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Sleep Disorders

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Research articles:

Goldstein, T. R., Bridge, J. A., & Brent, D. A. (2008). Sleep disturbance preceding completed suicide in adolescents. Journal of Consulting and Clinical Psychology, 76(1), 84-91. doi:10.1037/0022-006X.76.1.84

We examined sleep difficulties preceding death in a sample of adolescent suicide completers as compared with a matched sample of community control adolescents. Sleep disturbances were assessed in 140 adolescent suicide victims with a psychological autopsy protocol and in 131 controls with a similar semistructured psychiatric interview. Rates of sleep disturbances were compared between groups. Findings indicate suicide completers had higher rates of overall sleep disturbance, insomnia, and hypersomnia as compared with controls within both the last week and the current affective episode. Group differences in overall sleep disturbance (both within the last week and present episode), insomnia (last week), and hypersomnia (last week) remained significant after controlling for the differential rate of affective disorder between groups. Similarly, overall sleep disturbance (last week and present episode) and insomnia (last week) distinguished completers in analyses accounting for severity of depressive symptoms. Only a small percentage of the sample exhibited changes in sleep symptom severity in the week preceding completed suicide, but of these, a higher proportion were completers. These findings support a significant and temporal relationship between sleep problems and completed suicide in adolescents. Sleep difficulties should therefore be carefully considered in prevention and intervention efforts for adolescents at risk for suicide. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (from the journal abstract)

Krahn, L., Miller, B., & Bergstrom, L. (2008). Rapid resolution of intense suicidal ideation after treatment of severe obstructive sleep apnea. Journal of Clinical Sleep Medicine, 4, 64-65. Retrieved from EBSCOhost.

Patients with insomnia may develop suicidal ideation; however, we know of no reports of suicidal ideation associated with obstructive sleep apnea. We report on a 74-year-old man who presented to his primary care physician with excessive daytime sleepiness, poor quality nocturnal sleep, depressed mood, and suicidal ideation with active suicide plans. An emergency outpatient psychiatry consultation was arranged. The patient declined psychiatric hospitalization. He agreed to a trial of continuous positive airway pressure, using a self-titrating machine, followed by an urgent sleep study. Polysomnography revealed an apnea hypopneaindex of 64, arousal index of 91 and minimum oxygen saturation of 65%. The patient's sleep and excessive daytime sleepiness responded to nCPAP. The patient declined antidepressant medication but had excellent adherence to nCPAP. Suicidal ideation and depression resolved promptly and at 4-month followup were in remission. Further studies examining the relationship among untreated obstructive sleep apnea, depression, and suicidal ideation are warranted.

Krakow, B., Ribeiro, J. D., Ulibarri, V. A., Krakow, J., & Joiner, T. E. (2011). Sleep disturbances and suicidal ideation in sleep medical center patients. Journal of Affective Disorders, 131(1-3), 422-427. doi:10.1016/j.jad.2010.12.001   

Abstract: Objective: The purpose of this investigation was two-fold: first, we examined associations between suicidal ideation, maladaptive sleep patterns and abnormal sleep behaviors in a sleep center population, an understudied population in the domain of suicide research; and then, we explored whether significant associations remained after accounting for the possible influence of depressive symptoms. Method: Data were analyzed from intake information obtained from 1584 adult patients presenting at a community-based private sleep medical center. The sample was parsed into a Suicidal Ideation (SI) group (N =211) and No Suicidal Ideation (NSI) group (N =1373). Comparisons of these groups were made on measures of self-reported sleep complaints, habits, and behaviors, suicidal ideation, depressive symptoms, and associated psychopathology. Results: Approximately 13% of participants reported suicidal ideation. Clinically significant suicidal ideation was present in 4.5% of the sample. Compared to the NSI group, the SI group showed a pervasive pattern of significantly greater frequency or severity of sleep problems in areas of insomnia, nightmares and other parasomnia behaviors, poor sleep quality, and sleep-related psychophysiologic conditioning as well as worse sleep-related impairment and quality of life. Several relationships were significant after controlling for depressive symptoms. Discussion: Suicidal ideation was consistently associated with a broad array of sleep complaints, even when controlling for level of depressive symptoms. As these self-reported sleep disturbances are treatable sleep disorders, future research should examine the efficacy of sleep and behavioral medicine for reducing the risk of suicidal ideation. [Copyright &y& Elsevier]

