Assessing Religious Commitment in a Multicultural Inpatient Setting: A Psychometric Evaluation of the 10-item Belief into Action Scale.

Religious and spiritual (R/S) issues impact medical decision-making, particularly among highly R/S populations, for whom existing measures have limitations in identifying levels of R/S commitment. The Belief into Action (BIAc) scale was designed for this purpose and was never tested among hospitalized patients. We interviewed 152 patients (51% men) with a mean age of 48.9 years (SD = 15.2), having either cancer (27%), cardiovascular (26%), rheumatic (21%), or other diseases (26%). Cronbach alpha was .82 and a 3-factor structure (subjective, social, and private religious commitment) was the most robust. Results suggest the BIAc has adequate convergent, divergent, and incremental validity compared to other well-established questionnaires and is appropriate for the inpatient setting.

Sublingual and oral zolpidem for insomnia disorder: a 3-month randomized trial

Objective: To evaluate the safety and efficacy of a 5 mg sublingual dose of zolpidem, compared to a 10 mg oral dose, at bedtime and "as needed" following middle-of-the-night awakenings. Methods: Participants were randomized into an oral group (oral zolpidem 10 mg and sublingual placebo at bedtime and "as-needed") and a sublingual group (oral placebo and sublingual zolpidem 5 mg at bedtime and "as-needed"). Participants underwent medical evaluation, polysomnography, the psychomotor vigilance test, and completed questionnaires. Results: Of 85 patients, 67 met the criteria for insomnia (48±10 years; 79% women) and were randomized. Of these, 46 completed 92±5 days of treatment. Mild-to-moderate adverse events were reported by 25% of the participants, including headache, sleepiness, and dizziness. Both treatments decreased middle-of-the-night awakenings by an average of -3.1±2.3 days/week and increased total sleep time by 1.5 hours. Changes in sleep quality and insomnia severity scores were also favorable and comparable between groups: variation depended on continuation of treatment. Regarding PSG findings, sleep latency decreased more in the sublingual group than the oral group (-14±42 vs. 10±29 min; p = 0.03). The psychomotor vigilance test showed minor residual effects 30 minutes after awakening, which reversed after 2 hours. Conclusions: The safety and efficacy of both zolpidem formulations are comparable. The sublingual 5 mg dose induced sleep more rapidly. Clinical trial registration: NCT01896336

Sublingual and oral zolpidem for insomnia disorder: a 3-month randomized trial.

OBJECTIVE: To evaluate the safety and efficacy of a 5 mg sublingual dose of zolpidem, compared to a 10 mg oral dose, at bedtime and "as needed" following middle-of-the-night awakenings. METHODS: Participants were randomized into an oral group (oral zolpidem 10 mg and sublingual placebo at bedtime and "as-needed") and a sublingual group (oral placebo and sublingual zolpidem 5 mg at bedtime and "as-needed"). Participants underwent medical evaluation, polysomnography, the psychomotor vigilance test, and completed questionnaires. RESULTS: Of 85 patients, 67 met the criteria for insomnia (48±10 years; 79% women) and were randomized. Of these, 46 completed 92±5 days of treatment. Mild-to-moderate adverse events were reported by 25% of the participants, including headache, sleepiness, and dizziness. Both treatments decreased middle-of-the-night awakenings by an average of -3.1±2.3 days/week and increased total sleep time by 1.5 hours. Changes in sleep quality and insomnia severity scores were also favorable and comparable between groups: variation depended on continuation of treatment. Regarding PSG findings, sleep latency decreased more in the sublingual group than the oral group (-14±42 vs. 10±29 min; p = 0.03). The psychomotor vigilance test showed minor residual effects 30 minutes after awakening, which reversed after 2 hours. CONCLUSIONS: The safety and efficacy of both zolpidem formulations are comparable. The sublingual 5 mg dose induced sleep more rapidly. CLINICAL TRIAL REGISTRATION: NCT01896336.

Brain-derived neurotrophic factor gene polymorphism predicts interindividual variation in the sleep electroencephalogram.

