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Sleep-related problems in highly sensitive individuals: testing the mediation effect of perceived stress
No full textObjectives/Introduction: Sensory-processing sensitivity (SPS) is defined as an underlying phenotypic trait that describes individual differences in sensitivity to internal and external stimuli. High sensitivity is characterized by greater awareness of environmental subtleties, a tendency for over-stimulation, greater depth of information processing, and increased emotional reactivity. Thus, highly sensitive individuals are more vulnerable to stress. A recent study found that subjects scoring high on SPS reported more nightmare frequency and lower mental well-being than subjects scoring low on SPS. On this basis, we hypothesized that SPS contributes to sleep disruption and poor sleep quality and that this effect could be mediated by increased perceived stress.
Methods: Two hundred eight volunteers (mean age 36.24 ± 11.18;154 females) completed the following questionnaires: the Highly Sensitive Person (HSP) scale, the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). We considered the total score for the HSP, PSS, and ISI, while for the PSQI, the global score and its seven components.
Results: Correlation analysis revealed a positive correlation between HSP and PSS, r=0.18,p<0.01. HSP was also positively correlated with ISI, r=0.26,p<0.01, and PSQI global score,r=0.19,p<0.01,as well as with PSQI components: Subjective sleep quality,r=0.17,p<0.05, Sleep latency,r=0.17,p<0.05, and Daytime dysfunction,r=0.26,p<0.01. PSS was also positively correlated with ISI, r=0.50,p<0.01, and all PSQI scores except for sleep duration, with r coefficients ranging from 0.14 to 0.37,p<0.05. We then conducted mediation analysis with HSP as antecedent variable, PSS as mediator,and ISI and PSQI as outcomes. The analysis revealed that the effect of HSP on PSS completely mediated the effect of HSP on PSQI global score,0.22,p<0.01, and on its components Subjective sleep quality,0.04,p<0.05, and Sleep latency, 0.06,p<0.05. Instead, only a partial mediation was observed for the effect of HSP on ISI, 0.48,p<0.01,and on PSQI component Daytime dysfunction, 0.03,p<0.05.
Conclusions: Results supported the hypothesis that SPS correlates to increased sleep-related problems through increased perceived stress.Therefore, it is important to evaluate and further study sleep difficulties in highly sensitive individuals
REM sleep behavior disorder and other sleep disturbances in Alzheimer's disease, dementia with Lewy bodies and in dementia cases of uncertain classification
No full textObjectives/Introduction: Sleep disorders are common in persons with Alzheimer ́s disease (AD) and dementia with Lewy bodies (DLB). Their identification, especially of REM sleep behavior disorder (RBD), a core clinical feature for DLB diagnosis, is an important support to improve diagnostic accuracy between these two types of dementia and optimize therapeutic strategies.
Methods: In this ongoing study, consecutive patients with AD, DLB or uncertain diagnosis between AD/DLB and mild-to-moderate dementia severity are screened for sleep disturbances. Recruited patients undergo two consecutive full-night video-polysomnographies (vPSG). Patients diagnosed with moderate to severe obstructive sleep apnea (OSA) after the first vPSG are treated with positive airway pressure (PAP) ventilation during the second vPSG.
Results: To date, 31 patients have been screened and 13 recruited (60% men; mean age 77 ± 2 years; 46% Clinical Dementia Rating score [CDR] 1 and 54% CDR 2). At enrollment, 54% had a diagnosis of AD, 23% of DLB and 23% of AD/DLB. 69% of patients complained of poor sleep quality, while only 15% of excessive daytime sleepiness. 77% presented a high risk for OSA, 70% a clinically possible RBD and 38% restless legs syndrome. VPSG analysis confirmed OSA in 9 patients, periodic limb movements in 7 and confusional arousals in 4. 86% of OSA patients used PAP treatment for at least 5 hours during the second vPSG. RBD was confirmed in 10 patients. Based on these findings and according to current DLB diagnostic criteria, 5 patients previously diagnosed with AD and 2 patients AD/DLB were diagnosed with DLB. Moreover, CDR 2 patients presented a decrease in percentage of REM sleep and atypical REM sleep phases (predominant delta activity) as compared to CDR 1 patients (p = 0.048 and p = 0.027, respectively).
Conclusions: Our preliminary findings show a high comorbidity of vPSG-confirmed RBD with other primary sleep disorders (OSA in particular) in dementia patients. Both in AD and DLB, with the progression of cognitive decline, standard REM sleep scoring becomes complex. VPSG remains the gold standard for the diagnosis of RBD and its mimics and it is a useful tool for improving dementia diagnostic accuracy
Miglior Poster alla prima edizione del congresso All4AD – Alliance for Alzheimer’s disease and other Dementias
No full textI disturbi del sonno sono comuni nei soggetti con demenza di Alzheimer (AD) e a corpi di Lewy (DLB). La loro identificazione, soprattutto del disturbo del comportamento in sonno REM (RBD), criterio core
per DLB dal 2017, è importante per il miglioramento dell’accuratezza diagnostica, soprattutto in casi non candidabili ad approfondimenti con biomarcatori.
