No abstract

Symptoms of the central disorders of hypersomnolence extend beyond excessive daytime sleepiness to include non-restorative sleep, fatigue and cognitive dysfunction. They share much in common with myalgic encephalomyelitis/chronic fatigue syndrome, recently renamed systemic exertion intolerance disease, whose additional features include post-exertional malaise and orthostatic intolerance. We sought to determine the frequency and correlates of systemic exertion intolerance disease in a hypersomnolent population. One-hundred and eighty-seven hypersomnolent patients completed questionnaires regarding sleepiness and fatigue; questionnaires and clinical records were used to assess for systemic exertion intolerance disease. Sleep studies, hypocretin and cataplexy were additionally used to assign diagnoses of hypersomnolence disorders or sleep apnea. Included diagnoses were idiopathic hypersomnia (n = 63), narcolepsy type 2 (n = 25), persistent sleepiness after obstructive sleep apnea treatment (n = 25), short habitual sleep duration (n = 41), and sleepiness with normal sleep study (n = 33). Twenty-one percent met systemic exertion intolerance disease criteria, and the frequency of systemic exertion intolerance disease was not different across sleep diagnoses (p = .37). Patients with systemic exertion intolerance disease were no different from those without this diagnosis by gender, age, Epworth Sleepiness Scale, depressive symptoms, or sleep study parameters. The whole cohort reported substantial fatigue on questionnaires, but the systemic exertion intolerance disease group exhibited more profound fatigue and was less likely to respond to traditional wake-promoting agents (88.6% versus 67.7%, p = .01). Systemic exertion intolerance disease appears to be a common co-morbidity in patients with hypersomnolence, which is not specific to hypersomnolence subtype but may portend a poorer prognosis for treatment response.

The present study was designed to examine Asian American women's shifting, a coping mechanism that includes altering or modifying one's self-presentation to cope with racism-related stress. In particular, the relationship between Asian American ethnic identity, acculturation status, and racism-related stress was examined among Asian American women, to determine whether these hypothesized associations were mediated by shifting. A convenience sample of 483 Asian American adult women completed measures of acculturation, ethnic identity, racism-related stress, and shifting. Results of three structural equation models (full model with ethnic identity and acculturation as latent predictors and simplified models with each predictor examined separately) indicated partial mediation. Both ethnic identity and shifting positively predicted the outcome variable of racism-related stress; acculturation status was not a significant predictor of racism-related stress. These data extend our understanding of the shifting coping mechanism among Asian American women and the factors that are associated with racism-related stress. Implications for clinical work and future research are also discussed.What is the public significance of this article? Our findings reinforce the importance of examining racism-related stress, given the paucity of research regarding racism-related stress among Asian American women and the factors that may facilitate or hinder their well-being. Researchers and mental health providers should continue to examine shifting, as it may paradoxically allow Asian American women to cope with their racism-related stressors but perhaps with significant personal consequences.

No abstract

No abstract