Liu, X., & Buysse, D. (2006). Sleep and youth suicidal behavior: A neglected field. Current Opinion in Psychiatry, 19(3), 288-293. Retrieved from EBSCOhost.

PURPOSE OF REVIEW: Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research. RECENT FINDINGS: Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior. SUMMARY: Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior.

Pompili, M., Lester, D., Innamorati, M., Erbuto, D., Gentili, F., Tatarelli, R., & ... De Pisa, E. (2008). Reasons for living and sleeping patterns among youths: A further contribution to suicide prevention. Archives: The International Journal of Medicine, 1, 6-11. Retrieved from EBSCOhost.

Study Objectives: Sleep problems are common both in the general population and in psychiatric patients, reducing quality of life, well-being and work abilities with huge economic consequences. The aim of the study was to investigate the association between sleep patterns, depression and reasons for living in a non-clinical sample of Italian young adults attending university. Design and Setting: A questionnaire study of university students was conducted at the Sapienza University of Rome during the academic year 2003-2004. Participants were contacted in their departments during the regular academic year. Participants: A total of 300 university students (133 men and 167 women), mean age 23.3 (SD=3.0), participated in the study. Measurements: Respondents completed the Reasons for Living Inventory, the Zung Self-Rating Depression Scale, the Pittsburg Sleep Quality Index, and the Epworth Sleepiness Scale. Results: A significant negative correlation between reasons for living and sleep quality was observed whereas there was positive correlation between reason for living and daytime somnolence. Two regression analysis confirmed that sleep quality and daily somnolence were significant predictors of depression, but not directly of reasons for living. Gender differences were also observed. Conclusion: Sleep disturbances are prevalent in this population, and subjects who are depressed and who have sleep disorders (both sleep quality and daytime somnolence) have fewer reasons for living and are potentially at higher risk for suicide.

Sher, L. (2008). Sleep disturbances, synaptic homeostasis and suicidal behaviour. Australian and New Zealand Journal of Psychiatry, 42(12), 1070-1071. Retrieved from EBSCOhost.

Sleep abnormalities are common in patients with suicidal behavior. Sleep complaints such as insomnia, hypersomnia, nightmares, and sleep panic attacks are frequent in suicidal adolescents and adults. Sleep studies have reported various polysomnographic findings in suicidal patients with depression, schizoaffective disorder, and schizophrenia. Sleep difficulties should be considered in prevention and intervention efforts for patients at risk for suicide. Prevention efforts should target good sleep hygiene and early detection and treatment of problematic sleep patterns in order to decrease risk for suicide. Further studies are needed to investigate possible mechanisms of sleep disturbances in suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Sjöström, N., Hetta, J., & Waern, M. (2009). Persistent nightmares are associated with repeat suicide attempt: A prospective study. Psychiatry Research, 170(2/3), 208-211. doi:10.1016/j.psychres.2008.09.006

Abstract: The aim of this prospective study was to determine if sleep disturbances and nightmares are associated with increased risk of repeat suicide attempt. Patients (n =165) aged 18–68 years who were admitted to medical or psychiatric wards after a suicide attempt completed an initial interview; 98 of these took part in a 2-month follow-up interview. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and two self-report instruments, the Uppsala Sleep Inventory and the Comprehensive Psychopathological Rating Scale (CPRS) Self-Rating Scale for Affective Syndromes, were administered both at baseline and follow-up. Data concerning repeat suicide attempts within 2years were obtained from hospital records. Analyses were performed using Student''s t-test, chi-square test, and logistic regression. In total 42 patients (26%) made at least one repeat suicide attempt within 2 years. While neither difficulties initiating/maintaining sleep nor early morning awakening at baseline predicted repeat attempt, having frequent nightmares did (OR=3.15). The risk was further heightened when nightmares were reported at both baseline and 2-month follow-up (OR=5.20). These associations remained after adjusting for sex, axis-I DSM-IV diagnoses, and self-reported depression and anxiety symptom intensity. Our findings suggest that nightmares might constitute a marker for increased risk of suicidal behavior. [Copyright &y& Elsevier]

