Sleep Initiation and Maintenance Disorders: Partinen M

Kronholm E, Partonen T, Laatikainen T, Peltonen M, Härmä M, Hublin C, Kaprio J, Aro AR, Partinen M, Fogelholm M, Valve R, Vahtera J, Oksanen T, Kivimäki M, Koskenvuo M, Sutela H. · The National Public Health Institute, Turku, Finland. · J Sleep Res. · Pubmed #18275555 No free full text.

Abstract: A hypothesis concerning habitual sleep reduction and its adverse consequences among general population in modern societies has received wide publicity in the mass media, although scientific evidence supporting the hypothesis is scarce. Similarly, there is an extensively distributed belief, at least in Finland, that the prevalence of insomnia-related symptoms is increasing, but evidence for this is even sparser. These issues are important because of the known increased risk of mortality and health risks associated with sleep duration deviating from 7 to 8 h. To reveal possible trends in self-reported sleep duration and insomnia-related symptoms, we reanalyzed all available data from surveys carried out in Finland from 1972 to 2005. The main results were that a minor decrease of self-reported sleep duration has taken place in Finland, especially among working aged men. However, the size of the reduction (about 4%) was relatively small, approximately 5.5 min per each 10 years during the 33 years' time interval under study. The proportion of 7 h sleepers has increased and, correspondingly, the proportion of 8 h sleepers has decreased, but the extreme ends of the sleep duration distribution remained unchanged. Tentative evidence suggesting an increase in insomnia-related symptoms among working aged population during the last 10 years was found. In conclusion, the Finnish data during the past 33 years indicate a general decrease in self-reported sleep duration of about 18 min and an increase of sleep complaints, especially among the employed middle-aged population.

Partinen M, Hirvonen K, Hublin C, Halavaara M, Hiltunen H. · Haaga Neurological Research Centre NEURO, Department of Clinical Neurosciences, University of Helsinki, Mäkipellontie 15, FIN-00320 Helsinki, Finland. · Sleep Med. · Pubmed #14607350 No free full text.

Abstract: BACKGROUND: Occasionally, insomniac patients may take a sleeping pill after midnight. This may have consequences on their ability to drive a car and result in an increased risk of car accidents. METHODS: This double-blind, randomized, placebo-controlled, three-treatment three-period cross-over study investigated the effects of two frequently prescribed hypnotics of different classes in a real life condition on driving performance and psychomotor skills in insomniac women. Single doses of zolpidem 10 mg (Z), temazepam 20 mg (T) or placebo (P) were administered at 2:00 a.m. to 19 women aged 35-60 years in three treatment periods separated by wash-out periods of 3-14 days. After polysomnography at baseline and each treatment night, patients underwent, 5.5 h after drug intake at 7:30 a.m. on the next morning, a STISIM driving simulator test, and a subsequent neuropsychological test (FePsy). RESULTS: Eighteen insomniac women were included in the analysis (mean age 50 years, mean weight 69 kg, mean BMI 25.6 kg/m2). There were no differences between treatments for the primary outcome measure (mean time to collision; baseline: 0.120 s, P: 0.124, T: 0.118, Z: 0.124; P> or =0.12 for all pairwise comparisons). No differences were recorded for speed deviation and reaction time to tasks for the verum treatments, however, lane position deviation was greater after administration of zolpidem in comparison to both placebo and temazepam (P=0.025 and 0.05, respectively). There were no differences between treatments in the FePsy test. Both medications were well tolerated. CONCLUSIONS: 5.5 h after drug administration there were no major differences in psychomotor performances between both zolpidem and temazepam compared to placebo, which indicates the absence of significant residual effects at that time. However, certain patients were more susceptible than others to the drug effects (two patients with high number of collisions). This underlines the necessity to strongly advocate against the late intake of hypnotics if patients intend to drive a car early the next morning.

Mayer G, Wang-Weigand S, Roth-Schechter B, Lehmann R, Staner C, Partinen M. · Hephata-Klinik, Schwalmstadt, Germany. · Sleep. · Pubmed #19294955 No free full text.

