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Bastien, Célyne

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Bastien

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Célyne

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Université Laval. École de psychologie

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0000000292369125

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ncf10382258

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Subjective sleep quality in non-demented elderly adults with and without cognitive impairment

2014-02-12, Potvin, Olivier, Adam, Anne-Marie, Bastien, Célyne, Callahan, Brandy, Lorrain, Dominique, Hudon, Carol, Desjardins, Sophie, Forget, Hélène, Préville, Michel

Objective: Sleep problems are prevalent among older adults who are at risk of developing dementia. Until now, there have been relatively few studies investigating subjective sleep quality in these individuals. The first objective of this study was to compare seniors with cognitive impairment no dementia (CIND) and older adults without cognitive impairment (non‐CIND) on several subjective sleep measures. The second objective was to verify whether sleep parameters associated with CIND differ between men and women. Methods: The population sample consisted of 2287 French‐speaking older adults from Québec (Canada) aged between 65 and 96 years. Participants were classified as CIND or non‐CIND on the basis of their mini mental state examination score using sex, age, and education‐stratified normative data. All participants completed the Pittsburgh Sleep Quality Index, and responses of CIND and non‐CIND individuals were compared. A series of confounding variables (age, education, chronic diseases, mood disorders, anxiety disorders, and use of psychotropic drugs) were statistically controlled for. Student's t ‐tests were performed to compare characteristics of CIND and non‐CIND individuals; data from male and female participants were analyzed separately. Moreover, the association between each sleep variable and CIND was measured by odds ratios based on logistic regression. Results: On the whole, analyses revealed no significant association between subjective sleep parameters and CIND. Moreover, no difference was observed between men and women regarding subjective sleep quality. Conclusions: Overall, these results suggest that subjective measures of sleep do not allow differentiating cognitively impaired older individuals from those with normal cognition. Copyright © 2014 John Wiley & Sons, Ltd.

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Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia

2004-02-01, Radouco-Thomas, Monelly, Morin, Charles M., Leblanc, Jacynthe, Vallières, Annie, Bastien, Célyne, Guay, Bernard

OBJECTIVE: This study evaluated the effectiveness of a supervised benzodiazepine taper, singly and combined with cognitive behavior therapy, for benzodiazepine discontinuation in older adults with chronic insomnia. METHOD: Seventy-six older adult outpatients (38 women, 38 men; mean age of 62.5 years) with chronic insomnia and prolonged use (mean duration of 19.3 years) of benzodiazepine medication for sleep were randomly assigned for a 10-week intervention consisting of a supervised benzodiazepine withdrawal program (N=25), cognitive behavior therapy for insomnia (N=24), or supervised withdrawal plus cognitive behavior therapy (N=27). Follow-up assessments were conducted at 3 and 12 months. The main outcome measures were benzodiazepine use, sleep parameters, and anxiety and depressive symptoms. RESULTS: All three interventions produced significant reductions in both the quantity (90% reduction) and frequency (80% reduction) of benzodiazepine use, and 63% of the patients were drug-free within an average of 7 weeks. More patients who received medication taper plus cognitive behavior therapy (85%) were benzodiazepine-free after the initial intervention, compared to those who received medication taper alone (48%) and cognitive behavior therapy alone (54%). The patients in the two groups that received cognitive behavior therapy perceived greater subjective sleep improvements than those who received medication taper alone. Polysomnographic data showed an increase in the amount of time spent in stages 3 and 4 sleep and REM sleep and a decrease in total sleep time across all three conditions from baseline to posttreatment. Initial benzodiazepine reductions were well maintained up to the 12-month follow-up, and sleep improvements became more noticeable over this period. No significant withdrawal symptoms or adverse events were associated with benzodiazepine tapering. CONCLUSIONS: A structured, time-limited intervention is effective in assisting chronic users of benzodiazepine medication to discontinue or reduce their use of medication. The addition of cognitive behavior therapy alleviates insomnia, but sleep improvements may become noticeable only after several months of benzodiazepine abstinence.

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A preliminary evaluation of the physiological mechanisms of action for sleep restriction therapy

2013-09-16, Vallières, Annie, Ceklic, Tijana, Bastien, Célyne, Espie, Colin A.

Our objective was to investigate the physiological mechanisms involved in the sleep restriction treatment of insomnia. A multiple baseline across subjects design was used. Sleep of five participants suffering from insomnia was assessed throughout the experimentation by sleep diaries and actigraphy. Ten nights of polysomnography were conducted over five occasions. The first two-night assessment served to screen for sleep disorders and to establish a baseline for dependent measures. Three assessments were undertaken across the treatment interval, with the fifth and last one coming at follow-up. Daily cortisol assays were obtained. Sleep restriction therapy was applied in-lab for the first two nights of treatment and was subsequently supervised weekly. Interrupted time series analyses were computed on sleep diary data and showed a significantly decreased wake time, increased sleep efficiency, and decreased total sleep time. Sleepiness at night seems positively related to sleep variables, polysomnography data suggest objective changes mainly for stage 2, and power spectral analysis shows a decrease in beta-1 and -2 powers for the second night of treatment. Cortisol levels seem to be lower during treatment. These preliminary results confirm part of the proposed physiological mechanisms and suggest that sleep restriction contributes to a rapid decrease in hyperarousal insomnia.

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Long-term outcome after discontinuation of benzodiazepines for insomnia : a survival analysis of relapse

2005-01-01, Morin, Charles M., Bélanger, Lynda, Vallières, Annie, Bastien, Célyne

Discontinuation of benzodiazepine (BZD) treatment for insomnia can be a difficult task. Cognitive-behavior therapy (CBT) for insomnia, combined with a supervised medication taper, can facilitate withdrawal but there is limited evidence on long-term outcome after discontinuation. The objective of this study was to examine medication-free survival time and predictors of relapse (i.e., resumed BZD hypnotics) over a 2-year period in 47 older adults (mean age 62.1 years) with persistent insomnia and prolonged BZD use (average duration of 18.9 years), who had successfully discontinued BZD following CBT for insomnia, a supervised medication taper program, or a combined approach. The Kaplan–Meier product-limit method was used to estimate survival time, defined as time between end-of-treatment and relapse or end of follow-up. By the end of the 24-month follow-up, 42.6% of the samples had resumed BZD use. Participants in the Combined (33.3%) and Taper (30.8%) groups relapsed significantly less than their counterparts from the CBT group (69.2%). Survival rates at 3 months were 61.5% (CBT), 100% (Taper), and 80.9% (Combined). At 12 months, they were 38.5%, 83.3%, and 70.8%, respectively; and, at 24 months, they were 28.9%, 64.8% and 64.9%, respectively. Mean survival time was significantly longer for both the Taper (18.6 months, SE=2.1) and Combined groups (12.6 months, SE=1.4), relative to the CBT group (8.5 months, SE=1.8). Significant predictors of relapse included treatment condition, end of treatment insomnia severity, and psychological distress. In conclusion, there is a substantial relapse rate following BZD discontinuation among prolonged users. CBT booster sessions might enhance compliance with CBT and prove useful in preventing relapse.

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Sleep and circadian rhythm in response to the COVID-19 pandemic

