Sleep disordered breathing, insomnia symptoms, and sleep quality in a clinical cohort of U.S. Hispanics in south Florida.

STUDY OBJECTIVES: There is a paucity of information on the epidemiology of sleep disorders among US Hispanics. This study describes the frequency of sleep disordered breathing (SDB) risk, insomnia complaints, poor sleep quality, and daytime somnolence in a clinical cohort of ethnically diverse US Hispanics living in South Florida. METHODS: We explored the presence of sleep disorders in a cohort of Hispanics seen at primary care, pulmonary, and sleep clinics at the University of Miami and Miami Veterans Affair Medical Center. Participants completed validated questionnaires, evaluating risk of SDB, presence of insomnia symptoms, sleep quality, and daytime sleepiness. Polysomnography was completed on the majority of the sleep clinic participants. RESULTS: Participants (N = 282; 62% male; mean age 54 ± 15 years; mean BMI 31 ± 6 kg/m(2)) included Hispanics of Cuban, Puerto Rican, Central/South American, and Caribbean heritage. Excessive daytime sleepiness was noted by 45% of participants. Poor sleep quality was reported by 49%; 76% screened high risk for SDB, and 68% had insomnia symptoms. Sleep disorders were more commonly reported in sleep clinic participants; however, 54% of non-sleep clinic participants were high risk for SDB, 35% had insomnia complaints, 28% had poor sleep quality, and 18% reported daytime sleepiness. CONCLUSIONS: Sleep disorders (including SDB) are common in clinical samples of Hispanics in South Florida. These findings highlight the urgent need for linguistically relevant and culturally responsive screening, awareness and education programs in clinical sleep medicine among US Hispanics. CITATION: Shafazand S; Wallace DM; Vargas SS; Del Toro Y; Dib S; Abreu AR; Ramos A; Nolan B; Baldwin CM; Fleming L. Sleep disordered breathing, insomnia symptoms, and sleep quality in a clinical cohort of US Hispanics in South Florida. J Clin Sleep Med 2012;8(5):507-514.

Snoring and insomnia are not associated with subclinical atherosclerosis in the Northern Manhattan Study.

BACKGROUND: Sleep-disordered breathing is a risk factor for stroke, but its association with subclinical atherosclerosis remains controversial. Snoring and insomnia are frequently comorbid with sleep-disordered breathing and may contribute to stroke. Data on the relationship between snoring and insomnia with atherosclerotic disease are sparse. We investigated the relationship between markers of subclinical atherosclerosis, insomnia, snoring, and carotid intima-media thickness, in the Northern Manhattan Study. METHODS: A group of 1605 participants (mean age 65 +/- 8 years; 40% men; 61% Hispanic, 19% black, 20% white) who had carotid intima-media thickness measurements performed was assessed for self-reported sleep habits. Habitual snoring was defined as self-reported snoring greater than four times per week. Presence of insomnia was based on three items extracted from the Hamilton Rating Scale for Depression. Carotid intima-media thickness was expressed as a mean composite measure of intima-media thickness in the carotid bifurcation, common, and internal carotid artery. Multivariate linear regression models were used to identify associations between snoring, insomnia, and carotid intima-media thickness. RESULTS: Habitual snoring was present in 29% of the subjects and insomnia in 26%. There was a higher prevalence of self-reported snoring (84%) and insomnia (66%) among Hispanics than non-Hispanics. The mean total carotid intima-media thickness was 0.95 +/- 0.09 mm; among those with self-reported snoring was 0.94 +/- 0.09 mm; and among those with insomnia was 0.95 +/- 0.08 mm. After controlling for age, gender, race-ethnicity, body mass index and cardiovascular risk factors, snoring (P=0.986) and insomnia (P=0.829) were not significantly associated with increased carotid intima-media thickness. CONCLUSION: Snoring and insomnia were not significantly associated with subclinical atherosclerosis in this population-based community cohort.

Relationships between REM sleep findings and PTSD symptoms during the early aftermath of trauma.

Laboratory sleep findings in posttraumatic stress disorder (PTSD) have been characterized as incongruent with subjective complaints. Most findings relate to rapid eye movement (REM) sleep. Chronicity confounds relationships between objective sleep and PTSD. The authors report relationships between PTSD symptoms and objective sleep measures from the early aftermath of trauma. Thirty-five patients received polsomnography and PTSD assessment within a month of traumatic injury. Posttraumatic stress disorder status was established at 2 months. The REM segment duration correlated negatively with initial PTSD and insomnia severity, which also correlated with total sleep time. Relative beta frequency during REM sleep from a subset of cases correlated negatively with PTSD and nightmare severity. These findings suggest a link between subjective symptoms and REM sleep phenomena acutely following trauma.

Signs and symptoms of sleep apnea and acute stroke severity: is sleep apnea neuroprotective?

BACKGROUND: In animal models, brief periods of hypoxemia render the brain tolerant to subsequent ischemic insults. Sleep apnea leads to frequent episodes of nocturnal hypoxemia and may induce ischemic tolerance. Snoring and daytime sleepiness are cardinal symptoms of sleep apnea. We undertook this study to determine differences in stroke severity and early neurologic course in patients at risk for sleep apnea as determined by a sleep questionnaire. METHODS: Patients admitted with acute ischemic stroke completed the Berlin questionnaire. The Berlin questionnaire examines habitual snoring, daytime sleepiness, presence of hypertension, and body mass index (BMI) and classifies patients into a high or low risk for sleep apnea group. National Institutes of Health Stroke Scale (NIHSS) score was determined on admission and day 5 of hospitalization. Age, sex, cardiovascular risk factors, BMI, and stroke mechanism were determined prospectively. RESULTS: We enrolled 190 patients with a mean age of 60 years and 53% were men. The Berlin questionnaire classified 103 patients (54%) at high risk for sleep apnea. The median NIHSS score on admission and day 5 of hospitalization did not differ between the two groups after multivariate analysis. Examined separately, we found no effect of snoring, daytime sleepiness, or BMI on acute stroke severity and outcome. CONCLUSION: We found that a large number of patients admitted with acute ischemic stroke were at high risk for having sleep apnea. We were not able to show that a constellation of symptoms and features highly suggestive of sleep apnea influenced stroke severity or early neurologic course after acute ischemic stroke.

REM sleep and the early development of posttraumatic stress disorder.

OBJECTIVE: The potential for chronicity and treatment resistance once posttraumatic stress disorder (PTSD) has become established has stimulated interest in understanding the early pathogenesis of the disorder. Arousal regulation and memory consolidation appear to be important in determining the development of PTSD; both are functions of sleep. Sleep findings from patients with chronic PTSD are complex and somewhat contradictory, and data from the acute phase are quite limited. The aim of the present study was to obtain polysomnographic recordings during an acute period after life-threatening experiences and injury and to relate measures of sleep duration and maintenance and the timing, intensity, and continuity of REM sleep to the early development of PTSD. METHOD: Twenty-one injured subjects meeting study criteria received at least one polysomnographic recording close to the time of medical/surgical stabilization and within a month of injury. PTSD symptoms were assessed concurrently and 6 weeks later. Sleep measures were compared among injured subjects with and without significant PTSD symptoms at follow-up and 10 noninjured comparison subjects and were also correlated with PTSD severity. RESULTS: There was more wake time after the onset of sleep in injured, trauma-exposed patients than in noninjured comparison subjects. Development of PTSD symptoms was associated with shorter average duration of REM sleep before a stage change and more periods of REM sleep. CONCLUSIONS: The development of PTSD symptoms after traumatic injury is associated with a more fragmented pattern of REM sleep.