***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE To compare the hypnotic effects of a bedtime dose of zolpidem , triazolam , and placebo . DESIGN " Double-blind , r and omized , placebo- and active-controlled , parallel-group " trial . SETTING Six Canadian hospitals . PATIENTS 357 patients ( aged 19 to 71 years ) hospitalized the night before a surgical procedure . INTERVENTIONS At bedtime , each patient received either zolpidem 10 mg , triazolam 0.25 mg , or placebo , and was allowed to sleep for a maximum of 8 hours . MEASUREMENTS Outcome measures were subjective in nature and included a morning question naire , visual analog scales , and observation forms by study personnel . All continuous variables were analyzed by analysis of variance . All categorical data were compared using the Cochran-Mantel-Haenszel ( CMH ) test , and the percentage of patients asleep was compared using a CMH chi-square analysis . When significant overall treatment effects were observed , pairwise comparisons were undertaken . Compared with the placebo group , the following parameters were significantly ( p < 0.001 ) different in the zolpidem and triazolam groups : sleep latency was shorter , total sleep time was longer , patients fell asleep more easily , and the number of patients awake 2 hours after drug administration was lower . There were no differences between any groups in next-morning somnolence or ability to concentrate . Both drugs were well tolerated , with adverse event incidence rates nearly identical to placebo . CONCLUSIONS In patients suffering from transient insomnia , a single dose of zolpidem 10 mg was as effective as triazolam 0.25 mg , and both were more effective than placebo and were well tolerated OBJECTIVES To improve nighttime sleep in nursing home patients . DESIGN Controlled clinical trial . SETTING Eight community nursing homes enrolled two at a time . PARTICIPANTS Of 1,077 patients assessed in the eight nursing homes , 638 ( 59 % ) were eligible , and consent was obtained for 273 ( 43 % of those eligible ) . Of the 230 who underwent baseline assessment s , 173 completed the immediate-intervention phase of the trial ( 77 in the intervention group and 96 in the control group ) . A total of 160 subjects completed the intervention ( 77 in the immediate-intervention group and 83 in the delayed-intervention phase ) . INTERVENTION Trained research staff provided the intervention , which included daytime physical activity and attempts to keep subjects out of bed , evening bright light exposure , a consistent bedtime routine , nighttime care routines design ed to minimize sleep disruption , and strategies to reduce nighttime noise . Subjects from one nursing home received the intervention ( Group 1 ) , whereas subjects in the second nursing home served as a control group ( Group 2 ) ; then Group 2 received the intervention . MEASUREMENTS Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects . Secondary measures included assessment s of mood and behavior using the Neuropsychiatric Inventory , the Geriatric Depression Scale , and behavioral observations . RESULTS There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate-intervention phase of the trial . In the 160 subjects who completed the intervention , there were no significant changes in any actigraphic measure of nighttime sleep , nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography . CONCLUSION This multicomponent , nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients . Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible . Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials The purpose of this study was to develop and test the Verran and Snyder-Halpern ( VSH ) Sleep Scale , an instrument to subjectively measure sleep characteristics . Four major sleep factors and their associated characteristics were proposed for the Sleep Scale . Subjects completed three r and omly ordered sleep question naires on three consecutive weekday mornings within the first two hours after arising . Scales included the  VSH Sleep Scale , a sleep question naire and a sleep log .  The VSH Sleep Scale had a reliability coefficient of .82 ( theta ) . Construct validity was examined by factor analysis and correlations between Sleep Scale items and corresponding items on the two other study instruments . Scale validity also was assessed by the known groups method . Beginning support for the validity of the VSH Sleep Scale is provided Experimental sleep deprivation in healthy humans affects levels of ghrelin and leptin , two primary hormones involved in energy balance that regulate appetite and body weight . No study to date has examined levels of these hormones in patients with chronic insomnia . In this study , men diagnosed with primary insomnia using DSM-IV criteria ( n=14 ) and age and body weight comparable healthy control men ( n=24 ) underwent polysomnography .  Circulating levels of ghrelin and leptin were measured at 2300h , 0200h and 0600h . As compared to controls , insomnia patients showed less total sleep time , stage 2 and REM sleep and decreased sleep efficiency and more stage 1 sleep than controls ( p's<.05 ) . Ghrelin levels across the night were significantly lower in insomnia patients ( p<.0001 ) . Leptin was not significantly different between the groups . In conclusion , decreased nocturnal ghrelin in insomnia is consistent with findings for nighttime levels in sleep deprivation studies in healthy sleepers . These findings suggest that insomnia patients have a dysregulation in energy balance that may play a role in explaining prospect i ve weight gain in this population OBJECTIVES The sleep of nursing home residents is fragmented by frequent awakening episodes associated , at least in part , with environmental variables , including noise and light changes . The purpose of this study was to improve sleep by reducing the frequency of nighttime noise and light changes . PARTICIPANTS AND SETTING Two hundred sixty-seven incontinent nursing home residents in eight nursing homes . DESIGN A r and omized control group design with a delayed intervention for the control group . MEASUREMENTS Bedside noise and light monitors  recorded the number of 2-minute intervals at night with peak sounds recorded above 50 dBs and the number of light changes of at least 10 lux between adjacent 2-minute intervals . Daytime behavioral observations measured sleep and in-bed time during the day , and wrist activity was used to estimate sleep at night . Awakening events associated with the environmental variables