Abstract: STUDY OBJECTIVES: Long-duration (> or = 6 months) polysomnographic studies of insomnia medications are lacking. This study evaluated the long-term efficacy of ramelteon, a selective MT1/MT2 melatonin-receptor agonist used for insomnia treatment. DESIGN: Six-month, randomized, double-blind, placebo-controlled study. SETTING: Forty-six investigative sites in the United States, Europe, Russia, and Australia. PARTICIPANTS: Four hundred fifty-one adults (age > or = 18 years) with chronic primary insomnia. INTERVENTIONS: Ramelteon, 8 mg, or placebo 30 minutes before bedtime nightly for 6 months. MEASUREMENTS: Sleep was evaluated by polysomnography and morning questionnaires on the first 2 nights of Week 1; the last 2 nights of Months 1, 3, 5, and 6; and Nights 1 and 2 of the placebo run-out. Next-morning residual effects as well as adverse effects and vital signs were recorded at each visit. Rebound insomnia and withdrawal effects were evaluated during placebo run-out. RESULTS: Over the 6 months of treatment, ramelteon consistently reduced latency to persistent sleep compared with baseline and with placebo; significant decreases were observed at Week 1 and Months 1, 3, 5, and 6 (P < 0.05). Ramelteon significantly reduced subjective sleep latency relative to placebo at Week 1, Month 1, and Month 5 (P < 0.05), with reductions nearing statistical significance at Months 3 and 6 (P < or = 0.08). No significant next-morning residual effects were detected during ramelteon treatment. No withdrawal symptoms or rebound insomnia were detected after ramelteon discontinuation. Most adverse events were mild or moderate in severity. CONCLUSIONS: In adults with chronic insomnia, long-term ramelteon treatment consistently reduced sleep onset, with no next-morning residual effects or rebound insomnia or withdrawal symptoms upon discontinuation.

Ahlberg K, Jahkola A, Savolainen A, Könönen M, Partinen M, Hublin C, Sinisalo J, Lindholm H, Sarna S, Ahlberg J. · Institute of Dentistry, University of Helsinki, Helsinki, Finland. · Head Face Med. · Pubmed #18307774 links to  free full text

Abstract: BACKGROUND: The aims were to investigate the prevalence of perceived sleep quality and insufficient sleep complaints, and to analyze whether self-reported bruxism was associated with perceptions of sleep, and awake consequences of disturbed sleep, while controlling confounding factors relative to poor sleep. METHODS: A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular eight-hour daytime work. RESULTS: The response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). Self-reported bruxism occurred frequently (often or continually) in 10.6% of all subjects. Altogether 16.8% reported difficulties initiating sleep (DIS), 43.6% disrupted sleep (DS), and 10.3% early morning awakenings (EMA). The corresponding figures for non-restorative sleep (NRS), tiredness, and sleep deprivation (SLD) were 36.2%, 26.1%, and 23.7%, respectively. According to logistic regression, female gender was a significant independent factor for all insomnia symptoms, and older age for DS and EMA. Frequent bruxism was significantly associated with DIS (p = 0.019) and DS (p = 0.021). Dissatisfaction with current work shift schedule and frequent bruxism were both significant independent factors for all variables describing insufficient sleep consequences. CONCLUSION: Self-reported bruxism may indicate sleep problems and their adherent awake consequences in non-patient populations.

Ulfberg J, Bjorvatn B, Leissner L, Gyring J, Karlsborg M, Regeur L, Skeidsvoll H, Polo O, Partinen M, Anonymous00232. · Sleep Disorders Center, Avesta Hospital, SE-774-82 Avesta, Sweden. · Sleep Med. · Pubmed #17825613 No free full text.

Abstract: BACKGROUND: Restless legs syndrome (RLS) is a neurological movement disorder, which often causes sleep problems. However, the comorbidity of this disorder is not well known. This study aimed to document the prevalence of RLS in the general population of Sweden and to identify factors associated with this condition. METHODS: A cross-sectional study was performed in Sweden. One thousand subjects aged 18-90 years old underwent telephone interviews. The questionnaire assessed such factors as sleep variables, depressive mood, treatment of diabetes mellitus, and treatment with drugs for depression during the previous four-week period. RLS was diagnosed based on the minimal criteria provided by the International RLS Study Group. RESULTS: The prevalence of RLS was 5% (5.7% in women, 3.5% in men). Severe or very severe RLS symptoms during the previous week were noted by 64% of the RLS subjects. Factors associated with RLS were insomnia, excessive daytime sleepiness, periodic limb movements in sleep, and depressed mood. Those affected by RLS were not more often consumers of drugs for depression than non-RLS subjects. CONCLUSIONS: RLS is prevalent in the general population in Sweden. RLS negatively influenced sleep and was associated with depressed mood. Antidepressive drug treatment was not associated with RLS.

Ahlberg K, Ahlberg J, Könönen M, Alakuijala A, Partinen M, Savolainen A. · Institute of Dentistry, Department of Stomatognathic Physiology and Prosthetic Dentistry, University of Helsinki, Helsinki, Finland. · Acta Odontol Scand. · Pubmed #16040443 No free full text.