Obiettivo dello studio è la valutazione di pazienti con diagnosi di AD, DLB o incerta tra AD/DLB, affetti da almeno un disturbo del sonno di rilievo clinico e, alla luce dei risultati, l’eventuale rivalutazione della
diagnosi del tipo di demenza.
Da luglio 2018 sono stati screenati 29 pazienti e 12 (età tra 67 e 84 anni) sono stati sottoposti a due notti di video-polisonnografia (vPSG). All’arruolamento, il 42% aveva una diagnosi di AD, il 25% di DLB e il 33% incerta tra AD/DLB. Il 25% dei soggetti presentava eccessiva sonnolenza diurna, il 58% cattiva qualità di sonno, l'83% alto rischio di apnee in sonno (OSA) e il 75% un possibile RBD. In vPSG sono stati osservati risvegli confusionali in 5 soggetti, PLMD in 7 e OSA in 9. RBD è stato confermato in 10 soggetti e di conseguenza in 2 soggetti precedentemente AD è stata formulata diagnosi di DLB e in 4 soggetti AD/DLB, 3 sono stati diagnosticati DLB e 1 AD. I soggetti con CDR 2 rispetto a quelli con CDR 1 presentavano una diminuzione di sonno REM e fasi di sonno REM "dissociato" (p = .048 e p = .027, rispettivamente).
Il sonno delle persone con AD e DLB è molto disturbato, spesso più di un disturbo del sonno è presente e con il progredire della malattia il sonno REM si modifica. La vPSG contribuisce alla diagnosi del tipo di demenza in soggetti non candidabili ad altre indagini di neuroimaging e/o liquorali
Kitten Scanner reduces the use of sedation in pediatric MRI
No full textThe use of sedation before a magnetic resonance imaging (MRI) scan is a common practice to overcome motion artifacts and anxiety in children. However, this technique has its drawbacks. We retrospectively compared the number of children undergoing a brain MRI scan with or without sedation before and after the introduction of an educational training protocol using a toy scanner (the Philips Kitten Scanner) and we investigated the effectiveness of this training in relation to children's age and gender. We considered 1461 children between 4 years and 14 years. Of them, 158 had a diagnosis of autism spectrum disorder or attention-deficit hyperactivity disorder and were excluded from further analysis. After the introduction of the Kitten Scanner training protocol, the sedation need decreased by 30% in the total sample group and in children younger than 10 years in particular. Before the training, females were more likely to undergo the MRI examination without sedation as compared to males, while after its introduction this gender difference was no more visible
Compliance alla ventilazione notturna e dati polisonnografici in pazienti con demenza di Alzheimer e a corpi di Lewy affetti da OSAS: dati preliminari
No full textIntroduzione. I disturbi del sonno in generale e le Apnee Ostruttive in Sonno (OSA)
mostrano alta prevalenza in demenza di Alzheimer (AD), demenza a corpi di Lewy (DLB) e
altre forme di demenza fin dalle fasi precoci della malattia. L’OSA è fattore di rischio per
declino cognitivo e può determinarne una più precoce insorgenza, contribuire alla
patogenesi della demenza e avere un ruolo nella progressione di malattia. Inoltre l’OSA è
fattore di rischio per malattie cardio e cerebrovascolari. Trattare l’OSA, quando indicato
(casi moderati e severi), può contribuite a rallentare la progressione del declino cognitivo, a
controllare importanti comorbilità e a migliorare la continuità del sonno. Il trattamento
d’elezione per OSA, fino a quando la compliance è sufficiente ed in presenza di valido
carer, è la ventilazione a pressione positiva (CPAP/auto-CPAP). Non è stata dimostrata una
significativa riduzione della compliance a ventilazione in persone anziane sane e in AD. I
pochi dati disponibili hanno mostrato scarsissima compliance in DLB.
Metodi. Nell’ambito di uno studio video-Polisonnografico (vPSG) sul ruolo del disturbo
del comportamento in sonno REM in AD, DLB e demenza di incerta classificazione
(AD/DLB), i pazienti affetti da OSAS di grado moderato o severo sono stati trattati con
auto-CPAP e sono stati valutati compliance ed impatto della ventilazione sui parametri
polisonnografici.
