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To the Editor: Sleep disturbances commonly co-occur with mental disorders and often are sufficiently severe to warrant targeted treatment. Left untreated, sleep disturbances may exacerbate comorbid conditions and complicate recovery. Moreover, sleep disturbances are considered modifiable risk factors for onset and relapse of mental disorders.
Objective: Complex sleep-related behaviors (CSBs) are often associated with hypnotic use, especially zolpidem. The age effect on the occurrence of CSBs has not been adequately investigated. This study aimed to investigate and compare the clinical correlates of CSBs between adult and elderly subjects who were taking zolpidem.
Method: A total of 253 adults (aged 20-55 years) and 64 elderly subjects (aged ≥ 65 years) who were administered zolpidem for at least 3 months were enrolled from psychiatric outpatient clinics from June 2011 to May 2012. The sociodemographic characteristics of the participants, the dose of zolpidem, and the occurrence of CSBs were collected. Logistic regression analysis was used to examine the clinical correlates of CSBs.
Results: In total, there were 62 members of the adult group (24.5%) and 11 elderly subjects (17.2%) with CSBs; however, the difference did not reach statistical significance. Logistic regression analysis showed that there was a main effect of zolpidem dose (≥ 10 mg; OR = 2.82, P = .038) and alcohol use (OR = 2.05, P = .026), but not sex or age group. There were interactive effects between age group and zolpidem dose (P = .043), indicating that a higher dose of zolpidem was associated with CSBs only in the adult group and not in the elderly group. Adults with CSBs used a higher dose of zolpidem than adults without (mean ± SD: 15.4 ± 6.8 mg vs 11.3 ± 5.7 mg), whereas elderly patients with CSBs did not use a higher dose of zolpidem than those without (12.2 ± 5.4 mg vs 11.9 ± 7.0 mg).
Conclusions: A higher dose of zolpidem was correlated with CSBs only in the adult group and not in the elderly group. Future studies investigating the factors, other than dose, related to CSBs in the elderly will be performed.
Objective: To examine the effect of mind-body interventions (MBIs) on sleep quality among cancer patients, the moderating effects of the intervention components, subject characteristics, and methodological features of the relationship between MBIs and sleep.
Data Sources: Electronic databases, including PubMed, Cochrane Library, PsycINFO, and CINAHL, containing data with English-language restriction recorded up to September 15, 2013 were searched thoroughly using keywords related to various types of MBI and sleep.
Study Selection: Of the 114 identified citations, 99 were ineligible. Fifteen studies that followed 1,405 patients with cancer met the inclusion criteria and were analyzed.
Data Extraction: The primary outcome was change in the sleep parameter. Other variables related to components of MBIs, subject characteristics, and methodological features of the studies were also extracted.
Data Synthesis: The weighted mean effect size (ES) was −0.43 (95% confidence interval [CI], −0.24 to −0.62) and the long-term effect size (up to 3 months) was −0.29 (95% CI, −0.52 to −0.06). The sensitivity analysis revealed that MBIs had a significant effect on sleep (g = −0.33, P < .001). The moderating effects of components of the intervention, methodological features, subject characteristics, and quality of the studies on the relationship between MBIs and sleep were not found (all P values > .05).
Conclusions: This meta-analysis confirms that the MBIs yielded a medium effect size on sleep quality and the effect was maintained for up to 3 months. The findings support the implementation of MBIs into the multimodal approach to managing sleep quality in patients with cancer.
Restless legs syndrome (RLS) is a common disorder that can have a considerable impact on a patient's functioning and quality of life. The pharmacologic armamentarium for RLS contains dopamine agonists, a-2d ligands, and opioids, among other agents. Each of these types of drugs has strengths and limitations, and treatment selection should be based on the frequency of RLS symptoms and any accompanying pain. Dopaminergic augmentation, which exacerbates RLS symptoms, is the most common and challenging side effect of long-term RLS treatment with dopamine agonists and requires special clinical consideration. Iron status is also important to the effective management of RLS.
Restless legs syndrome (RLS) is a common sensory motor disorder characterized by the urge to move a leg, which worsens with physical and cognitive inactivity, particularly in the evening and at night, but transiently improves with activity. A number of diseases have symptoms that are often confused with those of RLS, and other conditions are associated with higher rates of RLS. RLS can also be exacerbated by certain medications. Because RLS lacks biomarkers and established tests to aid in its diagnosis, clinicians should be aware of the other disorders that can be confused with or accompany RLS.
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