Personne :
Ji, Xiaowen

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Université Laval. École de psychologie
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  • Publication
    Residual symptoms after natural remission of insomnia : associations with relapse over 4 years
    (Sleep Research Society, 2019-06-13) Morin, Charles M.; Ji, Xiaowen; Savard, Josée; LeBlanc, Mélanie; Ivers, Hans
    Study Objectives Chronic insomnia tends to “wax and wane” over lifetime. The presence of residual insomnia symptoms is common, especially among naturally remitted individuals. This study aims to examine the features of these residual symptoms and their potential association with future relapse. Methods A population-based data set on the natural history of insomnia was used for this secondary analysis. Residual insomnia symptoms were investigated in those who had insomnia symptoms/syndrome at baseline and achieved full remission (according to predetermined diagnostic algorithm) within the following 1 year. Cox regressions were used to determine the hazard ratio (HR) of each residual symptom for predicting relapse in the next 4 years. The nature and severity of residual symptoms were examined with an extended version of the Insomnia Severity Index (ISI), which incorporates additional items on sleep quality and specific sleep-related daytime impairments (on daytime fatigue, cognitive functioning, mood, interpersonal relationship, and daily activities). In addition, the presence of depressive symptoms and medical conditions were controlled for in investigating risks of insomnia relapse. Results A total of 434 participants were included in this study (age ranges from 18 to 94; 65.9% female); 248 of them had relapsed within 4 years. The response rate ranged from 78% to 83%. The most frequently reported residual symptoms with at least moderate severity (ISI items ≥2 on 0–4 ISI item scale) were poor “Quality of sleep” (39.2 %), followed by “difficulty maintaining sleep” (DMS; 27%). The most common residual daytime impairments related to insomnia were fatigue (24.7 %), mood disturbances (23%) and cognitive disturbances (22.6%). After controlling for baseline insomnia and depression severity and concurrent physical diseases, impairments of cognition (HR = 1.46), poor quality of sleep (HR = 1.43), disturbed mood (HR = 1.39), being female (HR = 1.36), DMS (HR = 1.35), and fatigue (HR = 1.24) were significantly associated with insomnia relapse in the next 4 years. Moreover, residual poor sleep quality and daytime insomnia symptoms were independent of DMS in predicting relapse. Subgroup regressions according to sex showed that for male participants, residual cognition impairments (HR = 1.98) was the most significant predictors of future relapse, whereas residual DMS (HR = 1.46) significantly predicted relapse for women only. Conclusion A wide range of residual symptoms exists in individuals with naturally remitted insomnia. Notably, residual DMS is the most common residual nighttime symptom and the only nighttime symptom associated with insomnia relapse. Additionally, perceived poor sleep quality and cognitive, mood, and somatic impairments attributed to sleep disturbances are also related to future relapse. Attention to these residual symptoms when initiating insomnia treatment is warranted to minimize future relapse.
  • Publication
    Accès libre
    Cognitive behavioral therapies for insomnia and hypnotic medications : considerations and controversies
    (Elsevier, 2019-03-29) Morin, Charles M.; Ji, Xiaowen; Cheung, Janet M.Y.
    - Insomnia is a prevalent and costly health problem that often remains untreated or is treated inadequately. There are, however, several evidence-based treatment options, including cognitive behavioral therapies (CBTs) and pharmacologic therapies, each with its own advantages and limitations. - Medications with specific indications for insomnia produce rapid symptomatic relief, but there is little to no evidence that sleep improvements are maintained after drug discontinuation or long-term, continued usage. Conversely, CBT takes longer than drugs to produce sleep improvements, but these improvements are well sustained over time. - Aside from their short-term and long-term benefits, other key considerations need to be taken into account when selecting among the different insomnia therapies. These include patients’ treatment preferences, how best to deliver CBT, whether to combine or sequence CBTs and medication therapies, and who should treat insomnia. These considerations may have a significant impact on efficacy, compliance, attrition, and access to treatment. - Several innovative treatment delivery methods relying on digital technology are increasingly used to treat insomnia. Although these self-help approaches may reduce cost and human resources and increase access, an important shortcoming is the high attrition rate during the course of these self-guided approaches. - The publications of clinical practice guidelines by several international medical and sleep organizations have reached the same recommendation, that is, CBT should be the first-line treatment of insomnia, and only when such treatment is not available or not effective should medication be considered for treating persistent insomnia. It is hoped that such strong and uniform endorsement by the medical and sleep community will help narrow the current gap between the available research evidence and clinical practices.
  • Publication
    Accès libre
    Sleep disturbances during the menopausal transition : the role of sleep reactivity and arousal predisposition
    (Routledge, 2021-06-27) Morin, Charles M.; Ji, Xiaowen; Ballot, Orlane; Ivers, Hans
    Background Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause. Methods Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40–60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design. Results Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances. Conclusion More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause.