OBJECTIVES: Thus far, the diagnosis of insomnia is based on purely clinical criteria. Although a broad range of altered physiological parameters has been identified in insomniacs, the evidence to establish their diagnostic usefulness is very limited. Purpose of this WFSBP Task Force consensus paper is to systematically evaluate a series of biomarkers as potential diagnostic tools for insomnia. METHODS: A newly created grading system was used for assessing the validity of various measurements in establishing the diagnosis of insomnia; these measurements originated from relevant studies selected and reviewed by experts. RESULTS: The measurements with the highest diagnostic performance were those derived from psychometric instruments. Biological measurements which emerged as potentially useful diagnostic instruments were polysomnography-derived cyclic alternating pattern, actigraphy, and BDNF levels, followed by heart rate around sleep onset, deficient melatonin rhythm, and certain neuroimaging patterns (mainly for the activity of frontal and pre-frontal cortex, hippocampus and basal ganglia); yet, these findings need replication, as well as establishment of commonly accepted methodology and diagnostic cut-off points. Routine polysomnography, EEG spectral analysis, heart rate variability, skin conductance, thermoregulation, oxygen consumption, HPA axis, and inflammation indices were not shown to be of satisfactory diagnostic value. CONCLUSIONS: Apart from psychometric instruments which are confirmed to be the gold standard in diagnosing insomnia, six biomarkers emerge as being potentially useful for this purpose.

• Klíčová slova
• Insomnia, biomarkers, diagnostic accuracy, grading system, psychometrics,
• MeSH
• biologické markery MeSH
• lidé MeSH
• poruchy iniciace a udržování spánku * diagnóza   MeSH
• spánek fyziologie   MeSH
• systém hypofýza - nadledviny MeSH
• systém hypotalamus-hypofýza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• biologické markery MeSH

We examined whether subjectively and objectively measured sleep health composites have a relationship with heart disease. 6,820 adults (Mage = 53.4 years) from the Midlife in the United States study provided self-reported sleep characteristics and heart disease history. A smaller sample (n = 663) provided actigraphy sleep data. We tested two sleep health composites, based on self-report only and both self-report and actigraphy, across multiple sleep dimensions. We used a weighted sum approach, where higher scores indicated more sleep health problems. Modified Poisson regressions adjusted for sociodemographics and known risk factors. Having more sleep health problems was associated with a higher risk of heart disease using the self-report sleep health composite (aRR = 54%, P < .001) and the actigraphy/self-report composite (aRR = 141%, P < .001). Individual sleep dimensions of satisfaction, alertness, and efficiency (from the self-report composite) and regularity, satisfaction, and timing (from the actigraphy/self-report composite) were associated with the risk of heart disease. The effect size of each sleep health composite was larger than the individual sleep dimensions. Race moderated the association between the actigraphy/self-report sleep health composite and heart disease. There was no significant moderation by sex. Findings suggest poorer sleep health across multiple dimensions may contribute to heart disease risk among middle-aged adults.

• MeSH
• aktigrafie MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci srdce etiologie   MeSH
• poruchy iniciace a udržování spánku komplikace   diagnóza   MeSH
• průzkumy a dotazníky MeSH
• rasové skupiny * MeSH
• riziko MeSH
• sexuální faktory MeSH
• spánková hygiena fyziologie   MeSH
• věkové faktory MeSH
• zpráva o sobě MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Although patients with insomnia often show a discrepancy between self-reported and objective sleep parameters, the role of and change in this phenomenon during treatment remain unclear. The present study aimed to assess the effect of cognitive behavioural therapy for insomnia on subjective and objective sleep discrepancy of total sleep time, sleep-onset latency and wake after sleep onset. The total sleep time discrepancy was also assessed across the entire therapy. The second aim was to examine the treatment outcome of two insomnia groups differing in sleep perception. Thirty-six adults with insomnia (mean age = 46.7 years, SD = 13.9; 22 females) were enrolled in the final analyses. Patients underwent a 6-week group cognitive behavioural therapy for insomnia programme. Sleep diary and actigraphy measurements were obtained during the therapy. Patients who underestimated total sleep time (n = 16; underestimating group) were compared with patients who accurately perceived or overestimated total sleep time (n = 20; accurate/overestimating group). After cognitive behavioural therapy for insomnia, a significant decrease of total sleep time and sleep-onset latency discrepancy was observed without a change in wake after sleep onset discrepancy in the total sample. Only the underestimating group reported decreased sleep-onset latency discrepancy after the treatment, whereas total sleep time discrepancy significantly changed in both groups. The underestimating group showed a significant decrease of total sleep time discrepancy from Week 1 to Week 2 when the sleep restriction was implemented, whereas the accurate/overestimating group showed the first significant change at Week 4. In conclusion, both groups differing in sleep perception responded similarly to cognitive behavioural therapy for insomnia, although different In conclusion, both groups differing in sleep perception responded similarly to cognitive behavioural therapy for insomnia, although different therapeutic components could play important roles in each group. components could play important roles in each group.