Sjostrom, N., Waern, M., & Hetta, J. (2007). Nightmares and sleep disturbances in relation to suicidality in suicide attempters. Sleep, 30(1), 91-95. Retrieved from EBSCOhost.

STUDY OBJECTIVES: To study the prevalence of specific sleep disturbances in suicide attempters and to examine the association between specific sleep disturbances and suicidality. DESIGN AND SETTING: A cross-sectional study in suicide attempters during the period October 1, 2001, to June 30, 2004. PARTICIPANTS: One hundred sixty-five patients aged 18 to 68 years who were admitted to medical units or psychiatric wards at Sahlgrenska University Hospital after a suicide attempt. INTERVENTIONS: N/A. MEASUREMENTS: The face-to-face interview included Structured Clinical Interview for DSM-IV-IV and the Suicide Assessment Scale. Two self-report instruments were employed, the Uppsala Sleep Inventory and Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. The latter assessed symptom burden. Using multiple logistic regression analyses, we examined associations between sleep complaints and suicidality. RESULTS: Eighty-nine percent of subjects reported some kind of sleep disturbance. The most common complaint was difficulties initiating sleep (73%). Other complaints included difficulties maintaining sleep (69%), nightmares (66%) and early morning awakening (58%). Nightmares were associated with a 5-fold increase in risk for high suicidality. This relationship remained after adjustment for psychiatric diagnosis and psychiatric symptom intensity. CONCLUSIONS: Sleep disturbances are common among suicide attempters. Nightmares are associated with suicidality. Our findings suggest that questions concerning sleep disturbance and nightmares should be addressed in the clinical assessment of suicidal patients.

Wojnar, M., Ilgen, M. A., Wojnar, J., McCammon, R. J., Valenstein, M., & Brower, K. J. (2009). Sleep problems and suicidality in the national comorbidity survey replication. Journal of Psychiatric Research, 43(5), 526-531. doi:10.1016/j.jpsychires.2008.07.006

Abstract: Objective: Links between sleep problems and suicidality have been frequently described in clinical samples; however, this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States. Methods: The WHO Composite International Diagnostic Interview was used to assess sleep problems and suicidality in the National Comorbidity Survey Replication (NCS-R). Relationships between three measures of sleep (difficulty initiating sleep, maintaining sleep, early morning awaking), and suicidal thoughts, plans, and attempts were assessed in logistic regression analyses, while controlling for demographic characteristics, 12-month diagnoses of mood, anxiety and substance use disorders, and chronic health conditions. Results: In multivariate models, the presence of any of these sleep problems was significantly related to each measure of suicidality, including suicidal ideation (OR=2.1), planning (OR=2.6), and suicide attempt (OR=2.5). Early morning awakening was associated with suicidal ideation (OR=2.0), suicide planning (OR=2.1), and suicide attempt (OR=2.7). Difficulty initiating sleep was a significant predictor of suicidal ideation and planning (ORs: 1.9 for ideation; 2.2 for planning), while difficulty maintaining sleep during the night was a significant predictor of suicidal ideation and suicide attempts (ORs: 2.0 for ideation; 3.0 for attempt). Conclusions: Among community residents, chronic sleep problems are consistently associated with greater risk for suicidality. Efforts to develop comprehensive models of suicidality should consider sleep problems as potentially independent indicators of risk. [Copyright &y& Elsevier]

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