2020-07-22, Morin, Charles M., Carrier, Julie, Bastien, Célyne, Godbout, Roger

Cet article discute de l’importance du sommeil dans un contexte de santé publique, particulièrement en période de crise sanitaire comme celle de la COVID-19, et offre quelques recommandations pratiques et appuyées de données probantes pour gérer les difficultés de sommeil durant cette pandémie. La COVID-19 et l’isolement imposé pendant la pandémie ont produit stress, anxiété et inquiétudes en lien avec la santé et la peur d’être infecté du virus, la perte d’emploi et problèmes financiers, et l’incertitude quant au futur. L’incidence des difficultés de sommeil a également augmenté de manière exponentielle durant cette crise. Outre le stress et l’anxiété causés par la pandémie, au moins deux autres facteurs contribuent à exacerber les problèmes de sommeil. Premièrement, plusieurs routines quotidiennes ont été altérées, notamment celles de se lever à la même heure chaque matin, de se présenter au travail, de manger, s’entraîner, avoir des contacts sociaux et pratiquer des loisirs à des heures relativement fixes; ces activités représentent des marqueurs de temps qui synchronisent nos cycles de veille-sommeil avec les cycles des jours et des nuits. La perte de ces repères, combinée à une réduction de l’exposition à la lumière du jour, essentiel à la synchronisation de l’horloge biologique, contribuent à perturber le sommeil et les rythmes circadiens. Le sommeil joue un rôle fondamental pour la santé mentale et physique; une durée et une qualité adéquate de sommeil permettent de développer une meilleure résilience afin de composer avec des événements de vie majeurs comme la COVID-19. L’éducation grand public est donc nécessaire pour sensibiliser la population à l’importance du sommeil et aux bonnes pratiques d’hygiène du sommeil et ainsi minimiser les conséquences à long terme de la pandémie sur la santé mentale et physique.

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Variability and predictability in sleep patterns of chronic insomniacs

2005-12-02, Morin, Charles M., Vallières, Annie, Bastien, Célyne, Beaulieu-Bonneau, Simon., Ivers, Hans

Sleep of chronic insomniacs is often characterized by extensive night-to-night variability. To date, no study has examined this variability with long series of daily sleep data. The present study examined night-to-night variability with a sample of 106 participants meeting DSM-IV diagnostic criteria for persistent primary insomnia. Participants completed daily sleep diaries for an average of 31 days (range: 18–56). Sleep efficiency, sleep onset latency and wake after sleep onset were derived from this measure. Despite evidence of extensive night variability, results showed that sleep patterns could be classified in three clusters. The first one was characterized by a high probability of having poor sleep, the second one by a low and decreasing probability, and the third one by a constant median probability of having a poor sleep, which is an unpredictable sleep pattern. In the first cluster, poor sleep was expected each night for patients with a predominance mixed insomnia including the three insomnia subtypes. In the second cluster, patients presented moderate insomnia, sleep-onset latency below the threshold level and a predominance of sleep-maintenance insomnia. In the third pattern, poor nights seemed unpredictable for patients with moderate to severe insomnia associated with the lowest proportion of sleep-maintenance insomnia. Overall, sleep was predictable for about two-thirds of individuals, whereas it was unpredictable for about one-third. These findings confirm the presence of extensive variability in the sleep of chronic insomniacs and that poor sleep may be predictable for some of them. Additional research is needed to characterize those sleep patterns in terms of clinical features and temporal course.

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Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia : a randomized controlled trial

2009-05-20, Mérette, Chantal, Morin, Charles M., Savard, Josée, Baillargeon, Lucie, Vallières, Annie, Bastien, Célyne, Guay, Bernard, Ivers, Hans