Abstract: A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular 8-hour daytime work. The aims were to investigate the prevalence and severity of perceived orofacial pain (Research Diagnostic Criteria for Temporomandibular Disorders Axis II) and to analyze whether current orofacial pain was associated with reported bruxism and insomnia symptoms (Diagnostic and Statistical Manual of Mental Disorders-IV and the International Classification of Sleep Disorders Revised). The response rate in the irregular shift-work group was 82.3% (56.6% men) and in the regular daytime-work group 34.3% (46.7% men). Current orofacial pain was found overall in 19.6%, of which 88.3% had experienced the pain over 6 months. All claimed that their pain fluctuated. No subjects with chronic orofacial pain reported disabling pain, and grades III and IV were not found. Insomnia symptoms and frequent bruxism were significantly more prevalent in chronic pain grade II than in lower grades. According to logistic regression, current orofacial pain was significantly positively associated with frequent bruxism (p < 0.001), female gender (p < 0.001), and disrupted sleep (p < 0.01), and significantly negatively associated with age over 45 years (p < 0.01). Our results revealed a clear-cut association between perceived orofacial pain and reported bruxism. The association held with both chronic orofacial pain intensity and current pain. Based on the multivariate analyses, it can be concluded that disrupted sleep and bruxism may be concomitantly involved in the development of orofacial pain.

Martikainen K, Partinen M, Hasan J, Laippala P, Urponen H, Vuori I. · Community Health Centre of the City of Tampere, Hatanpäänkatu 24, SF-33100 Tampere, Finland. · Sleep Med. · Pubmed #14592322 No free full text.

Abstract: OBJECTIVE: The objective of this study is to assess the impact on insomnia symptoms of somatic diseases, psychological factors, living habits and life events during the previous year. BACKGROUND: Although health problems are a significant cause of insomnia, psychosocial factors are considered to be even more important. The relative impact of these and other factors on insomnia calls for further evaluation. METHODS: A questionnaire study in a randomly selected middle-aged population in Finland (N=626, 264 men and 362 women). RESULTS: In our study, 9.8% of men and 17.0% of women reported the occurrence of insomnia at least once a week during the previous 3 months. Insomniacs perceived their health as 'poor' or 'rather poor' more often than others and depression, allergic rhinitis, asthma, hypertension and heart symptoms such as arrhythmias were more common among them. Insomnia was not a side-effect of the treatment of these diseases; lack of medical treatment was associated with a higher incidence of insomnia. Work-related factors such as 'moving to a poorer job or to poorer working conditions' during the past year increased the possibility of insomnia, while moving house seemed to have a positive effect. When comparing these associations in logistic regression models, nervousness and tension were, however, the factors most significantly associated with insomnia. CONCLUSIONS: Psychosocial factors appeared to be more significantly associated with prolonged insomnia than somatic health problems.

Ohayon MM, Partinen M. · Stanford Sleep Epidemiology Research Center, School of Medicine, Stanford University, Stanford, CA, USA. · J Sleep Res. · Pubmed #12464102 No free full text.

Abstract: The purpose of this study is to assess the prevalence of insomnia symptoms and diagnoses in the general population of Finland. A total of 982 participants, aged 18 years or older and representative of the general population of Finland, were interviewed by telephone using the Sleep-EVAL system. The participation rate was 78%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and International Classification of Sleep Disorders (ICSD), associated and sleep/mental disorders and daytime consequences. The overall prevalence of insomnia symptoms occurring at least three nights per week was 37.6%. Difficulty initiating sleep were mentioned by 11.9% of the sample, difficulty maintaining sleep by 31.6%, early morning awakenings by 11.0% and non-restorative sleep by 7.9% of the sample. Global dissatisfaction with sleep was found in 11.9% of the sample. Daytime consequences (fatigue, mood changes, cognitive difficulties or daytime sleepiness) were reported by 39.9% of participants with insomnia symptoms and 87.6% of those with sleep dissatisfaction. A deterioration of sleep in summer or winter was associated with more complaints of sleep dissatisfaction. Prevalence of any DSM-IV insomnia diagnosis was 11.7%. More specifically, DSM-IV diagnosis of primary insomnia had a prevalence of 1.6% and DSM-IV diagnosis of insomnia related to another mental disorder was at 2.1%. Insomnia was a symptom of another sleep disorder in about 16% of cases and of a mental disorder in about 17% of cases. As reported in other Nordic studies, sleep quality was worse in summer. Insomnia symptomatology was common and was reported by more than a third of Finnish participants. Compared with other European countries studied with the same methodology (France, the UK, Germany, and Italy), the prevalence of DSM-IV insomnia diagnosis was 1.5 to two times higher in Finland.