Risultati. Dal luglio 2018 (arruolamento in corso), sono stati consecutivamente
screenati con testistica sonnologica 31 pazienti e di questi, 12 (4 AD e 8 DLB; 66% uomini;
età compresa tra 67-84 anni, 42% CDR 1 e 58% CDR2) hanno effettuato 2 vPSG. Durante
la prima notte in vPSG, è stata rilevata la presenza di OSA di grado moderato o severo in 7
pazienti (3 DLB e 4 AD). Nella seconda notte in vPSG i pazienti OSAS sono stati ventilati
con auto-CPAP, tutti con stesso modello e marca di ventilatore dopo scelta di adeguata
maschera e adattamento: si è osservata buona compliance in tutti i pazienti con tempo
medio di utilizzo del ventilatore di 8 ore e 46 minuti (utilizzo minimo: 6 ore e 22 minuti).
Tra i parametri del sonno, l’efficienza di sonno è migliorata e la veglia infra-sonno si è
ridotta anche se non significativamente. In tutti i soggetti si è ottenuto buon controllo del
quadro di OSAS.
Conclusione. I nostri dati dimostrano che la ventilazione a pressione positiva per OSAS
può essere proposta anche a pazienti DLB con sufficiente capacità di collaborazione e
valido carer. La compliance e il controllo dell’OSAS verificati in vPSG nella prima notte
di ventilazione sono risultati buoni sia in AD che DLB. L’aderenza al trattamento va
verificata nel tempo con scarico di dati di utilizzo da ventilatore come da regole di buona
pratica clinica e da linee guida per OSAS
Effects of thought suppression on visual perception
No full textThought suppression has paradoxical effects. Previous research has shown that this mental control strategy may increase the accessibility of the suppressed thoughts. This intriguing effect is usually explained by the need to closely monitor the target thought in order to efficiently suppress its occurrence in one's mind. The aim of the present study was to examine whether thought suppression can also modulate the detection and representation of visual stimuli. We used the technique of continuous flash suppression (CFS), which allows to investigate the processing of visual information in the absence of visual awareness. Specifically, we hypothesized that when participants are instructed to suppress thoughts about a “target picture”, the target-picture presented to one eye may have a paradoxical advantage in perception and thus break suppression faster than non-target stimuli against a dynamic noise pattern presented to the other eye..
Sensory-processing sensitivity as a confounder in the positive relationship between mindful awareness and psychological distress: A theoretical review
No full textMindfulness meditation is credited as a positive driver of promoting psychological well-being and reducing stress, anxiety, and depression symptoms. However, dispositional mindfulness has been somewhat correlated with psychological distress, as awareness has been positively correlated with psychological symptoms and negative affective states in many studies. This counterintuitive phenomenon has been tentatively explained in a variety of ways, including a wrong interpretation of the items of the mindfulness assessment scales in nonmeditators. The most credited explanation is that increasing attention to present-moment experiences would boost affective reaction to negative experiences and therefore exacerbate related psychological symptoms. This hypothesis is unsatisfactory, as there is much contrasting evidence in this regard. Therefore, we propose a new hypothesis: in dispositional studies, the assessment of the awareness skill of mindfulness would be affected by sensory-processing sensitivity, which could be a confounder in its relationship with psychological distress. Sensory-processing sensitivity refers to a temperamental trait characterized by both awareness of sensorial stimulation and reactivity to experience. Thus, highly sensitive persons usually report increased awareness of subtleties in the environment, ease of overstimulation, and increased affective reaction to stimulation. In support of our hypothesis, we showed in particular how the most widely used scale for assessing mindful awareness could be paired with and interpreted as a measure of sensory-processing sensitivity. We then propose a set of testable hypotheses to drive future research on this topic. If supported by future experimental results, our hypothesis would shed new light on the overall field of dispositional mindfulness studies
Sleep and aging
No full textThe goal of this article is to focus on some aspects that the authors consider relevant for clinical practice and for defining a future research agenda and not so much to give a complete review on all aspects of sleep and aging. The world population is aging, and the aging population is rapidly changing. There are important differences among younger-old and older-old persons, with sex specificity. New lifestyles, work, and familial and social habits can alter circadian rhythms, even in elderly persons.
In the last 2 decades, sleep deficiency and hypersomnolence became important concerns of everyday life. These problems are having a “human impact” (), a relatively new concept that is a synthesis between health and social impact. This concept can be applicable to problems such as the environment and climate and can be used to develop programs and decisions on human health and welfare.
In aging, “subjective” and “objective” sleep characteristics show several differences between men and women. Such aspects need to be deeply investigated for tailoring diagnostic and therapeutic interventions according to sex and gender. Studies have focused on the relationship between sleep and the preclinical phases of neurodegenerative diseases and dementia. Sleep disturbances may be present at the earliest stages of neurodegeneration or neuroinflammation: growing epidemiological data have demonstrated that sleep disturbances can be considered a risk factor for dementia. Greater attention to sleep since midlife and among older adults can offer new opportunities for multidomain interventions for the prevention of neurodegenerative disorders and other chronic conditions
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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