257 research outputs found
Stress, Sleep, and Allergy
Allergic diseases have recently increased dramatically in the western
world, now affecting about 30% of the Swedish population. The reasons for
this increase are unclear, but some of the suspects are behavioral
factors, such as stress and sleep. Problems with stress are also common
today, and stress may change the set-points for the functioning of the
body, for instance in the immune system. Sleep, on the other hand, is
important for recuperation, and disturbed sleep acts a stressor in
itself. Allergic patients often report stressful situations to cause
allergic symptom exacerbations, and experience increased fatigue and
disturbed sleep, especially when exposed to allergen. However, most
aspects of the relations between stress, sleep, and allergy are still
obscure. Therefore, this thesis aimed at increasing the understanding of
these links.
The thesis is based on three studies. The first is a quasi-experimental
study of medical students with or without atopy, who were observed at two
occasions, i.e. during a calmer study period and during a potentially
stressful examination period (papers I & II). Assessments included blood
sampling, lung function testing, and questionnaires and diaries on
allergic and psychological symptoms and sleep. The results show that both
atopic and non-atopic students increased ratings of stress and negative
mood, had altered sleep patterns and changes in immune parameters, e.g. a
marked increase in regulatory T-cells, during examination. Atopic
participants also showed specific responses to stress, such as a shift
towards T-helper 2 dominance, increased anxiety and disturbed sleep.
Despite these changes, allergic symptoms were not affected.
Paper III is based on a prospective epidemiological study, using parent
report questionnaire data on aspects of disturbed sleep and allergy from
the Twin Study of Child and Adolescent Development (TCHAD). Controlling
for confounding effects of several factors, including gender, birth
weight, and socioeconomic status, results from this study show that being
overtired in childhood (age 8-9) predicts development of rhinitis in
adolescence (age 13-14), but also that having asthma in childhood is
predictive of becoming overtired in adolescence. Controlling for gender
only, it also replicates findings from cross sectional studies of
associations between allergy and disturbed sleep.
The findings from paper I-III suggest that treatment of sleeping problems
that are comorbid with e.g. allergies is an important issue. Therefore,
paper IV is a randomized controlled trial of the efficacy of a CBT-based
self-help treatment for insomnia with comorbid problems, including
allergy. Assessments with questionnaires and sleep diaries took place at
pre-treatment, post-treatment and three-month follow-up. The study shows
that participants in the treatment groups display much improved sleep,
and that the sleep of allergic individuals improved to the same extent as
that of non-allergic individuals, despite co-existing allergic symptoms.
In conclusion, stress is involved in allergy relevant immune changes, and
the cumulative negative effects of stress (i.e. allostatic load) seem to
be increased in atopic individuals as compared to non-atopics. The
results thus speak for stress as a co-factor in an allergic reaction when
exposed to allergen. Aspects of disturbed sleep may be involved in the
development of allergy and vice versa, but disturbed sleep, also in
individuals with allergy, can be treated efficiently with a CBT-based
self-help treatment. The results of the thesis confirm a link between
stress, sleep, and allergy, and suggest future studies to test if
successful treatment of stress and sleep may decrease symptom expression
or even diminish the risk for developing allergic disease
Insomnia â A Heterogenic Disorder Often Comorbid With Psychological and Somatic Disorders and Diseases: A Narrative Review With Focus on Diagnostic and Treatment Challenges
Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea (COMISA). In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases.publishedVersio
Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: a systematic review and meta-analysis
The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects.
Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design.
A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I2 = 84.5%; tau2 = 0.31; p < 0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01â0.90; I2 = 87.5%; tau2 = 0.48, p < 0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02â0.92; I2 = 88.3%; tau2 = 0.36; p = 0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12â0.80; I2 = 52.9%; tau2 = 0.07; p = 0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD = 0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD = 0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test.
In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used
The European Academy for Cognitive Behavioural Therapy for Insomnia : An initiative of the European Insomnia Network to promote implementation and dissemination of treatment
Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBTâI) should be the firstâline treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBTâI Academy that would enable a Europeâwide system of standardized CBTâI training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBTâI, preconditions for health professionals to teach CBTâI, the way in which CBTâI should be taught, who should be taught CBTâI and to whom CBTâI should be administered. Furthermore, diverse aspects of CBTâI care and delivery were discussed and incorporated into a steppedâcare model for insomnia.Peer reviewe
Hydrocarbon-degrading bacteria in deep-water subarctic sediments (Faroe-Shetland Channel)
We would like to thank Premier Oil Ltd for providing sediment samples from FSC135. We would also like to thank the chief scientist Dr George Slesser, the FRV Scotia captain and crew, and Marine Scotland scientific staff for their assistance in sediment sampling from stations FSC500 and FSC1000. This research was funded by the NERC award NE/L00819X/1. E.G. was funded by the MASTS pooling initiative (The Marine Alliance for Science and Technology for Scotland), and their support is gratefully acknowledged. MASTS is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions.Peer reviewedPublisher PD
Chemical Dispersant Enhances Microbial Exopolymer (EPS) Production and Formation of Marine Oil/Dispersant Snow in Surface Waters of the Subarctic Northeast Atlantic
This manuscript contains work conducted during a Ph.D. study undertaken as part of the Natural Environment Research Council (NERC) Centre for Doctoral Training (CDT) in Oil and Gas. It is sponsored by Heriot-Watt University via their James Watt Scholarship Scheme to LS and whose support is gratefully acknowledged. Partial support was also provided through a Royal Society Research Grant (RG140180) and a Society for Applied Microbiology grant to TG. DP received funding from the MASTS pooling initiative (The Marine Alliance for Science and Technology for Scotland) and their support is gratefully acknowledged.A notable feature of the Deepwater Horizon oil spill was the unprecedented formation of marine oil snow (MOS) that was observed in large quantities floating on the sea surface and that subsequently sedimented to the seafloor. Whilst the physical and chemical processes involved in MOS formation remain unclear, some studies have shown that extracellular polymeric substances (EPS) play a role in this process. Here, we report that during exposure of subarctic northeast Atlantic seawater to a chemical dispersant, whether in the presence/absence of crude oil, the dispersant stimulates the production of significant quantities of EPS that we posit serves as a key building block in the formation of MOS. This response is likely conferred via de-novo synthesis of EPS by natural communities of bacteria. We also describe the formation of marine dispersant snow (MDS) as a product of adding chemical dispersants to seawater. Differential staining confirmed that MDS, like MOS, is composed of glycoprotein, though MDS is more protein rich. Using barcoded-amplicon Illumina MiSeq sequencing, we analyzed, for the first time, the bacterial communities associated with MDS and report that their diversity is not significantly dissimilar to those associated with MOS aggregates. Our findings emphasize the need to conduct further work on the effects of dispersants when applied to oil spills at sea, particularly at different sites, and to determine how the product of this (i.e. MOS and MDS) affects the biodegradation of the oil.Publisher PDFPeer reviewe
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