Context: Cognitive behavioral therapy (CBT) and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It is unclear whether combined or maintenance therapies would enhance outcome. Objectives: To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome. Design, Setting, and Patients: Prospective, randomized controlled trial involving 2-stage therapy for 160 adults with persistent insomnia treated at a university hospital sleep center in Canada between January 2002 and April 2005. Interventions: Participants received CBT alone or CBT plus 10 mg/d (taken at bedtime) of zolpidem for an initial 6-week therapy, followed by extended 6-month therapy. Patients initially treated with CBT attended monthly maintenance CBT for 6 months or received no additional treatment and those initially treated with combined therapy (CBT plus 10 mg/d of zolpidem) continued with CBT plus intermittent use of zolpidem or CBT only. Main Outcome Measures: Sleep onset latency, time awake after sleep onset, total sleep time, and sleep efficiency derived from daily diaries (primary outcomes); treatment response and remission rates derived from the Insomnia Severity Index (secondary outcomes). Results: Cognitive behavioral therapy used singly or in combination with zolpidem produced significant improvements in sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy (all P<.001); a larger increase of sleep time was obtained with the combined approach (P = .04). Both CBT alone and CBT plus zolpidem produced similar rates of treatment responders (60% [45/75] vs 61% [45/74], respectively; P = .84) and treatment remissions (39% [29/75] vs 44% [33/74], respectively; P = .52) with the 6-week acute treatment, but combined therapy produced a higher remission rate compared with CBT alone during the 6-month extended therapy phase and the 6-month follow-up period (56% [43/74 and 32/59] vs 43% [34/75 and 28/68]; P = .05). The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the 6-month follow-up compared with patients who continued to take zolpidem during extended therapy (68% [20/30] vs 42% [12/29]; P = .04). Conclusion: In patients with persistent insomnia, the addition of medication to CBT produced added benefits during acute therapy, but long-term outcome was optimized when medication is discontinued during maintenance CBT.

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Sequential treatment for chronic insomnia : a pilot study

2010-06-07, Morin, Charles M., Vallières, Annie, Bastien, Célyne, Guay, Bernard, LeBlanc, Melanie

This article explores the efficacy of sequential treatment involving medication and cognitive behavioral treatment (CBT) for insomnia. In a multiple baseline across-subjects design, 6 participants with primary chronic insomnia received 1 of the following treatment sequences: (a) concurrent combination of medication and CBT for the 10-week treatment duration (Combined); (b) medication for the first 5 weeks, with introduction of CBT at week 4 and medication withdrawal after the 5th week resulting in treatment overlap during weeks 4 and 5 (Overlapping: Medication → Combined → CBT); and (c) medication alone for the first 5 weeks followed by CBT alone for an additional 5 weeks (Medication→CBT). Each sequence led to significant sleep improvements, but these improvements occurred at different times during the intervention. Participants in the Combined and in the Overlapping sequences improved their sleep during the 1st phase of treatment, whereas those in the Medication→ CBT sequence improved mostly during the 2nd phase of treatment. These preliminary results suggest that a sequential treatment is effective for chronic insomnia. In addition, the results suggest that sleep improvements are more likely to emerge when CBT is introduced, with an Overlapping sequence showing a slight advantage over the other sequences. Additional clinical trials should be conducted with larger samples to replicate these preliminary findings.

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Validation of the Insomnia Severity Index as an outcome measure for insomnia research

2001-06-25, Morin, Charles M., Vallières, Annie, Bastien, Célyne

Background : Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints. Objective : This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients. Methods : The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians. Results : The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions. Conclusions : The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.

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Precipitating factors of insomnia

2010-06-07, Morin, Charles M., Vallières, Annie, Bastien, Célyne

Insomnia is a prevalent health complaint whose onset is precipitated by a variety of factors. There is an important need to identify and describe these factors to improve our understanding of risk factors and the natural history of insomnia. This article is aimed at identifying and describing the types of precipitating factors related to the onset of insomnia. A total of 345 patients evaluated for insomnia at a sleep-disorders clinic completed a sleep survey and underwent a semistructured clinical interview. As part of the evaluation, the specific precipitating events related to the onset of insomnia were identified. Subsequently, these factors were categorized (work-school, family, physical or psychological health, or indeterminate), and their affective valence (negative, positive, or indeterminate) was coded. The most common precipitating factors of insomnia were related to family, health, and work-school events. Sixty-five percent of precipitating events had a negative valence. These events differed with the age of onset of insomnia but not with the gender of participants. These findings are useful to identify potential risk factors for insomnia and improve our understanding of the natural history of insomnia.