-
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To evaluate the effectiveness of a multidisciplinary program, including Cognitive behavioral therapy (CBT), in the treatment of patients with chronic migraine (CM) and... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effectiveness of a multidisciplinary program, including Cognitive behavioral therapy (CBT), in the treatment of patients with chronic migraine (CM) and concomitant chronic insomnia (CI).
MATERIAL AND METHODS
The study included 96 patients with CM and CI, average age 35.7±8.6. All patients underwent clinical interviews and testing using clinical and psychological techniques. Patients were randomized into two groups: group 1 received study treatment (an multudisciplinary program including CBT for pain and insomnia, combined with standard treatment for migraine), group 2 received standard treatment for migraine (preventive and acute pharmacotherapy for migraine, recommendations about lifestyle and sleep hygiene). All patients were assessed for clinical and psychological parameters before treatment and at 3, 6, 12 and 18 months follow-up.
RESULTS
At 3 month follow-up a statistically significant improvement was observed in group 1: a decrease in the frequency of headaches and the use of painkillers, parameters on the Insomnia Severity Index (ITI), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Migraine Disability Assessment (MIDAS) (<0.05). At 6, 12 and 18 months follow-up the achieved improvements were maintained. At 3 month follow-up, group 2 showed a statistically significant improvement in only 4 parameters: a decrease in the frequency of headaches and painkiller use, and parameters for ITI and MIDAS. These parameters increased to values that were not statistically significantly different from the parameters before treatment in group 2 at 6 month follow-up. At 3 month follow-up in group 165% of patients achieved clinical effect (CE) according to CM (headache frequency decreased by 50% or more), in group 2 - 40%, which was not statistically significantly different (>0.001); in group 1, 76% of patients achieved CE according to CI (ITI decreased by 8 points or more), which is statistically significantly more than in group 2 with 45% of patients with CE (<0.001). At 18 month follow-up, in group 1, 81.5% of patients achieved CE according to CM, which is statistically significantly more than in group 2 with 33% of patients with CE (<0.001); in group 1, 85% of patients achieved CE according to CI, which is statistically significantly more than in group 2, where 38% of patients had CE (<0.001).
CONCLUSION
High effectiveness of CBT in patients with CM and combined CI was noted.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Migraine Disorders; Cognitive Behavioral Therapy; Female; Adult; Male; Prospective Studies; Treatment Outcome; Middle Aged; Chronic Disease
PubMed: 38934675
DOI: 10.17116/jnevro2024124052110 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To study the features of the manifestation of insomnia and its impact on the condition and quality of life in patients with chronic tension-type headache.
OBJECTIVE
To study the features of the manifestation of insomnia and its impact on the condition and quality of life in patients with chronic tension-type headache.
MATERIAL AND METHODS
The study included 65 patients with chronic tension-type headache and insomnia. Patients filled out questionnaires on headache severity, sleep quality, emotional status and quality of life. Seventeen patients underwent polysomnography.
RESULTS
Patients with more severe insomnia had significantly more severe anxiety (<0.001) and depression (=0.025). Such patients assessed their quality of life worse according to the SF-12 questionnaire (<0.002) and the Subjective Well-Being Scale (<0.001), a higher level of central sensitization was observed in patients with more severe insomnia (<0.001).
CONCLUSION
The negative impact of insomnia on the condition of patients is not so much an increase in pain as such, but rather its influence on the quality of the emotional state and life in general, as well as an increase in the interdependence and mutual influence of other clinical and psychophysiological manifestations of the disease. Therefore, the clinical significance of insomnia is the deterioration of a person's ability to tolerate pain, which is the main prerequisite for a decrease in quality of life.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Female; Male; Quality of Life; Adult; Middle Aged; Surveys and Questionnaires; Tension-Type Headache; Depression; Anxiety; Polysomnography; Headache Disorders; Sleep Quality; Clinical Relevance
PubMed: 38934674
DOI: 10.17116/jnevro2024124052105 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Pregnancy is associated with a number of physiological changes in a woman's body, which in turn affect the quality and duration of sleep. According to research, insomnia... (Review)
Review
Pregnancy is associated with a number of physiological changes in a woman's body, which in turn affect the quality and duration of sleep. According to research, insomnia and other sleep disorders are associated with a high risk of adverse pregnancy outcomes, as well as postpartum complications. Understanding the mechanisms of sleep disorders during pregnancy is necessary to form an integrated approach in the management of this group of patients. The appointment of medicinal and non-medicinal therapies, as well as general recommendations for lifestyle correction in order to treat sleep disorders, is focused on the safe and prolific effect of a particular drug on the mother and fetus. This review also examined the safety profile of commonly used groups of drugs for sleep disorders during pregnancy.