Previous studies have suggested that brain-derived neurotrophic factor (BDNF) participates in the homeostatic regulation of sleep. The objective of this study was to investigate the influence of the Val66Met functional polymorphism of the BDNF gene on sleep and sleep EEG parameters in a large population-based sample. In total 337 individuals participating in the São Paulo Epidemiologic Sleep Study were selected for analysis. None of the participants had indications of a sleep disorder, as measured by full-night polysomnography and questionnaire. Spectral analysis of the EEG was carried out in all individuals using fast Fourier transformation of the oscillatory signals for each EEG electrode. Sleep and sleep EEG parameters in individuals with the Val/Val genotype were compared with those in Met carriers (Val/Met and Met/Met genotypes). After correction for multiple comparisons and for potential confounding factors, Met carriers showed decreased spectral power in the alpha band in stage one and decreased theta power in stages two and three of nonrapid-eye-movement sleep, at the central recording electrode. No significant influence on sleep macrostructure was observed among the genotype groups. Thus, the Val66Met polymorphism seems to modulate the electrical activity of the brain, predicting interindividual variation of sleep EEG parameters. Further studies of this and other polymorphic variants in potential candidate genes will help the characterization of the molecular basis of sleep.

Inspiratory flow limitation in a normal population of adults in São Paulo, Brazil.

STUDY OBJECTIVES: Inspiratory flow limitation (IFL) during sleep occurs when airflow remains constant despite an increase in respiratory effort. This respiratory event has been recognized as an important parameter for identifying sleep breathing disorders. The purpose of this study was to investigate how much IFL normal individuals can present during sleep. DESIGN: Cross-sectional study derived from a general population sample. SETTING: A "normal" asymptomatic sample derived from the epidemiological cohort of São Paulo. PATIENTS AND PARTICIPANTS: This study was derived from a general population study involving questionnaires and nocturnal polysomnography of 1,042 individuals. A subgroup defined as a nonsymptomatic healthy group was used as the normal group. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: All participants answered several questionnaires and underwent full nocturnal polysomnography. IFL was manually scored, and the percentage of IFL of total sleep time was considered for final analysis. The distribution of the percentage of IFL was analyzed, and associated factors (age, sex, and body mass index) were calculated. There were 95% of normal individuals who exhibited IFL during less than 30% of the total sleep time. Body mass index was positively associated with IFL. CONCLUSIONS: Inspiratory flow limitation can be observed in the polysomnography of normal individuals, with an influence of body weight on percentage of inspiratory flow limitation. However, only 5% of asymptomatic individuals will have more than 30% of total sleep time with inspiratory flow limitation. This suggests that only levels of inspiratory flow limitation > 30% be considered in the process of diagnosing obstructive sleep apnea in the absence of an apnea-hypopnea index > 5 and that < 30% of inspiratory flow limitation may be a normal finding in many patients.

Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study.

OBJECTIVE: Using polysomnography, the gold standard for sleep assessment, this study aimed to describe the objective prevalence of insomnia in the São Paulo, Brazil, Epidemiologic Sleep Study cohort of 1,101 adults (20-80 years old). METHODS: Objective insomnia was defined by meeting 1 of the following criteria: sleep onset latency >30 minutes (sleep initiating insomnia), wake after sleep onset lasting >30 minutes (sleep maintenance insomnia), total sleep time <360 minutes and a terminal wakefulness >30 minutes (insomnia with too short duration of sleep or early morning awakening), or a combination of the previous quantitative criteria (mixed disorder). Using validated questionnaires based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, subjective insomnia was categorized into 3 groups: good sleepers, insomnia symptoms, and DSM-IV insomnia. RESULTS: A total of 1,042 subjects participated in the study (95% response rate). The prevalence of objective insomnia was 32%. The subjective prevalence of insomnia symptoms was 45%, and the subjective prevalence of DSM-IV insomnia was 15%. Sociodemographic factors were similar in both the objective insomnia and the DSM-IV insomnia groups. Age, but not psychiatric symptoms, was predictive of objective insomnia. The subjective criteria were not adequately sensitive (36%) to identify objective insomnia, but were adequately specific (77%) to rule out polysomnography noninsomnia. INTERPRETATION: The prevalence of objective insomnia assessed by polysomnography was higher than the prevalence of subjective insomnia according to DSM-IV-validated questionnaires. Clinical trials.gov ID: NCT00596713.