were derived from the wrist activity data . INTERVENTION A behavioral intervention implemented between 7:00 p.m. and 6:00 a.m. that involved feedback to nursing home staff about noise levels and implementation by research staff of procedures to both abate noise ( e.g. , turn off unwatched television sets ) and to individualize nighttime incontinence care routines to be less disruptive to sleep . RESULTS Noise was reduced significantly , from an average of 83 intervals per night with peak noises recorded above 50 dBs to an average of 58 intervals per night in the group that received the initial intervention , whereas noise in the control group showed no change ( MANOVA group x time P < .001 ) . All 10-dB categories of noise from 50 to 90 + dBs were reduced , and light changes were reduced from an average of four per night per resident to two per night ( P < .001 ) . Despite these significant changes in the environmental variables , there was a significant differential improvement in the intervention group on only two night sleep measures : awakening associated with a combination of noise plus light ( P < .001 ) and awakening associated with light ( P < .001 ) . However , there was a significant correlation between change in noise and change in percent sleep from baseline to intervention ( r = -.29 , P < .05 ) , suggesting that the intervention did not reduce noise to low enough levels to produce a significant improvement in sleep . The intervention effects on all environmental variables were replicated in the delayed intervention group , who again showed significant improvement on the same sleep measures . Observations of day sleep and in-bed time did not change over the phases of the trial for either group . CONCLUSION The significant reductions in noise and light events result ing from the intervention did not lead to significant improvements in the day sleep and most night sleep measures . An intervention that combines both behavioral and environmental strategies and that addresses daytime behavioral factors associated with poor sleep ( e.g. , excessive time in bed ) would potentially be more effective in improving the night sleep and quality of life of nursing home residents Insomnia is a common phenomenon in cancer patients ; nevertheless , there are only a few intervention results published covering this topic . We examined the effects of a multi-modal psychological sleep management programme combining relaxation techniques , sleep hygiene , cognitive techniques and advice in stimulus control technique on various sleep and quality -of-life variables . We compared two intervention groups up to 6 months after treatment , one with progressive muscle relaxation ( n=80 ) , the other with autogenic training ( n=71 ) . A control group ( n=78 ) received only a st and ard rehabilitation programme . It was a heterogeneous sample of adult patients ( mean age 58 years ) predominantly with breast , kidney or prostate cancer staying for 3 or 4 weeks in an oncological rehabilitation clinic . In comparison to the control group , the analysis of variance for repeated measures ( R-MANOVA ) showed significant improvements over time , indicating that intervention group participants benefited with moderate- or large-scale effects on sleep latency ( p<0.001 ) , sleep duration ( p<0.001 ) , sleep efficiency ( p<0.001 ) , sleep quality ( p<0.001 ) , sleep medication ( p<0.05 ) and daytime dysfunction ( p<0.05 ) . In quality -of-life subscales , there was mainly improvement over time . This may indicate a benefit of the rehabilitation treatment in general . No evidence was found for any differences between the two intervention groups . The results suggest that the use of a multi-modal psychological sleep intervention could enhance various sleep parameters and well being of patients . The efficacy on quality of life is still under review Objective Because of around-the-clock activities , environmental noise and light are among the many causes of sleep disturbance in an intensive care unit ( ICU ) . The implementation of guidelines may potentially change behavior rules and improve sleep quality . Design A prospect i ve interventional study , observing the effects of simple nighttime guidelines on light and noise levels in an ICU . Setting A modern surgical ICU , subdivided into six identical three-bed rooms . Patients Critically ill adult patients . Intervention Between two observation periods , five guidelines were implemented to decrease both light and noise during the night shift in the patient ’s room . Measurement Light levels and noise levels were obtained using a  luxmeter  and a sound level meter  [ A-weighted decibels ( dB ) scale ] and were monitored continuously from 11 pm to 5 am both before ( period P1 ) and after ( period P2 ) the implementation of guidelines . Main Results Similar patient ’s gravity and nursing workload scores were observed between P1 and P2 . A low mean ( < 5 Lux ) and maximal light level were measured during both P1 and P2 . The implementation of guidelines lowered mean light disturbance intensity with a greater variability of light during P2 . All noise levels were high and corresponded more to a quiet office for noise level equivalents and to a busy restaurant for peak noise levels during both P1 and P2 . Guidelines decreased the noise level equivalent ( P1 , 51.3 dB ; P2 , 48.3 dB ) , peak noise level ( P1 , 74.9 dB ; P2 , 70.8 dB ) , and the number of acoustic identified alarms ( P1 , 22.1 dB ; P2 , 15.8 dB ) during P2 . Conclusion The night light levels were low during both periods , and lowering the light levels induced a greater variation of light , which may impair sleep quality . All measured noise levels were high during both periods , which could contribute to sleep disturbance , and the implementation of guidelines significantly lowers some important noise levels . The background noise level was unchanged 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 sample s 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 r and omized-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 perce 
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FINDINGS Little evidence for the nursing interventions , sleep hygiene , music , natural sound and vision , stimulation of acupoints , relaxation , massage and aromatherapy is found .
However , large effect size of interventions were found when using massage , acupuncture and music , natural sounds or music videos .
The use of  sleep hygiene and relaxation  , on the other h and , produced only small effects .