Topics: Humans; Pregnancy; Female; Pregnancy Complications; Sleep Wake Disorders; Pregnancy Outcome; Sleep Initiation and Maintenance Disorders
PubMed: 38934673
DOI: 10.17116/jnevro202412405299 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache...
OBJECTIVE
To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache (MOH) in comparison with patients without MOH.
MATERIAL AND METHODS
The prospective case-control study included 171 patients, aged 18 years and older, with MOH (main group), and173 patients with primary headaches without MOH (control group). A neurologist conducted an initial examination and professional interview before the start of treatment. To diagnose sleep disorders, the International Classification of Sleep Disorders (3rd edition, 2014) was used. Additionally, an assessment was made using the Insomnia Severity Index Scale, the Epworth Sleepiness Scale (ESS) and the Lausanne Obstructive Sleep Apnea Syndrome Scale (NoSAS).
RESULTS
Statistically significant differences were revealed in the prevalence of the following complaints about sleep disorders in patients with MOH: lack of sleep (51.5%), frequent awakenings during sleep (43.3%), discomfort in legs before falling asleep or at rest in the evening (37.4%). Difficulties falling asleep occurred equally often in both patients with MOH (43.9%) and without MOH (37.0%), as well as daytime sleepiness (40.4% vs 36.4%) and the presence of snoring (13% of patients in each group). Patients with MOH were significantly more likely to suffer from chronic insomnia (60.2% and 47.4%, respectively, =0.02; OR 1.7; 95% CI 1.1-2.6) and restless legs syndrome (37.4% and 22.0%, respectively, =0.002; OR 2.1; 95% CI 1.3-3.4). The incidence of hypersomnia and obstructive sleep apnea syndrome did not have statistically significant differences.
CONCLUSION
Patients with MOH compared to patients without MOH have a significantly higher incidence of main complaints of sleep disorders, chronic insomnia and restless legs syndrome, which indicates the importance of sleep disorders in the pathogenesis of medication-overuse headaches and requires timely diagnosis and treatment to prevent the progression of both headaches and sleep disorders.
Topics: Humans; Male; Female; Middle Aged; Adult; Headache Disorders, Secondary; Prospective Studies; Case-Control Studies; Sleep Wake Disorders; Sleep Initiation and Maintenance Disorders; Incidence; Sleep Apnea, Obstructive; Prevalence; Aged
PubMed: 38934672
DOI: 10.17116/jnevro202412405293 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN).
MATERIAL AND METHODS
Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3-4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score - 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI).
RESULTS
Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group (<0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months (<0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group (<0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain.
CONCLUSION
Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.
Topics: Humans; Diabetic Neuropathies; Male; Female; Sleep Initiation and Maintenance Disorders; Middle Aged; Neuralgia; Severity of Illness Index; Aged; Pain Measurement; Adult; Treatment Outcome; Sleep Quality
PubMed: 38934671
DOI: 10.17116/jnevro202412405287 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To investigate the relationship between symptoms of trait anxiety, state anxiety and symptoms of insomnia and the degree of their influence on daytime functioning...
OBJECTIVE
To investigate the relationship between symptoms of trait anxiety, state anxiety and symptoms of insomnia and the degree of their influence on daytime functioning disorders in adolescent girls.
MATERIAL AND METHODS
The study included 50 healthy adolescent girls, senior school students, aged 15-17 years, selected as simple random sample. Insomnia symptoms and their impact on daytime functioning were assessed using the SLEEP-50 (S-50) questionnaire. Trait and state anxiety were assessed using the Spielberger questionnaire. The method of path analysis was used to identify significant associations.
RESULTS
There was a positive association of the severity of daytime functioning disorders with the severity of insomnia symptoms (β=0.45; <0.001) and the level of trait anxiety (β=0.34; =0.004). Trait anxiety was also a significant predictor of state anxiety (<0.001), with a direct relationship between these parameters (β=0.62). Positive covariation of insomnia symptoms severity and state anxiety was found (β=0.53; <0.001).