• Klíčová slova
• actigraphy, cognitive behavioural therapy for insomnia, insomnia, objective - subjective sleep discrepancy, sleep misperception,
• MeSH
• aktigrafie metody   MeSH
• kognitivně behaviorální terapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polysomnografie MeSH
• poruchy iniciace a udržování spánku diagnóza   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: The Pittsburgh Sleep Quality Index (PSQI) is one of the widely used and recommended measures of assessing sleep quality in chronic insomnia; however certain psychometric properties of the questionnaire are still unknown in this group of patients. The present study aimed to examine the internal consistency, and structural and convergent validity of the Czech version of the PSQI in chronic insomnia patients. The usefulness of the standard and alternative scoring systems was also investigated in relation to symptoms of sleepiness, insomnia, depression, and anxiety. METHODS: In our study, 105 participants filled out a series of questionnaires including PSQI, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Beck Depression and Anxiety Inventories (BDI, BAI). RESULTS: The internal consistency of the questionnaire using Cronbach's alpha was 0.608. A series of confirmatory factor analyses revealed adequate fit for three structures. A three-factor model descriptively stood out among the rest but subsequent correlational analyses did not provide sufficient support for accepting an alternative scoring model. CONCLUSIONS: The results highlight the issue of structural variance of the PSQI and in chronic insomnia point to the important role of the PSQI components of daytime dysfunction and sleep disturbances in showing comorbid symptoms with daytime sleepiness and psychopathology.

• MeSH
• chronická nemoc MeSH
• deprese psychologie   MeSH
• dospělí MeSH
• faktorová analýza statistická MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• polysomnografie MeSH
• poruchy iniciace a udržování spánku diagnóza   psychologie   MeSH
• průzkumy a dotazníky MeSH
• psychometrie MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spánek * MeSH
• stupeň závažnosti nemoci MeSH
• úzkost psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: In practical sleep medicine, therapists face the question of whether or not to discontinue the ongoing use of hypnotics in patients, as well as the possible effects of discontinuation. The aim of this study was to evaluate the effects of discontinuing third-generation hypnotics on the results of cognitive-behavioural therapy (CBT) for primary insomnia in patients after long-term abuse. METHODS: Twenty-eight outpatients were treated by CBT for 8 weeks. The treatment outcome was estimated by means of differences among subjective clinical scales and polysomnography variables assessed before and after the treatment period. The therapeutic effect in a subgroup of 15 patients who had previously received hypnotics and were successively withdrawn during weeks 2-6 was compared to the effect achieved in patients who had not used hypnotics before CBT. RESULTS: There were no significant differences in baseline subjective and objective sleep characteristics between the hypnotic abusers and non-abusers. According to clinical scales and most polysomnographic measures, CBT was highly effective in both groups of subjects; it produced the greatest changes in total sleep time, REM sleep and sleep efficiency. Unexpectedly, discontinuation of hypnotics, as a factor in the analysis, was followed by an additional improvement of sleep efficiency and wake after sleep onset parameters. CONCLUSION: Our study confirmed the efficacy of CBT in both hypnotic-abusing and non-abusing patients with chronic insomnia. The results of this study suggest that tapered withdrawal of third-generation hypnotics during CBT therapy for chronic insomnia could be associated with improvement rather than worsening of sleep continuity.

• MeSH
• dospělí MeSH
• farmakoterapie statistika a číselné údaje   MeSH
• hypnotika a sedativa terapeutické užití   MeSH
• kognitivně behaviorální terapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nenasazení léčby statistika a číselné údaje   MeSH
• polysomnografie MeSH
• poruchy iniciace a udržování spánku diagnóza   farmakoterapie   terapie   MeSH
• senioři MeSH
• spánek REM fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• hypnotika a sedativa MeSH

BACKGROUND: The reliability of the subjective statements reports on disturbed night sleep and alertness in the daytime was assessed by their correlation to the objective indicators in patients with mild depression. METHOD: Among patients with depression, altogether 28 patients with insomnia were examined. Their answers to typical questions, as they are used during a psychiatric interview, were scored. In parallel, night sleep quality and alertness level in the daytime were objectively estimated by means of polygraphic recording. RESULTS: The subjective statements on the type of insomnia, the estimated time of falling asleep, frequent awakenings and occurrence of disturbing dreams seem to be unreliable. Similarly, the results were disappointing when the patients were asked about alertness disturbances in the daytime. An unexpected finding was the lack of any significant correlation to the scores obtained by means of Epworth's scale. Among the factors possibly influencing the patients' reports, age, sex, coffee intake and also chronic administration of sedatives or hypnotics showed a low correlation with the sleep and alertness indicators. CONCLUSION: The statistical evaluation indicated rather poor agreement between the subjective and objective items. The statistical evaluation suggested that anxiety and depression significantly influence reports on sleep quality and alertness disturbances in the daytime.

• MeSH
• arousal fyziologie   MeSH
• bdění fyziologie   MeSH
• cirkadiánní rytmus fyziologie   MeSH
• depresivní poruchy diagnóza   psychologie   MeSH
• elektroencefalografie statistika a číselné údaje   MeSH
• komorbidita MeSH
• lidé MeSH
• polysomnografie MeSH
• poruchy iniciace a udržování spánku diagnóza   MeSH
• poruchy spánku a bdění diagnóza   psychologie   MeSH
• průzkumy a dotazníky * MeSH
• psychiatrické posuzovací škály * MeSH
• sny fyziologie   MeSH
• spánek fyziologie   MeSH
• úzkostné poruchy diagnóza   psychologie   MeSH
• zdravotní stav MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Sleep and depression are hanging together. The article is attempted to search answer on the question what is first: sleep or affective disorders? The answer is necessary for the search of the rational therapy--decrease pharmacotherapy and increase nonpharmacological approaches.

• MeSH
• deprese komplikace   MeSH
• lidé MeSH
• poruchy iniciace a udržování spánku diagnóza   farmakoterapie   etiologie   MeSH
• úzkost komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH