Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients

Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night’s rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients’ hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients’ neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients’ neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.Regional Ministry of Health of Andalusia (PI-0259-2017

Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study

Background: Insomnia has been associated with decreased academic performance and unhealthy behaviors in university students. Although many studies have analyzed sleep phenomenology among this population, only few have focused on insomnia and its related variables. In addition, such studies do not always include a clinical interview or a specific and validated instrument for measuring insomnia. This study aimed to explore the prevalence of insomnia symptoms and the relationship between insomnia and health habits, mental health, and academic performance in a large university student sample. Methods: Five hundred and eighty-two students were recruited from the University of Granada, Spain. Data were collected through an online survey with questions on sociodemographic and academic data and health habits as well as the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleep Hygiene Index, and Sleepiness, Depression, Anxiety, and Stress Scales. A multiple regression analysis explored the relationship between academic performance, health habits, mood state, and insomnia symptoms. Results: The prevalence of students with symptoms of insomnia was high (39.7%). A multiple logistic regression analysis revealed that depression, sleep hygiene, stress and anxiety were significant predictors of insomnia symptoms. Multivariate analyses revealed that subjective insomnia symptoms, sleep efficiency, and depression were significantly correlated with academic performance in a dependent way. Conclusions: In university students, anxiety, stress, and poor sleep hygiene are risk factors for insomnia, which plays an important role in academic performance. Promoting sleep and mental health could be a potentially effective way to improve their academic performance

Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study

Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = -0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.Spanish Government PSI2009-13765 PID2019-109612GB I00/AEI/10.13039/50110001103

Hypoxia Is Not a Main Stress When Mycobacterium tuberculosis Is in a Dormancy-Like Long-Chain Fatty Acid Environment

The capacity of Mycobacterium tuberculosis (Mtb) to sense, respond and adapt to a variable and hostile environment within the host makes it one of the most successful human pathogens. During different stages of infection, Mtb is surrounded by a plethora of lipid molecules and current evidence points out the relevance of fatty acids during the infectious process. In this study, we have compared the transcriptional response of Mtb to hypoxia in cultures supplemented with a mix of even long-chain fatty acids or dextrose as main carbon sources. Using RNA sequencing, we have identified differential expressed genes in early and late hypoxia, defined according to the in vitro Wayne and Hayes model, and compared the results with the exponential phase of growth in both carbon sources. We show that the number of genes over-expressed in the lipid medium was quite low in both, early and late hypoxia, relative to conditions including dextrose, with the exception of transcripts of stable and non-coding RNAs, which were more expressed in the fatty acid medium. We found that sigB and sigE were over-expressed in the early phase of hypoxia, confirming their pivotal role in early adaptation to low oxygen concentration independently of the carbon source. A drastic contrast was found with the transcriptional regulatory factors at early hypoxia. Only 2 transcriptional factors were over-expressed in early hypoxia in the lipid medium compared to 37 that were over-expressed in the dextrose medium. Instead of Rv0081, known to be the central regulator of hypoxia in dextrose, Rv2745c (ClgR), seems to play a main role in hypoxia in the fatty acid medium. The low level of genes associated to the stress-response during their adaptation to hypoxia in fatty acids, suggests that this lipid environment makes hypoxia a less stressful condition for the tubercle bacilli. Taken all together, these results indicate that the presence of lipid molecules shapes the metabolic response of Mtb to an adaptive state for different stresses within the host, including hypoxia. This fact could explain the success of Mtb to establish long-term survival during latent infection

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Análisis polisomnográfico del sueño en la fibromialgia: identificación de los cambios objetivos del sueño tras diversas opciones de tratamiento cognitivo-conductual

Tesis Univ. Granada. Departamento de Personalidad, Evaluación y Tratamento PsicológicoEste estudio ha sido financiado a traves del proyecto PSI2009-13765, subvencionado por el Ministerio de Ciencia e Innovación (España)

Psychometric properties of the Spanish version of the Sleep Hygiene Index

The Sleep Hygiene Index (SHI) has shown adequate psychometric properties in samples from several countries but has not been validated in Spanish. The aims of the study were to translate the original (i.e., English) version of the SHI into Spanish and to evaluate the psychometric properties of this instrument (i.e., factor structure, internal consistency reliability, and concurrent, predictive and discriminant validity) in Spanish adults. The overall sample, comprising 548 university students, was divided into two groups based on their self-reported insomnia symptoms (Insomnia Severity Index) because sleep hygiene has been shown to be closely related to insomnia. The Pittsburgh Sleep Quality Index and Stanford Sleepiness Scale were used for testing concurrent validity. The Depression, Anxiety and Stress Scale was used for testing predictive validity. Three items were dropped from the original SHI scale due to their low factor loadings. A principal component analysis revealed a four-factor solution for the SHI, accounting for 65.58% of the total variance in the overall sample, for 65.34% in the non-insomnia group, and for 63.50% in the insomnia group. Factor 1 comprised items regarding sleep-disrupting behaviors; Factor 2 comprised items regarding cognitive activation; Factor 3 comprised items about bedroom comfort; and Factor 4 comprised items on sleep/wake time. Omega coefficient indices for the SHI ranged from .751 to .878 in the overall sample, from .734 to .822 in the non-insomnia group, and from .724 to .835 in the insomnia group. The Spanish version of the SHI can be regarded as a reliable tool with adequate concurrent and predictive validity for assessing sleep hygiene in Spanish people with or without insomnia symptoms

The current situation of wind energy in Spain

Successive international commitments relating to energy and climatic change (embodied in the Kyoto Protocol) and the need to rationalise the sources of generated energy, have meant that renewable energies have started to gain a great deal of importance within the worldwide energy network. In the case of Wind Energy, and in terms of production, Spain is the second most important country at European level and the third most important country at global level. Spain holds these positions as a result of the establishment of a stable regulatory framework, better understanding of the resource and improved technology that have afforded considerable cost reduction in terms of initial investment, maintenance and exploitation. This article focuses on these circumstances in view of their relevance at international level, which is due to the highly feasible possibility of exporting Spain's experiences to other countries with guarantees of success.Renewable energy Wind power Energy policy

Sleep quality, clinical and psychological manifestations in women with Systemic Lupus Erythematosus

Aim: Sleep problems are a common complaint in Systemic Lupus Erythematosus (SLE) patients. We analyzed sleep quality with subjective and objective measures in a sample with SLE and its possible relationships with the main manifestations of the disease. Method: 21 women with SLE and 20 healthy women participated in the study. All participants were evaluated with actigraphy for a week and they completed self-report instruments of sleep quality, quality of life, fatigue, anxiety, depression and perceived stress. Comparison analyses between the two groups were done using Chi-square and t-Student. The association between sleep quality and the remaining variables was explored using Pearson correlation coefficients. Results: SLE patients had higher fragmentation index in the actigraphic analysis and a perception of poorer sleep quality more fatigue, anxiety and depression than the control group. Bivariate analyses showed that the perception of more sleep disturbance and daytime dysfunction was associated with a lower health-related quality of life, more fatigue, emotional discomfort and more perceived stress. Also the fragmentation index in the actigraphy was significantly related to the perception of poorer quality of sleep. Conclusion: SLE women had a poorer sleep quality (objective and subjective). These alterations could play a modulatory role in clinical and psychological manifestations of the disease and affect the quality of life in this population. More research is needed to clarify these relations and to determine the potential benefits of interventions directed to improve sleep in the clinical managing of the patients with SLE.This study was financially supported by the Spanish Ministry of Science and Innovation through project PSI-2014-58379-P

Exploring the clinical utility of an electronic diary in fibromyalgia patients: A pilot study: Explorando la utilidad clínica de un diario electrónico en pacientes con fibromialgia: Un estudio piloto

This study examines the usefulness of an electronic diary (ED) in the monitoring of clinical manifestations of fibromyalgia (FM), compared to traditional pencil-and-paper self-reports.  Fourteen women with FM completed an interview, several questionnaires, and an ED for a week (several times a day) recording pain, fatigue, sleep, difficulty in thinking, emotional distress, difficulty in daily functioning, and coping with the disease, and stress. There were no differences in the symptoms throughout the moments of the day, observing a sleep latency of 45.36 minutes and sleep duration of 6.25 hours. Significant correlations were found between ED measures depending on the time of day, and between ED measures and questionnaires. The ED showed to be useful for the evaluation of FM symptomatology, and can be a key component in psychological intervention programs.Abstract: This study examines the clinical utility of an electronic diary (ED) in the monitoring of the clinical manifestations of fibromyalgia (FM), compared to traditional paper-pencil self-reports. Fourteen women with FM completed an interview, several questionnaires, and an ED for a week (several times a day) recording pain, fatigue, sleep, difficulty in thinking, emotional distress, difficulty in daily functioning, coping with the disease, and stress. There were no differences in symptoms throughout the different moments of the day. A sleep latency of 45.36 minutes and sleep duration of 6.25 hours was observed. Significant correlations were found between ED measures depending on the time of day, and between ED measures and questionnaires. The ED showed to be useful for the evaluation of FM symptomatology and could be a key component in psychological intervention programs. Keywords: electronic diary; fibromyalgia; pain; sleep; emotional distress. Explorando la utilidad clínica de un diario electrónico en pacientes con fibromialgia: Un estudio piloto Resumen: Este estudio examina la utilidad de un diario electrónico (DE) en el seguimiento de las manifestaciones clínicas de la fibromialgia (FM) frente a los tradicionales autoinformes de lápiz y papel. Catorce mujeres con FM completaron una entrevista, varios cuestionarios y un DE durante una semana (varias veces al día) registrando dolor, fatiga, sueño, dificultad para pensar, malestar emocional, dificultad en el funcionamiento diario, afrontamiento de la enfermedad, y estrés. No hubo diferencias en los síntomas a lo largo de los momentos del día, observándose una latencia del sueño de 45,36 minutos y una duración del sueño de 6,25 horas. Se encontraron correlaciones significativas entre las medidas del DE dependiendo de la hora del día, y entre las medidas del DE y los cuestionarios. El DE demostró ser útil para la evaluación de la sintomatología de la FM y puede ser un componente clave en los programas de intervención psicológica. Palabras clave: diario electrónico; fibromialgia; dolor; sueño; malestar emocional