CONCLUSION
Improving sleep quality and daytime functioning in adolescents with insomnia symptoms should take into account personality characteristics. High levels of trait anxiety increase the negative effects of insomnia on the impaired daytime functioning.
Topics: Humans; Adolescent; Female; Sleep Initiation and Maintenance Disorders; Anxiety; Surveys and Questionnaires; Sleep Quality; Severity of Illness Index; Personality
PubMed: 38934668
DOI: 10.17116/jnevro202412405266 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA). (Review)
Review
OBJECTIVE
Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA).
MATERIAL AND METHODS
The literature search was carried out using the databases PubMED, Google Scholar, E-library, Cyberleninka for the period 2013-2023 and included reviews and original articles.
RESULTS
The main groups of factors affecting adherence to CPAP therapy in patients with OSA have been established. These include sociodemographic and socioeconomic factors, the severity of OSA and the severity of clinical symptoms, and psychosocial factors. Strategies that can improve adherence were identified (educational technologies for patients, telemedicine technologies, behavioral therapy, modern technical interventions).
CONCLUSION
Factors that improve adherence to CPAP therapy are high levels of education and income, more severe OSA forms accompanied by daytime sleepiness, support from the patient's spouse and social support. Factors such as low levels of education and income, smoking, symptoms of depression and hypochondria, as well as side-effects worsen adherence to CPAP therapy, including refusal to continue treatment. It should be noted that all the identified factors are very closely associated with each other, so it is necessary to evaluate them comprehensively in each patient with OSA.
Topics: Humans; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Patient Compliance; Social Support; Socioeconomic Factors
PubMed: 38934667
DOI: 10.17116/jnevro202412405258 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep... (Review)
Review
Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.
Topics: Humans; Sleep Apnea, Obstructive; Tonsillectomy; Pharynx; Treatment Outcome; Otorhinolaryngologic Surgical Procedures; Bariatric Surgery
PubMed: 38934666
DOI: 10.17116/jnevro202412405253 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other...
Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.
Topics: Humans; Multimorbidity; Practice Guidelines as Topic; Quality of Life; Sleep Initiation and Maintenance Disorders
PubMed: 38934665
DOI: 10.17116/jnevro202412405239 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To compare the effect of stage 3 fragmentation and the paradoxical phase of night sleep on melatonin (MT) secretion, and to evaluate the effects of changes in autonomic...
OBJECTIVE
To compare the effect of stage 3 fragmentation and the paradoxical phase of night sleep on melatonin (MT) secretion, and to evaluate the effects of changes in autonomic balance and activation reactions that occur in the orthodox and paradoxical phases of sleep.
MATERIAL AND METHODS
Fifteen healthy men participated in three sessions: with stage 3 fragmentation, with fragmentation of paradoxical sleep, and in a control experiment in which sleep was not disturbed. In each experiment, 7 saliva samples were collected in the evening, at night and in the morning and the MT content was determined. Heart rate variability was analyzed using an electrocardiogram and autonomic balance was assessed.
RESULTS
Sleep fragmentation was accompanied by activation reactions and reduced the duration of stage 3 and paradoxical phase sleep by 50% and 51% in the corresponding sessions. Fragmentation of paradoxical sleep also led to an increase in the duration of night wakefulness. Sleep disturbances caused an increase in MT secretion in the second half of the night and in the morning, especially pronounced in sessions with fragmentation of paradoxical sleep, in which upon awakening MT was 1.8 times higher than in the control. Stage 3 fragmentation was accompanied by increased sympathetic activation, while fragmentation of paradoxical sleep did not cause autonomic shifts. The subjects were divided into 2 clusters: with high and low MT in night and morning saliva samples. In all sessions, subjects with high MT had 1.7-2 times longer duration of night wakefulness; in sessions with fragmentation, they had significantly more activations in the paradoxical phase of sleep.
CONCLUSION
Night sleep disturbances cause an increase in MT secretion, especially pronounced during the fragmentation of the paradoxical phase. An increase in MT levels does not depend on changes in autonomic balance and is apparently associated with activation of the serotonergic system, which accompanies disturbances in the depth and continuity of sleep.
Topics: Humans; Melatonin; Male; Sleep, REM; Adult; Saliva; Sleep Deprivation; Sleep, Slow-Wave; Young Adult; Heart Rate; Autonomic Nervous System; Wakefulness
PubMed: 38934663
DOI: 10.17116/jnevro202412405226