broadly similar among women and men. Furthermore, they remained even
after considering key correlates of sleep and sickness absence
including socioeconomic position, working conditions, health
behaviors, obesity, and mental and physical health. Health data were
derived from physical examination conducted by field physicians. These
data are more objective, and help provide more robust evidence. We
further covered all key sleep disturbances and sleep duration for more
comprehensive understanding about the contribution of sleep to
sickness absence. Finally, a novel method developed by the authors
(Härkänen & Kaikkonen) allowed us to estimate the difference in
sickness absence days per working year among those reporting and not
reporting different sleep disturbances. Using the difference in days
absent from work, we were further able to estimate the hypothetical
direct costs of sickness absence highlighting notable societal
significance of sleep. Thus, a large part of all costs of sickness
absence are attributable to poor sleep. For example, those sleeping 5
hours or less or 10 hours or more, were absent from work ca 5-9 days
more, as compared to those with optimal sleep length. The optimal
sleep length with the lowest risk of sickness absence was 7 hours 46
minutes for men and 7 hours 38 minutes for women.
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Adolescent Insomnia Linked to Depression, Anxiety and Chronotype

MedicalResearch.com Interview with:
Pasquale K Alvaro
School of Psychology
University of Adelaide
South Australia, Australia

Medical Research: What are the main findings of the study?

Answer: In adolescents, insomnia is related to depression beyond chronotype (a classification system for circadian rhythms or body clock), anxiety and age. Insomnia is also related to Generalised Anxiety Disorder (GAD) beyond chronotype, depression and age. Depression accounts for the relationship between insomnia and Obsessive Compulsive Disorder (OCD), Separation Anxiety Disorder (SAD) and Social Phobia (SP). Furthermore, an evening chronotype  (delayed sleep phase, that is, preferring to go to bed in the early morning) predicts insomnia beyond depression, anxiety and age. Moreover, an evening chronotype predicts depression beyond insomnia, anxiety and age. Finally, insomnia and depression account for the relationships between an evening chronotype and panic disorder, OCD, SAD and SP.

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Insomnia and Health Services Utilization in Middle-Aged, Older Adults

Hemodialysis.com Interview with: Christopher Kaufmann, MHS
Department of Mental Health,
Johns Hopkins Bloomberg School of Public Health
Hampton House, Room 800
624 North Broadway
Baltimore, MD 21205
email: ckaufman@jhsph.edu

MedicalResearch.com: What are the main findings of the study?

Mr. Kaufmann:  The purpose of our study was to examine the association between insomnia and the use of a number of costly health services.  We used data from the Health and Retirement Study, a large nationally representative longitudinal population-based study of US middle-aged and older adults.  We found that individuals who reported a greater number of insomnia symptoms were more likely to report being hospitalized, using home healthcare services, and using nursing homes two years later.  After we accounted for a number of demographic and clinical characteristics, the association between number of reported insomnia symptoms and hospitalization remained statistically significant.

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